Losing a large amount of weight is a big accomplishment that should be a cause for celebration, but sometimes significant weight loss leaves you with loose or sagging skin. Almost all areas of the body can be affected including the abdomen, breasts, buttocks, arms, legs, sides, back, neck and face.
This can be distressing because these skin rolls may look worse to some people than how they appeared before losing weight. The excess skin can be both an emotional and physical burden by negatively impacting self-image and creating problems such as skin rubbing, irritation, and pain from the extra folds of skin. Some people will even feel that the skin is heavy, pulling and straining their bodies in ways that affect their posture and ability to participate in exercise and other activities.
Skin excess after weight loss can be frustrating, and while exercise might help tone the underlying muscles, it cannot tighten the overlying skin. The best solution in these cases is to have body contouring surgery, also known as skin removal surgery.
Body contouring is an umbrella term for a range of surgical procedures that are designed to remove excess skin that results from weight loss. The goal is to restore a more natural and aesthetic body profile so people can enjoy a better and healthier lifestyle.
It is very important to have a customized surgical plan, as each person’s body and skin appearance will be different after weight loss. The combination of techniques your surgeon recommends will vary depending on your unique body features.
Body contouring is complex and involves an element of artistry, so it is important to choose a surgeon who has specialized training and experience in aesthetic plastic surgery. A good surgeon will listen to your vision for your body and discuss which procedures will give a final result that will meet your goals.
Dr. Ginger Xu uses her extensive technical training to make sure each person’s appearance aligns with their unique identity. Dr. Xu is a board-certified plastic surgeon with specialty training in aesthetic plastic surgery from Harvard. She is now based in the San Francisco Bay area.
Body contouring procedures are designed to remove excess skin after significant weight loss, in order to restore a more natural and aesthetic shape to the body. The procedures can also help people who have sagging skin due to other reasons such as pregnancy or aging.
Each person has an inherited amount of skin elasticity and after weight loss, the ability of the skin to contract or “recoil” differs. Some people are left with more dramatic rolls of skin that may feel heavy, sag and pull on the body, causing skin irritations and posture issues. This is especially the case after massive weight loss.
Body contouring must be customized to each person’s problem areas. Skin excess can occur in all dimensions, and there are a variety of options to address this and create a tailored approach. The goals are to ultimately restore a more natural body profile and improve quality of life.
Body contouring is not a method for weight loss or a replacement for weight loss. To decrease the overall size of the body and lose excess fat, either weight loss or liposuction are better options. Liposuction is a procedure to remove fat and can help with fat deposits but does not reduce loose skin. A combination of liposuction and skin-removal techniques are often used for optimal body contouring results.
Once you have tried weight loss and have maintained a stable and healthy weight for at least six months, you and your surgeon will be in a better position to understand which combination of procedures can help you achieve your goals for the appearance of your body.
You may want body contouring procedures for a range of reasons such as:
- Aesthetic improvement to excess, sagging skin anywhere on the body – either after weight loss or due to aging, pregnancy, inherited skin conditions, or other reasons
- Aesthetic improvement to deflated body parts that were previously more full and shapely – common areas include the breasts and buttocks
- Relief of weight from heavy skin rolls – these can cause body strains and posture problems
- Smoothing out of redundant skin folds – can cause skin rubbing, irritation, rashes, and tears
Body contouring can address one area or several areas at once. You are a good candidate for body contouring if you:
- Have completed your weight-loss journey and achieved your goal body weight
- Have maintained that goal body weight for at least six months
- Know why you want surgery to change the appearance of your body
- Have an idea of what you would like to achieve with their surgery
- Understand what the surgery involves
- Have realistic goals for what can be achieved with the procedures
- Can take off time for recovery
- Are in good health and have optimized your nutritional status
Are a non-smoker or have not smoked for six weeks or more – smoking negatively affects wound healing
Body contouring or skin removal surgery includes a wide range of standard procedures that can be done alone or in combination. Each of these procedures improves specific body areas by removing excess sagging skin and tightening or lifting tissues to create a more smooth, aesthetic, and youthful appearance. The best results may also involve strategically increasing volume in areas where the body appears deflated by using implants or fat. Examples include:
- Breast lift
- Male breast reduction
- Tummy tuck
- Arm Lift (Brachioplasty)
- Thigh lift (thighplasty)
- Butt augmentation
In addition to these standard procedures, there are also more specialized procedures designed specifically to help people after a more significant amount of weight loss. After massive or extreme weight loss (more than 100lbs), individuals can have patterns of skin excess that develop around the circumference of the body and across several dimensions. Large incisions may be required in these situations to adequately remove all of the excess skin in relevant areas of the body.
