Best skin tightening treatments for body after 50 pound weight loss? (Photos)

Question

Hello I recently lost over 50lbs and am back to a regular workout schedule of 5+ days per week. I’m really excited to continue my health and wellness journey and was wondering what the best non-surgical treatments are for tightening loose skin with a little sagging on my thighs, much more in lower abs as per the pics submitted. I realize a lift and mini tuck are likely the best solutions but wanted to explore non-surgical options first. Thank you!

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Ryan Rebowe, MD · Answer

Following weight loss, the main issue with the skin is the loss of elasticity. This is impossible to restore fully, and therefore typically noninvasive or nonsurgical options are typically limited. The InMode device, BodyTite, is specifically targeted to these areas of weight loss. Your thighs are likely to benefit from this, however your abdomen will need excision contouring, such as a tummy tuck or belt lipectomy, to have any significant tightening effect.

Charles Riccio, MD · Answer

Hi, AnnS2023,
Thank you for your question. There are many options for "skin tightening," but generally your return on these "minimally invasive" interventions will be mild at best. As you noted, the best solution would likely be surgical, which will give you the best result and help you avoid wasting money on multiple treatments that won't give the results you are looking for. Many patients end up trying multiple different modalities only end up dissatisfied and eventually do undergo surgery.As always, please reach out to a board certified plastic surgeon for an in person consultation and to determine what options would be best to address your specific concerns. 
Hope this helps!

Camille Cash, MD · Answer

Congratulations on your impressive weight loss! From the photos and description of your concerns the best results will come from surgical treatments such as a tummy tuck.  You may get some improvement from less invasive options but it's important to understand the limitations as well.  You can look into BodyTite which is minimally invasive and requires no general anesthesia.  I've attached a video on this option that I hope you find helpful.

Bradley Hall, MD · Answer

This is a very common problem we are seeing now with everybody losing weight from either weight loss surgery, medications, or life changes. Patients who have lost a lot of weight tend to have excess skin in several areas, in your situation that includes the leg and abdomen as you have noted, but the back and buttock may also be involved as well. I bring that up because an extended abdominoplasty or a circumferential body lift may also address some of the outer upper thigh laxity and the abdominoplasty component would adequately treat the front of your abdomen. The thighs may be amenable to a vertical incisions thighplasty, where excess skin is removed from the thigh to remove redundant skin. This involves making an incision along the inner side of the leg. I would not necessarily recommend having those surgeries performed together though just because they are competing forces on the skin near the incision and may lead to unnecessary wound after surgery. But if your arms or breasts were areas that were concerning you, those may be able to be addressed at the surgery for your trunk.

Lisa Vuich, MD · Answer

Thanks for your question. In non-surgical aesthetics, skin tightening is going to be "all about heat delivery". This is because the microinjury of heat is needed to stimulate collagen and elastin production in the skin, which happens during the healing response to the treatment. There are many devices which deliver what is called "bulk heating"- this means they deliver heat, often through radiofrequency energy, to the tissue without any 'disruption' of the skin surface. Example: Venus Bliss, but there are many, many devices which work "like this". The upside of this approach is zero downtime. The downside is you are often talking about 8 to 12 sessions, then a maintenance session every few months for a while ideally. So that's time and labor intensive. Another downside- because you are transmitting heat from the surface straight through, there is a "limit" to how high the heat can be set in order not to burn the surface skin. The next level of approach, to get around that limitation, is to deliver the heat at the tips of microneedles which penetrate the skin surface. This requires numbing of course. These microneedles are insulated partially so that significant heat does not reach the skin surface (no burn)- so now you CAN deliver very high temps to the deeper skin/fat layers and more heat + more penetration more results in fewer treatment sessions. You pay for this with some downtime- mainly redness, some puffiness, temporary "dots" on the skin- all of that resolves over the course of a few weeks of course. A great example of this type of treatment is Morpheus8 Body. This is the most advanced device of its kind available in the US. So, you could certainly do a series of 3 Morpheus8 Body sessions to any area you wish and achieve a very nice result with minor downtime. Finally, you could also consider a procedure called BodyTite, which is also performed off the Morpheus8 device. This is the "highest level" of tightening in a SINGLE procedure, but it requires more numbing (lidocaine infused into the tissues) and it involves a heat probe gliding in the fatty layer under the skin, delivering the heat to "full thickness" skin and fat. Very potent tightening, but more downtime as you wear a compression garment afterwards for a couple of weeks to speed healing and resolution of swelling. Most clients are satisfied with the results of a single BodyTite session for a region, though it could be repeated if and when desired. This procedure is considered minimally invasive, completely non-surgical. I hope that is helpful to you and congratulations on your accomplishment!

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