You have done the hard part. The weight is off, or nearly off, and what is left behind is skin that will not go back. It sits over the lower abdomen, under the arms, on the inner thighs, on the chest. It gets in the way of clothes, of exercise, sometimes of walking, and in the folds it stays damp and rubs and breaks down. This page explains why it happens, what actually helps, what does not, and when it stops being a cosmetic question and becomes a medical one.
In short: Skin that has been stretched at high volume for years loses much of its elastic recoil permanently. Once the fat underneath is gone, that skin has nothing to retract with. Some tightening continues for 12 to 24 months after your weight settles, and building muscle, losing weight gradually, not smoking and eating enough protein all help at the margins — but no cream, device, supplement or exercise removes redundant skin, because removing skin means excising it. Whether you need surgery, and which operation, depends on how much skin there is and what it is doing to you.
- Will I get loose skin?
- Will it go away?
- What helps and what does not
- Skin or fat?
- When it becomes medical
- Which operation
- Cost and Medicare
- Questions
Will I get loose skin if I lose 20kg or 40kg?
There is no threshold at which loose skin switches on. It is not the number of kilograms alone — it is how far the skin was stretched, for how long, and how much recoil it had to begin with. Two people who both lose 30kg can end up in entirely different places.
What makes loose skin more likely:
- How long you carried the weight. Years of sustained stretch damages the elastic fibres permanently. Weight carried for two years behaves differently from weight carried for twenty.
- How high the starting weight was. The further the skin was stretched, the less likely it is to recover.
- How quickly it came off. Rapid loss — after bariatric surgery, or on weight-loss medication — gives the skin less time to adapt. Gradual loss allows more remodelling.
- Age. Collagen and elastin decline from the thirties onwards. The same weight loss at 25 and at 55 does not produce the same skin.
- Sun damage and smoking. Both degrade the elastic network directly. Smoking also matters later, because it substantially increases wound complications if you do have surgery.
- Genetics. Some people simply have better skin recoil than others, and there is nothing to be done about that.
- Pregnancies. Prior stretching of the abdominal skin and separation of the abdominal muscles compounds the effect.
As a rough guide rather than a rule: a loss of around 20kg in someone under 40, carried for a few years, often leaves mild to moderate laxity that improves considerably over the following year. A loss of 40kg or more, particularly in someone who carried the weight for a decade or longer, usually leaves redundant skin that will not resolve. Most patients Dr Kumar sees have lost 40kg or more.
None of this is a reason to lose weight more slowly than is safe or advised. Loose skin is a manageable problem. The health consequences of carrying the weight are not.
Will the loose skin go away?
Some of it. Not all of it, if the loss was large.
Skin continues to remodel and retract for roughly 12 to 24 months after your weight stabilises, and the change over that period can be meaningful — enough that it is genuinely worth waiting before deciding anything. This is one of the reasons surgeons ask for six months of stable weight before operating, and often prefer longer: the skin you have at three months is not the skin you will have at eighteen.
What will not change is redundant skin — a fold that hangs, an apron over the lower abdomen, a curtain of skin on the upper arm. That tissue is surplus. There is no volume left to fill it and no elastic capacity left to shrink it. Waiting longer does not remove it; it only delays the decision.
The practical test is time plus honesty. Give it a year after your weight settles. If at that point you are still gathering skin in your hand, it is not going anywhere.
What actually helps, and what does not
Worth doing, with realistic expectations:
- Resistance training. Building muscle adds volume back underneath the skin, which fills part of the envelope. It makes a visible difference to arms, thighs and chest in mild to moderate laxity. It cannot fill an apron of abdominal skin.
- Losing the weight gradually where you have the choice. Slower loss gives skin more opportunity to remodel.
- Protein and overall nutrition. Collagen synthesis requires adequate protein, vitamin C, zinc and iron. Deficiencies are common after bariatric surgery and after rapid loss on medication, and they matter both for skin quality now and for wound healing later.
- Stopping smoking and vaping. Nicotine constricts the small vessels that supply the skin. It affects skin quality and, if you go on to surgery, it is the single biggest modifiable risk factor for wound breakdown.
- Sun protection and hydration. Modest effects, but they are free.
- Time. The most underrated intervention, and the one that costs nothing.
What will not remove redundant skin:
- Exercise. You can tone muscle. You cannot tone skin. Skin has no contractile tissue to train.
