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How to Deal With Extra Skin After Major Weight Loss

U.S. News & World Report - Health logo U.S. News & World Report - Health 2/27/2017 Anna Medaris Miller

Stretch marks of a man after weight loss.: There are options to deal with unwanted skin. © (Getty Images) There are options to deal with unwanted skin. Whether you embrace it or surgically remove it, all options come with risks and benefits.

When Kelly Coffey looks at her body in the mirror, she beams. “I think I’m super hot,” says the personal trainer in Northampton, Massachusetts, unapologetically. 

It hasn’t always been that way. Fifteen years ago, Coffey was twice her size and possessed only a sliver of her self-worth today. But after years of gaining, losing and regaining weight until exceeding 300 pounds, she underwent gastric bypass surgery in 2003 at age 23. She hoped the procedure would protect her from riding the weight roller coaster her mom endured for decades.

“I could see what a toll it took on her to find herself back at square one again so many times,” says Coffey, now 37. “I saw how much time and effort and energy she put into that part of her life, and I wanted nothing to do with it.”

But after undergoing the weight-loss surgery, losing more than 160 pounds, gaining much of it back and eventually settling into her current healthy weight (and mindset), she had another procedure to consider: plastic surgery to remove skin that didn’t disappear when her belly did. “It was an extra part of me that I didn’t need anymore,” says Coffey, who settled on an abdominoplasty – aka “a tummy tuck” – to ditch it.

More and more people are seeking methods to remove extra skin and reshape the body after they lose significant weight, particularly because the development of gastric bypass surgery has made sustainable weight loss more achievable, says Dr. Jennifer Capla, a plastic surgeon in New York City who specializes in body-sculpting treatments after massive weight loss.

But more and more people aren’t necessarily talking about the fact that big-time weight loss – think 50 to hundreds of pounds – inevitably leaves people with saggy skin, no matter how many miles they run or broccoli florets they eat. More than aesthetically undesirable and psychologically burdensome for many, flabs of skin can put some people at risk for rashes, infections and even immobility, Capla says.

“A lot of people are hiding,” says Capla, who points out that contestants on reality shows like “The Biggest Loser,” whom she’s treated, go shirtless at the beginning but cover up once the weight comes off. “Everyone will say, ‘Wow it’s amazing – you look so great. But in the meanwhile, they’re struggling with the fact that they’re sitting in multiple kinds of compression garments just to hold loose skin in and be able to function every day.”

Fortunately, there are options to deal with unwanted skin, although they aren't cheap, easy or perfect. “Most people … are under the illusion that there’s some magic pill – usually a cream or something you can do, like shrink-wrap yourself,” Coffey says. “[People often write me] to confirm that this method they’ve heard of for eliminating loose skin actually works, and it never works.” 

To figure out what will work best for you, start with these expert tips: 

1. Give yourself a break.

You just lost a lot of weight – and are keeping it off. Bravo! Not only have you beat the odds (research suggests only about 20 percent of people maintain a weight loss of at least 10 percent of their initial body weight for one year), but you’ve also likely reduced your chances of heart disease, Type 2 diabetes and other significant health risks related to being overweight or obese – flaps of skin or not. Plenty of folks have spoken out about accepting, even celebrating, their loose skin as a sort of battle scar from their weight-loss journey.

2. Don't regret.

It’s not worth wondering what you could have done during the weight-loss process to minimize leftover love handles. The answer is most likely nothing, says Dr. Alexes Hazen, associate professor in the Hansjorg Wyss Department of Plastic Surgery at NYU Langone Medical Center. “[One misconception] is that if the weight loss is slow, the skin will adapt, and that is not the case,” she says. In her work with personal training clients, Coffey has found that many of the factors that affect how skin will look most (such as age, genetics, heaviest weight and weight loss and gain history) are moot by the time extra skin is a concern.

15 Weight-Loss Tips from Real People Who Lost Over 50 Pounds: <p>You don’t have to take our word for it—but take theirs!</p><p>These days, it’s hard to find someone who doesn’t have a strong opinion about dieting. Your neighbor is doing keto, your coworker is on <a href="http://www.eatthis.com/atkins-guide">Atkins</a>, and your brother can’t stop raving about Paleo. Now, it’s your turn to make a decision. You want to lose weight, but you don’t quite know where to start. Of course, there are knowledgeable people who have reasonable advice—like personal trainers, dieticians, and nutrition experts—but sometimes, it’s nice to hear weight loss advice straight from the horse’s mouth: from real people who really lost a lot of weight.</p><p>That’s why we’ve found people who have successfully lost more than 50 pounds. (Some more than 100!) Steal their tips, get inspired, and then kick off your own journey with these <a href="http://www.eatthis.com/how-to-lose-weight-without-going-to-the-gym">30 Easy Ways to Lose Weight—Without Going to the Gym</a>.</p> 15 Weight-Loss Tips from Real People Who Lost Over 50 Pounds

3. Know your options.

One of the cheapest and safest ways to reduce the appearance of extra skin is to strength train, found Coffey, who credits weight-lifting with sculpting her arms and back into a shape that made her happy sans surgery. "The little bit of power I had in the situation, I definitely used," she says.

