Table of Contents
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
People talk about how they’ll be happier and more confident as soon as they lose 5, 10, even 50 pounds. And while we know that isn’t necessarily true because confidence doesn’t work that way, people who do succeed in losing a large amount of weight often report a newfound source of insecurity: loose skin. While our skin is designed to accommodate a certain amount of ebb and flow in our weight and shape—like during pregnancy, for example—its structure can become damaged if stretched far enough for a long enough period of time.
There are multiple layers to your skin, but the innermost layer is made up of proteins such as elastin and collagen. In fact, collagen makes up 75–80% of your skin, which is one of the reasons why there are so many beauty products with collagen in the formula (Cleveland Clinic, 2016). Collagen fibers form the structure of your skin that gives it strength, and elastin gives your skin elasticity and contributes to its tightness.
But this structure that’s so integral to the shape and tightness of your skin gets damaged when pushed beyond its limit. Researchers have observed damage to the structure of both the top and bottom layer of skin in patients who had been morbidly obese. And the skin is considerably weaker in people who have lost a massive amount of weight due to thinning and the damage to this network of fibers (Sami, 2005). But this now-loose skin isn’t just a visible change; there are real health risks associated with loose skin following weight loss.
Challenges of extra skin after weight loss
There is no shortage of products aimed at tightening skin after weight loss (more on them specifically later), and that’s proof that people want it gone. Some people with excess loose skin report feeling self-conscious about it, and large enough sections can make certain movements cumbersome.
In one study, participants who had lost 110 pounds were most likely to report discomfort with excess skin caused by massive weight loss following surgery. But even including those who lost less than this amount, a staggering 92.8% of patients who had lost weight following bariatric surgery reported discomfort with excess skin. The areas that bothered them the most were the abdomen, upper arms, and buttocks. Half of these people reported that the skin hindered their daily physical activity (Giordano, 2013).
There are real emotional ramifications, too, and these issues drive further physical issues. Post-bariatric surgery patients who had not undergone body contouring surgery, which removes excess skin, scored their appearance, body satisfaction, and physical functioning lower than those who had received procedures such as abdominoplasties, thigh lifts, or breast lifts in one study (Zwaan, 2014). And in another small study of 26 women who had undergone the procedure, lost a significant amount of weight, and now had excess skin, 76.9% reported that their physical activity was limited by the skin. But researchers also noted that 45.2% of the women reported avoiding exercise because of how their excess skin flapped and caused people to stare (Baillot, 2013).
Bariatric surgery: surgical interventions for weight loss
How can you get rid of excess skin after weight loss?
Since excess skin is such a serious issue both physically and mentally for patients, it should come as no surprise that there are many treatments aimed at tightening skin after major weight loss. Surgery isn’t the only option, though it certainly is the most effective. Below, we’ve outlined all the different options for tightening skin, and noted what we know and don’t know about their effectiveness.
Plastic and reconstructive surgery for loose skin is common in people who have had weight loss procedures such as bariatric surgery. Foreign studies estimate that around 30% of all bariatric patients will seek out plastic surgery to get rid of excess skin at some point (Wagenblast, 2014). Plastic surgeons perform several different surgical procedures to remove sagging skin from the body, including abdominoplasty (also called a tummy tuck), thigh lifts, and breast lifts.
These invasive procedures can get rid of loose skin strategically from specific body parts, but they’re not without risks. Patients are put under general anesthesia for the skin removal procedure, and the recovery time is longer than some other options.
Dermatology experts seem torn as to whether this treatment is considered minimally invasive or non-invasive. During a microneedling session, a dermaroller—a roller with close to 200 tiny needles attached—is used to prick the skin in a designated area. Typical procedures use topical anesthesia and last between 45 minutes and an hour. The idea is that the pricks encourage collagen production, the foundation of that firming, and shaping the lower layer of skin. There’s typically no downtime, though irritants like sun exposure may make minor inflammation worse.
But it’s estimated that the new collagen is laid down over the course of three to six months following treatment, and you’ll need multiple treatments to potentially see the skin-firming results. There’s also very little research on microneedling, which is primarily done on the face. Research has been done on its effectiveness for stretch marks, but even this work looked at a combination therapy of microneedling and fillers.
There’s no shortage of cosmetic procedures now aimed at contouring areas of the body. Exact methods differ, but these procedures (such as FaceTite, BodyTite, and VelaShape) use methods such as radiofrequency, infrared light, and massage to diminish loose skin. The problem is that for many of them, all the research done on their efficacy is funded and conducted by people investing in or consulting with the company. Ideally, we can point to independent research that says something works.
Independent work has found that patients who undergo VelaShape on the abdomen, buttocks, and thighs see improved tightness in their skin, but the study was done on women post-pregnancy, not after massive weight loss due to bariatric surgery (Winter, 2009). All studies on BodyTitle appear to be tied to the company that developed the technology.
