Loose skin after weight loss
Intentionally losing weight is often seen as a positive, especially if you’re overweight or obese. You’re likely to become more body-positive, your fitness will be improved, and you’re at a lower risk of obesity-related complications like heart disease and stroke.
However, for some people, this weight loss has a consequence: loose skin.
In this guide, we’ll discuss the causes of loose skin, the impact of weight loss jabs such as Wegovy and Mounjaro, why loose skin can be more than just cosmetic, what you can do to prevent it, and what’s available to help.
The causes of loose skin
Loose skin isn’t limited to weight loss; it can be caused by a number of changes (and damage), such as ageing and too much sun exposure. It’s caused by the loss of collagen and elastin, two proteins that give the skin its firmness and elasticity.
If these proteins are damaged or reduced, the skin won’t be able to hold its shape, leading to sagging. Here are some of the common places people tend to experience loose skin:
- Stomach
- Face
- Neck
- Buttocks
- Arms
- Legs
Below, we’ll go into further detail about the different causes of loose skin.
Loose skin caused by quick, drastic weight loss
Losing a lot of weight quickly, especially with medications like Wegovy or Mounjaro, can sometimes lead to loose skin. With Mounjaro, you could lose up to 25% of your body weight;[1] for example, dropping from 100kg to 75kg. For Wegovy, this number ranges between 15% and 17% loss of body weight in 68 weeks.
This can also be the case with bariatric surgery[2] (like a gastric bypass or sleeve), where the stomach is made smaller, reducing the amount of food you can consume.
Weight loss injections work by suppressing your appetite and keeping you feeling fuller for longer, leading to reduced calorie intake and, ultimately, weight loss. However, many people focus solely on medication and diet, overlooking the importance of exercise.
Building muscle is a game-changer during any weight loss journey, especially when the weight loss is quick and drastic. We’ll dive deeper into why later in this guide.
Prolonged obesity
The longer you’ve lived with obesity, the more likely you are to have loose skin after losing weight. This happens because your skin stretches to accommodate the extra fat, and over time, the fibres that keep it firm and stretchy—collagen and elastin—can get worn out or damaged.
When these fibres weaken, it’s harder for your skin to shrink back after weight loss, leaving it loose. The longer your skin stays stretched, the harder it becomes for it to return to its original shape.
Loose skin and age
Ageing is one of the main causes of loose skin. Unfortunately, there’s very little you can do to prevent loose skin caused by ageing, as you can’t stop the clock on ageing itself!
When we age, our bodies naturally produce less collagen and elastin. We also lose fat below the cheeks, nose, temples, eyes and chin area, which can give a sunken appearance. This fat loss makes it harder for the skin to shrink back into place after being stretched.
Genetics
Genetics play a big role in whether or not you’ll have loose skin after weight loss or as you age. Some people naturally have more elastic skin, thanks to their genes, which helps it bounce back better after being stretched.
Others might inherit weaker collagen and elastin fibres, making them more prone to sagging. Your genetic makeup also influences factors like skin thickness, how quickly you age, and how your body stores fat—all of which can affect the likelihood and severity of loose skin.
Loose skin after pregnancy
Loose skin after pregnancy happens because your skin stretches to accommodate your growing belly. The main causes include rapid weight gain, a big baby or multiples, genetics (how elastic your skin is), and how quickly you lose the pregnancy weight. Age and hydration levels can also play a role.
Sun exposure
Sun exposure can contribute to loose skin by breaking down collagen and elastin. Over time, UV damage weakens the skin's structure, making it thinner, less resilient and more prone to sagging. This effect is amplified if your skin is already stretched from weight changes, pregnancy or ageing.
Smoking
Smoking causes loose skin by damaging collagen and elastin. Nicotine reduces blood flow, cutting off oxygen and nutrients your skin needs to stay healthy. It also creates free radicals that break down skin cells and lower vitamin C levels, which are essential for collagen production.
