Weight Loss And Skin FAQs
Frequently, questions are asked in the different forums here at 3FC about what happens to our skin as we lose weight and what can be done about it after we reach our goal weights. The following FAQs have been put together to try to answer some of the most common questions. If you have a question that isn’t listed here, post it in the Maintainers Forum and we’ll see if anyone can answer. Please note: I’m not a doctor, nor is anyone else who has contributed to these FAQs, but we all have first-hand experiences with excess skin after weight loss and can try to answer based on our own personal knowledge, opinions, and experiences.
1. What will my skin look like when I reach my target weight?
The most important thing to remember about weight loss and your skin is that no one — not even a doctor— can tell in advance what your skin will look like when your reach your goal weight. Every person’s skin will react differently to weight loss.
However, many people who lose a significant amount of weight are unpleasantly surprised to find that their skin looks worse and worse as the pounds drop off. Fat cells themselves never go away entirely; they empty out but their structure remains behind. As the fat from the cells and inches melt away, there’s less support for the overlying skin and it starts to look deflated — collapsed and wrinkled — like a balloon that was blown up and popped. Since the underlying fat layer to which the skin was attached is now gone, it flops around loosely.
There are some common variables that affect how your skin will react to and look after weight loss:
* How old are you? — the younger you are, the more elastic your skin is.
* How long were you overweight? — skin that has been stretched for many years is less elastic than skin that was only stretched for a brief time.
* What are your skin genetics? — some people are genetically blessed with elastic skin.
* Do/did you smoke? — smoking negative affects the skin’s ability to tighten up.
* How much weight did you lose and how quickly did you lose it? — the more weight you lose, the more likely it is that you’ll have excess skin. Extremely rapid weight loss (e.g. loss as a result of gastric bypass surgery) can also cause loose skin to occur.
* Are/were you a sun worshipper? — sun damages skin.
* Were you ever pregnant? — a large pregnancy can permanently damage the underlying fibers of the skin and permanently separate the ab muscles that keep your stomach flat.
From Joseph F. Capella, MD:
2. Will exercise affect the way my skin looks when I reach my target weight?
… following massive weight loss ... with few exceptions, individuals following significant weight loss develop generalized or focal areas of excess skin.
The primary cause of excess skin following weight loss is relatively simple. Similar to pregnancy where the muscles, skin and other tissues of the abdominal wall expand to accommodate the fetus, a similar process occurs with the accumulation of fat in the body. There are important differences however. The process of fat accumulation in morbidly obese individuals often begins during childhood or adolescence, prolonging the period of tension on the skin. In addition, the area of tissue expansion in obesity is generalized rather than limited for the most part to the abdomen.
With weight loss and following the delivery of a baby, the affected tissues tend to retract. When the tissues do not return to their previous state it is because they have been permanently damaged. In the case of skin, the elastic fibers have been broken. This can give the appearance of striae, a condition often seen on the breasts and abdomen following pregnancy. How closely the skin and other tissues of the body resemble their appearance prior to pregnancy or obesity depends on similar factors.
Probably the most important determinant of how much loose skin an individual will have following weight loss is age. Younger patients tend to have less loose skin. The next most important factor is the amount of weight loss. An individual who loses 250 lbs. is likely to have more excess skin than somebody losing 80 lbs. Other less important variables include complexion, amount of sun exposure received over a lifetime, heredity and whether somebody is a smoker. Fair skinned people in general tend to develop more loose skin than darker individuals. Sun worshippers tend to sustain more tissue damage over the years and consequently more loose skin following weight loss. Some people tend to have " better" skin than others of similar complexion and lifestyle. This may be the result of hereditary factors that are not readily apparent. Finally, smoking breaks down collagen, a major component of skin and other structural components of the body. Smokers develop more loose skin than their non-smoking counterparts.
Exercise that includes increasing muscle tone can tighten connective tissue between muscles and overlying skin. A regular exercise regimen is helpful to maintain ones weight following bariatric procedures and can serve to tighten loose skin to some degree.
Exercise alone can’t make your skin tighten up; however, building muscle as you lose weight and afterwards can help to fill up some of the loose skin. There’s an interesting discussion of exercise and its effect on skin here: Why do some people just shrink?
3. Are there any creams or lotions that I can rub on my skin that will make it tighten up? Will 'brushing' my excess skin make it go away?
No, but it certainly never hurts to moisturize.
4. Are there any vitamins or supplements that I can take that will make my skin tighten up?
5. Is it true that if I lose weight ‘the right way’ that my skin will tighten up and I won’t have any loose or excess skin?