Medication’s impact on weight gain and obesity
Natural remedies for loose skin
We should be clear: natural remedies may be less effective than surgical options. But depending on how much saggy skin you have, they may be a preferable option to cosmetic surgery. Building muscle mass may decrease the look of sagging skin by filling in more of the area. If you aim to build muscle, it’s important to remember that your scale weight may increase, though you’ll be improving your body composition.
Taking collagen peptides as a supplement may help strengthen your body’s collagen fibers, as one review of previous research found (Juher, 2015), but we don’t know if the benefits apply to people after massive weight loss who struggle with excess or loose skin since it wasn’t tested on this demographic. This effect may be strengthened if you take it with vitamin C, which is essential for collagen synthesis (Pullar, 2017). More research is being done, which may illuminate how supplements that combine vitamin C and collagen affect collagen synthesis (Lis, 2019).
You may be tempted to toss that skin firming cream in your basket, but make sure you check the label first. Antioxidants and cell regulators are known combatants of skin aging, which includes a breakdown in collagen structure similar to what happens after massive weight loss. L-ascorbic acid, a form of vitamin C, in concentrations of 5–15%, has proven effective at firming skin by boosting the production of collagen.
Cell regulators such as retinols, peptides, and growth factors (GF) also play a direct role in collagen metabolism and may encourage the production of more (Ganceviciene, 2012). But, again, the effects will be less dramatic than with surgical procedures and may require a prolonged, consistent application to work, if they work at all.
- Baillot, A., Asselin, M., Comeau, E., et al. (2013). Impact of Excess Skin from Massive Weight Loss on the Practice of Physical Activity in Women. Obesity Surgery, 23(11), 1826–1834. doi: 10.1007/s11695-013-0932-0. Retrieved from https://link.springer.com/article/10.1007/s11695-013-0932-0
- Cleveland Clinic. (2016). Skin. Retrieved Jan. 31, 2020 from https://my.clevelandclinic.org/health/articles/10978-skin
- Ganceviciene, R., Liakou, A. I., Theodoridis, A., et al. (2012). Skin anti-aging strategies. Dermato Endocrinology, 4(3), 308–319. doi: 10.4161/derm.22804. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23467476/
- Giordano, S., Victorzon, M., Koskivuo, I., & Suominen, E. (2013). Physical discomfort due to redundant skin in post-bariatric surgery patients. Journal of Plastic, Reconstructive & Aesthetic Surgery, 66(7), 950–955. doi: 10.1016/j.bjps.2013.03.016. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23578737/
- Juher, T. F. & Perez, E. B. (2015). An overview of the beneficial effects of hydrolysed collagen intake on joint and bone health and on skin ageing. Nutricion Hospitalaria, 32(Suppl 1), 62–66. doi: 10.3305/nh.2015.32.sup1.9482. Retrieved from https://pubmed.ncbi.nlm.nih.gov/26267777/
- Kalra, M. G., Higgins, K. E., & Kinney, B. S. (2014). Intertrigo and Secondary Skin Infections. American Family Physician, 89(7), 569–573. Retrieved from https://www.aafp.org/pubs/afp/issues/2014/0401/p569.html
- Lis, D. M. & Baar, K. (2019). Effects of Different Vitamin C–Enriched Collagen Derivatives on Collagen Synthesis. International Journal of Sport Nutrition and Exercise Metabolism, 29(5), 526–531. doi: 10.1123/ijsnem.2018-0385. Retrieved from https://pubmed.ncbi.nlm.nih.gov/30859848/
- Pullar, J. M., Carr, A. C., & Vissers, M. C. M. (2017). The Roles of Vitamin C in Skin Health. Nutrients, 9(8), 866. doi: 10.3390/nu9080866. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28805671/
- Sami, K., Elshahat, A., Moussa, M., et al. (2015). Image analyzer study of the skin in patients with morbid obesity and massive weight loss. Eplasty, 15(e4). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311578/
- Wagenblast, A. L., Laessoe, L., & Printzlau, A. (2013). Self-reported problems and wishes for plastic surgery after bariatric surgery. Journal of Plastic Surgery and Hand Surgery, 48(2), 115–121. doi: 10.3109/2000656x.2013.822384. Retrieved from https://pubmed.ncbi.nlm.nih.gov/23879775/
- Winter, M. (2009). Post-pregnancy body contouring using a combined radiofrequency, infrared light and tissue manipulation device. Journal of Cosmetic and Laser Therapy, 1–7. doi: 10.1080/14764170903134334. Retrieved from https://pubmed.ncbi.nlm.nih.gov/19951194/
- Zwaan, M. D., Georgiadou, E., Stroh, C. E., et al. (2014). Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups. Frontiers in Psychology, 5. doi: 10.3389/fpsyg.2014.01310. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25477839/
Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine and is Ro's Chief Clinical Officer.