How to firm loose skin after weight loss

When you think about hitting your goal weight, you probably think of clothes fitting better, having more energy, and getting compliments from friends. Dealing with loose skin after weight loss? Not so much. Loose skin is completely normal, though, and just a natural side effect that happens when you drop weight. 

It's not just a matter of fat loss. “Weight loss removes the volume that had been stretching the skin, but whether the skin 'snaps back' depends on the health of its collagen, elastin, and underlying connective tissue," says Dr. Jessie Cheung, M.D., a board-certified dermatologist in New York, NY and Willowbrook, IL.

So there’s a lot going on, both in and under the skin, that can lead to loose skin. Fortunately, it’s possible to address it, even though that might take some time, patience, and, in some cases, surgery. Here’s how to tighten loose skin after weight loss.

Key Takeaways

• Dramatic weight loss causes loose skin, but aging, genetics, and sun exposure can also contribute to it.

• It’s not possible to prevent loose skin entirely when you’re losing weight, but eating protein, doing resistance training, and having a good skin-care routine may help.

• Collagen creams and supplements don’t really help, but certain in-office procedures like radiofrequency can improve mild laxity.

• For hanging skin or folds, nothing beats surgery, which can be done to remove excess skin on the arms, legs, and abdomen.

It’s tough to avoid loose skin after you’ve lost some weight, in part because the fat that once made skin smooth and taut is now gone. “Skin stretches to accommodate increased body volume [or fat],” says Dr. Melanie Palm, M.D., a board-certified dermatologist in San Diego, CA. “After significant weight loss, that underlying support disappears, but the skin does not always have enough elasticity to contract around the smaller frame.”

The quality of your skin can impact this. “Collagen and elastin fibers can become stretched, fragmented, or structurally weakened after years of carrying excess volume,” says Palm. To that end, one small study found that in people who had "massive" weight loss, their collagen and elastin fibers were reorganized to be weaker and less resilient.

Beyond that, weight loss in general — especially the rapid weight loss that can happen with GLP-1 medications — can impact the fat tissue itself, as one study in the Journal of Drugs in Dermatology concluded, on which Palm was a co-author. The authors found that not only does carrying weight (before you lose it) lead to weaker skin, but it can also make the fat tissue softer and less stiff, and therefore more likely to sag.

How much weight loss leads to loose skin?

There’s no exact number to predict how much loose skin you’ll get if you lose weight. Plus, “it's highly dependent on age, genetics, how long the weight was carried, and where on the body the loose skin will appear,” says Dr. Keith Blechman, M.D., a board-certified plastic surgeon in New York, NY. “For some people it's very possible with even a 20% loss in body weight that areas such as the breasts could become noticeably deflated, but for other people not so much.” 

Other factors that lead to loose skin

Age is really the biggest factor when it comes to loose skin. “Collagen quality declines with time, so a 50-year-old and a 25-year-old losing the same weight will not have the same skin outcome,” says Cheung. Genetics can also play a role. “Two people who lose exactly the same amount of weight can have very different outcomes because their skin and connective tissue are not biologically identical,” says Palm.

Another factor is where on the body the person carried the weight. After all, “the abdomen, upper arms, thighs, breasts, lower face, and neck often show laxity differently,” says Palm. For instance, your skin can look wrinkled or folded on the abdomen, or it can hang over the stomach; meanwhile, it can be thin and crepey on the arms. “On the thighs, it may show up as rippling, folds, or loose skin around the inner thighs and knees,” she says.

And finally, your lifestyle habits can have implications, too. If you have a history of sun exposure or smoking, your skin’s collagen and elastin reserves might be less resilient — and therefore less likely to “snap back” once you’ve lost weight.

GLP-1s don’t have any special impact on your skin, per se, “but they're so effective at weight loss,” says Blechman. The skin is simply responding to that more dramatic weight loss. Compared to a more gradual rate of loss, the quick pace of changes when you’re on a GLP-1 “can create a visible change in facial and body volume before the skin has had much opportunity to remodel,” says Palm.

But it’s hard to say that GLP-1s definitively cause more loose skin. There’s just no strong research comparing GLP-1, bariatric surgery, and gradual weight loss — and their respective amount of skin laxity — at this point.

Collagen creams: MYTH

At best, most so-called firming lotions can just hydrate the skin’s surface so it looks and feels smoother. “They can't rebuild the structural collagen and elastin network that's actually been damaged,” says Blechman. 

Collagen supplements: MYTH. 

Some studies suggest that certain collagen peptides may improve hydration or elasticity, but “patients should not expect a powder or gummy to correct moderate-to-severe loose skin,” says Palm. They can’t deliver the amount of tightening that an in-office procedure can, and of course there’s no way they can remove hanging skin.

Gradual weight loss: IT’S COMPLICATED. 

Recent evidence has found that massive (and rapid) weight loss can lead to loose or hanging skin, but there's no comparison to show that, conversely, losing the same amount of weight more slowly will make a difference in loose skin.

There’s no way to prevent loose skin from forming, especially after you lose weight. However, there are still things you can do to give yourself the best possible outcome, like losing weight at a healthy pace, loading your plate with protein, and pairing changes in your diet with strength training — all habits that Weight Watchers can help you stick with alone or paired with a GLP-1. Here’s how they help minimize loose skin.

