Weight loss surgery can significantly transform your health and body composition. While the results can be life-changing, many patients notice excess or sagging skin as the body adjusts to rapid fat loss. This is a common concern, affecting up to 96% of people who undergo the surgery, and can have a big impact on health, comfort, and confidence. Fortunately, there are many treatment options that can target loose skin to help patients feel and look their best.
Understanding Excess Skin After Weight Loss Surgery
If you are contemplating weight loss surgery, you are probably thinking ahead to the results and what to expect during recovery. Weight loss surgery typically brings health benefits, but you may also experience some undesirable changes that can occur when a substantial amount of weight is lost in a short period of time, either through surgery or other means.
Excess skin after a gastric sleeve or another bariatric surgery usually happens because the skin is stretched beyond its elastic limit when a person gains weight and then cannot fully retract after significant weight loss. The amount of excess skin can depend on the amount and rate of weight loss, age, and genetics.
Why Excess Skin Occurs
- Skin stretching: When a person gains weight, their skin stretches to adapt to the extra volume. The stretching of skin can affect its overall elasticity and lead to excess skin when weight is lost. After a lifetime of having a higher body mass index (BMI), a person’s skin is chronically stretched out, much like a water balloon.
- Loss of elasticity: As a person gains weight over time, their skin can lose its ability to return to its original shape, which would cause excess skin after weight loss surgery. A loss of elasticity is also natural to aging and can become worse as the skin is repeatedly stretched from weight gain. With aging, the skin loses elasticity, which affects its ability to contract during significant weight loss.
- Rapid weight loss: When a person loses a lot of weight fast, their skin might not have enough time to adjust to the change and return to its original state, causing sagging and excess skin.
- Personal factors: Age, genetics, bodyweight distribution, and the amount of weight a person loses can also affect the amount of excess skin they have after bariatric surgery. The amount of excess skin a person may have after bariatric surgery depends on genetics, bodyweight distribution, and how much weight is lost.
Common Areas Affected
After significant weight loss from bariatric surgery, many people commonly experience extra skin. It’s normal to experience loose skin around the abdomen, thighs, upper arms, and face. Common areas include:
- Abdomen: The stomach is a common area to have loose skin after weight loss surgery, especially in the lower stomach.
- Thighs: Extra skin can show near the inner thighs, often irritating the skin while walking.
- Arms: The upper arms are a common place to see sagging skin after a lot of weight loss.
- Breasts: Flat or drooping breasts may occur after bariatric surgery.
- Face and neck: While less common, weight loss surgery can also lead to sagging jowls, a double chin, or a less defined jawline from losing facial fat and skin elasticity.
The exact areas and amount of extra skin after weight loss surgery can depend on the amount of weight the patient loses, their age, and genetics. Some people might see extra skin in multiple areas of their bodies, while others may notice it in only one or two.
Read also: Support for Saggy Breasts
Physical and Emotional Impact
Excess skin can be distressing since it affects not only appearance but also function and health. Excess skin can affect a person’s appearance and self-esteem and can also be physically uncomfortable.
The additional loose skin on the body could make it harder to bathe and get around day to day. It might even keep people from doing their favorite activities or hobbies. The exact physical effects can include chafing, rashes, and pain near skin folds, as well as more moisture in these areas that can lead to infection. Loose skin can also make it harder to exercise or even change how often a person works.
Emotionally, many people see their extra skin as a constant reminder of their past weight or feel less confident in their appearance overall. The biggest gain [from addressing excess skin] is self-confidence. A lot of patients have a long story behind their decision to pursue bariatric surgery. Excess skin can also cause medical issues like infections and skin rashes. And having a lot of loose, excess skin can make it difficult for people to fit into clothes.
Non-Surgical Approaches to Managing Excess Skin
While surgical intervention is often considered the most effective solution for excess skin, several non-surgical approaches can help manage and minimize its appearance.
- Gradual Weight Loss: Rapid weight loss gives skin less time to adjust. Lose weight gradually: Rapid weight loss gives skin less time to adjust.
- Hydration: Staying hydrated can keep the skin supple and resilient so it can more effectively manage changes from weight loss. Hydrated skin is more elastic and will be better able to manage the changes in your body weight.
