Losing weight, especially when managing overweight or obesity, offers significant health benefits, reducing the risk of various diseases. However, a common consequence of major weight loss is the development of loose skin, which can lead to self-consciousness, physical discomfort, and a reduced quality of life for some individuals. This article explores the causes of loose skin after weight loss and provides an overview of natural and medical solutions to help tighten and manage it.
What Causes Loose Skin After Weight Loss?
The skin, the body's largest organ, acts as a protective barrier against the environment. Its innermost layer contains proteins like collagen and elastin. Collagen, constituting 80% of the skin's structure, provides firmness and strength, while elastin provides elasticity, enabling the skin to stay tight.
During weight gain, the skin expands to accommodate increased growth, such as during pregnancy. Skin expansion during pregnancy occurs over a few months, and the expanded skin typically retracts within several months of delivery. However, when skin has been significantly stretched for an extended period, the collagen and elastin fibers can become damaged, losing their ability to retract. Consequently, substantial weight loss may result in excess skin hanging from the body. Generally, the greater the weight loss, the more pronounced the loose skin. Research suggests that individuals undergoing weight loss surgery may produce less new collagen, and its composition might not be as strong as the collagen found in young, healthy skin.
Factors Contributing to Loss of Skin Elasticity
Several factors contribute to the development of loose skin following weight loss:
- Length of Time: The longer a person has been overweight or obese, the looser their skin may be after weight loss, owing to elastin and collagen loss.
- Amount of Weight Lost: Rapid loss of substantial body weight typically results in a greater amount of loose skin than more moderate weight loss.
- Age: Older skin has less collagen than younger skin and tends to be looser following weight loss. As you age, your body produces less collagen, which can also cause skin to sag.
- Genetics: Genes may influence how skin responds to weight gain and loss.
- Sun Exposure: Chronic sun exposure reduces collagen and elastin production, potentially contributing to loose skin. Sun damage impacts the skin’s elasticity and can cause skin to sag over time. Applying plenty of lotion with sun protection factor (SPF) 30 or higher can help keep this damage from happening.
- Smoking: Smoking reduces collagen production and damages existing collagen, resulting in loose, sagging skin. Research shows that tobacco smoke and the intake of nicotine have a toxic effect on skin and increase the chances of premature aging.
Potential Problems Caused by Excess Loose Skin
Excess loose skin following significant weight loss can present both physical and emotional challenges:
Read also: Weight Loss and Skin Elasticity
- Physical Discomfort: Excess skin may be uncomfortable and interfere with normal activity. "I cannot get my legs out because the skin hangs over my knee so much."
- Emotional Discomfort: An older longitudinal study found a possible increase in self-consciousness after weight loss.
- Decreased Physical Activity: While a 2022 study found that weight loss encouraged more people to exercise, excess skin was found to interfere with exercise in some people after bariatric surgery.
- Skin Irritation and Breakdown: An older 2014 study found that of 124 people who requested plastic surgery to tighten skin after weight loss surgery, 44% had reported skin pain, ulcers, or infections due to the loose skin. Loose skin can form folds that trap moisture, sweat, and bacteria. If moisture continues to collect within folds of skin, the skin can rub together and cause a condition called intertrigo. This red or brownish-red rash is more common in warm, humid climates and during the summer months and can cause itching and stinging.
- Body Dissatisfaction: Loose skin from weight loss may negatively affect body image and mood.
Natural Remedies to Tighten Loose Skin
The following natural remedies may improve skin strength and elasticity to some degree in people who have lost small to moderate amounts of weight.
- Perform Resistance Training: Engaging in regular strength training is one of the most effective ways to build muscle mass in both young and older adults. The Physical Activity Guidelines for Americans recommends doing strength training twice a week. An increase in muscle mass may help improve the appearance of loose skin. Building muscle beneath that skin can help fill the gap. That’s why strength training, which focuses on muscle growth, has been shown to improve skin elasticity and thickness.
- Take Collagen: Collagen hydrolysate is very similar to gelatin. It’s a processed form of the collagen found in the connective tissue of animals. Collagen hydrolysate may have a protective effect on skin’s collagen. Skin elasticity, along with texture and hydration, increased significantly after 12 weeks of taking a liquid collagen supplement. Another popular source of collagen is bone broth, which can also provide other health benefits.
- Consume Certain Nutrients and Stay Hydrated: Certain nutrients are important for the production of collagen and other components of healthy skin:
- Protein: Adequate protein is vital for healthy skin. The amino acids proline, hydroxyproline, and glycine play a direct role in collagen production. Plant or animal protein is essential for the maintenance and repair of skin tissue and helps build muscle.
- Vitamin C: Vitamin C is needed for collagen synthesis and also helps protect skin from sun damage. Fruits and veggies rich in vitamins C and E help prevent cell damage.
- Omega-3 Fatty Acids: The omega-3 fatty acids found in fatty fish and plant sources, including walnuts, chia, and flax, may help increase skin elasticity and have anti-aging effects. Foods rich in omega-3 fatty acids, such as salmon, tuna, walnuts, almonds, and edamame, help restore collagen in your skin and help improve firmness.
