Significant weight loss commonly leaves excess skin that does not retract, and it rarely affects only one part of the body. Patients who have lost a substantial amount of weight, whether through bariatric surgery or sustained dietary and exercise change, frequently find that the abdomen, arms, thighs, breasts, and back are all involved to different degrees. Because each area is addressed by a different operation, planning usually becomes a question of sequence and priority rather than a single decision.
Why Skin Does Not Always Retract
Skin has a limited capacity to contract once it has been stretched over a prolonged period. Collagen and elastin, the structural proteins that give skin its recoil, are damaged when skin is held under sustained tension. Once that damage has occurred, the skin does not return to its previous state when the underlying volume reduces.
Several factors influence how much retraction occurs. These include the amount of weight lost, how long the higher weight was carried, the rate of loss, age at the time of loss, genetics, sun exposure history, smoking, and whether there have been repeated cycles of weight gain and loss. Younger patients with a shorter duration of weight excess generally retain more elasticity, though this varies considerably between individuals.
Exercise builds the muscle beneath the skin but does not remove redundant skin. Where the concern is skin excess rather than residual fat, continued training will not resolve it, and this distinction is one of the first things assessed at consultation.
Which Areas Are Commonly Affected and What Addresses Each
Loose skin is a descriptive term rather than a diagnosis, and the operation appropriate to each area differs. The following outlines how each region is generally approached.
Abdomen. Usually the area patients raise first, and often the most functionally troublesome. Abdominoplasty removes excess skin and fat from the lower abdomen and can repair separation of the abdominal muscles where present. Where redundancy extends around the flanks and lower back, a more extensive circumferential procedure may be discussed.
Upper arms. Brachioplasty, commonly called an arm lift, removes excess skin along the inner and posterior upper arm. It leaves a permanent linear scar running from the armpit towards the elbow, and accepting that trade off is central to the decision.
Breasts. Weight loss frequently results in loss of breast volume together with skin redundancy. Depending on the pattern, this may be addressed by a breast lift, by a lift combined with volume restoration, or in some cases by a reduction where residual volume remains substantial.
Thighs. Inner thigh redundancy can cause chafing and skin irritation. A thigh lift addresses this, and scar position and the tendency of thigh scars to widen are important parts of the discussion.
Back and flanks. Rolls across the back and flanks are common after major weight loss and are often addressed as part of a circumferential procedure rather than in isolation.
Liposuction alone is not a treatment for loose skin. It reduces fat volume and, where skin elasticity is already poor, can make redundancy more apparent. It is sometimes used in combination with skin excision, but it does not substitute for it.
Symptoms That Often Accompany Excess Skin
For many patients the concern is not solely appearance. Redundant skin folds can produce recurrent inflammation of the skin within the fold, commonly known as intertrigo, along with recurrent fungal or bacterial infection, persistent moisture, odour, and skin breakdown. Difficulty with clothing fit, restriction during exercise, and hygiene difficulty are also frequently reported.
Where these symptoms are present and have been documented over time by a general practitioner, they are clinically relevant. They form part of the assessment and are also relevant to any discussion about Medicare eligibility.
When Surgery Is Generally Considered Appropriate
Timing matters, and proceeding too early can compromise both safety and outcome. The following factors are assessed.
- Weight stability, generally maintained for at least six months, since further loss after surgery can produce new redundancy
- Nutritional status, which is particularly relevant after bariatric surgery, as deficiencies in protein, iron, vitamin B12, vitamin D and zinc impair wound healing and are common after gastric bypass or sleeve gastrectomy
- Body mass index, which influences both anaesthetic risk and wound healing risk
- Smoking status, since smoking substantially increases the risk of wound healing complications and skin loss in these procedures
- General health, including diabetic control, cardiovascular health, and any history of blood clotting disorder
- Realistic understanding of the scarring involved, which in these procedures is extensive and permanent
Patients who have had bariatric surgery are generally advised to have their nutritional status reviewed and any deficiency corrected before body contouring surgery is planned.
Single Stage or Staged Surgery
Patients frequently ask whether several areas can be addressed in one operation. Sometimes they can, but combining extensive procedures increases surgical time, blood loss, fluid shifts, and the cumulative risk of complications, and it makes recovery considerably more demanding.