- Exercise: Regular exercise increases fat burning, builds and tones muscle, and raises your energy level. Strength exercises might help build muscle to fill the space left from fat weight loss, which might reduce the appearance of sagging or loose skin after bariatric surgery. Well-developed muscles form a supportive structure beneath the skin, helping to prevent sagging and promoting a youthful appearance. Exercise also increases blood circulation, delivering essential nutrients that encourage skin cell turnover.
- Topical Creams: There are several over-the-counter and prescription creams that can help with aesthetics after your procedure. Some products, such as body butter, are great for moisturizing the skin, while other products claim to reduce visible stretch marks.
- Nutrition: Proper nutrition remains a cornerstone of recovery. Prioritize food and drink that both conform to your diet and also provide for better skin elasticity.
- Mobility Exercises: Beyond nutrition, gentle stretching and mobility exercises maintain circulation and improve how the skin conforms to the body’s new shape.
Surgical Options for Excess Skin Removal
Thankfully, several surgical treatments can target extra skin and help patients feel healthier and more confident in their bodies. Plastic surgeons can remove excess skin, reshape contours, and restore comfort, particularly around areas prone to irritation or infections.
Read also: Neck Lift Alternatives
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. The type of surgery recommended typically depends on the area or areas of concern for my patient. The abdomen, breasts, arms, or thighs are the most common areas for treating excess skin. In general, the goal is to remove the excess tissue and then try to contour the remaining tissue.
Excess skin removal procedures include:
- Arm lift (brachioplasty): to remove excess skin that hangs down from your upper arm Tightens and smooths the underlying tissues to eliminate excess skin and stubborn fat, revealing slender, toned arms.
- Breast lift (mastopexy): to firm up breasts by tightening tissue and removing excess skin. In many cases, I use the body’s own tissue to augment sagging breasts. There are also options available for men, including chest contouring.
- 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. A lower body lift removes excess skin and fat from multiple areas of the body, usually the abdomen, thighs, hips, and gluteal area. It can also restore contour and improve definition, tightening the skin and reshaping the lower body for an attractive appearance.
- Panniculectomy: to remove the apron of excess skin (called a pannus) that hangs below your belly button. Known as a panniculectomy, the removal of excess skin is performed most often in the abdominal area.
- Thigh lift: to give your inner thighs a sleeker appearance. Thighs can be particularly problematic after weight loss, a thigh lift is typically an ideal solution to achieve slender, shapelier legs.
- Tummy tuck (abdominoplasty): to remove excess skin and tighten weak or separated abdominal muscles. For the abdomen, the most common surgery performed is an abdominoplasty, or “tummy tuck.” That involves removing overhanging skin and contouring the mid-abdomen to match the contour into the thighs and pubic region. A tummy tuck removes excess skin and fat from the abdomen and tightens the abdominal muscles. The surgery can help with everyday function and result in a smoother, flatter stomach.
What to Expect Before and After 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. My first concern is always safety. That’s why, for instance, I want to see that my patients are free from smoking or using any kind of nicotine product for at least six weeks before having skin surgery. That’s important because tobacco use can interfere with wound healing. Many times my patients already know that because tobacco cessation is a criteria for bariatric surgery as well.
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.
After a tummy tuck, most patients will be able to move around within the first few hours after surgery and can return to normal activities within three weeks. Most patients fully recover within three to six months. After an arm lift, patients can usually return to work or school within two weeks and normal activity levels within six. Most patients will be able to move around within the first few hours and recover safely at home after a lower body lift, experiencing complete healing within six to eight weeks.
Read also: Arm Lift Alternatives
Recovery from skin tightening varies by treatment type. Non-surgical treatments may cause mild redness, swelling, and tenderness for a few days. Cool compresses and over-the-counter medications can provide relief. Avoid sun exposure and use gentle products during recovery. After surgical treatments, initial recovery takes 1 to 2 weeks, with swelling and bruising expected. Final results are often obscured for several weeks, but you may notice immediate improvements to your overall figure.
Important Considerations
- Timing: 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. In general, I like to do surgery for excess skin about 18 months after bariatric surgery. This is because patients need to be at a stable, healthy weight for a steady 6 months before having skin surgery. If they gain or lose weight after the plastic surgery procedure, patients can lose the aesthetic benefits. In general, it is recommended to wait until a patient’s weight has been stable for at least a year or longer before considering skin removal surgery. This is to ensure the skin has reached its “new normal,” so the final amount of excess skin is clear. It is also because if patients undergo surgery before their weight stabilizes, weight loss or gain can affect the end results.
