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Noelle Garbaccio, Jade Smith, Samuel Lin, MD, FACS
In the era of current techniques in bariatric surgery and the availability of GLP-1 receptor agonists like Ozempic, more people are achieving significant weight loss than ever before. However, reaching this milestone often uncovers a new challenge: the persistent issue of excess skin. This loose, redundant skin can be a substantial obstacle, impacting physical comfort, hygiene, and even mental well-being long after the weight itself is gone.
Excess skin is common following significant weight loss, regardless of the method used. More than at least 70% of individuals experience some degree of excess skin after drastic weight loss, with rates as high as 92.8% among those who undergo bariatric surgery. This high percentage is likely due to the effectiveness of bariatric procedures in achieving rapid and substantial weight loss, which doesn’t allow the skin adequate time to retract to the new body shape.
Excess skin brings both physical and psychological implications. While the health risks of obesity far outweigh the issues associated with skin laxity, the impact of excess skin remains significant. Physically, loose skin folds can lead to mechanical irritation and intertrigo, a condition where prolonged moisture exposure between folds leads to inflammation, skin breakdown, and ulceration. Bacteria and fungi flourish in the moist environment of skin folds, increasing the likelihood of infections and other skin complications. Site-specific concerns also arise: excess skin in the midsection contributes to urinary incontinence and sexual dysfunction. This can interfere with daily activities, highlighting the functional limitations that come with severe skin laxity.
Beyond physical discomfort, excess skin can negatively impact self-esteem and quality of life. Many individuals express feeling self-conscious and socially isolated, often avoiding activities that involve skin exposure, such as swimming or exercising in public. This can contribute to a sedentary lifestyle, making it harder to preserve weight loss.
For those who have achieved dramatic weight loss, maintaining their new size can be challenging. Research shows that up to 40% of lost weight can be regained within months of discontinuing medications like Ozempic, partially due to the body’s natural reduction in metabolic rate after weight loss. Studies, including long-term findings from participants in "The Biggest Loser," illustrate that a lower resting metabolism persists after substantial weight loss, complicating maintenance.
Experts suggest regular physical activity—expending 1,500 to 2,000 calories per week—can support weight stability. To make physical activity more accessible and enjoyable, those struggling with the physical limitations of excess skin may consider body contouring surgery to restore ease of movement. Numerous surveys demonstrate that physical activity increases after procedures like abdominoplasty and liposuction, conveying long-term aesthetic and functional benefits for people struggling with excess skin.
Achieving massive weight loss is an extraordinary and commendable milestone. Skin laxity is an unwelcome side effect that may diminish the feeling of accomplishment. One should feel assured that loose skin is a challenge shared by almost everyone with fast and substantial changes in weight. Addressing surplus skin through body contouring surgery is an effective way to restore body confidence, alleviate discomfort, and sustain an active lifestyle, contributing to long-term improvements in health and quality of life after weight loss.
References:
- Giordano S, Victorzon M, Koskivuo I, et al. Physical discomfort due to redundant skin in post-bariatric surgery patients. J Plast Reconstr Aesthet Surg. 2013;66(7):950–5.
- Biörserud C, Olbers T, Fagevik Olsén M. Patients' experience of surplus skin after laparoscopic gastric bypass. Obes Surg. 2011;21(3):273–7.
- Gilmartin, Jo. "Body image concerns amongst massive weight loss patients." Journal of clinical nursing 22.9-10 (2013): 1299-1309.
- Gray, M., Weir, D. (2007). Prevention and treatment of moisture-associated skin damage (maceration) in the periwound skin. Journal of Wound Ostomy & Continence Nursing, 34(2), 153-157.
- Biörserud C, Olbers T, Fagevik Olsén M. Patients' experience of surplus skin after laparoscopic gastric bypass. Obes Surg. 2011;21(3):273–7.
- Cai, Aijia, et al. "Body Contouring Surgery Improves Physical Activity in Patients After Massive Weight Loss—a Retrospective Study." Obesity Surgery, vol. 30, no. 1, 2020, pp. 146–53, https://doi.org/10.1007/s11695-019-04145-3.
- Horton CE, Vorstman B, Teasley D et al. Hidden penis release: adjunctive suprapubic lipectomy. Ann Plast Surg 1987; 19: 131-4.
- Adham MN, Teimourian B, Mosca P. Buried penis release in adults with suction lipectomy and abdominoplasty. Plast Reconstr Surg 2000; 106: 840-4.
- Fothergill, Erin, et al. "Persistent Metabolic Adaptation 6 Years after 'The Biggest Loser' Competition." Obesity (Silver Spring, Md.), vol. 24, no. 8, 2016, pp. 1612–19, https://doi.org/10.1002/oby.21538.
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