- Creams, oils, collagen supplements and body wraps. Nothing applied to or swallowed for the skin reverses damaged elastic fibres.
- Radiofrequency and ultrasound skin-tightening devices. These can produce a small, measurable improvement in mild laxity by stimulating collagen. They do not remove surplus skin, and they are not a treatment for post-weight-loss redundancy. Clinics that market them as an alternative to surgery for patients with an apron are not describing what the technology does.
- Cryolipolysis and other fat-reduction treatments. These target fat. Removing more volume from beneath already loose skin generally makes it look worse.
- Liposuction on its own. Same problem, surgically. Liposuction has a role alongside skin excision, not instead of it.
This is worth being blunt about because the non-surgical market for post-weight-loss patients is large and the claims are often unsupportable. If you have genuine redundant skin, the only thing that removes it is an operation that cuts it out — and that is a significant decision with permanent scars, not something to be talked into.
Is it skin, or is it fat?
This distinction decides which operation, if any, is appropriate — and patients frequently get it wrong in both directions.
Stand in front of a mirror and gather the tissue that bothers you between your thumb and fingers. Thin, pliable tissue that folds easily and creases like fabric is skin. Thicker, firmer tissue that resists folding is fat. Most people after major weight loss have a combination, in different proportions in different areas.
A second check: lie flat on your back. Loose skin largely falls away to the sides and the abdomen flattens. Intra-abdominal fat — the fat inside the abdomen around the organs — does not move, and the abdomen still stands proud. That second pattern is not something skin surgery improves, and it is the most common reason Dr Kumar advises a patient against an operation they have come in asking for.
A third, for women who have had children: if a ridge bulges down the midline when you sit up from lying, that is likely separation of the abdominal muscles (rectus diastasis) rather than skin or fat, and it is repaired during an abdominoplasty rather than by removing skin alone.
When loose skin stops being cosmetic
For a substantial proportion of patients after major weight loss, the skin is not primarily an appearance problem. It is a functional one, and this distinction is also what determines whether Medicare contributes.
The recognised functional problems are:
- Intertrigo. Recurrent inflammation, maceration and breakdown of the skin in the fold, where moisture is trapped and surfaces rub. It often becomes secondarily infected with bacteria or yeast, and it recurs as soon as treatment stops, because the fold is still there.
- Interference with daily activities. Difficulty walking or exercising because of the weight or bulk of the apron; trouble with hygiene; back pain from the load; difficulty with continence care; inability to find clothing that fits.
- Recurrent infections requiring antibiotics, and in some cases cellulitis.
- Restriction of work — an issue for patients in physical occupations in particular.
If any of this describes you, the most useful thing you can do is start documenting it with your GP now. Medicare items 30177 and 30179 require that the skin condition has failed three months of conventional non-surgical treatment and that the redundant skin interferes with activities of daily living, with weight stable for at least six months. Those are documented periods. They cannot be assembled retrospectively the week before surgery, and patients regularly arrive at consultation who plainly meet the criteria on the substance but cannot demonstrate it on paper.
What to ask your GP to record: dated photographs of the affected fold; each episode of rash or infection and what was prescribed; your weight at each visit; and a note of what you cannot do because of the skin.
If you decide on surgery, which operation?
There is no single “skin removal surgery”. The operation is chosen by area and by how much skin there is, and most patients after major weight loss need more than one, staged over 12 to 24 months.
- Lower abdomen, apron only — a panniculectomy removes the overhanging apron without tightening the muscle layer or reshaping the waist. Often the right choice where the aim is functional.
- Abdomen, with muscle repair and reshaping — an abdominoplasty.
- Abdomen with vertical as well as horizontal excess — a fleur-de-lis abdominoplasty, which adds a vertical scar to take up width. Common after very large weight loss.
- Excess continuing around to the back and buttocks — a circumferential body lift.
- Upper arms — an arm lift (brachioplasty).
- Inner thighs — a thigh lift.
- Breasts — a breast reduction, or a breast lift with fat grafting where volume as well as position has been lost.
- Male chest — male chest contouring, which is a different operation from gynaecomastia surgery and is often confused with it.
- Mons pubis — a monsplasty, frequently overlooked and frequently the area patients are most reluctant to raise.
The order matters. The abdomen is almost always first, the chest and breasts usually next, arms and thighs last. The reasoning, and how the stages are spaced, is set out on the excess skin removal page.
