With the great boom and excellent results obtained with weight loss surgery, body contouring surgery has become a new plastic surgery subspecialty due to the large number of patients who have undergone surgical bariatric procedures with excellent results in terms of disease control, weight loss and maintenance.

The body contouring sub-subspecialty caters to patients with massive weight loss and patients with specific anatomical contour deformities related to pregnancy, aging, or weight loss from diet and exercise, but its demand has increased in the last two decades thanks to obesity surgery.

Aesthetic questions of patients when losing weight

The most frequently asked skin-related questions from patients considering gastric sleeve surgery or other weight loss procedures are:

  • If I have sleeve or bypass surgery, is it a fact that I will have loose or saggy skin?
  • What can I do to reduce the chance of saggy skin?
  • Will I get stretch marks?
  • If I have saggy skin, what options do I have?

There are many other related questions, but the previous ones are the most common.

First of all, we must consider the ultimate goal of obesity surgery: health and quality of life.

Sagging skin is not so relevant when you're doing something (obesity surgery) that will so favorably change your life in virtually every way. Weight loss surgery is not cosmetic surgery, nor is it surgery to "look good", it is a surgery whose main objective is to improve the patient's health, which is achieved by far in almost all cases.

The fact that, as an added benefit, it gives such good results in terms of how the patient looks and feels is also important. Still, even if it doesn't, obesity surgery justifies any inconvenience, such as excess skin.

Is there saggy skin after the gastric sleeve?

If you have sleeve or bypass surgery, is it a fact that you will have loose skin?

The answer is that numerous factors determine the amount of excess skin that will remain after significant weight loss.

BMI (Body Mass Index)

In the case of patients who are not highly obese and whose index is below 40 are less likely to develop sagging skin since theirs is not as "tight" as those whose BMI is above 50.


Another critical factor in determining whether or not the patient will have this excess skin is age; according to our experience, one of the main factors to predict whether the person has a high probability of presenting this situation. As expected, it is not the same to operate on a 25-year-old woman than on a 65-year-old woman since the connective tissue found in and under the skin in young patients is much more elastic, thus allowing the skin to retract and return to its original shape before having the obesity problem.


Likewise, the gender of the patient plays a very relevant role since men tend to have thicker and more elastic or stretch-resistant skin than women.

Physical activity level

Finally, it is essential to highlight that those patients who exercise routinely after surgery (preferably daily) will be able to replace fat with muscle to a large extent, in addition to helping to tone the connective tissue of the skin to a certain extent.

Is it possible to prevent saggy skin or stretch marks after weight loss surgery?

The idea that saggy skin can be prevented or reduced with homemade or professional creams or solutions does not have a scientific basis. However, it is worth trying measures that are not drastic or very expensive, such as using creams used by pregnant women to reduce the formation of stretch marks.

In the market, there are many brands and options of creams or abdominal patches to reduce the formation of stretch marks. Some consider that they are helpful, and those who think that they have no effect and that it depends exclusively on the other factors previously mentioned.

Our recommendations

We recommend that all our patients focus on those factors over which they have some or complete control, such as exercise, eating a healthy diet, and having adequate hydration.

Make an effort to follow the recommendations to the t, and if you want to use a homemade cream or solution as an addition, as long as these additional methods do not expose you to any risk.

What about malabsorptive procedures and saggy skin?

It is also important to highlight that in the case of patients undergoing malabsorptive procedures such as bypass or duodenal switch, SADI, etc., it is more likely to think that skin problems will occur.

Unlike restrictive procedures such as the gastric sleeve, the intragastric balloon, the bariclip, or any other procedure in which the absorption of the nutrients that the person ingests is not altered.

In the case of patients with malabsorptive procedures, as the name indicates, the absorption capacity of essential nutrients for the skin, such as vitamins and fatty acids, is altered, which can eventually cause alterations in the appearance of the skin, which does not happen with restrictive procedures.

Even so, it is estimated that approximately only 20% of patients undergoing procedures of this type will require some aesthetic procedure to remove excess skin.

Solutions for saggy skin when losing weight

Suppose the patient cannot avoid this excess skin. In that case, the good news is that there is an effective solution, which is not necessarily simple but is very satisfactory for patients who decide to undergo treatment for this situation.

It is necessary to be objective and realistic since, in the case of patients whose obesity is considerable, no cream, exercise, or genetic advantage will be able to prevent the generation of excess skin. In these cases, after approximately two years or a little more, after surgery, it may be advisable to perform cosmetic surgery, better known as body contouring or body contouring surgery.

Said procedures in a serious and formal medical practice must be performed by a certified plastic surgeon and preferably with a subspecialty or years of experience in this type of procedure, to obtain the best possible results. At Obesity Free, we have highly trained colleagues in this area of plastic surgery. If you require a recommendation from one of them at any time, you can contact us without any commitment.

Concluding remarks

In the case of those patients who have already undergone weight loss surgery and developed excess skin, we have some observations. However, it is best to rely on a specialist in the field of skin, such as a dermatologist or plastic surgeon.

Hanging skin can be the origin of dermatological problems such as dermatitis due to irritation and skin fungus formation (which can occur in obese patients both pre and postoperatively).

In these situations, it is even more advisable to obtain an assessment and a therapeutic plan from a plastic surgeon to determine if the patient meets the criteria for this type of procedure.

There are several types of approaches for performing a tummy tuck or brachioplasty, mammoplasty, or other types of medical and surgical procedures offered by plastic surgeons to solve the problem and provide an excellent aesthetic result. The treatment options vary and depend directly on the patient's characteristics and the excess skin's location. The selection of the procedure or procedures will be determined by the plastic surgeon in conjunction with his patient.

In conclusion, since this situation has a solution, there is no objective justification for giving up the idea of undergoing weight loss surgery for fear of developing excess skin. The development of chronic diseases such as diabetes, high blood pressure, obstructive sleep apnea, cancer, etc., are diseases or problems that are much more serious and complex to solve than hanging skin.

If you want to know my opinion regarding your particular case, previous to weight loss surgery with us, contact us whenever you like.