Obesity affects millions of people every year, and Americans spend billions of dollars on health foods, supplements, exercise equipment, and gym memberships to try to lose weight. Some people manage to lose a few pounds here and there before putting it back on a few months later. Others, though, have had great success stories where they’ve been able to lose a dramatic amount of weight in relatively short order. The success is exhilarating! But one aspect of significant weight loss that sometimes gets overlooked is the loose skin left over after fat deposits underneath are burned off.
To understand how and why skin responds to weight loss in this way, it’s first helpful to understand the basic mechanisms of weight gain and weight loss. Fundamentally, weight gain occurs when a person consumes more calories than are expended through the body’s normal physiological processes and daily physical activity. These excess calories—in the form of glucose—get converted into fat cells and accumulate in adipose tissue deposits all over the body. Over time, the accumulation of fat deposits under the skin becomes outwardly visible, and eventually a variety of obesity-related health problems can also emerge.
Weight loss, conversely, occurs when the equation is reversed and more calories are expended than consumed. This can be achieved through either reducing the amount of calories that are part of a daily diet or by increasing the amount of physical activity. While it doesn’t happen overnight, consistently shifting the balance to using more calories than are consumed through eating will prompt the body to begin using the energy stored in adipose tissue. As more and more of this tissue is converted back into glucose to be used by other cells in the body, the visible fat under the skin will diminish.
In the majority of cases, the excess, sagging skin associated with weight loss typically only occurs after a medical intervention like bariatric surgery or endobariatric surgery. Though gastric bypass has long been the most common type of weight loss surgery, new advances in technology have led to minimally invasive procedures like endoscopic sleeve gastroplasty (ESG). After a procedure like this is performed, a severely obese person may lose a substantial amount (50 pounds or more) of excess body weight over a matter of months. The fact that the weight is lost so rapidly is why the skin will be loose and saggy.
But the saggy skin is actually a product of weight gain rather than weight loss, and this is due to skin elasticity. Among other components, skin contains a protein called elastin that is gathered in bundles called elastic fibers. These fibers are what gives skin its ability to stretch and bend, and they are highly useful for causing the skin to snap back into place after stretching to accommodate an arm movement, for example. Elastin fibers are of course also the reason the skin can stretch out as subcutaneous fat deposits gradually get larger during long-term weight gain.
When people are younger, their skin is at its maximum elasticity, and therefore younger people (20s) who lose a lot of weight will find their skin contract to a pre-weight condition. As we age, however, skin loses elasticity and has reduced collagen production; collagen is another type of protein that is involved in giving skin structure and firmness. So for somebody who gradually gains weight in their 30s or 40s, for instance, their skin will become stretched out; then, if they lose weight later, the reduced plasticity and collagen will be more likely to result in loose, sagging skin.
For some, depending on how much weight was lost and how quickly, the resulting loose skin may not be a major concern. For others, sagging skin may bring up body image and self esteem issues that were already relevant during the obese times. Yet even if it isn’t a problem for aesthetic reasons, there are some possible physical complications. Folds of sagging excess skin can rub and chafe and cause painful or itchy rashes. It can also be hard to keep clean, and bacteria can potentially grow and cause an infection in the small tears where chafing happens. There are also practical concerns in terms of the discomfort caused by loose skin in certain types of exercise or movement.
In summary, there are several factors that will impact the extent of sagging skin one can expect after losing a lot of weight: age, genetics, the amount of weight gained, the amount of weight lost, and the rapidity of the weight loss. The ability to tighten skin back up, then, will be dependent on these factors and may vary greatly from person to person. If the sagging is relatively minor, there are some “at home” remedies that may have a positive effect on skin aesthetics:
In more extreme cases of sagging skin after massive weight loss, the only real option is plastic surgery. Also sometimes known as body contouring surgery, these procedures are performed by a plastic surgeon and involve extra skin removal and skin tightening and reshaping the remaining skin. There are various types of body contouring surgery, depending on a person’s needs and desires; below are some common examples:
Losing a significant amount of weight in a short time seems like a dream come true, but many people don’t realize the effect this can have on their skin. Losing any amount of weight is undoubtedly a good thing if you’re overweight, but the best way to avoid issues of loose skin is to lose weight gradually over time. This can be easier said than done, however, since most people who opt for bariatric surgery only did so because other methods didn’t work or weren’t sustainable over the long term.
At True You Weight Loss, we offer several state-of-the-art alternatives to typical bariatric surgery that are much easier on the body and have much quicker recovery times. If you’ve been trying to lose weight through diet and exercise alone without much success, you’re not alone. Through endobariatric procedures like ESG or the placement of a gastric balloon, you can finally find the long-term solution you’ve been seeking. To learn more about our offerings and how we can help you on your weight loss journey, please contact us today to request a consultation.