There are myths, misinformation and outright lies floating around the Internet about skin and weight loss. The Big Lie is that if you lose weight ‘the right way’ you won’t have any problems with your skin — that it will shrink to fit your new body. The ‘right way’ is commonly held out to be through healthy eating, exercising and lifting weights, drinking lots of water, using lotions of various types, losing slowly, and taking various supplements and oils. Often whoever is espousing the ‘right way to lose weight’ is selling something: a book, lotion, supplement, or weight loss plan. Or that person is simply misinformed and has never personally lost enough weight to get to the point where excess skin is an issue. In any event, they’re wrong. You can lose weight 'the right way' and have a lot of excess skin.
6. Am I a failure if I lose weight ‘the right way’ and still have a problem with excess skin?
No! The Big Lie perpetrates the myth that we've done something wrong if we reach our goal weights and don't have magically shrinking skin. Many people have lost weight the right way and have problems with excess skin. You’re a success for losing the weight! Don’t let ignorant people make you feel like you're a failure.
7. Why do I see pictures and read stories in magazines, books, and on the Internet about people who say that they have lost a lot of weight but have tight skin with no excess skin problems?
Everyone is different and there may be a few lucky souls who can lose large amounts of weight with no excess skin problems. Those folks would probably be ones who lost their weight at a young age, hadn’t been overweight for very long, and/or were genetically blessed with elastic skin. Unfortunately, however, sometimes people just aren’t honest about their skin problems because they are selling products or services or trying to make a name for themselves. So you have to consider the source: does this person, magazine, company, or book stand to profit from giving the illusion that you can lose weight without having any problems with excess skin? Keep in mind that photos can be airbrushed and that lighting, posture, makeup, and hair styles make a huge difference in before and after photos. Sometimes excess skin is tucked into clothing, even skimpy posing suits, to make it ‘disappear’.
In other words, be cautious about believing all that you may ‘see’ and ‘hear’ about weight loss without excess skin problems. Especially if it involves your money!
8. When will I be able to tell whether my skin will tighten up after weight loss?
Try not to worry prematurely about potential skin problems before you reach your goal weight. Many body changes happen as you lose the last ten or twenty pounds. Most plastic surgeons tell you to wait at least six months after you reach your goal weight and stabilize there to see how your skin reacts to your weight loss. However, not much is likely to change after a year.
Remember, if you decide that your skin looked better before you lost weight, you can always gain the weight back again – but we bet you won’t!
9. I’ve reached my goal weight and waited six months and still have a problem with excess skin. What can I do?
At this point, it comes down to two choices: live with the skin or have it surgically removed. Excess skin problems can usually be camouflaged under clothing quite nicely. If you don't want to live with the skin, you can schedule a consultation with a plastic surgeon to discuss surgical options. You might want to consider talking to a doctor just to find out what all your options are even if you don’t think that you would consider surgery.
10. What kind of doctor would I see?
A plastic surgeon.
11. How do I find a plastic surgeon?
Look for a board-certified plastic surgeon: American Society of Plastic Surgeons
Talk to friends about their experiences and recommendations. Plastic surgery is becoming common today and you may know quite a few people who have had surgery. Get referrals from your GP or gynecologist since they are likely to have seen the results of various surgeons’ work and know their reputations.
Visit several doctors to be sure that you find one who you are compatible with and feel like you can work with as a partner. More than any other medical specialty, plastic surgery is an art and you want to have total confidence that your doctor understands your wants and needs and can get you the results that you expect.
12. How much does a consultation cost?
Ask when you call for an appointment. Some may be free, some may be between $50 and 150, depending on where you live. Some doctors will waive the fee if you end up doing the surgery with them.
13. What happens at a consultation?
You will need to undress and show the doctor what’s bothering you. After a large weight loss, the skin problems are frequently all over our bodies, so you might as well forget about modesty. Often the doctor will take photographs. He/she will discuss treatment options and their costs.
14. What should I ask a plastic surgeon?
It’s a good idea to go in with a written-out list of questions. There’s an excellent list of suggested questions at TuckThatTummy.com
. You might not want or need to ask all of them but it’s a good place to start thinking about your own questions.
15. What kinds of plastic surgeries are done for excess skin?
Here are the names of some of the various procedures:
* Arms: arm lift or brachioplasty
* Thighs: thigh lift or lower body lift
* Face/neck: face lift
* Breasts: breast lift, mastopexy
* Butt: butt lift, lower body lift
* Entire lower body (abdomen, butt, thighs): lower body lift, belt lipectomy
Many of the above can be combined with lipo to remove excess fat. Frequently multiple procedures are done together to save on expenses.
16. Does plastic surgery leave scars?
Yes. Unfortunately it’s a trade-off between scars and excess skin. Most scars can be camouflaged by clothing or a bathing suit or underwear, although those on the arms and knees and other exposed areas are more visible. Scars go through a maturation process as they heal, starting off as red and raised, and fading to thin white lines over the course of a year. Your doctor will suggest products and techniques (like massage) to minimize scarring. You need to avoid tanning and sun exposure on your scars for a year.