- Surgeon Specialization: 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.
- Liposuction: You may have heard that you can have liposuction and body contouring, such as a tummy tuck, at the same time. Liposuction can help remove stubborn fat deposits, but it isn’t a weight loss surgery. One beneficial effect of significant weight loss is reduced visceral fat-the fat surrounding the organs that cannot be removed through liposuction.
Other Potential Post-Surgery Changes
Beyond excess skin, it's important to be aware of other potential changes that can occur after weight loss surgery. At NYU Langone’s Weight Management Program, we want to help you prepare for and understand the effects, immediate and longer term, that you may experience after your procedure.
- Hair Loss: During the first six months after surgery, almost everyone who has weight loss surgery experiences hair loss or thinning. Hair loss is alarming, but it typically doesn’t lead to baldness and is reversible. When your weight stabilizes and you consume more protein, your hair grows back. Chemical hair treatments, such as straighteners and perms, should be avoided.
- Nausea or Dumping Syndrome: Because your new stomach pouch is quite small, you cannot eat as much food as you once did. Therefore, if you get full but continue to eat, or eat quickly without chewing thoroughly, pain and vomiting are likely to occur. You have to learn to eat more slowly, to chew food thoroughly, and to stop eating when you feel full. Overeating or consuming concentrated sweets or carbohydrates can lead to nausea and dumping syndrome, which occurs when the contents of the stomach quickly enter the small intestines, causing profuse sweating, nausea, dizziness, palpitations, and weakness. If you don’t have problems eating during the first month after surgery and then suddenly experience nausea or vomiting after eating or drinking, you may have developed a stricture, or narrowing, at the point where the stomach pouch connects with the small intestine. This can be serious-you should call your surgeon for further evaluation.
- Nutritional Deficiencies: Nutritional deficiencies can occur, particularly in patients who have a gastric bypass, which causes food to skip the duodenum-the section of the small intestine where most iron and calcium are absorbed. Left uncorrected, this can lead to anemia or osteoporosis, among other conditions. The good news is that these problems can be avoided by eating the correct foods in small amounts, taking daily vitamin and mineral supplements, and getting regular medical checkups that include blood testing.
- Lactose Intolerance: After certain bariatric surgeries, lactase, the enzyme needed to digest milk and other dairy products, does not reach food in the usual fashion. Consequently, you may become lactose intolerant, leading to gas, cramping, and diarrhea. Try avoiding dairy products and switching to alternatives, such as soy milk, rice milk, or lactose-free milk such as Lactaid.
- Changed Bowel Habits: Weight loss surgery can change your food intake as well as your digestion. Some patients experience constipation, which can be treated with a mild, natural stool softener or by simply drinking more fluids. After a duodenal switch, patients may experience diarrhea. This is usually caused by having too much fat in the diet. If that is not the case, a small amount of pancreatic enzymes may be required to help your digestion, which can be prescribed by your surgeon.
- Loss of Muscle Mass: Because you’re consuming far fewer calories and less protein, your body burns other energy stores to maintain itself. The body prefers to use protein-rich muscle for energy before it taps into fat. Therefore, your initial weight loss may come at the expense of your muscle mass. This is most common after a gastric bypass, sleeve gastrectomy, or duodenal switch. Fortunately, loss of muscle mass can be avoided by exercising every day and consuming more protein. We recommend both regular aerobic activity and weight lifting. These activities can be alternated, but should be done at least three times a week for 20 to 30 minutes, though daily exercise is ideal and should be your goal.
- Gallstones: With any rapid weight loss, there is an increased risk of developing gallstones. About 1 in 10 people who undergo bariatric surgery ultimately need to have their gallbladders removed. At NYU Langone, we do not routinely remove gallbladders at the time of weight loss surgery because most people would have their gallbladders removed unnecessarily. Instead, anyone who still has a gallbladder at the time of gastric bypass or duodenal switch surgery is prescribed a medication that prevents gallstones from forming after surgery. If your gallbladder still needs to be removed, it can be done laparoscopically at a later date.
- Gastric Band Adjustments: If you have gastric band surgery, band adjustments are critical to the success of your surgery. If your weight loss plateaus, or if you continue to be hungry after eating, your band needs tightening. This is a simple procedure that your surgeon or nurse can usually perform in our office.