Every one of these operations trades loose skin for a long permanent scar. That is the deal, and anyone unwilling to accept it is not a candidate however much skin they have.
Cost and Medicare
Surgery performed solely to change appearance is not covered by Medicare, whatever the amount of weight lost. Where documented functional criteria are met, these items may apply:
- 30177 — abdominal lipectomy with radical abdominoplasty.
- 30179 — circumferential lipectomy (belt lipectomy or body lift).
- 30166 — abdominal skin removed as a wedge excision for functional problems.
- 30169 — non-abdominal skin, one or two areas such as arms or thighs.
Items 30177 and 30179 require all three of: intertrigo or another skin condition risking loss of skin integrity that has failed three months of conventional treatment; interference with activities of daily living; and weight stable for at least six months. Items 30166 and 30169 require a loss of at least five BMI units with six months of weight stability.
The rebate is not the main event. What matters more is that an applicable item number is what allows your private health fund to contribute to the hospital admission — usually the single largest cost. No item number means no fund contribution to hospital, and that gap is far larger than the Medicare rebate itself.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. A referral is required. You will receive a written, itemised quote after your consultation, and where surgery is staged each stage is quoted separately.
Not sure whether what you have needs surgery?
That is a reasonable thing not to know, and it is exactly what a consultation is for. Dr Kumar will examine you, tell you how much of what bothers you is skin and how much is fat, whether you are likely to meet the Medicare criteria, and whether he thinks you should wait. If surgery is not the right answer for you, he will say so. A GP referral is required.
Common questions
How long after weight loss should I wait before seeing a surgeon?
You can be seen at any point, and an early consultation is often useful for planning and for starting the Medicare documentation. Surgery itself generally waits until your weight has been stable for at least six months, and Dr Kumar often prefers 12 months, because skin continues to retract over that period and because operating on a weight that is still moving produces a result that changes again.
Does loose skin weigh much?
More than most people expect. An abdominal apron removed after major weight loss commonly weighs several kilograms, and occasionally considerably more. That weight is counted in your BMI, which is one reason BMI is a poor measure in post-weight-loss patients and why Dr Kumar does not assess candidacy on that number alone.
I lost the weight on medication rather than surgery. Is it different?
The skin behaves the same way — what matters is how much stretch it was under and for how long, not the method of loss. Two things do differ in practice. Loss on weight-loss medication is often rapid, which gives skin less time to adapt. And weight regain after stopping the medication is common, which matters because surgery on a weight that then rises again undoes the result. There is more on this on the loose skin after weight-loss medication page.
Can I have skin removal surgery before I reach my goal weight?
Usually not, and the reason is not arbitrary. If your weight continues to fall after surgery, new laxity appears and you may need a revision; if it rises, the closure comes under tension and the result is worse. Medicare’s six-month stability requirement exists for the same reason. There are exceptions — a panniculectomy for an apron causing recurrent infection is sometimes justified at a higher weight because the aim is functional — but they are assessed individually.
Will insurance or Medicare cover it because of the rashes?
It may, but the rash on its own is not enough. For items 30177 and 30179 the skin condition must have failed three months of conventional non-surgical treatment, the redundant skin must interfere with your activities of daily living, and your weight must have been stable for six months — all documented. Start that record with your GP as soon as the problem begins rather than when you decide on surgery.
Do men get loose skin after weight loss too?
Yes, and men are well represented among Dr Kumar’s post-weight-loss patients. The pattern differs: the abdomen and the flanks are usually the dominant areas, and the chest is a common second, where loose skin is frequently mistaken for gynaecomastia. They are different problems with different operations and different Medicare items, and telling them apart is a clinical assessment rather than something you can judge from a photograph.
Will I have a lot of scarring?
Yes. These operations exchange redundant skin for long permanent scars, placed where clothing and swimwear will usually cover them but not hidden. Scars take 12 to 18 months to fade and flatten, healing varies between people, and some patients form thickened or pigmented scars. Dr Kumar will mark the expected scar pattern on you at consultation so you can see where it falls before you decide anything.
Talk it through with Dr Kumar
Consultations at Westmead, Penrith and Orange, with surgery at Westmead Private Hospital. Patients travelling from the Central West are seen in Orange.
This page is intended as general information and is not a substitute for individual medical advice. All surgery carries risk, and individual results will vary. Surgical photographs on this website are intended for viewers aged 18 and over. Read more about the risks of surgery here.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