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Some people who’ve lost a modest amount of weight (say, less than 30 pounds) or who otherwise just want to tighten up their skin a bit might also consider dermatological options like radiofrequency tightening, although such procedures aren't necessarily painless, permanent or effective for everyone, says Dr. Kevin Pinski, medical director of Pinski Dermatology and Cosmetic Surgery in Chicago. Dermatologists are probably better served to help patients who've lost massive weight reduce the appearance of stretch marks with prescription creams, microdermabrasion or other treatments, he says.

The most extreme (and effective) treatment involves putting most of your body – arms, breasts, back, abdomen, buttocks and thighs – through plastic surgery, which can include both skin removal and body reshaping techniques, Capla explains. “You can’t do everything at one time, so for me, the most important thing is what is most important to [the patients] and what their goals are,” she says. 

4. Seek experts – and save your money.

To find out what treatment or combination of treatments – if any – are right for you, consult with board-certified plastic surgeons and board-certified dermatologists who have worked with weight-loss patients before. Surgeries on formerly overweight or obese patients require a special skillset and can be riskier: People who've had a type of bariatric surgery that limits nutrient intake, for example, need to be "nutrient stable" before undergoing plastic surgery to minimize wound-healing risks, says Capla, who also requires weight-loss patients to maintain a stable weight for at least six months prior to surgery.

Hazen recommends beginning your consultations early in the weight-loss process if possible. "Most procedures are not covered by insurance," she says, "and patients may want to plan ahead and begin saving money."

5. Manage expectations. 

Every option comes with risks and trade-offs. Outside of the financial burden, surgeries for removing excess skin will leave scarring and can require more than a month of recovery time. In retrospect, Coffey, whose procedure cost $30,000 and left her unable to lift heavy weights for three months, may not have done it again. “For some reason, plastic surgery doesn’t sound like ‘real’ surgery, but it’s real,” she says. “I’ve had several surgeries in my life and it was just as horrible as anything else.”

It’s also critical to truly understand that you have far more power over your own happiness than any plastic surgeon, dermatologist, cream or laser. “No matter how you look, if you’re treating yourself like crap from day to day, that’s how you’re going to feel,” says Coffey, who created the free online workshop, “Why We Sabotage Our Food and What We Can Do About It.” “And conversely, if you’re treating yourself great, no matter what, you’re going to feel great.” 

Eat like a caveman: Kyle Kranz is a 29-year-old former athlete who lost 85 pounds after gaining weight steadily after suffering a bad injury because of a car accident in middle school. 'I was unable to play football and soccer like I previously had,' he says. Then a friend of his, who was starting to focus on his health a bit more, invited Kranz to join him during his freshmen year of high school. While in high school, he credits his weight loss to 75 percent dietary changes and 25 percent working out, which for him, consisted of mostly lifting weights, since the accident didn't allow him to run. But the greatest difference for Kranz came from curbing what he puts in his mouth every single day. 'You lose weight quickly when your diet changes from fast food, soda, and chips to meat and vegetables. I was the high schooler eating pre-portioned and pre-prepared—thanks for the help, Mom!—chicken breast and veggies for lunch. I also found out I actually enjoyed lifting weights, and put together a fairly respectable home gym in a spare bedroom,' he says. Though he eventually recovered and was able to become an endurance athlete, doing everything from swimming to cycling to running, Kranz maintains a caveman-like attitude toward nutrition. 'My favorite health advice is something I read from <a href='http://michaelpollan.com/'>Michael Pollan</a>, when he said, 'Eat real food. Not too much. Mostly plants.' Eating real food and not processed junk was the biggest game changer for me,' he says. (Follow <a href='http://www.rd.com/health/diet-weight-loss/how-to-lose-weight/'>these 40 fast, easy tips to lose weight</a>.) The Inspiring Secrets of People Who Lost 50+ Pounds—and Kept It Off

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