I have lost 85 pounds without bariatric surgery. Weight loss has been on my mind basically my whole life, especially since I started this journey in earnest in July 2019. And, as proud of myself as I certainly am for losing this weight and finally becoming more healthy, I ignore it. toes with pervasive anxiety and a nagging question: What about excess skin?
Due to the slower rate at which I’m losing weight, I haven’t experienced any loose skin yet, although I still have at least 50 pounds. I worry, perhaps too much, whether I will be able to reach my goal weight without needing a skin tightening at the end of this journey.
It’s a pretty unsexy subject – which is why it’s rarely, if ever, discussed. But for those like me who are on long weight loss journeys or whose bodies have changed significantly during pregnancy, it’s a nagging question: Will I experience excess skin as I lose more weight? And if I do, what can I do about it?
Apparently, I’m not the only one with questions, according to the New York plastic surgeon to the stars Lara Devgan. “Skin tightening remains one of the elusive black boxes in the world of plastic surgery,” he says. We said we are all I’m still learning about best practices—from me to the medical professionals.
So, I decided to investigate further. Bringing together five accomplished dermatologists and plastic surgeons from around the country, I ask them all my questions. And here’s what they have to say.
If you want to try to reduce loose skin from significant weight loss, lose weight slowly.
“Gradual rather than rapid weight loss can prevent excess skin after major weight loss,” Los Angeles-based dermatologist Harold Lancer says. “However, rapid weight loss on a large scale will always result in excess skin.” Devgan seconds it. “The best way to prevent sagging skin after weight loss is to do your best to lose weight at a slow and steady pace,” she says. “While it may sound appealing to get to the finish line quickly, that’s actually the worst thing you can do when it comes to sagging skin.” Losing weight slowly, he says, allows the skin to contract and shrink as the body’s shape shrinks.
If you are having weight loss surgery, consider a one-two punch surgery: weight loss surgery followed immediately by skin removal surgery.
While I personally haven’t opted for weight loss surgery, many do – and there’s no shame in that. But because of the faster rate at which weight is lost after surgery, there is a greater chance of excess skin. Why should we worry about excess skin, especially after faster weight loss? It’s “because collagen and elastin fibers are damaged when the skin is stretched significantly and stays stretched for a long time,” says New York City plastic surgeon David Shafer. “Patients should plan for staged procedures if undergoing weight loss surgery followed by skin removal surgery.”
Skin elasticity depends on two main factors: age and genetics. But lifestyle choices matter too.
“Typically, younger patients with thicker, more sebaceous skin will have more skin tightening during weight loss because of better elasticity,” says Devgan. “Starting in the 20s, tissue elasticity begins to decline. Even in the absence of weight fluctuation, loss of tissue sweep and reduced firmness can be seen in midface descent in the late 20s, breast sagging in the 30s, abdominal sagging in the 40s, and limb relaxation in the 50s’.
However, everyone’s body is different, says Devgan. “There is a huge variation in the human experience, so some patients may lose 50 pounds with little change in their body, while others may lose as little as 10 and see tissue laxity.” If you’re genetically blessed with unusually great tissue elasticity, Devgan says, it can be less dramatic. (And lucky you.)
Lifestyle choices can also play a role, says Boston-based dermatologist Ranella Hirsch. How long were you at the weight you started losing? Are you a smoker? Do you spend a lot of time unprotected in the sun? All these factors affect the elasticity of the skin.
Keep skin well hydrated.
“Using an emollient moisturizer rich in vitamin E will help improve skin protection and lock in moisture,” says Devgan. And the topical, medical-grade ingredients you use on your face to firm and tighten skin—like hyaluronic acid, peptides, niacin, squalene, vitamins C and B, retinol, and bakuchiol—can work elsewhere, too. says. “Most people focus on using these on the face and neck in their daily routine, but from a molecular perspective, their effectiveness is present anywhere in the body.”
Our favorite body creams
Toning body cream Biossance Squalane + Caffeine
Sol de Janeiro Bom Dia Bright Body Cream with Vitamin C
Augustinus Bader The Body Cream with TFC8 Moisturizer
But save your money on creams that promise you the world.
“Losing large amounts of weight quickly tends to leave skin behind,” says Hirsch. “Although creams with incredible claims abound, they actually do little.”
Instead, consider non-invasive treatments and even weight training.
Building muscle through weight training can help reduce the appearance of loose skin, says New York dermatologist Dendy Engelman. “This helps reduce the appearance by replacing lost fat with muscle mass.” And there are non-surgical options for dealing with loose skin after weight loss, but they won’t help with skin folds or sagging skin.
“Non-invasive treatments like laser and radiofrequency can help tighten the skin, but there’s a limit to how much they can do,” adds Shafer. “Saggy skin generally needs surgical excision with procedures such as abdominoplasty, body lift and arm lift.” There is a difference between Loose skin and hang skin, says Shafer. “It is possible that patients can manage and treat excess skin without undergoing skin removal surgery, such as if the skin is loose but not hanging.” He adds, “In this case, non-invasive treatments can be helpful, but hanging skin requires surgical excision.”
If excess skin is interfering with your life, then it’s time to consider plastic surgery — with input from multiple medical professionals.
“After significant weight loss, people can have skin that hangs off their body,” says Engelman. “These heavy folds can cause health problems such as pain, inflammation and frequent infections from the skin constantly rubbing against each other. This can happen during exercise or during daily activities. When a person is experiencing functional problems due to excess skin, it should be a sign that this problem needs to be addressed.” And, of course, everyone’s journey is different.
Lancer says some people will tolerate moderate slack and be happy with their weight loss achievement. Others will seek skin tightening for as little as five pounds of weight loss (he’s based in LA, after all). But, he says, if plastic surgery is an option on the table, “I would recommend getting at least three opinions from doctors who do excess body skin reduction exclusively. Once you choose a doctor, do a small area on your body so you can evaluate the procedure, how your body is healing, and your results. Then you can determine if you want to move on to a comprehensive larger process.”
He suggests consulting a dermatologist about non-surgical options, and then having the doctor recommend plastic surgeons who specialize in excess body skin reduction if you think that’s the right path for you. It is an important decision that should not be taken lightly. Bring medical professionals along for your entire weight loss journey (even if you’ve already started) and ask all the questions: Which particular procedure is best? How much will it cost? Will insurance cover it? (From my research so far, not if it’s cosmetic, but maybe if it would help fix something that limits the functionality of your daily life.) No questions are off limits, and don’t try to make these decisions on your own.
Above all – and perhaps most importantly – be proud of yourself.
If this piece concerns you at all, whether from long-term weight you’ve been carrying or pregnancy weight loss or anywhere in between, it means one thing: You’ve made significant strides toward better physical health, and that should be applauded. “Everyone’s weight loss story is different, and some days are harder than others,” says Engelman. “I say, try to be kind to yourself. You’ve just achieved a huge feat and you should be proud of it.”
Devgan agrees. “Achieving a personal health goal like significant weight loss is an incredible achievement that anyone should be proud of,” she says. “While excess skin can feel like a burden or a source of self-consciousness, it’s also a reminder of the metaphorical and literal weight loss of a previous version of ourselves. You can’t have a couture dress without a seam and you can’t have surgery without a scar. Life has limitations, but that doesn’t make it any less beautiful. It makes it more real.”