Over time, this makes your skin thinner, weaker and more likely to sag. The repeated motion of smoking can even cause wrinkles and sagging around your mouth. Quitting smoking is the best way to protect your skin and keep it firmer for longer.
How much weight loss causes loose skin?
It’s not just the amount of weight lost that causes loose skin but also how quickly it’s lost. For instance, losing 20 lbs in a month might result in more loose skin compared to losing 50 lbs over the span of a year.
That said, people with a significant amount of weight to lose, like those with a BMI over 40 or more than 100 lbs to shed, are generally more likely to experience loose skin when reaching a healthier weight.
Is one weight loss treatment more likely to cause loose skin than another?
Certain weight loss treatments are more likely to cause loose skin than others. Rapid weight loss methods, like surgery (e.g. gastric bypass) or extreme diets, can lead to loose skin because the skin doesn’t have time to adjust to the sudden change in size.
Liposuction, which removes fat quickly, can also result in loose skin, as it doesn’t allow the skin to shrink gradually with the fat loss.
Weight loss injections, such as those using medications like semaglutide (Wegovy) or tirzepatide (Mounjaro), can promote faster weight loss, potentially leading to loose skin if the weight drops too quickly.
What is ‘Ozempic face’?
‘Ozempic face’ is a term that describes the facial changes that can occur with weight loss caused by Ozempic (for weight management, this drug is now known as Wegovy), a medication that’s used for both type 2 diabetes and, more recently, weight loss.
As semaglutide (Wegovy/Ozempic) helps individuals lose a significant amount of weight, some may notice a more hollow or aged appearance in their faces, with the loss of fat in the cheeks, under-eye area and jawline. This can lead to sagging skin, wrinkles or a more gaunt look, similar to what happens with rapid weight loss in general.
The effect is not exclusive to Ozempic but can happen with any significant weight loss, especially when it occurs quickly.
Loose skin-related issues
For some, loose skin is more than just a cosmetic concern—it can cause physical and emotional distress. Loose skin folds are more prone to chafing, irritation and pain, particularly in warmer weather. This can trap sweat and bacteria, which can lead to rashes or infections.
Beyond that, loose skin can affect your mental health. After working hard to lose weight, you might struggle to fully enjoy the results if you have leftover skin. It can also make finding well-fitting clothes a challenge or make you uncomfortable in the outfits you used to love.
Additionally, loose skin can hinder physical activities, making certain exercises uncomfortable or difficult. Fortunately, you can take steps that may help tighten loose skin.
How to tighten loose skin during weight loss
It’s possible to tighten loose skin during your weight loss journey, but the effectiveness will depend on factors like the amount of weight lost, age, genetics and skin elasticity.
If you’re on a weight loss treatment like Wegovy or Mounjaro, it’s important to follow these steps to minimise the amount of loose skin you will have. Remember, the earlier you start, the better the outcome will be!
Focus on building muscle mass during exercise
Exercising with a focus on building muscle mass helps tighten loose skin by filling out the space underneath the skin. When you lose weight, especially a significant amount, the skin may not shrink back as quickly or fully as the fat beneath it reduces.
Building muscle through strength training exercises replaces the lost fat with lean muscle, which can help to push the skin back into place, making it look firmer and less saggy.
Include nutrients in your diet
To help reduce loose skin during weight loss, focus on including nutrients in your diet that support skin health and elasticity. Collagen-rich foods like bone broth, vitamin C-rich fruits and vegetables, and vitamin E found in nuts and seeds can all promote skin repair and firmness.
Omega-3 fatty acids from fatty fish and zinc from beans and whole grains help maintain the skin’s hydration and support collagen production.
Hydration
Hydration is essential for maintaining the skin’s elasticity, especially during weight loss. Drinking plenty of water helps keep your skin plump, supple and better equipped to adapt as your body changes.
Proper hydration supports the production of collagen, the protein responsible for skin structure and firmness, while also flushing out toxins that can affect the skin’s quality. Hydrated skin is less prone to dryness and sagging, making it look smoother and healthier.
