Loose Skin: Obesity’s Badge of Courage

Do you know what the largest organ of the human body is? The skin covering your body is your largest organ, and one that needs some attention during the weight loss process.  One of the most common questions that patients ask during their weight loss journeys is about loose skin that comes with weight loss. This is not an easy topic to discuss for many patients, because they may feel ashamed, isolated, or self-conscious.  They may blame themselves for the negative consequences of their obesity and just suffer in silence. The loose skin that can remain after weight loss is not just a matter of vanity, but can also impact self-esteem, safety, health and accountability.  We will address some of the most common questions about this topic, and we hope that you’ll find it useful, educational, and encouraging.

“Why do people have loose skin after losing weight?”

Our skin has an elastic quality that can diminish naturally as you age, but it can also be affected by other factors.  As someone gradually gains weight, the skin’s elasticity allows it to grow as their body grows. Sometimes, when a body size increases quickly, the skin may have scars from stretching too quickly called “stretch marks,” or striae.  When your body decreases in size, that stretched out skin may bounce back SOME, but for most people who lose a lot of weight, there is some remaining skin that doesn’t bounce back and will hang loosely over what used to be increased adiposity (or fat). 

“Why do some people have more loose skin than others?”

There are many factors that determine how severe loose skin may be after weight loss.  Age is a huge factor, because as was mentioned before, as we age, the elastic quality of our skin naturally decreases. So, if the skin has been stretched over a larger body for a long period of time or at a more advanced age, the skin will not bounce back as much as a younger person’s skin would. Essentially, the amount and duration of the stretching of the skin will impact the skin’s ability to return to shape after weight loss.  Other factors can contribute to skin’s elasticity such as genetics, skin care, sun exposure, internal and external hydration, timing/speed of weight loss, physical activity, and previous skin conditions.

“What kinds of problems are caused by loose skin?”

Most patients complain that they don’t like how loose skin looks. A person’s self-image must not be taken lightly, because it’s an important part of the personal motivation toward health.  Many people feel that they will be judged for their loose skin because it evidences previous obesity, which carries a lot of stigma. So, the stigma of loose skin carries over from the stigma of overall obesity. 

Loose skin can also present health and hygiene issues.  Skin may fold over itself, creating areas where moisture, bacteria and odor can build up. If the condition persists, rashes and infections can occur, and the skin can tear.  This might cause pain and presents difficulty with feeling clean and smelling fresh, which only adds to the stigma the patient may feel.

Sexuality is another area that can be greatly impacted by the development of loose skin after weight loss.  While reducing your weight can have great benefits for overall confidence, health, and well-being, it cannot be ignored that loose skin can look and feel very different to both the patient and their partner, and this can have a negative impact on intimacy  This can be very sensitive to discuss, but it’s important to manage expectations as you move forward in your weight loss journey.  Don’t be afraid to discuss your experiences or concerns with your medical team.

“What can I do to prevent or improve loose skin?”

There is no way to completely avoid loose skin after surgery.  There are some measures that you can take for the best possible results for you.

Hydration: It is important to provide the best possible care for your skin during the weight loss process.  You should keep skin hydrated by drinking plenty of fluids throughout the day.  You should also hydrate the outside of the skin by applying skin lotioncream, or oil regularly to keep skin as moisturized, soft, and elastic as possible.  Before you dry off from your bath or shower, try applying moisturizer for maximum benefit and to reinforce a regular habit.  Use sunscreen with at least SPF15 on exposed areas of skin if you are outdoors for more than 15 minutes.

Nutrition: Getting adequate protein is a great way to help nourish the skin and keep it healthy.  You may try a collagen powder supplement or a biotin supplement for additional nutritional support. Keep in mind that collagen protein is not a complete protein like meat or whey protein, but it does have specific benefit for health of skin, hair and nails.  If you’re working with a registered dietitian, ask what is the right supplement for you and how much you should take, and discuss what your nutritional protein goal should be.

Hygiene: If you have skin folds that tend to trap moisture, avoid adding too much moisturizer to these areas. Skin folds should be kept dry and clean, and you may try applying a small amount aluminum-free deodorant, body powder, or cornstarch to the area as needed.  If you have an area that becomes very odorous, red and itchy, you may have developed an infection. Make sure you tell your medical provider if a skin condition persists, because you might require medication to treat your rash.

