Dealing with loose skin after weight loss

Have you lost a significant amount of weight and are looking for an effective skin tightening solution for the saggy skin left behind? Getting rid of loose skin after weight loss isn’t easy, but there are steps you can take to improve the look of excess skin and hopefully get your confidence back.

Who might get loose skin?

After losing weight, loose skin can seem like the final hurdle. First, we hope you’ve taken a moment to congratulate yourself. Weight loss can be tough – and losing a large amount of weight is a journey you can only truly understand if you’ve been through it. The rewards of bringing your weight down to within a healthy range include a reduced risk of high blood pressure, heart disease and some cancers, as well as more energy, less back pain and a general better quality of life to name just a few.¹ However, after the hard work of losing weight, loose skin can remain in places where you once had excess fat - such as stomach, thighs, chest, arms, and neck – which can range from a barely-noticeable few millimetres to several highly visible inches.

What causes excess skin after weight loss?

The skin has a remarkable elastic ability which enables it to expand and shrink when our weight changes. However, gaining and losing large amounts of weight can put too much strain on the skin and cause permanent changes to the structure and elasticity of the skin. The top layer of our skin is called the epidermis. Beneath the epidermis is the dermis, which is full of elastin and collagen, the fibrous cords which anchor the skin to the fat cells beneath. Below that is the hypodermis. The hypodermis is where our fat cells are, and as they expand with weight gain, the other two layers which sit above the hypodermis stretch to accommodate the increase in fat beneath.² This stretching causes tiny ruptures in the collagen and elastin of the skin. This micro-damage won’t necessarily show when you’re carrying the extra weight (although it may show in the form of stretch marks, especially on the stomach area). However, when you lose the weight, the stretched skin doesn’t have the cushioning of the expanded fat cells, so the increased surface area can cause skin to appear to ‘hang’ off the body.³ The older you are and the longer you’ve been overweight are factors which affect your skin’s ability to regain its original form after weight loss. Further, your skin’s overall health, including factors such as sun exposure and damage from smoking which damage collagen, can play a role in how easily it bounces back.⁴

How to get rid of loose skin

Creams

During the 20^th century, the cosmetics market cottoned on to the fact that many people wanted firmer, tighter skin. This revelation launched a million skin creams with claims ranging from the eradication of cellulite to disappearance of ‘bingo wings’. The truth is there is no quick answer to the question of how to tighten skin, but you can improve the appearance of your skin’s tone and texture, as well as address mild sagging, with a cream. Nourishing, hydrating ingredients such as hyaluronic acid, lanolin, argan oil, cocoa butter help keep moisture in and plump up the top layer of the skin (the epidermis) which will improve the look of the loose skin.⁵ Look for firming creams with active ingredients, such as caffeine. Caffeine is able to penetrate the skin barrier and become absorbed by the blood vessels close to the surface of the epidermis (the top layer of skin).⁶ Caffeine constricts the blood vessels which stops the area of skin from being swollen by removing excess fluids from the area.⁷ Further, to see long-term benefit, you’ll have to commit to regular application of firming creams as many have ingredients, such as retinol, which take several weeks to have an effect.

Exercise

Loose skin can be improved with exercise, specifically strength (resistance) training exercise. This works by building the muscles underneath the skin, to create stronger and more stable foundation for the skin to sit on. You don’t need a gym membership or fancy equipment for strength training. You can do it at home with resistance bands, or even using household objects such as large filled water bottles for exercises such as weighted squats and lunges. Exercises such as press-ups and planks can be done without any equipment at all, although we recommend a soft, firm mat such as a yoga mat to protect knees and elbows.

Supplements

Collagen makes up around a third of your body’s protein.⁸ Collagen is made up of strong chains of amino acids which are what give firm skin its plumpness and resilience. In the skin, collagen is found in the middle layer (the dermis).⁹ With weight gain, especially significant weight gain, the collagen chains in the dermis can become stretched and damaged to accommodate the pockets of fat below. Then, if we lose lots of weight, the damage to our skin’s natural collagen becomes apparent in visible loose skin. One method which might help restore some of the bounce and structure to your skin after weight loss is to take collagen supplements. A clinical trial conducted in 2019 demonstrated significant improvements in skin hydration, elasticity, and density in participants after twelve weeks of taking oral collagen supplements.¹⁰ The best type of collagen for improving skin density is Type I collagen – found in fish and marine life.¹¹

Surgical treatments

If you’ve tried creams and exercise but haven’t seen results, or if you have lots of loose skin and need a more drastic solution, there are a range of non-invasive dermatological and surgical treatments to try. These include: Microneedling This treatment involves a qualified practitioner making hundreds of tiny pricks in the surface of your skin down to the second layer (the dermis). This causes micro injuries which your body will then begin to heal, triggering the production of new collagen and elastin and tightening the skin tissue as a result. The results can be excellent but there will be a few day’s downtime while the skin heals. The procedure isn’t cheap, starting at around £150 per session – and you’ll need several sessions.¹² Laser resurfacing There are different types of laser therapy for loose skin, from non-invasive infrared lasers which heat the cells to stimulate collagen but don’t remove any layers of skin, to ‘ablative’ surgery which peels off the top few layers of the epidermis. This might sound a little scary, but in the hands of a trained professional, it’s safe and very effective for loose skin.¹³ Again, there is downtime of several days and the cost can be several thousand for large areas such as stomach, thighs and arms.

Surgery

If you’ve tried other methods and haven’t seen results, or if you have significant amounts of loose skin that you feel is negatively affecting your life, you might be wondering about surgery. Surgery can offer the most dramatic and visible results, but like all surgery, it’s not without risks. Excess skin removal requires a general anaesthetic and surgical aftercare, which usually involves an overnight hospital stay and several weeks downtime.¹⁴ Private loose skin removal surgery is a good option, although it is expensive and all risks should be carefully considered. In the UK, the NHS does offer loose skin surgery, but it’s not available from all NHS trusts so it depends on where in the UK you live. There are also criteria you’d have to meet to be eligible, for instance in some trusts you will only be approved if your current BMI is between 18 and 25, or if you’ve lost at least half your body weight or if you can demonstrate that the loose skin is affecting you functionally in your daily life.¹⁵ You should never rush into surgery. If you’re considering a surgical solution for your loose skin, see your GP for a chat to discuss your options and decide whether it might be right for you. Last updated: 14 July 2020 Sources 1 https://www.nhs.uk/common-health-questions/lifestyle/what-are-the-health-benefits-of-losing-weight/ 2 https://www.nursingtimes.net/clinical-archive/dermatology/skin-1-the-structure-and-functions-of-the-skin-25-11-2019/ 3 https://www.healthline.com/health/beauty-skin-care/skin-elasticity 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213755/ 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885180/ 6 https://pubmed.ncbi.nlm.nih.gov/23075568/ 7 http://drkaitlynrose.com/thelatest/caffeine-for-skin-tightening 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846778/ 9 https://www.ncbi.nlm.nih.gov/books/NBK21582/ 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835901/ 11 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278207/ 12 https://www.harleymedical.co.uk/skin-treatments/microneedling 13 https://www.bupa.co.uk/health-information/cosmetic-surgery-and-procedures/laser-facial-resurfacing 14 https://mft.nhs.uk/wythenshawe/services/burns-and-plastics/body-contouring/ 15 http://www.fundingrequests.cscsu.nhs.uk/wp-content/uploads/2016/02/01-Provision-of-cosmetic-treatments-and-surgery-November-2015.pdf