Aim for at least 8-10 glasses of water daily, and include water-rich foods like cucumbers, oranges and watermelon in your diet to boost your hydration levels.
Sun protection
Protecting your skin against the sun is so important for maintaining healthy, elastic skin and preventing premature ageing, especially during weight loss when your skin may be more vulnerable.
Excessive sun exposure breaks down collagen and elastin, leading to sagging and wrinkles over time. To protect your skin, apply a broad-spectrum sunscreen with at least SPF 30 daily, even on cloudy days. Reapply outdoors every two hours, and seek shade during peak sun hours.
Consistent sun protection preserves your skin’s elasticity and reduces the risk of sun damage and skin cancer.
Loose skin treatments - do they work?
Loose skin treatments can work, but their effectiveness depends on the severity of the sagging, treatment type and personal factors like your skin’s elasticity.
Topical loose skin treatments
It’s important to note that although topical treatments, such as creams and serums, may potentially improve mild cases of loose skin, they are unlikely to work on more severe cases.
Retinoids (vitamin A)
Retinoids, such as retinol, tretinoin and adapalene, stimulate collagen production and promote cell turnover. This helps improve the skin’s elasticity and firmness over time, making the skin appear smoother and more youthful.
Vitamin C
Vitamin C is a powerful antioxidant that supports collagen synthesis and protects the skin from free radical damage. It improves firmness and brightens the skin.
Peptides
Peptides are small proteins that enhance the skin’s natural repair processes and stimulate collagen production. They help strengthen and firm the skin, reducing the appearance of sagging.
Hyaluronic acid
Hyaluronic acid helps retain moisture in the skin, keeping it hydrated and plump. While it doesn’t directly tighten the skin, it smooths its texture and reduces the appearance of looseness.
Firming agents
Caffeine and other firming agents temporarily tighten the skin by reducing water retention and improving its texture. These effects are short-term but can provide a firmer appearance.
Elastin and collagen-infused moisturisers
These collagen moisturisers hydrate the skin deeply, improving its smoothness. While they don’t penetrate deeply enough to rebuild skin structure, they can enhance the skin’s surface appearance with regular use.
Massage and dry brushing
Massaging and dry brushing the skin can enhance blood flow and encourage collagen production, amplifying the benefits of topical treatments. They also improve product absorption, increasing the effectiveness of ingredients like retinoids and peptides to help the skin look firmer and more toned.
Professional loose skin treatments
Professional loose skin treatments are best suited for mild to moderate cases. Below, we’ll list a range of treatments that may be helpful.
Chemical peels
Chemical peels help with loose skin by removing the top layer of old, damaged skin. This encourages the skin to produce new, smoother and firmer skin.
The process also boosts collagen production, which helps tighten the skin and reduce sagging. Over time, this leads to a more toned appearance, especially for mild skin loosening.
Ablative laser resurfacing
Also known as ‘laser peeling,’ this procedure removes the outermost layer of skin, similar to a chemical peel. The laser also applies heat to the deeper layers, stimulating collagen production for firmer skin.
Ultrasound skin tightening
This treatment uses heat to trigger collagen production. Focused ultrasound energy is directed through the skin's surface to heat the deeper layers, promoting skin tightening.
Radiofrequency
Radiofrequency uses heat energy to stimulate collagen production, focusing on the outer layer of the skin. This process helps tighten and firm the skin over time.
IPL/RF combination treatments
These treatments combine intense pulsed light (IPL) with radiofrequency (RF) to heat both the outer and deeper layers of the skin. The goal is to stimulate collagen production and improve skin texture and firmness.
Botox
Botox involves injecting botulinum toxin into specific areas of the skin. While it primarily relaxes wrinkles, it can also help reduce the appearance of loose skin by relaxing muscles that contribute to sagging.
Surgical loose skin treatments
Typically, surgery is the most effective option for those with severe loose skin. Here are some surgical procedures available. If your loose skin is in multiple places on your body, you may need a combination of these treatments to combat the problem fully.
