Loose Skin After Weight-Loss Medication

Weight-loss medication has changed how many Australians reach a healthier weight. What it has not changed is skin. Skin that has been stretched over years does not retract in proportion to the fat lost beneath it, and after a large reduction in weight many people are left with loose skin across the abdomen, arms, thighs, breasts or chest.

• Why the skin stays loose
• When to consider surgery
• The assessment
• Which operations are used
• What surgery can and cannot do
• Nutrition and muscle
• Recovery
• Risks
• Cost and Medicare
• Where Dr Kumar operates
• Common questions

Why the skin stays loose

The skin envelope behaves in much the same way whether weight comes off through bariatric surgery, medication or diet alone. What determines how much loose skin remains is how much weight was lost, how long the skin was stretched, your age and your genetics — not the method.

Two things about medical weight loss do change the surgical conversation. Weight often comes off faster, so people present sooner and sometimes before their weight has settled. And a proportion of the weight lost on these medications is lean tissue rather than fat, which matters for how you prepare for an operation and how you heal afterwards.

Once skin has lost its elastic recoil, no topical treatment, device or exercise programme restores it. Training rebuilds the muscle underneath, which can improve the shape of a limb or an abdomen, but it does not reduce the skin envelope sitting over it.

When is the right time to consider surgery

Timing matters more here than in almost any other area of plastic surgery. Operating on a body that is still changing shape means operating on a moving target.

What the assessment involves

Your first contact is a phone consultation with one of Dr Kumar’s nurses, who takes your history, explains the pathway and arranges an appointment.

At the in-person consultation Dr Kumar examines the skin envelope, the underlying muscle, and any hernias or previous scars; assesses your weight history and current nutrition; and sets out which procedures may be clinically appropriate, in what order, and what recovery realistically involves. Where it is useful, he arranges a DEXA body composition scan, which separates fat mass from lean muscle and informs how much can sensibly be done in one operation and how long to leave between stages.

Most people who have lost a large amount of weight need more than one operation, staged over time rather than combined.

Which operations are used

There is no single operation for loose skin after weight loss. The procedures most often discussed are:

• Tummy tuck (abdominoplasty) — removes redundant skin and fat from the lower abdomen and repairs separated abdominal muscle.
• Body lift (belt lipectomy) — a circumferential procedure addressing the abdomen, flanks, back and buttock in one operation.
• Arm lift (brachioplasty) — removes loose skin from the upper arm.
• Thigh lift (thighplasty) — addresses the inner and outer thigh.
• Breast reduction (reduction mammoplasty), breast lift (mastopexy) or breast lift with implants (augmentation mastopexy) — for breasts that have lost volume and position.
• Male breast reduction (gynaecomastia surgery) and male chest contouring — for men with residual chest skin and glandular tissue.
• Monsplasty (mons pubis reduction) — commonly planned alongside an abdominoplasty or body lift.

An overview of the whole pathway is set out on the body contouring after weight loss page.

What surgery can and cannot achieve

Body contouring removes skin and reshapes the contour beneath it. It is not a weight-loss operation and it does not treat the causes of weight gain.

These operations trade loose skin for scars. The scars are long and permanent, usually placed where underwear and clothing sit, and they do not fade to invisibility. Individual results vary and no outcome can be guaranteed.

What surgery can do for many people is allow clothing to fit, reduce skin irritation and rashes within the folds, and make exercise possible without the weight and movement of redundant skin. Examples of Dr Kumar’s work are in the before and after gallery.

Preparing for surgery: nutrition and muscle

Before surgery, Dr Kumar’s team will offer to refer you to his Accredited Practising Dietitian. Her role is prehabilitation — making sure your protein intake, iron, vitamin B12 and weight are where they need to be before an operation, and supporting you through healing afterwards.

This matters more after significant weight loss than most patients expect. Where weight has come off quickly, or where a proportion of what was lost was lean tissue, protein stores and micronutrients are commonly low. Nutritional preparation before surgery is associated with fewer post-operative complications and a shorter hospital stay.

Resistance training in the months before surgery is encouraged for the same reason.

Recovery

Recovery depends on which operation you have and how many areas are treated. As a general guide, expect a hospital stay of one to several nights, compression garments for a number of weeks, drains for a period after the larger procedures, and a graded return to activity over six to twelve weeks. Dr Kumar and his team set out a specific timeline for your operation before you book.

The nurses who take your first phone call and measure you for your garments are the same ones who review your wounds at every appointment afterwards. They also work on the wards at Westmead Private Hospital, so there is a good chance of a familiar face during your stay. Dr Kumar reviews his surgical patients for twelve months after surgery.

Risks and considerations

Body contouring after significant weight loss is major surgery. Risks include bleeding, infection, delayed wound healing and wound breakdown, seroma (fluid collection), altered or lost sensation in the skin, deep vein thrombosis and pulmonary embolism, complications of anaesthesia, asymmetry, contour irregularity, poor scarring, and the possibility of further surgery to revise a result.

Risk is higher in this group than in patients who have not lost a large amount of weight, particularly for wound healing problems. Smoking, diabetes, poor nutrition and unstable weight all increase that risk.

Any decision to proceed should be made only after you have had time to consider the risks, the recovery and the costs. Read more about the risks of surgery here.

Costs, Medicare and health funds

Dr Kumar does not publish package prices for body surgery. These operations differ too much between individuals — in how many areas are treated, whether muscle repair is needed, how long the operation takes and how long you stay in hospital — for a single advertised figure to be meaningful.

You receive a written, itemised quote before any booking is made, setting out the surgical, anaesthetic and hospital fees separately.

Some post-weight-loss procedures attract a Medicare item number where specific clinical criteria are met. Whether you meet those criteria is a clinical assessment rather than a choice, and Dr Kumar will tell you plainly at consultation. Where a Medicare item applies, private health insurance may also contribute to the hospital component, depending on your level of cover and any waiting periods. There is more detail in the guide to Medicare rebates and plastic surgery and on the costs and payment page.

Where Dr Kumar operates

Dr Kumar consults at Westmead, Penrith and Orange. Surgery after significant weight loss is performed at Westmead Private Hospital, a fully accredited private facility.

Common questions