Lose at a steady pace

Unless you have to lose weight quickly, try to lose weight at a steady pace. Ideally, “the goal should be steady, medically supervised progress — not seeing how quickly the number on the scale can fall,” says Palm. If you’re concerned about the skin side effects, she also recommends seeing a provider, like your dermatologist, before starting a weight-loss medication “to evaluate baseline laxity, facial volume, and skin quality and develop a plan that evolves as you lose weight,” she says.

Prioritize protein

If you’re on a GLP-1, there’s a good chance you’re eating less overall. If that’s the case, just make sure you “consume enough protein and total nutrition to maintain muscle and support collagen production,” says Palm. For the average person, the recommended daily allowance is 0.8 grams of protein per kilogram of body weight. If you're eating protein for weight loss, Weight Watchers recommends bumping that up to 1 gram of protein per kilogram of body weight in order to maintain your muscle mass. (This can easily be tracked in the Weight Watchers app.)

Lift weights

Strength training — and consequently building muscle — won’t account for all of the fat you’ve lost, but “preserving and even building muscle provides better support underneath the skin and improves body contour,” says Cheung. That lean muscle mass will still fill in some space beneath the skin.

Stay hydrated and support your skin health

Taking care of your skin shouldn’t take a backseat when you’re on your weight-loss journey. Hydration supports normal skin function, for one. And maintaining a consistent skincare routine with retinoids and sunscreen can support overall skin health, although these won't completely prevent loose skin, says Cheung. Retinoids help increase cellular turnover and spur new collagen production, which can help smooth skin. And sunscreen is essential because without it, UV exposure can break down your existing collagen — which only exacerbates the issue.

There are non-surgical treatments for loose skin after weight loss, but the looser the skin, the more intense the procedure will be. “These treatments can improve skin quality and firmness, but they won't replicate the results of surgery when there's significant excess skin,” says Cheung. In other words, they work best if you have mild-to-moderate laxity.

Depending on the area of the loose skin and whether you’re a good candidate, this might include radiofrequency-based skin tightening, radiofrequency microneedling, ultrasound-based treatments, and certain laser technologies, according to Palm. All of these methods work by creating controlled injuries deep within skin, which can trigger new collagen production for firming. Though it depends on where you live and the exact procedure, non-invasive skin tightening can run an average of $2,326, per the latest stats from the American Society of Plastic Surgeons.

If you’ve lost substantial volume in the face with the weight loss, you might need a combination of filler, which adds volume, in addition to the tightening treatments noted above, which smooth the skin. Biostimulatory injectables, such as poly-L-lactic acid (Sculptra®) or calcium hydroxylapatite (Radiesse®), work by stimulating the creation of your own collagen. “Used appropriately, they may help improve collagen support in selected facial or body areas,” Palm says. These types of filler can cost an average of $901, although again, it depends on your location, how much you need, and other factors.

When the excess skin is substantial — meaning it hangs in folds or causes physical issues like rashes, chafing, or even infection — non-invasive options won’t do the trick. “For real hanging skin, surgery is really the only option,” says Blechman. If you’re going for loose-skin surgery, you should be at your current weight for at least six months, as “surgery works best on a stable weight, not a moving target,” he says. On the upside, if you can provide proof of issues caused by the excess skin, like rashes or an infection, your insurance may cover the cost of surgery, although it depends on your plan.

Types of skin-removal surgery

The type of loose skin-removal surgery ultimately depends on where your loose skin is located, although it’s common to get it multiple places at once. 

• Panniculectomy (approx. $8,000 to $13,500): This removes the skin hanging below the abdomen. It’s similar to a tummy tuck, but doesn’t involve tightening the muscles underneath the way a tummy tuck does.
  

• Breast lift (approx. $6,800): This surgery can address the look of “deflated” breasts that can come up with weight loss.
  

• Arm and thigh lifts (approx. $6,000 to $8,000): These procedures remove excess skin on the arms and thighs. 
  

• Body lift (approx. $11,000): This procedure can remove the skin from the arms, abdomen, and thighs. “It's also common to undergo surgery on more than one part of the body since GLP-1-driven weight loss tends to affect multiple areas at once rather than just one,” says Blechman.

What recovery looks like

The recovery really varies by procedure. For instance, “patients undergoing breast lifts usually return to work after a week, and are back to their preoperative exercise routine in about two months, although this can vary by individual,” says Blechman. Meanwhile, if you have a body lift, the downtime can be a matter of months.

Also, keep in mind that your body needs time to recover no matter what kind of surgery you get. “It really takes the body up to a year or two to totally settle in and stabilize,” says Blechman. “During that time the swelling slowly resolves and the scars mature.”

Other than how it might impact your self-confidence, there’s no harm in loose skin. There’s no way to prevent it entirely, anyway, although certain habits, such as building muscle, eating protein, and protecting your skin can help. And if you’re looking into how to treat loose skin that’s already appeared, you have options, although it’s helpful to set realistic expectations. “There is a big difference between slightly crepey or lax skin — which may respond well to time and nonsurgical treatment — and a large amount of excess skin, which generally requires surgery for complete correction,” says Palm. Once you’ve reached and maintained your weight for a few months, talk to your doctor to determine which options might be right for you.