Dear Alice,

I have recently begun planning a healthier lifestyle. I am aiming to lose a rather large amount of weight. My question is, will skin shrink along with your body mass? I have heard some say that skin will not shrink down when you lose weight, and you have to have plastic surgery to remove the excess skin. Is this true? I have done an extensive amount of research on the subject, and I have found almost nothing. I am not concerned with a bit of saggy skin, but when I do reach my weight goal, I don't want to look like an old, lumpy sack of potatoes. Please help!

— Skinful in Ohio

Dear Skinful in Ohio,

Making significant changes towards adopting a healthier lifestyle is no easy feat, so congrats on taking steps towards a healthier you! Furthermore, managing expectations regarding weight loss is an essential part of that process, so it’s great that you’re thinking ahead about what the finish line might realistically look like. Depending on the amount lost and whether or not you end up with excess skin after the weight loss at all will depend on a combination of how much weight you lose, how quickly you lose that weight, and the elasticity of your skin (more on all that later). Unfortunately, there’s no formula to predict exactly how much excess skin you’ll end up with and whether it will shrink along with your body mass. So, the short answer to your question is this: ultimately, the decision to get surgery to remove loose or excess skin is up to you.

Generally speaking, individuals who lose a large amount of weight very quickly (i.e., 50 to 100 pounds in a few weeks or months) are more likely to end up with loose, excess skin. This includes people who undergo surgical interventions to lose weight (such as gastric bypass surgery, a.k.a. stomach stapling) but may also include individuals who lose a dramatic amount of weight using traditional diet and exercise. On the other hand, people who lose a moderate amount of weight (less than 50 pounds) over a longer period of time might find that their skin more readily adjusts to the gradual weight loss, minimizing the appearance of loose skin. In these cases, the skin usually doesn't have to shrink so suddenly, and sometimes looser areas can be tightened up through strength training — by building new muscle mass to replace the fatty tissue that was once there.

In addition to the total amount of weight loss and the rate at which it’s lost, your skin's elasticity, or the skin’s ability to stretch and then recover, might also contribute to your final results. The greater the amount of fatty tissue beneath the skin, and the longer that fatty tissue stretches the skin, the less elasticity the skin retains. If you can imagine your skin as a rubber band, the harder you pull on the band and the longer you maintain that tension, the less easily that band will bounce back to its original shape. Similarly, skin is less likely to completely shrink in cases of extreme and rapid weight loss due to this diminished elasticity. However, the skin’s natural elasticity (which is dependent on factors such as your lifetime sun exposure, whether or not you have a history of smoking, as well as genetic factors) also plays a role, and even among people who lose weight more slowly over time, poor elasticity may still lead to excess skin after weight loss.

With that being said, loose and excess skin is sometimes removed for non-cosmetic reasons via surgery. Excess skin post-weight loss, especially when not properly cared for, can lead to rashes, infections, eczema, chafing, pinching, itching, and pain, which can all persist in the skin folds. These conditions may contribute to other difficulties including irritation or discomfort that could prevent you from moving actively. It may also interfere with your ability to find clothing that fits comfortably and in a way that makes you feel your best. Generally, people are advised to wait at least a year after losing the weight to begin surgery because the skin’s elasticity is highest during that first year. Other considerations for body contouring surgery include the impact of the excess skin on your self-esteem and satisfaction with the weight loss. Some people may feel that the excess skin doesn’t fit with their expectations of their post-weight loss body. This discordance may be severe enough to cause psychological distress like depression or anxiety, and they may ultimately decide to undergo body contouring surgery.

While you work towards reaching your target weight, you may want to talk with your health care provider about lifestyle changes. Your provider can help you to strategize and execute a weight loss plan that’s effective, safe, and sustainable in the long-run. If you do choose body contouring surgery, they can also monitor your recovery moving forward. In addition, it might also help to talk with a mental health professional who can work with you to bolster your health holistically (e.g., by helping you with things such as stress management and healthy coping strategies) to ensure that you also feel emotionally supported throughout your journey.

Thinking about your physical and emotional expectations and what the future might bring with your intended weight loss will help you be better prepared for the challenges ahead. Kudos to you for beginning that process and good luck!

Alice!

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