Extensive Weight Loss

In recent years, the necessity to perform operations on patients suffering from large quantities of loose skin has increased. This has been caused by the massive increase in bariatric surgical operations, which can achieve very extensive weight loss.

It is now regular, following such operations upon the stomach and digestive system, for patients to lose tens of kilos. Most of these people will go on to notice large quantities of excess skin on various parts of their bodies. Loose, excess skin can be particularly annoying, and for this reason they will seek out a plastic surgeon to improve their body image.

The problem may be found in various areas of the body, such as the abdomen, the chest, the inside of the thighs, the upper arms, the breasts, the buttocks and the back. In several cases, this sagging may even be encountered on the face, making it appear aged.

Therefore, treating sagging skin in patients who have undergone extensive weight loss is a multilateral procedure.


Organizing a meeting to be examined and informed by a plastic surgeon is a very important step for the correct execution of the procedure. To begin with, the plastic surgeon must determine what exactly is disturbing you. Perhaps there is sagging in several areas and you wish to correct all of them. However, such an operation is usually impracticable, as it will cause the severity of the surgical operation to increase massively. For this reason, some order must be imposed based on how much you wish to prioritize each individual operation. This prioritizing depends upon how extensive the problem is in each area, but also upon the subjective perception of the patient afflicted by it.

Certainly, the degree of sagging will not be even throughout the body. It is best for one to begin with the area that is most bothersome. In all likelihood, this procedure should be able to be combined with another operation, but it is up to the practitioner to determine how extensive this operation will need to be, in order to avoid placing too much stress on the patient’s organism.

It is best for such operations to be arranged once the patient has achieved their desired weight. Only then can a doctor judge accurately the procedures and methods that must be undertaken.


As explained above, there are several types of excess skin removal surgery which may be performed individually or in conjunction. Any operation aiming to correct loose skin, may be employed to rectify problems after massive weight loss. 

Such operations tend to be specifically categorized as:

1.    Lower body lift (belt lipectomy)

This operation essentially combines abdominoplasty with a buttock lift. It is a fairly extensive operation. A circumferential incision is made, beginning from the lower abdomen, curving around the body and ending on the upper buttock. Again, this is a fairly extensive operation, but has multiple benefits. The operation may last between 4 and 6 hours, and will then require a week of follow-up treatment. Of course, up to one-and-a-half month may have to pass before a return to intensely demanding activities may be made.

2.    Abdominoplasty

When dealing with a large degree of sagging to the abdomen, abdominoplasty may be performed via the standard method, but usually the incision will have to be more extensive. The good news is, it can be made quite significantly lower than is the case with regular abdominoplasties. In cases where the horizontal span of the stomach is greatly affected by sagging, a horizontal incision may not suffice, needing to be supplemented by a vertical central incision, i.e. an incision above and below the navel (Fleur de lis technique). This of course is only necessary in very special cases dealing with large quantities of loose skin. Other than that, the procedure should follow the pattern of the classic abdominoplasty.


3.    Breast lift

This deals with one of the most frequent problems observed in patients who have lost a large quantity of weight. The procedure is not dissimilar to the standard breast lift, which is performed in cases of general sagging. In such cases, breast augmentation may have to be combined with the lift.

4.    Inner surface of the thigh

This area tends to undergo a greater degree of sagging compared to the rest of the thighs. This is due to the texture of the skin and its reduced elasticity. Incisions are made in the groove between the thigh and the genital organs. When dealing with more extensive sagging, however, a vertical incision may be required on the inner surface of the thigh.

5.    Buttock lift

There are several varieties of techniques that may be employed for this operation, and the placement of the incisions depends on which of these is employed. The classic method of the buttock lift requires the incision to be made horizontally in the upper buttock, beginning from the middle and horizontally traversing the entire surface of the buttock.

6.    Upper arm lift

In this case, incisions can be made either in the armpit, to deal with lesser degrees of sagging, or extending from the armpit and reaching to the elbow. Again, when dealing with lesser degrees of excess skin, the incisions can be limited to the armpit, where they will very discreet. Otherwise, when needing to make more extensive incisions, these are placed on the interior of the arm, and are as such easy to cover when the arms are at rest. Of course, though the incisions will become faded in time, they will never fully disappear, and the patient should be aware that the marks may be visible when their arms are lifted. A good method to employ is combining this operation with liposuction, which can be performed via a circumferential incision around the upper arm.

This tends to produce the best results.

7.    Sagging male breast

Small degrees of sagging may be corrected via the classic corrective surgery for gynecomastia. When the degree of sagging is greater, skin removal may also be required. This operation will leave a few marks, but these are on the whole preferable to the initial problem.

8.    Sagging back skin

This case pertains to sagging which may be observed in certain parts of the upper back, around the ribcage. This is not encountered frequently, but when such correction is required, it is performed by removing the excess skin. This can be combined with an upper arm lift or breast lift. In these cases, the procedure is referred to as an Upper Body Lift.

9.    Face lift

Often, extensive weight loss may cause sagging around the face. In such cases, the standard procedure for rhytidectomy should be followed.

All the aforementioned operations are required frequently in cases of extensive weight loss. However, note that a discussion with the plastic surgeon beforehand is most important. Patients who have recently lost a lot of weight run a higher risk of complications than most others. Of course, such complications are correctable, but a thorough discussion with your surgeon is required in order to ensure you are fully informed.

In general, these procedures require quite thorough scheduling and understanding between doctor and patient, in order to be able to regain an aesthetically acceptable body image.