- Water: Staying well-hydrated may improve the skin’s appearance. Women who increased their daily water intake had significant improvements in skin hydration and function. Drinking 2 or more liters of water per day may significantly improve skin health.
Medical Treatments to Tighten Loose Skin
Medical or surgical treatments are more invasive options to tighten loose skin after major weight loss.
- Body Contouring Surgery: People who have lost a significant amount of weight via bariatric surgery or other weight-loss methods often request surgery to remove excess skin. In body contouring surgery, a surgeon makes a large incision and removes excess skin and fat. They then suture the incision with fine stitches to help minimize scarring. Specific body contouring surgeries include:
- Abdominoplasty (tummy tuck): Removal of skin from the abdomen.
- Lower-body lift: Removal of skin from the belly, buttocks, hips, and thighs.
- Upper-body lift: Removal of skin from the breasts and back.
- Medial thigh lift: Removal of skin from the inner and outer thighs.
- Brachioplasty (arm lift): Removal of skin from the upper arms.Multiple surgeries are usually performed on different body parts over time after major weight loss. Body contouring surgeries may require a brief hospital stay, followed by a period of recovery time at home. There may be also some complications from the surgery, such as bleeding and infections. Body contouring surgery may improve quality of life after significant weight loss.
Types of Excess Skin Removal Procedures
There are several different procedures for removing excess skin. Most people need a combination of surgeries to get the look they seek. Your doctor can help determine which procedures will benefit you the most. Excess skin removal procedures include:
- Arm lift (brachioplasty) to remove excess skin that hangs down from your upper arm.
- Breast lift (mastopexy)to firm up breasts by tightening tissue and removing excess skin.
- Facelift (rhytidectomy) to give your face a smoother, younger appearance and get rid of excess skin around your neck.
- Lower body lift to remove excess skin and fat from your stomach, butt and outer thighs.
- Panniculectomy to remove the apron of excess skin (called a pannus) that hangs below your belly button.
- Thigh lift to give your inner thighs a sleeker appearance.
- Tummy tuck (abdominoplasty) to remove excess skin and tighten weak or separated abdominal muscles.
What to Expect Before Excess Skin Removal Surgery?
Follow your doctor’s recommendations when preparing for surgery. You may need to:
- Get blood work (lab tests).
- Stop taking certain medications that increase bleeding risk, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).
- Not take vitamins and herbal supplements.
- Quit smoking or using tobacco products.
What Happens During Excess Skin Removal Surgery?
Depending on the procedures, you may have surgery at a hospital and stay overnight. Or the procedure may take place at a surgical facility, and you’ll go home the same day (outpatient procedure). Excess skin removal often takes place in stages. You may need multiple surgeries. Certain procedures, such as a lower body lift or a panniculectomy combined with a tummy tuck, can occur during the same surgical appointment.
Read also: Surgical Options for Excess Skin
Alternative Medical Procedures
Although body-contouring surgery is by far the most common procedure to remove loose skin, less invasive options with a lower risk of complications include:
- Radiofrequency Treatment: Such treatments may use a combination of infrared light, radiofrequency, and massage to reduce loose skin. While this treatment doesn’t induce weight loss, it may help reduce small areas of fat cells. This treatment uses low-frequency electromagnetic waves to create heat that penetrates the skin and encourages collagen and elastin production as well as production of new skin cells. It can take as long as 6 months for skin to show improvement in tone, texture, and firmness. The good news is there is no downtime afterward, and side effects tend to be minor. With one treatment, you can see an improvement that can last up to 3 years.
- Ultrasound: A research review of ultrasound treatment for skin tightening found it to be efficacious, effective, and safe with minimal adverse effects. This procedure stimulates collagen growth by targeting skin tissue deep within the dermis. The result is that over time, the body begins to make collagen again, which makes sagging skin firmer and more elastic. You can expect to feel warmth at the site along with temporary swelling, redness, or tenderness.
- Laser skin tightening: This method uses a light to send heat deep into the skin to tighten loose skin all over the body. Unlike the other nonsurgical procedures, laser skin tightening requires three to five treatments to show results, which will appear gradually about 6 months after the final treatment.
It appears that although there are fewer risks with these alternative procedures, the results may not be as dramatic as with body contouring surgery.
Considerations Regarding Weight-Loss Medications and Surgery
GLP-1 medications have changed how people lose weight. While they may not work as quickly as bariatric surgery, which often results in major weight loss within six to 12 months, GLP-1 medications can still lead to significant weight loss over 12 to 18 months. Gradual, significant weight loss from medication can lead to loose or sagging skin, prompting may to choose body contouring surgery to feel more comfortable and confident in their bodies.
If you’re on weight-loss medications and exploring surgery for loose skin, consult both your physician and a board-certified plastic surgeon. You will need to stop your medication for a short time before surgery. Some GLP-1 drugs slow digestion, which can raise the risk of problems with anesthesia. Your surgical team will tell you how long to stop the medication before the procedure. They will also let you know when it is safe to start taking it again. Your surgeon will want to make sure your weight has been stable for at least six months before the surgery.
