After Weight Loss, Many Face a New Issue: Excess Skin

April 25, 2025

The popularity of GLP-1 drugs have revolutionized weight loss. They’ve also increased the demand for surgery to remove excess skin. Dramatic weight loss leaves many patients with loose, sagging skin, which can affect quality of life and self-image, says University Hospitals plastic surgeon Joseph Khouri, MD.

“Patients lose all this weight, they go off insulin, their hearts are much healthier, but they can feel disappointed by a new problem they didn’t have before,” Dr. Khouri says. “For some, it’s the extra skin on the belly or the thighs interferes with exercising or even daily movement.”

Skin-Removal Surgeries

Dr. Khouri says the only way to get rid of excess skin is plastic surgery. Some patients have misconceptions that liposuction will help, but the procedure removes fat, not excess skin.

Common skin-tightening procedures include:

Abdominoplasty. Better known as a tummy tuck, it’s the most common type of surgery to remove excess skin.
Fleur-de-Lis panniculectomy. A more extensive procedure for patients with massive weight loss. A traditional tummy tuck involves a horizontal incision, while Fleur-de-Lis panniculectomy makes horizontal and vertical incisions, which enhances the contouring effect
Arm lifts or “brachioplasty.” Removes excess skin on the inside of the upper arm.
Breast lifts and bra line lifts remove excess skin from the upper back and side of the chest.
Lower body lifts tighten the buttocks and thighs.

Who Is a Candidate for Surgery?

“I look for patients to be at their ideal weight for six months to a year, preferably a year,” says Dr. Khouri. Other important factors include:

Patients need to be generally healthy, with any medical conditions properly managed.
Mental health conditions such as anxiety, eating disorders and body dysmorphia also need to be ruled out or properly managed.
No nicotine for a minimum of six weeks before surgery, which can interfere with wound healing.

Does Insurance Cover Surgery?

In many cases, insurance doesn’t cover surgery. For insurance approval, excess skin must be causing rashes and sores that interfere with daily activities and don’t respond to non-surgical treatments such as antibiotics, Dr. Khouri says.

Some insurers require waiting at least 18 months after bariatric surgery or weight loss. After that, insurance will typically cover some portion of surgery for most patients, such as excess belly skin causing sores, but not other procedures such as breast lifts or upper arm surgery.

“We try to help patients get portions of the procedures covered, but some procedures insurance companies consider cosmetic,” says Dr. Khouri.

Multiple procedures can be done in one surgery. Belly and upper arm surgeries are often done together, for example. “When multiple areas need to be addressed it’s best to start with the abdomen, as this serves as the core around which to contour the remainder of the body,” says Dr. Khouri. “For the most part, it’s best to avoid areas in which the lift or contouring goes in opposite directions. For example a tummy tuck and breast lift, where the abdominal skin is pulled downward and the breast skin is pulled upward.”

What to Expect from Surgery

Dr. Khouri says it’s important to manage expectations. Patients who undergo massive weight loss often have significant extra skin, the removal of which will leave scarring.

“I stress to patients that you are trading scar for skin, in order to achieve the functional and aesthetic benefits of removing the excess skin,” he says. “We try to place scars in hidden locations and to minimize them as much as possible.” He emphasizes the importance of properly caring for scars for at least one year. “Sunscreen and constant scar massage are absolutely vital to optimizing how the scar looks.”

Recovery generally takes about two weeks. “Plan to return to exercise around 4 weeks. Between 4 and 6 weeks, gradually ramp up your activities so that at 6 weeks you’re doing what you were doing before surgery. Obviously, it’s different for different parts of the body. And if we’re doing multiple procedures, it’s going to compound the recovery.”

Dr. Khouri says skin surgery is a game-changer for patients. “Some of the happiest patient I have are weight-loss patients who have body contouring procedures. It’s a tremendous life-changing scenario for them.”