The surgical procedures described below are the more specialized ones designed to specifically address the unique body contouring needs of people after massive weight loss.
Upper body lifts can include a combination of techniques to remove excess skin on the arms, back, and breasts or chest area. The unique problem area that is targeted with this approach is the skin excess along the sides of the chest, extending onto the back. Upper body lifts can include:
- Arm lift (Brachioplasty)
- Back lift – liposuction and skin removal of rolls of tissue on the upper back and sides of the chest
- Breast lift
- Male breast reduction
These techniques can be customized for specific body types:
- Breast lift or male breast reduction incisions can be horizontally extended from the breasts (or the folds under male enlarged breasts) to the upper back so the surgeon can remove excess skin from the sides of the chest
- Arm lift (Brachioplasty) incisions can be vertically extended from the armpit (axilla) along the sides of the chest so the surgeon can gather extra skin in that area
Lower body lifts can include a combination of techniques to remove sagging skin on the abdomen, buttocks, groin, and thighs. Lower body lift procedures include:
A complete lower body lift can address the front or back of the body or both (going all around the entire body). In one technique called a “belt lipectomy,” the incisions are extended along the belt line. A circumferential body lift will have incisions extending around the entire circumference of the body along the bikini line.
Skin removal procedures can be completed in one session or can be staged. Like a tummy tuck, these procedures enable the surgeon to tighten underlying support structures like the abdominal muscles, and also reposition and reshape tissue to achieve an optimal body contour. Skin removal is typically combined with some amount of liposuction.
The pattern of incisions and scarring for each body depends on the location and amount of excess tissue. The surgeon will try to place these incisions in areas that are hidden by clothing and swimsuits.
Liposuction can be used in combination with skin removal procedures to treat stubborn fat deposits. Dr. Xu prefers to perform liposuction in moderation because excessive liposuction can damage the blood vessels to the surface tissues, which could lead to skin death. Dr. Xu uses specialized techniques that preserve good blood flow to the skin and do not cause traumatic damage to repositioned and reshaped tissue.
There are many possible combinations of techniques your surgeon can use and each combination has the potential to give different levels of scarring. Your surgeon can tell you about the best approach to suit your situation. After massive weight loss, a multi-staged surgical plan might be the best way to optimize your results.
During a consultation, Dr. Xu can recommend the best combination of techniques for you after she examines your body and has a good understanding of your vision and goals.
All body contouring procedures carry the potential for extended scars, especially after massive weight loss. Your surgical plan should take into account your anatomy and body type, your vision for your body, and your tolerance for scarring.
Although these procedures will result in significant scarring, they may also provide the optimal body contour. People having body contouring need to weigh the benefit of skin removal with the level of scarring caused by the procedure.
Although scars fade with time, everyone scars differently and some patients may experience scar spreading or unfavorable scarring. If this occurs, scar revision procedures can help improve the appearance of problematic scars. In general, following your surgeon’s recovery instructions is crucial to minimize scarring and getting the best results.
It is important that people embarking on a surgical plan for body contouring after weight loss have realistic expectations about the final results.
Although patients will see an immediate difference when they wake up from surgery, it can take up to two years for the body to heal and settle before the final results will be clear.
