The Weight-Loss Side Effect That No One Talks About

Studies show that the vast majority of people who lose 50 percent or more of their body weight (whether through surgery or lifestyle change) report being unhappy with their bodies later. Why? Because even after all the work and the weight loss, losing that much body fat usually results in excessive amounts of loose skin on the abdomen, arms and thighs. However, medical experts agree that the health benefits of losing weight far outweigh any potential problems that might be caused by excess skin.

Does Everyone Have Loose Skin after Losing Weight?
Thankfully, no! There are many factors, including age and genetics, that determine how much your skin will "snap back" after weight loss. The younger you are when you lose weight, the easier it will be for your skin to adapt. As we age, our skin naturally loses elasticity, and this is exacerbated by things like sun exposure and even gravity. (Try avoiding that one without becoming an astronaut!)

The amount of weight you lose and whether your weight has cycled dramatically throughout your lifetime will also play a role in how your skin looks. There is no scientific evidence to the popular advice that losing weight slowly will prevent skin from sagging, so focus, instead, on losing weight at a pace that works for you and your body.

What Can I Do if I Have Loose Skin after Losing Weight?
The only way to really get rid of excess skin is to have it surgically removed. If you've maintained your new weight for 12-24 months but still have excess skin, you can safely assume that it won't shrink more on its own. Body-contouring surgery can address one or more problem areas. Common procedures include:
  • Panniculectomy: This procedure, which is sometimes covered by insurance, removes hanging skin from the abdomen. It's often performed along with an abdominoplasty.
  • Abdominoplasty: Also known as a tummy tuck, this option removes hanging skin from the abdomen and tightens the underlying abdominal muscles. It is usually not covered by insurance.
  • Belt Lipectomy: This "body lift" removes excess skin on the thighs and buttocks.
  • Medial Thigh Lift: Removes excess skin from the upper leg.
  • Mastopexy: Removes excess skin from the breasts and tightens the surrounding tissue.
  • Brachioplasty: Removes excess skin from the upper arms.
As with any kind of surgery, body-contouring procedures are not without risk. Full recovery can take many months, and it's usually necessary to take 2-4 weeks off work (more if you have a physically demanding job). There will certainly be pain, bruising, swelling and long-term scarring. Other risks include infection, asymmetry, uneven scarring, tissue death and seroma (a lump caused by fluid buildup in tissue).
If you decide to pursue surgery, ask your family doctor for a recommendation. Don't be shy about interviewing multiple plastic surgeons until you find one you trust. You can search for a board-certified plastic surgeon in your area through the American Society of Plastic Surgeons website.

If you've experienced medical problems because of your excess skin, insurance will sometimes cover certain procedures. That's why it's important to see your doctor if you develop a rash, infection or strange odor in a skin flap. Not only can your doctor help diagnose the real culprit (for example, a fungal infection versus a yeast infection), you'll need documentation if you plan to pursue insurance approval for plastic surgery.

Amanda Gignac (POOKASLUAGH) recently recovered from abdominoplasty and panniculectomy surgery and shares the details of her decision and surgery experience on her SparkPeople blog. "I decided to go through with this surgery for two reasons," she explains. "The first had to do with health. My skin was severely damaged and the stomach muscles separated during my third pregnancy 10 years ago. For the last decade, I've dealt with constant skin infections, due to having very sensitive skin. In the last year, some of the skin that had been infected the most had started to change texture and color and I was worried about that. Plus, with my core muscles separated, many exercises were very difficult. My balance was always off, which contributed to back pain and hip, knee and ankle injuries. The second had to do with my mental health. I'd lost over 100 pounds and was at a healthy weight, but still felt like I wasn't really a success. I was still very self-conscious about my body all the time because of my stomach. I have stretch marks on many parts of my body, but I could live with that. No matter how much I tried, though, I couldn't come to love that extra skin on my abdomen or the way it made me look. It was holding me back from really feeling good about my weight loss."