Build muscle: While there are no ways that will completely prevent loose skin after weight loss, you can try to create more definition and shape by building up the muscle that lies underneath your skin.  Having a strong underlying structure can help the skin to be less mobile and “jiggly,” and overall body definition can improve.  You can try to use some light weights or exercise bands for resistance exercises at home, or you can use free weights or weight machines at the gym to help tone muscle and improve shape. Also, having more muscle on the body makes the metabolism more efficient!  There are many benefits to strength training, so why not pump some iron?!

Compression: Many patients find that compression garments can keep skin pulled tight against the body, provide shape, allow for movement, and feel more comfortable. These garments will not provide a permanent solution but may allow for easier movement and looking and feeling better in clothing.  If you have loose skin around the abdomen or legs, you could try compression shorts or capris under clothing. You may also find that compression tanks or shirts can address skin around the upper body like the arms, chest and back.

Non-surgical dermatology treatments: There are some non-surgical dermatological treatments that can tighten and smooth skin by stimulating deeper tissues with heat.  These treatments may be helpful for loose skin that’s less severe or in smaller treatment areas on the body.  

“How can I remove the loose skin?”

The only way to completely remove loose skin is to address it surgically.  The areas that may be treated with surgical skin removal are the abdomen, back, waist, breast, chest, arms, thigh, face, and neck.  You may wish to consult with a plastic/reconstructive surgeon about what the best options are for your individual health status and goals. 

The surgery to remove excess skin is much more invasive than bariatric surgery. The incisions can be very significant, and many times suction drains may be left in place after surgery to control swelling.  The decision to remove excess skin is an important one and it should not be taken lightly. Many patients feel that looking, feeling and functioning as normally as possible after weight loss is necessary for sustaining their results and improving self-image.

It is recommended that a plastic/reconstruction surgeon be consulted once you have reached your goal weight and have sustained it for a period of time.  Some plastic surgeons have recommendations and limitations regarding your weight loss to reduce the chances of complications.  For instance, some may require that weight loss be sustained for months or even an entire year so that the results will be optimal.  Losing or gaining too much weight after skin removal surgery can significantly impact the overall benefit of the treatment. Some will only take patients once their BMI has reached a certain threshold in order to reduce surgical risk. Research and consult different providers before making a final decision.

“Will my health insurance cover skin removal procedures?”

Generally speaking, health insurance plans will cover procedures that are considered medically necessary if they cover the treatment at all. For skin removal, the general rule of thumb is that skin removal below the waist COULD be considered medically necessary. Skin removal above the waist is generally deemed as an aesthetic correction and not a medical intervention, and for this reason most insurance providers will not cover skin removal if is it above the patient’s waist.  There may be exceptions to this, so it’s important to investigate your individual plan’s limitations.

If you do have coverage for skin removal, it’s important to provide medical documentation of any problems that the loose skin may pose to your health. For instance, if you have recurrent rashes because of loose skin, document what treatment you have tried, and you may even want to take pictures of the rashes.  If an insurance plan agrees to cover a skin removal procedure, they will require evidence of the patient’s current condition.  Even though it may be uncomfortable to discuss with your medical provider, it’s important that your medical records contain appropriate documentation to support your medical claim.

Some patients will pay for skin removal procedures out of pocket.  The expense can be very significant, but spending those funds on yourself may serve as an important element of your long-term commitment to your health and accountability to your healthy habits.

“What if I can’t afford to remove my loose skin?”

This can be a very difficult fact for most patients to accept, because everyone wants to look as good as they feel.  The title of this article refers to loose skin as a “badge of courage.”  How you perceive yourself will be reflected in how others receive you.  The loose skin that remains after weight loss could be a reminder of the negativity that you may have experienced with obesity stigma.  HOWEVER, it may also be a reminder to yourself of how hard you have worked to lose weight and be healthier.  We always encourage patients to keep the big picture in mind, and that is that your life and your health are very precious.  While it is difficult to walk around carrying extra skin, we encourage you to be grateful to your body for its ability to move, function, live, and breathe. When you feel frustrated about the loose skin, take the opportunity to appreciate what you did to earn that loose skin.  You worked hard, you made sacrifices, you spent a lot of time and sometimes a lot of money to get your body smaller and healthier.  Let that extra skin you see in the mirror serve as a pat on your back for achieving what you have.  It takes a lot of courage to make the decision to change your life and take back control of your health, and loose skin will not change that. You may not like how the loose skin looks and feels, but acknowledge the importance of what it represents.