What Causes Loose Skin After Weight Loss?
The skin is the largest organ in your body and forms a protective barrier against the environment.
The innermost layer of your skin consists of proteins, including collagen and elastin. Collagen, which makes up 80% of your skin's structure, provides firmness and strength. Elastin provides elasticity and helps your skin stay tight.
During weight gain, skin expands to make room for increased growth in the abdomen and other parts of the body. Pregnancy is one example of this expansion.
Skin expansion during pregnancy occurs over a few months' time, and the expanded skin typically retracts within several months of the baby's birth.
By contrast, most overweight and obese people carry extra weight for years, often beginning as early as childhood or adolescence.
When skin has been significantly stretched and remains that way for a long period of time, collagen and elastin fibers become damaged. As a result, they lose some of their ability to retract (1).
Consequently, when someone loses a lot of weight, excess skin hangs from the body. In general, the greater the weight loss, the more pronounced the loose skin effect.
What's more, researchers report that patients who have weight loss surgery form less new collagen, and the composition is inferior compared with the collagen in young, healthy skin (2, 3, 4).
Bottom Line: Skin stretched during significant weight gain often loses its ability to retract after weight loss due to damage to collagen, elastin and other components responsible for elasticity.
Factors That Influence the Loss of Skin Elasticity
Several factors contribute to loose skin following weight loss:
Length of time overweight: In general, the longer someone has been overweight or obese, the looser their skin will be after weight loss due to elastin and collagen loss.
Amount of weight lost: Weight loss of 100 pounds (46 kg) or more typically results in a greater amount of hanging skin than more modest weight loss.
Age: Older skin has less collagen than younger skin and tends to be looser following weight loss (5).
Genetics: Genes may affect how your skin responds to weight gain and loss.
Sun exposure: Chronic sun exposure has been shown to reduce skin's collagen and elastin production, which may contribute to loose skin (6, 7).
Smoking: Smoking leads to a reduction in collagen production and damage to existing collagen, resulting in loose, sagging skin (8).
Bottom Line: Several factors affect loss of skin elasticity during weight changes, including age, genetics and the length of time someone has carried excess weight.
Problems Related to Excess Loose Skin
Loose skin due to massive weight loss may cause physical and emotional challenges:
Physical discomfort: Excess skin can be uncomfortable and interfere with normal activity. A study of 360 adults found this problem occurred most often in people who had lost 110 pounds (50 kg) or more (9).
Decreased physical activity: In a study of 26 women, 76% reported that their loose skin limited exercise mobility. What's more, 45% said they had stopped exercising altogether because their flapping skin caused people to stare (10).
Skin irritation and breakdown: One study found that of 124 people who requested plastic surgery to tighten skin after weight loss surgery, 44% had reported skin pain, ulcers or infections due to the loose skin (11).
Poor body image: Loose skin from weight loss can have negative effects on body image and mood (12, 13).
Bottom Line: A number of problems may develop due to loose skin, including physical discomfort, limited mobility, skin breakdown and poor body image.
Natural Remedies to Tighten Loose Skin
The following natural remedies may improve skin strength and elasticity to some degree in people who have lost small to moderate amounts of weight.
Perform Resistance Training
Engaging in regular strength-training exercise is one of the most effective ways to build muscle mass in both young and older adults (14, 15).
In addition to helping you burn more calories, an increase in muscle mass may also help improve the appearance of loose skin.
Collagen hydrolysate is very similar to gelatin. It is a processed form of the collagen found in the connective tissue of animals.
Although it hasn't been tested in people with loose skin related to major weight loss, studies suggest that collagen hydrolysate may have a protective effect on skin's collagen (16, 17, 18).
In a controlled study, collagen strength increased significantly after four weeks of supplementation with collagen peptides, and this effect remained for the duration of the 12-week study (18).
Collagen hydrolysate is also known as hydrolyzed collagen. It comes in powdered form and can be purchased at natural food stores or online.
Another popular source of collagen is bone broth, which provides other health benefits as well.
Consume Certain Nutrients and Stay Hydrated
Certain nutrients are important for the production of collagen and other components of healthy skin:
Protein: Adequate protein is vital for healthy skin, and the amino acids lysine and proline play a direct role in collagen production.
Vitamin C: Vitamin C is needed for collagen synthesis and also helps protect skin from sun damage (19).
Omega-3 fatty acids: A small study found that the omega-3 fatty acids in fatty fish may help increase skin elasticity (20).
Water: Staying well hydrated may improve your skin's appearance. One study found that women who increased their daily water intake had significant improvements in skin hydration and function (21).
Use Firming Creams
Many "firming" creams contain collagen and elastin.
Although these creams may temporarily give a slight boost to skin tightness, collagen and elastin molecules are too large to be absorbed through your skin. In general, collagen must be created from the inside out.
Bottom Line: Some natural remedies help tighten loose skin after pregnancy or small to moderate weight loss.
Medical Treatments to Tighten Loose Skin
Medical or surgical treatments are usually necessary to tighten loose skin after major weight loss.
Those who have lost a significant amount of weight via bariatric surgery or other weight loss methods often request surgery to remove excess skin (22).
In body-contouring surgery, a large incision is made, and excess skin and fat are removed. The incision is sutured with fine stitches in order to minimize scarring.
Specific body-contouring surgeries include:
Abdominoplasty (tummy tuck): Removal of skin from the abdomen.
Lower-body lift: Removal of skin from the belly, buttocks, hips and thighs.
Upper-body lift: Removal of skin from the breasts and back.
Medial thigh lift: Removal of skin from the inner and outer thighs.
Brachioplasty (arm lift): Removal of skin from the upper arms.
Multiple surgeries are usually performed on different body parts over the span of one to two years after major weight loss.
Body-contouring surgeries usually require a hospital stay of one to four days. Recovery time at home is typically two to four weeks. There may be also some complications from the surgery, such as bleeding and infections.
That being said, most studies have found that body-contouring surgery improves quality of life in formerly obese people. However, one study reported that some quality of life scores decreased in those who had the procedure (23, 24, 25, 26).
Alternative Medical Procedures
Although body-contouring surgery is by far the most common procedure to remove loose skin, there are also less invasive options with a lower risk of complications:
VelaShape: This system uses a combination of infrared light, radiofrequency and massage to reduce loose skin. In one study, it led to significant loss of belly and arm skin in overweight adults (27, 28).
Ultrasound: A controlled study of ultrasound treatment in people who had bariatric surgery found no objective improvement in loose skin. However, people did report relief of pain and other symptoms following treatment (29).
It appears that although there are fewer risks with these alternative procedures, the results may not be as dramatic as with body-contouring surgery.
Bottom Line: Body-contouring surgery is the most common and effective procedure to remove loose skin that occurs after major weight loss. Some alternative procedures are also available, but not as effective.
Having excess loose skin after weight loss can be distressing.
For people who have lost small to moderate amounts of weight, skin will likely retract on its own eventually and may be helped by natural remedies.
However, individuals who have achieved major weight loss may need body-contouring surgery or other medical procedures to tighten or get rid of loose skin.