These procedures will improve your body contours, but major weight loss usually results in dramatic changes to both the surface tissues and underlying structures of your body such that there is often a limit to what can surgically be achieved. In these cases, it may not be realistic to envision a perfectly sculpted body as your final result. Another consideration is the effect of staged procedures on the interim appearance of your body. In other words, when one area of your body is tightened, it may appear out of proportion with other areas of your body that have not been surgically treated.
The results of body contouring are long-lasting but there is no guarantee of precise results. Tissues can sometimes continue to stretch or change even after surgery and look different with time. The success of body contouring also relies in part on the person following their surgeon’s instructions and maintaining their body weight and healthy lifestyle. In the short term, fluctuations in body weight could affect scar healing. In the long term, fluctuations will further stretch the skin. Natural aging processes will cause some loss of firmness, but these changes should be minor if you maintain your body weight.
Another consideration is that lower body lifts and extensive tummy tucks can create a less natural look around the pubic area, as tightening of the surrounding tissues can pull on this area.
Surgery for people who have had massive weight loss (100 lbs or more) is more complex. Typically, there is a larger amount of excess skin in all dimensions and staged procedures might be needed to give the best possible results.
Extreme weight loss can result in:
- Excessive sagging of skin
- Delicate and thin skin
- Wound-healing problems
The delicate condition of the skin and the extended incisions means that people have a higher risk of complications from surgery (see “Complications” below). After massive weight loss, especially if achieved by bariatric or weight-loss surgeries such as gastric bypass, people are at higher risk of nutritional deficiencies and wound healing problems. Before surgery, a health clearance from your primary care doctor is needed. It is crucial that your nutritional status is optimal and your vitamin levels are adequate with no deficiencies.
You and your surgeon must communicate and work together so you have a good understanding of the process that will give you the best results. The goal of a good surgeon should be to arm you with the knowledge to understand the factors affecting your body contouring.
Dr. Xu can discuss how your age, the extent of your weight loss, and the condition of your skin affects the customization of your surgical plan and the results you can achieve.
It is important you have a realistic understanding of:
- How your body will look after surgery or during the process of staged procedures
- The limitations of the procedures
- Any short- and long-term effects such as scarring
- Any possible complications
- The potential need for more surgery or staged surgery
People have different levels of scarring they can tolerate. Dr. Xu can explain which technique she would recommend for your situation and the level of scarring you can expect.
Techniques causing more scarring might also give you body contours that are closer to your goals. Dr. Xu can give you the information you need to weigh the benefit of a more aesthetically pleasing body shape with the level of scarring.
Dr. Xu encourages open and honest communication about your body, your lifestyle and what you want for the future. Photos of your desired look can help her understand your needs. Your medical history is also important, including any information about pregnancies, breastfeeding, weight loss trajectory, nutritional or vitamin deficiencies, or other medical conditions.
Things to also discuss with Dr. Xu include:
- Why you want the surgery?
- Your future lifestyle goals
- What appearance do you hope to achieve?
- Your tolerance for scarring
- What sort of body shape you would like?
Dr. Xu understands the responsibility of transforming a person’s appearance to better reflect their identity and build self-esteem. Her top priority is understanding your vision and desires.
Once Dr. Xu has examined your body, she will use her artistic sense and technical expertise to recommend an approach to your surgery that will best suit your goals. During a consultation, Dr. Xu will explain:
- The different types of body contouring or skin removal options
- Which body contouring options would best suit your needs
- What types of incisions will be needed
- How much scarring you can expect
- How a combination of surgeries can fulfill your vision for your body
- Any need for further operations
- Potential complications or side effects
Once you and Dr. Xu have agreed on an approach to your surgery, Dr. Xu will book your surgery time and give you instructions on what to do before and after your surgery.
Dr. Xu will also let you know which medications you should and should not take prior to your surgery and what to do on the day of your surgery. It is important to stop smoking at least six weeks prior to surgery.
