If you lose a lot of weight, you can end up with sagging skin that may or may not tighten up. This is less of a risk if you lose weight slowly. Your age, the length of time you've been overweight, the amount of weight you lost and the elasticity of your skin are all factors that will determine whether or not sagging skin after weight loss will stay that way or shrink down over time. Exercise, particularly strength training, can help by toning muscles, which can shape your body and improve your appearance. However, although you can exercise muscles, you can't exercise skin - if you've dropped a lot of weight and your skin is sagging, the only alternative is plastic surgery to remove the excess. In general, plastic surgeons recommend waiting about a year after your weight loss to see to what extent your skin conforms to your new shape. (Insurance may cover the surgery if there are associated health risks, such as repeated bacterial or fungal infections in overhanging skin folds.)
The American Society of Plastic Surgeons (ASPS) recently reported a dramatic increase in patients seeking plastic surgery to remove excess, sagging skin after significant weight loss. A survey showed that plastic surgeons performed more than 52,000 body contouring procedures in 2003, and the ASPS projected a 36 percent increase for 2004. Some of these patients had undergone gastric bypass surgery to promote weight loss. At least three different operations are available to deal with overabundant skin:
- Abdominoplasty (tummy tuck): Surgeons remove excess fat and skin from the abdomen and tighten the muscles of the abdominal wall. The operation takes two to five hours. You should be able to go back to work in two to four weeks and can resume exercising four to six weeks after the operation.
- Breast Lift (mastopexy): With this procedure, surgeons remove redundant skin from sagging breasts and reposition tissue and nipples. The operation takes one to three hours. Plan on at least a week for recovery; you'll have to wait at least a month before resuming strenuous activity.
- Upper Arm Lift (brachioplasty): Here, surgeons remove loose skin (and sometimes excess fat through liposuction) in the upper arms. The surgery takes about two hours, and recovery requires at least two weeks.
Andrew Weil, M.D.