Weight loss and excess skin

Originally Published: April 13, 2007
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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,

Considerable weight loss is often suggested for people who are overweight or obese, but this process can in fact leave behind loose skin. Since you're planning on losing a large amount of weight, it's great that you're thinking ahead and looking to find out more about the process and what to expect. It isn't clear, however, if you plan to lose the weight through lifestyle changes alone or through surgical intervention. Other factors like your starting weight, height, and goal weight are also unknown.

The short answer to your question is that the condition of your skin will depend on the method of weight loss (which can determine how quickly you lose weight), the amount of weight loss, and your skin's elasticity. Also, health care providers recommend that people keep a close eye on the condition of their skin for at least two years after weight loss. If loose skin remains after two years, surgery may be the only option to make it go away — aside from regaining the weight.

These days, more and more people are losing large amounts of weight quickly with the help of weight loss surgeries. When people lose 50 - 100 pounds in a relatively short period of time, it's less likely that skin will be able to shrink along with body mass. On the other hand, when people lose a moderate amount of weight (less than 50 pounds) over the course of months, the skin has a better chance of keeping up. In these cases, the skin doesn't have as far to shrink, and loose areas can often be tightened up through exercise — perhaps by building muscles.

Along with the rate and amount of weight loss, you should also consider your skin's elasticity. Elasticity is the extent to which skin is able to stretch and then recover to normal once the need to stretch is removed — as in the case of weight gain and loss. The more fat that sits beneath the skin and the longer it remains, the less accommodating the skin becomes. For this reason, skin is less likely to shrink in cases of extreme and rapid weight loss because elasticity is diminished. In cases where skin is permanently stretched, people who have lost a lot of weight may be left with excess skin. Do you have an idea of how elastic your skin is now? If you do end up experiencing loose skin, how will you cope as you wait the recommended two years before deciding if surgical removal is for you?

People often look to surgery to remove loose skin. The actual surgeries are called body lifts, and they focus on the areas where there is especially loose skin. Lifts are often done around the abdomen, thighs, breasts, and arms. Insurance companies rarely consider these procedures to be medically warranted unless they're needed to clean up an infection resulting from the process of weight loss surgery. This means patients usually have to foot the bill.

Although it's becoming ever more common for people to turn to surgical interventions to aid in drastic weight loss, it's still important to try hard to make behavioral changes in working towards or maintaining a healthier weight. This will certainly benefit your health and well-being, no matter what your weight is and no matter what your skin looks like.

Alice