Janet Gershen-Siegel (JESPAH) is quick to admit that her decision to pursue plastic surgery was partially driven by vanity. She documented her tummy tuck and breast lift in detail on her SparkPeople blog (here, here and here) and doesn't pull any punches when it comes to describing the grueling process of recovery. "It's been a few years and I am, overall, pleased with the results," she says of the surgery. "Even with some regain, my body shape is still better proportioned. That's essentially why I had it all done in the first place. I was (at the time) able to fit into medium-sized blazers, for example, but they would ride up my belly and hips as I had too much skin overhang. I also felt it was unattractive. The main thing that I think plastic surgery did for me was to make it harder, if someone had never met me before, to see that I had been over 300 pounds at one time." 

What If I Gain Weight Again After Having Surgery?
It is certainly possible to gain weight as any point in your life after having excess skin removed through surgery. This is a big reason that surgeons recommend that women wait until they're finished having children to undergo this type of procedure.

Jaynee Germond (FIT4MEIN2013), who lost 160 pounds and opted for surgery to remove excess skin from her abdomen, has a unique perspective. She regained 140 pounds after her procedure but worked hard to lose it all again. "Oddly, I do not have a lot of excess skin after this weight loss episode," she explains. "I have some, but I am a 56-year-old grandmother, not a 20- or 30-something woman. I have accepted who I am and will embrace it. The bottom line, no pun intended, is that we need to be happy with who we are before, during and after weight loss. None of us are going to look like super models. Even the supermodels don't look like supermodels before their makeup technicians and airbrushed photos! We need to accept the bodies that we were given and the 'battle scars' as proof of work well done."

What If I Don't Want (or Can't Afford) Surgery to Remove Excess Skin?
To prevent infections, rashes and other problems, do your best to keep excess skin as clean and dry as possible. For example, be sure to shower immediately after exercise and dry yourself thoroughly. To prevent chafing, some people wear shaping undergarments, which you can buy in any department store. If that doesn't provide enough support, there are also specially-designed bariatric garments for people who have lost a large amount of weight. Finally, there are several simple steps you can take to improve the overall health and appearance of your skin:
  • Don't smoke. If you smoke, this is just one more reason to quit. The reasons why smoking damages the skin are still unclear, but smokers tend to have more wrinkles than nonsmokers.
  • Protect yourself from the sun. Sun exposure accelerates the breakdown of elastin in the skin, which causes it to sag prematurely. Here's how to keep your skin safe and healthy.
  • Stay hydrated. Experts disagree on whether drinking more water can make your skin look better, but being well-hydrated definitely helps your body's largest organ function properly.
  • Moisturize. Protect the outer layers of your skin by applying a moisturizer within two minutes of a bath or shower (when your skin is best able to absorb it).
  • Lift weights. Building a shapely layer of lean muscle through strength training will make your skin look better by giving it some support from the inside.

Kristina Davis (TINAJANE76), who lost 110 pounds with SparkPeople, decided against surgery for her excess skin. "I've mostly come to accept my loose skin, but sometimes it bothers me," she says. "I think part of that is because I feel like I don't quite have the body I should in light of how much work I put in to lose the weight and maintain it. I also occasionally fall victim to comparing my body to others' and I feel like it's unfair. Most of the time, I'm OK with it and realize that even if I can't always wear certain styles of clothing because they accentuate my problem areas, I still look and feel a world better than I did when I was obese--and even more important, I'm much healthier. I've pondered surgery to have it removed and even went to a consultation once. In the end, I decided to accept my body as-is and work on other things I can do to minimize my problem areas like weight training, drinking lots of water and moisturizing."

Don Doornbos (DDOORN), who has lost more than 200 pounds with SparkPeople, has a similar outlook. "A huge part of losing the weight for me has been to greatly increase my ability to be kind and accepting toward myself, regardless of my weight," he says. "It's the final emotional muscle to develop! So I hope to be able to achieve enough emotional strength to be able to go shirtless in public and to be okay with it, no matter what stares I might get from others--to be strong enough, self-accepting enough to live my life to the fullest!"

Ultimately, the choice about how to deal with excess skin after weight loss is an extremely personal one. There is no one right answer for everyone. Learning how to dress to accentuate your assets is a great first step, but there is no harm in consulting with a surgeon to discuss your unique needs and options. In the end, the most important thing to remember is that losing weight will improve your health dramatically whether you ever feel comfortable enough to wear a bikini or not.

For more information and support about dealing with excess skin after weight loss, join the At Goal & Maintaining + Transition to Maintenance SparkTeam.
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