By Leah Rae Russell lost more than 200 pounds over a decade, but she says she wasn’t able to fully appreciate her accomplishment until she took a final step: tightening and removing about 3 pounds of skin hanging from her chest and stomach.
The change has been so dramatic, she often doesn’t recognize herself when she looks in the mirror.
“I find myself looking in mirrors a lot, and I feel like it comes off very conceited, but it’s really just kind of trying to accept the fact that what you’re seeing in the mirror, that’s your body. That’s not someone else,” said Russell, 31, who lives in South Sioux City, Nebraska.
Russell had two procedures to tighten and lift loose and sagging skin on her breasts and abdomen about two months ago. Although she’s still healing, she has already seen big improvements.
The surgeries were necessary for her self-esteem but also because the apron of skin hanging from her midsection would rub and cause rashes. A second roll of skin above that was also causing problems.
“My belly button would be bleeding and raw all the time,” she said. “No matter how often you’re showering or powdering or anything like that, it gets to a point you have so much excess skin, there’s a limitation to how much you could just treat it without getting rid of it.”
Thanks to effective and popular new drugs for weight loss and diabetes — an estimated 1 in 8 adults in the US has used Ozempic or a similar GLP-1 medication — demand for procedures to lift and tighten skin has surged.
“The numbers are overwhelming,” said Dr. Steven Dayan, a board-certified plastic surgeon and a clinical assistant professor at the University of Illinois. “I think we’re going to see a huge influx of patients who are interested in aesthetic treatments, and we need to know how to treat them best.”
Cosmetic surgeries to tighten skin are on the rise
In 2022, the year after the first GLP-1 medication for weight loss, Wegovy, was approved in the US, breast lifts and tummy tucks – the two procedures Russell had – increased 30% and 37%, respectively, from 2019, according to the American Society of Plastic Surgery. Upper arm lifts, to get rid of flapping skin sometimes called angel wings, increased 23% in the same period. Facelifts, lower body lifts and buttock lifts also saw similar increases. These procedures ticked up again in 2023.
The American Society of Plastic Surgery says the popularity of Ozempic and similar medications is fueling the trend.
“We are lifting from head to toe,” said Dr. Michele Shermak, a board-certified plastic surgeon in Baltimore and a spokesperson for the society.
Shermak says these patients are often younger – in their 30s and 40s – than those who traditionally sought face lifts and other skin-tightening procedures. Their relative youth and health mean people seeking skin removal after weight loss tend to recover quickly after their surgeries, which is a bonus, she said.
On the other hand, Dayan says the patients he’s seen after weight loss sometimes don’t get the results they want from procedures to tighten their skin because the weight loss has changed it, making it thinner and less elastic.
Dayan says he’s done a handful of lifting procedures on weight loss patients, and although some people are pleased with their results, others aren’t.
“Some of them are like, ‘All my skin is still loose,’” he said. “There’s a limit to how much better you can get these people, so their expectations may not be in check with what they want.”
Rapid weight loss can leave skin behind
Russell’s experience contending with rolls and flaps of hanging skin after major weight loss is echoed in online support groups, where people seek advice on how to prevent it but also what to do about it. Many say they feel frustrated to have worked so hard and lost so much weight, only to see drooping, wrinkled saddlebags when they look in the mirror.
Russell, who is 5 feet 9 inches, dropped from a high of 340 pounds to 133. In jean sizes, she says, she shrunk from a size 30 to a size 0.
She credits her transformation to hard work and a combination of bariatric surgery and weight loss medication that helped her recover from disordered eating that she struggled with from a young age.
“I went on Weight Watchers when I was in fifth grade with my mom,” she said. “I was 300 pounds when I went to college when I was 17.
“I had personal trainers. I’d done diet plans. There was nothing that could control my food addiction and my binge eating disorder. It was just more than I could handle,” Russell said.
She feared she would die without serious help, so she had bariatric surgery in 2012, which led to a 120-pound weight loss.
Then she had her daughter, Aurora, and regained 50 pounds through pregnancy. But she was determined to keep going.
