Significant weight loss—whether achieved through diet and exercise, GLP-1 medications such as Ozempic, Wegovy, Zepbound, or tirzepatide, or bariatric surgery—can dramatically improve your health and quality of life. However, many patients are left with loose, excess skin that does not fully retract on its own.
Although some skin contraction may occur after weight loss, surgery is often the most effective way to remove significant excess skin and improve body contours. Non-surgical skin-tightening treatments may provide modest improvement, but they generally cannot produce the same results as surgical body contouring.
At your consultation in St. Louis, Dr. Boswell will evaluate your concerns, discuss your goals, and create a personalized treatment plan.
Areas Commonly Affected by Weight Loss
Excess skin after weight loss may affect the:
- Abdomen, waist, flanks, and back
- Buttocks and thighs
- Breasts and chest
- Upper arms
- Face and neck
Not every patient needs treatment in all of these areas. The amount of loose skin depends on several factors, including:
- The amount of weight lost
- Your body shape and fat distribution
- Your age
- Skin elasticity
- The amount of time your weight has remained stable
Some patients lose a significant amount of weight and have minimal excess skin, while others may desire treatment in several areas after a smaller amount of weight loss. Certain procedures may be safely combined to reduce the number of surgeries or stages needed.
Lower Body Lift and Circumferential Body Lift
A circumferential body lift—also called a lower body lift or belt lipectomy—is a core procedure for many patients after massive weight loss.
During this procedure, a band of excess skin and fat is removed from around the lower torso. The incision typically extends around the circumference of the lower body, allowing the front, back, and sides to be lifted and reshaped during one operation.
A lower body lift can improve the appearance of the:
- Abdomen
- Waist
- Flanks
- Lower back
- Buttocks
- Hips
- Outer thighs
The procedure generally takes approximately four hours, although the exact operating time varies from patient to patient. Patients who have lost more than approximately 60 pounds may benefit more from a circumferential body lift than from abdominoplasty alone. However, the best procedure depends on your individual anatomy and goals.
Abdominoplasty
An abdominoplasty, or tummy tuck, removes excess skin from the front of the abdomen and may tighten the abdominal muscles when necessary. The incision typically extends from one hip to the other, although the exact length depends on the amount of excess skin.
Unlike a circumferential body lift, an abdominoplasty does not treat excess skin of the flanks, lower back, buttocks, or outer thighs.
Some patients have excess fat along the flanks but do not have significant loose skin in that area. For these patients, liposuction may be added to an abdominoplasty to improve the contour of the waist and sides.
During your consultation, Dr. Boswell will determine whether an abdominoplasty, circumferential body lift, or another procedure is most appropriate for you.
Breast Lift, Breast Reduction, and Breast Augmentation
Because breasts are made up largely of fat and glandular tissue, weight loss often leads to a decrease in breast volume and breast sagging.
The appropriate procedure depends on your breast size, shape, and personal goals:
- Breast lift, or mastopexy: Raises and reshapes sagging breast tissue when you are satisfied with your breast volume.
- Breast reduction: Removes breast tissue and excess skin when the breasts are both sagging and larger than desired.
- Breast augmentation: Adds volume when the breasts are too small but do not have significant sagging.
- Breast lift with augmentation: Combines lifting and added volume when the breasts are both sagging and smaller than desired.
Dr. Boswell will help you determine which option best fits your anatomy and goals.
Arm Lift and Axilloplasty
After significant weight loss, patients commonly develop loose skin along the back of the upper arms. The surgical treatment for this concern is called a brachioplasty, or arm lift.
If excess skin extends from the upper arm onto the side of the chest, an axilloplasty may be added to address this area.
Patients with a smaller amount of excess skin may see improvement through strength training focused on the biceps, triceps, and shoulders. If the primary concern is excess fat with minimal loose skin, liposuction alone may be an appropriate option.
Thigh Lift and Leg Contouring
The thighs can be challenging to contour because patients often have a combination of excess skin and excess fat. Patients with a pear-shaped body type may retain more fat from the abdomen through the thighs and may need to reach a lower body mass index to achieve their desired contour.
In general, a lower body mass index—often below 30—is associated with improved leg contour and a lower risk of complications. However, every patient is different, and candidacy is determined individually.
Groin-Crease Thigh Lift
A groin-crease thigh lift places the incision in the natural crease of the groin, where it can be concealed beneath clothing. This procedure primarily improves the upper third of the inner and front thigh.
Extended Thigh Lift
An extended thigh lift uses an incision that extends down the inner thigh, similar to the inseam of a pair of pants. In some cases, the incision may extend below the knee.
Although the scar is more visible, it usually fades over time. This approach can provide greater improvement to the front, inner, and back portions of the thigh than a groin-crease thigh lift.
Liposuction
Liposuction may be performed with a thigh lift or several months before surgery to reduce excess fat and “debulk” the thighs. Staging procedures may help improve the final contour and allow for safer treatment.
Facial Skin Removal After Weight Loss
Significant weight loss can affect the face in two ways: it may cause volume loss and leave behind stretched, loose skin.
Procedures such as a deep-plane facelift or neck lift can address loose skin and improve the contours of the face and neck. Restoring volume to hollow areas—such as the temples, cheeks, or area around the mouth—may further improve the result.
When volume enhancement is desired without surgery, hyaluronic acid fillers such as Juvéderm or Restylane may be used. Fillers are performed in the office, but they are temporary and require maintenance treatments.
When a patient is already undergoing surgery, fat transfer may be an option. This involves removing fat from another area of the body and transferring it to areas of the face that have lost volume.
Your Consultation in St. Louis
During your consultation, you and Dr. Boswell will discuss all of the areas that concern you. Together, you will determine:
- Which areas would benefit from treatment
- Which procedures are most appropriate
- Whether procedures can be safely combined
- Whether treatment should be performed in stages
- How to prepare for surgery and recovery
Your initial consultation typically takes 60 to 90 minutes. Additional consultations are available if you have further questions or would like to discuss your treatment plan in greater detail.
The procedures described above are not appropriate for every patient. Surgical recommendations, risks, benefits, and expected results will be discussed during an individualized consultation with Dr. Boswell.