Loose skin after substantial weight loss can cause more than changes in appearance. Hanging folds may lead to chafing, recurring rashes and discomfort, and skin-care products cannot remove the excess tissue, according to University of Rochester Medicine specialists.
In a Nov. 12 article, cosmetic dermatologist Mara C. Weinstein Velez and plastic surgery specialists William Bruce and Brielle Raine explain how treatment depends on the location and amount of loose skin, changes in facial volume and whether a person’s weight has stabilized.
Why skin may stay loose
When weight falls, the fat beneath the skin occupies less space. Skin that stretched over that tissue may not contract enough to match the body’s smaller size. Changes can appear around the jawline and cheeks or as folds on the abdomen, arms and thighs.
The extent of tightening depends on factors including age, genetics, skin type, lifestyle and the speed of weight loss, the article explains. Some tightening can occur over time, but the skin may not return fully to its earlier shape. Gradual weight loss can also leave excess skin.
The facial changes sometimes called Ozempic face are not unique to GLP-1 medications, Weinstein Velez explains. Weight loss through medication, bariatric surgery, or diet and exercise can reduce facial fat and leave skin looking looser. A clinician can assess whether the concern involves lost volume, loose skin or both.
What skin care and office treatments can do
Weinstein Velez recommends discussing skin care early in the weight-loss process. Her recommendations include gradual weight loss, strength training, adequate protein and hydration. Those measures can support skin and underlying tissue, but they cannot guarantee that loose skin will be prevented.
She also advises caution about products marketed as collagen or cellulite creams. The article identifies retinol, peptides and ceramides as ingredients she recommends for supporting skin quality, while emphasizing the limits of topical treatment.
Office procedures may offer another option. Weinstein Velez describes laser rejuvenation and ultrasound treatments, including Sofwave and Ultherapy, as ways to strengthen skin. The amount of improvement varies with the extent of looseness and when treatment starts. Bruce and Raine describe using injectable fillers alongside topical treatments when facial volume loss needs attention.
These approaches serve a different purpose from removing hanging tissue. Improving skin quality does not eliminate extra skin, the plastic surgery specialists explain.
When surgery may be considered
For substantial folds, surgery is generally the most effective treatment described in the article. Excess skin can be difficult to clean and may develop infections, wounds or repeated rashes. It can also cause pain, affect posture and interfere with exercise.
Bruce and Raine generally recommend maintaining a stable weight for six months before skin-removal surgery. Preparation also includes avoiding nicotine, managing existing medical conditions and addressing nutritional deficiencies so the body can heal. Further substantial weight loss after surgery can create additional hanging skin.
Depending on the location, procedures may include arm, thigh, breast or lower-body lifts, as well as face or neck lifts. A panniculectomy removes hanging abdominal skin. A tummy tuck removes excess skin and tightens the abdomen, potentially including supporting tissue beneath it. Surgery leaves scars, although surgeons plan incision placement to reduce their visibility.
The timing of a consultation can differ from the timing of treatment. Weinstein Velez recommends establishing a relationship with a dermatologist early, even before skin changes become apparent. To evaluate how much skin has tightened after weight loss, she recommends waiting until the goal weight has been maintained for six months to a year.
Insurance requirements vary
A surgeon’s recommendation does not guarantee insurance coverage. According to the article, insurers may consider the amount of weight lost, the effect of excess skin on health and daily activities, and treatments already attempted.
Requirements may include a weight-loss or body mass index threshold, documentation of recurring rashes or activity limitations, a prescribed course of treatment that has not resolved symptoms, and photographs of the affected area. The specialists advise checking the plan’s requirements online or contacting the insurer before arranging a consultation.
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