She next turned to the GLP-1 medication Wegovy and a stimulant called Vyvanse that she takes to help control binge eating, which she once did every few days.
“I haven’t had a binge in 16 months or something like that now. That’s never happened in my life,” she said. “So that’s been really, really wild.”
There have been lots of wins along the way. The numbers on the scale are down. Her health has improved. She has more energy — or at least as much as someone can have after chasing around a lively 2-year-old all day.
But after all the weight loss, there were still things that still bugged Russell. Buying the right clothing size was tricky. If a shirt fit in the shoulders, it would be too tight over the extra skin around her middle. If the waist fit, the shoulders would look huge, like a linebacker’s, she said. She couldn’t buy jeans with a fitted waist because the extra skin wouldn’t fit into them.
She promised herself that if she ever reached her goal weight, she would have the surgery to remove the extra skin.
“I was very curious what I would look like without the effects of obesity,” she said.
What to expect after surgery
Insurance will sometimes cover skin removal procedures after weight loss. Every plan is different, though, and most don’t cover skin removal that’s purely for cosmetic reasons. Many plans require that patients prove that they are having health problems, such as infections, from the extra skin. Some also require that people maintain weight loss for a certain amount of time or try prescription medications before the surgery is covered.
To get coverage, Russell’s plan required the skin to hang to a certain length, and hers wasn’t quite low enough to qualify. She also needed a more extensive kind of tummy tuck, called a fleur-de-lis, which cuts the abdominal skin from hip to hip and pelvis to breastbone to remove excess skin and tighten the underlying muscles. Her insurance would have paid to remove only part of her extra skin so ultimately, she decided to do it without insurance. She took out a loan to afford it, paying $13,000 for both procedures.
Russell also went online to get support and advice from people who’d been through the same procedure.
Some risks of skin removal surgeries include bleeding and blood clots, infections, bruising, and swelling. Patients also need to figure out how to cope with some pretty intense activity limitations during the early part of their healing. People who have tummy tucks, for example, are advised to stay hunched over for two weeks after their procedures while the skin heals.
“I spent a lot of time in Facebook groups, reading support groups and what other people were experiencing and what complications they were having and tips and tricks they had,” she said.
“I read some people had a pretty rough go, because it is a major surgery. Your entire abdomen has been cut open and cut off. It does have inherent risk,” she said.
She was told it could take a full year for the swelling to completely go down and for the lymphatic system to drain the tissues. After eight weeks, though, Russell says she feels great. Her activity restrictions are gone. She doesn’t have any swelling or sores. Her scars are minimal.
“I’m pretty much on track for the best that they could hope for.”
Shermak says patients who seek skin removal should expect some scarring, but it’s usually not as bad as they may fear.
“The scars are very strategically placed. Typically, they’re camouflaged or hidden in areas that are between different body regions,” she said.
Weight regain is always a risk for patients, especially if they develop a tolerance to their medications or if they decide to come off them altogether.
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Shermak said that she’s seen people who’ve had skin removed regain weight after bariatric surgery and that the fat doesn’t seem to go back to the same places it was in before.
“So they tend to gain weight more kind of on their insides, I’d say, like around their liver and bowels and things like that,” she said.
Fat around the internal organs can contribute to problems like high blood pressure, heart disease, diabetes, cancer and fatty liver disease.
“People just have to stay on it with regards to their health and their wellness and their physical activity,” Shermak said.
And what about prevention? Is there anything that can prevent sagging, loose skin after weight loss?
Everyone is different, Shermak said. Biology and genetics often determine how elastic the skin may be, but the rate of weight loss seems to be important, too.
“People who just drop weight super fast, I think the skin can’t catch up,” she said. “I think losing weight in a more gradual way can minimize problems.”
Russell said she would definitely recommend the surgery to anyone who wanted to do it.
“All bodies are beautiful. And my skin was a part of me, and it was a physical representation of everything I’ve been through … and I wasn’t ashamed of it,” she said.
“I was having health concerns, and I was curious what I would look like without it. So that’s why I went forward,” Russell said. “I have no regrets.”