A staged approach spreads the surgery across separate episodes, usually several months apart. Which areas are combined, and in what order, depends on your priorities, your anatomy, your general health, and practical matters including recovery time available to you. There is no standard sequence that suits everyone, and the plan is developed individually at consultation.
Medicare and Excess Skin Surgery
Some procedures for excess skin may attract a Medicare benefit where specific criteria are met, typically requiring documented clinical consequences such as recurrent skin infection or functional impairment rather than appearance alone. Criteria differ between procedures and body areas, and abdominal surgery is assessed differently to arm or thigh surgery.
Eligibility is assessed on an individual basis and is not guaranteed. Where a procedure is medically indicated and you hold an appropriate level of private hospital cover, your insurer may contribute towards hospital fees. Patients are encouraged to contact their fund before consultation to understand their level of cover, any applicable waiting periods, and their excess.
Scarring
Body contouring surgery after major weight loss involves long, permanent scars. Abdominoplasty leaves a scar across the lower abdomen and around the umbilicus. Brachioplasty leaves a scar along the inner arm. Thigh lift and circumferential procedures leave correspondingly extensive scars.
Scar appearance is influenced by genetics, skin type, tension across the wound, and post-operative care, and it varies between individuals having the same operation. Scars generally look least favourable in the first three months and continue to soften over twelve months or more. Patients who find the scarring trade off difficult to accept are encouraged to consider carefully whether these procedures are appropriate for them.
Dr Mark Hanikeri FRACS (PLAS) sees patients in Perth to discuss body contouring after weight loss. Patients are encouraged to raise every area of concern at the first consultation so that a complete planning framework can be established rather than addressing areas piecemeal.
Frequently Asked Questions
Will loose skin tighten on its own after weight loss?
Some retraction occurs in the months following weight loss, particularly in younger patients with good skin elasticity and a shorter duration of weight excess. Where skin has been stretched over a prolonged period, the structural proteins that give skin its recoil are damaged and full retraction does not occur. Exercise builds the underlying muscle but does not remove redundant skin.
How long should I wait after weight loss before considering surgery?
Dr Hanikeri generally recommends that weight has been stable for at least three to six months before surgery is considered, because further weight loss afterwards can create new skin redundancy. Patients who have had bariatric surgery are also generally advised to have nutritional status reviewed and any deficiency corrected first, as this affects wound healing.
Can several areas be treated in one operation?
Sometimes, however, combining extensive procedures increases surgical time, blood loss, and the cumulative risk of complications, and it makes recovery more demanding. A staged approach across separate surgical episodes is often more appropriate. Which areas can reasonably be combined, and in what order, is determined individually at consultation.
Is excess skin removal covered by Medicare?
A Medicare benefit may be available for some procedures where specific criteria are met, generally requiring documented clinical consequences such as recurrent skin infection or functional impairment rather than appearance alone. Criteria differ between procedures and body areas. Eligibility is assessed on an individual basis and is not guaranteed.
Does liposuction remove loose skin?
No. Liposuction reduces fat volume and does not remove skin. Where skin elasticity is already reduced, liposuction can make redundancy more apparent rather than less. It is sometimes used in combination with skin excision procedures but it is not a substitute for them.
Further Reading
- Body Contouring Perth: https://markhanikeri.com/body-contouring/
- Skin Laxity After Weight Loss: When Might Surgery Be Considered: https://markhanikeri.com/skin-laxity-after-weight-loss-when-might-surgery-be-considered/
- Body Contouring After Significant Weight Loss: Your Options: https://markhanikeri.com/body-contouring-after-significant-weight-loss-your-options/
- Brachioplasty Perth: https://markhanikeri.com/brachioplasty/
- Abdominoplasty Perth: https://markhanikeri.com/abdominoplasty/
- Body Contouring Perth: Common Areas: https://markhanikeri.com/body-contouring-perth-common-areas/
| Written by Dr Mark Hanikeri – Specialist Plastic Surgeon, Perth WA. Dr Hanikeri holds Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery and has practised in Perth for over two decades. Consultations are conducted at accredited facilities in Subiaco and Murdoch. |