You may need to get a blood test or undergo additional testing depending on your medical history. Dr. Xu may also correspond with your primary care doctor to ensure you are in an optimal state of health prior to surgery.
In the weeks before surgery, recommendations to help you prepare include:
- Making sure you get enough sleep and rest
- Eating a healthy diet with adequate protein and nutrition
- Exercising or engaging in physical activity to strengthen your body
- Maintaining a positive state of mind
- Prioritizing your well-being and reducing stress levels
It is essential that you feel comfortable about your upcoming procedure and fully understand the process. Dr. Xu encourages her patients to ask any questions about their surgery or recovery.
After your body contouring surgery, you will feel mild to moderate discomfort. The amount of pain you feel depends on a number of factors such as:
- The combination of body contouring surgeries used
- How many surgeries were completed at the same time
- The amount of skin removed
- Your age
- Your health before the surgery
Prescription pain medications might be needed for the first week or two. After this time, any pain should be relieved with over-the-counter or non-opioid medications.
The immediate recovery time varies depending on what procedures you choose, but in general, while there are limitations to strenuous activities, walking, and light movement is encouraged. During this early recovery time, you should avoid lifting any heavy items. Some people may have had drains inserted and should follow their surgeon’s instructions to look after the drains.
Once bruising and tenderness have gone, you can return to normal activities. Most people can return to work after a week or two, but strenuous exercise should be avoided for six weeks or more. Ask your surgeon when you can return to the full range of activities.
Dr. Xu can advise you of any additional recovery needs for your unique combination of body contouring procedures.
A body mass index (BMI) of less than 30 is preferred for body contouring. If your BMI is above this, it is recommended that you lose weight before considering body contouring. Afterward, you should maintain a healthy, stable weight for at least six months so the condition of your skin stabilizes before surgery. Any weight fluctuations after surgery will affect healing and the appearance of your body.
To maintain your improved body contours, it is important to stay around the same body weight. Early fluctuations in weight could affect scar healing and fluctuations at any time will further stretch the skin. If you gain a substantial amount of weight, this will cause you to lose your surgical results.
The location of scars depends on the surgical technique your surgeon uses. Surgeons will try to ensure scars are hidden under clothing but this is not always possible. Dr. Xu uses surgical techniques to decrease the risk of scars spreading or thickening and will instruct you on how to minimize scars after surgery. Scars never disappear, but they will fade and become less obvious with time.
Your risk for complications will depend on the specific technique used and Dr. Xu will make you aware of these before you have surgery. Each person must consider the risks associated with body contouring and accept the risks before surgery can commence.
Specific complications of skin removal/body contouring include:
- Chronic swelling due to disruption of the flow of lymphatic fluid (lymphedema)
- Seroma or fluid collection due to retention of excess fluid – may need drains
- Wound separation or breakdown – caused by stretching, pulling, tension and the force of gravity on any incisions, especially concerning in the groin region
- Poor scarring – thick or discolored scars, depending on your body’s natural healing ability and genetic predisposition toward hypertrophic or keloid scar formation
- Additional revision surgery – may be needed to obtain the desired result, especially in cases of significant skin removal
The risk of some common complications can be decreased by following your doctor’s post-surgery instructions. Potential general complications after surgery include:
- Bleeding or hematoma (a collection of blood)
- Chronic pain
- Suture irritation or extrusion
- Fat necrosis
- Minor asymmetries
The cost of body contouring will depend on the type of technique used and which combination of procedures is used.
Multiple combination surgeries are more complex and will cost more. The best way to understand the costs of surgery is to schedule a consultation with Dr. Xu, a board-certified plastic surgeon with a high level of technical knowledge and the sense of artistry necessary to help people achieve their aesthetic goals.
Many people are unaware of the full scope and possibilities of plastic surgery. Dr. Xu will listen to your vision for your body, review the options that are available to you, and advise you on an optimal surgical plan that will best meet your needs.