It’s important to note that surgical treatments aren’t for everyone; they are expensive and come with risks. You may find it helpful to read this NHS resource on whether cosmetic surgery is right for you before you make your decision.
Abdominoplasty (tummy tuck)
A tummy tuck, or abdominoplasty[3], is a surgical procedure designed to remove excess skin and fat from the abdomen. It also tightens the underlying abdominal muscles that may have become weakened or stretched, particularly after pregnancy or significant weight loss.
Brachioplasty (arm lift)
An arm lift, or brachioplasty, targets loose or sagging skin in the upper arms, often resulting from ageing, drastic weight loss or genetics. The procedure removes excess skin and fatty tissue and then tightens the remaining skin for a smoother, more defined arm contour.
Mastopexy (breast lift)
A breast lift, or mastopexy, is a procedure that removes excess skin from the breasts and tightens the breast tissue to make them more uplifted. This procedure is particularly beneficial for women who have experienced sagging breasts due to pregnancy, breastfeeding, weight loss or ageing.
Rhytidectomy (facelift)
A facelift[4], or rhytidectomy, addresses loose skin and sagging in the face and neck. It involves removing excess skin, tightening underlying tissues, and lifting the facial muscles. The procedure can reduce the appearance of deep lines, wrinkles and jowls, rejuvenating the face by improving facial contour.
Belt lipectomy (lower body lift)
A lower body lift, also known as a belt lipectomy, removes excess skin and fat from the stomach, buttocks and outer thighs. It’s especially useful for individuals who have undergone significant weight loss, leaving behind loose, sagging skin in the lower body.
It’s often combined with other body contouring procedures like a tummy tuck or thigh lift.
Thigh lift
A thigh lift targets excess skin and fat in the inner and outer thighs, often caused by ageing, weight loss or genetics. The procedure removes sagging skin, tightens the remaining skin, and reshapes the thigh area.
This surgery can improve the contour of the legs, reducing skin folds and creating a smoother appearance, particularly for individuals with loose or hanging skin after weight loss.
Panniculectomy
A panniculectomy is a surgical procedure that removes excess skin and fat that hangs below the belly button, often referred to as a ‘pannus’. This condition is common after significant weight loss, where the remaining skin and fat create a heavy, drooping apron of skin.
Unlike a tummy tuck, a panniculectomy primarily focuses on removing the hanging skin without tightening the abdominal muscles. It can improve comfort and hygiene and enhance body shape, but it doesn’t address muscle tightening or cosmetic contouring like a tummy tuck does.
Can you remove loose skin on the NHS?
The NHS doesn't typically offer professional or surgical treatments for loose skin as it’s classified as cosmetic, meaning it isn’t essential to your health. However, in some cases, the NHS may cover loose skin removal if:
- There’s been significant weight loss
- You now have a healthy BMI below 30
- The loose skin interferes with basic, daily tasks like eating, sleeping and walking
- There are persistent and severe skin infections in the folds of excess skin
Please note that each specific loose skin surgery may come with its own criteria on whether it’s available on the NHS.
If you think you may be eligible to receive loose skin treatment through the NHS, you should first speak to your GP for advice. They may refer you to the relevant channels.
Many people deal with loose skin after weight loss, especially after losing a significant amount of weight. For some, it’s more than just a cosmetic concern; it can also cause problems like difficulty moving, hygiene issues or even skin infections.
Regular exercise or skincare routines can sometimes help, but in more severe cases, surgery might be needed.
The NHS usually classifies treatments for loose skin as cosmetic. However, they may cover these treatments if the excess skin is causing serious medical or functional issues.
Each case is different, so a professional assessment is required to determine if you’re eligible. For more details, it’s best to talk to your GP for guidance on the next steps.
Sources
- [1] https://www.healthline.com/health-news/heres-how-much-weight-people-regain-after-stopping-mounjaro-zepbound#How-much-weight-can-you-lose-on-Mounjaro-or-Zepbound
- [2] https://www.nhs.uk/conditions/weight-loss-surgery/
- [3] https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/tummy-tuck/
- [4] https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery/facelift/