You may discover people telling you horror stories about scarring in an effort to scare you off from surgery (my aunt's best friends daughter had surgery ... blah blah blah)
. Do yourself a favor - talk to doctors, look at photographs, and make up your own mind about what is acceptable to you.
17. How much does all this excess skin weigh — will I lose weight if I get rid of the skin?
“Dry skin” (skin drained of all its fluids) doesn’t weigh much at all (they drain it back into your body in the OR before they cut it off). Frequently, however, some fat is removed along with excess skin and that adds some weight to what’s removed. The total weight can range from just a pound or two to twenty or more pounds, depending on the amount of excess skin and attached fat that you have. Everyone’s experience will be different — a plastic surgeon would have examine you in order to answer that question for you.
18. How much does plastic surgery cost?
2006 Average Surgeons Fees
(these do not include operating room, hospital, anesthesia, or miscellaneous expenses) from the American Society of Plastic Surgeons
Thigh lift: $3885
Face lift: $4856
Butt lift: $4527
Lower body lift: $7578
Breast augmentation: $3600
Total average costs of the various procedures
(surgeon’s fee, anesthesia fee, operating room fee, and implant fee (if applicable)) from InfoPlasticSurgery.com
Arm lift (brachioplasty): $5000 – 6500
Abdominoplasty: $6000 - 8000
Face lift: $7000 - 9000
Mastopexy: $5000 - 6000
Breast augmentation: $5000 - 6500
The cost will vary depending on the doctor, where you live, and whether you are combining procedures but these numbers give you a ballpark idea of the costs.
19. Does insurance cover plastic surgery to remove excess skin?
You will have to check your own medical insurance to answer this question for sure. Typically, skin removal, even after massive weight loss, is considered to be cosmetic and not covered unless you can show that it is causes a medical problem, like rashes or back pain. Keep in mind that your insurance company is only interested in medical problems caused by the excess skin after you reach your stable goal weight. They don’t need information about any problems with rashes, backaches, or pain that you had while you were overweight, so don’t be concerned if you didn’t document problems that you previously had. If your skin is causing you problems once you’re at goal, take photos and visit your PCP for treatment.
On a practical level, it’s unlikely that insurance will cover any surgery unless you previously had weight loss surgery -- WLS patients seem to have better results with insurance coverage than non-WLS patients. Cosmetic surgery is not deductible as a medical expense for tax purposes.
20. Can I finance the surgery?
Some plastic surgeons offer financing plans, either themselves or through various companies. Check with your doctor. Tip: many surgeons give cash discounts. Be aware that the interest rates offered by cosmetic loan companies can be rather high. Shop around – you might save money on both surgery fees AND interest rates if you can use, say, a home equity loan or 401(k) loan at a lower interest rate, and pay your surgeon cash (i.e. certified or personal check).
21. Will a hospital pay for my skin removal if I agree to donate the skin to help burn victims?
No. This is an urban legend that’s frequently passed around the Internet. Hospitals use cadaver or synthetic skin for skin grafts.
22. Can you recommend any web sites for more information?
When researching a plastic surgeon, your first stop should be the American Society of Plastic Surgeons
website (of course, if you’re outside the U.S. you’ll need to find the certification board in your country. It IS imperative that you research your surgeon carefully).
Other useful sites:
Medline Plus on Plastic and Cosmetic Surgery
Tuck That Tummy
and its sister websites Liposuction4You
, Beauty After Pregnancy
, and Breast Lift 4 You
Plastic Surgery 4 U
: detailed information on a variety of procedures, with photographs
has videos of lipo and a breast lift
: info from Dr. Jean Loftus, whose book is cited below.
Also check out the Discovery Health
website for some informative articles and the TV listings – they have some interesting (if somewhat sensationalized) shows about plastic surgery.
If you know of any great sites, please post them!
23. Can you recommend any books for more information?
Karen (MrsJim)’s favorite book on the subject is “Two Girlfriends Get Real About Cosmetic Surgery” by Susan J. Collini and Charlee Ganny. This book manages to be both informative AND a fun read as well!
Another book Karen recommends is “The Smart Woman’s Guide to Plastic Surgery: Essential Information from a female plastic surgeon” by Jean M. Loftus, M.D. Not as much fun to read but packed with good info. Check ‘em out.
24. Are there 3FC members who have personal experience with weight loss and excess skin? Have any of them had plastic surgery for skin removal?
I’ve had several surgeries for skin removal and will tell my story in a separate post, below. Others with personal experiences, pre- or post-surgery, are invited to post also.