Candidacy for Excess Skin Removal Surgery
You may be a good candidate for skin removal surgery if:
Read also: Weight Loss and Red Light Therapy
- You’ve maintained your goal weight for at least six months - small weight fluctuations are normal, but significant regain can affect results
- You are in good health - chronic medical conditions can raise the risk of complications
- You have realistic expectations - body contouring surgery can improve your shape, but it won’t make you look like a supermodel
- You understand the risks - like any surgery, complications such as bleeding, infection and scarring are possible
Can Excess Skin Removal Take Place at the Same Time as Another Weight Loss Surgery?
No. Excess skin removal surgeries can only take place after bariatric (weight loss) surgery. A plastic surgeon can’t remove the excess skin until you lose the extra weight. It may take one to two years to achieve your goal weight after bariatric surgery. You also need to maintain that weight loss for at least six months before getting body contouring procedures.
Also, two different types of surgeons perform these procedures:
- Bariatric surgeons perform weight loss procedures like gastric bypass and gastric sleeve.
- Plastic (cosmetic) surgeons perform body contour procedures.
The Role of Skin Elasticity
Skin elasticity is what allows for your organs to expand beneath the skin when you gain a lot of weight, build up your muscle mass, or are pregnant. The elastin and collagen found in the dermis give skin this give-and-take quality. Like rubber bands, elastic fibers, made up of elastin in the skin, make it able to flex, stretch, and expand. The fat found inside the hypodermis causes the skin to expand during weight gain. As this subQ fat increases, your skin stretches to make room for it. Like that rubber band, if the skin is stretched far enough for long enough, it won’t snap back into its original shape - which can lead to loose or saggy skin.
Additional Factors Contributing to Loose Skin
Loose skin can be caused by a number of things, including:
- How quickly weight is lost
- The percentage of total body weight lost
- How long you’ve been at your starting weight
- Genetics
- Age
Hygiene and Skin Care for Loose Skin
Loose skin can form folds that trap moisture, sweat, and bacteria. Health care experts recommend washing between the folds with pH-balanced liquid soap, cleanser, or disposable wipes before gently patting skin dry. Other things that can help you stay dry include staying away from tight clothing or wearing items made from fabrics that are quick-drying or wick away sweat.
Addressing Body Image and Mental Health
Despite your weight loss, loose skin may become an issue that impacts your body image, as well as your mental and physical well-being. Loose skin may be a reminder of when you had overweight or obesity. You may feel so self-conscious that you withdraw from social activities or feel anxious or depressed.
Strategies for Managing Skin During Weight Loss
There are ways to take care of your skin during and after weight loss to keep it looking its best.
- Gradual Weight Loss: Slow, gradual weight loss gives that all-important collagen and elastin in the epidermis time to retract. Gradual weight loss is also considered better for your general health. The CDC recommends trimming down at a rate of 1-2 pounds per week.
- Strength Training: Building muscle beneath that skin can help fill the gap. That’s why strength training, which focuses on muscle growth, has been shown to improve skin elasticity and thickness.
- Diet and Hydration: Cutting calories should not mean cutting down on the nutritious foods that your body, especially your skin, needs. For both weight loss and to improve skin health and firmness, include the following nutrients:
- Foods rich in omega-3 fatty acids, such as salmon, tuna, walnuts, almonds, and edamame, to help restore collagen in your skin and help improve firmness
- Fruits and veggies rich in vitamins C and E to help prevent cell damage
- Plant or animal protein for the maintenance and repair of skin tissue and to help build muscle.
- Experts advise drinking 2 or more liters of water daily for skin health.
Skin Care Products
There’s no magic cream or lotion that can tighten up excess saggy skin, but some products do help prevent skin from loosening.
- Sunscreen: Sun damage impacts the skin’s elasticity and can cause skin to sag over time. Applying plenty of lotion with sun protection factor (SPF) 30 or higher can help keep this damage from happening.
- Moisturizers: Moisturizers may help plump the skin and relieve dryness right away. But if you don’t keep applying them, the effects won’t last.
- Skin-firming products: Lotions, serums, and creams that contain retinoids may have some positive effects on saggy skin, as retinol promotes the skin’s ability to make collagen.
Nonsurgical Methods to Tighten Loose Skin
Today, there are a variety of nonsurgical (also called noninvasive) methods to tighten loose skin. These procedures should be performed by or overseen by a licensed dermatologist, plastic surgeon, or cosmetic surgeon.
- Radiofrequency therapy: This treatment uses low-frequency electromagnetic waves to create heat that penetrates the skin and encourages collagen and elastin production as well as production of new skin cells.
- Ultrasound skin tightening: This procedure stimulates collagen growth by targeting skin tissue deep within the dermis. The result is that over time, the body begins to make collagen again, which makes sagging skin firmer and more elastic.
- Laser skin tightening: This method uses a light to send heat deep into the skin to tighten loose skin all over the body.