Hi, Thanks for your question. It's understandable that you have concerns about skin sagging after undergoing gastric sleeve surgery. After this surgical procedure and in similar cases, I always recommend two surgical options. The first option is surgical procedure to remove the excess of skin, if required, i.e. body lift (Abdominoplasty, back lift, tight lift, arm lift etc) . This procedure is performed in patients with significant weight loss and involves removing excess of skin. However this procedure involves an extensive scars. The second option is a less invasive approach: Vaser liposuction combined with Renuvion/J plasma or Bodytite on the upper and lower abdomen, flanks, and back area. The second option is ideal for patients who want to achieve body contouring and improve the waistline with less extensive scars; however, this procedure does not remove excess skin. The combination of Renuvion with Vaser liposuction can increase the likelihood of skin tightening, and my preferred method involves circumferential body Vaser liposuction (360-degree approach) and Renuvion/J plasma, which is an excellent option for women or men who want to improve their body contour and silhouette with fewer scars and avoid a tummy tuck. Renuvion only requires one session and is typically performed under general anesthesia or sedation in a hospital setting. Bodytite requires one session in combination with Morpheus 8 (three sessions four weeks apart). Before undergoing Vaser liposuction, it's essential to have a preoperative assessment to determine if you are a suitable candidate. Factors such as a BMI less than 30-32, overall health, and medications you are taking will be evaluated. It's important to note that liposuction is not a weight loss procedure and should not be used as a substitute for a healthy diet and regular exercise. Additionally, while Vaser Liposuction can effectively remove unwanted fat, it may not address loose skin or stretch marks. Therefore, it's important to have realistic expectations and understand the limitations of the procedure. I would suggest to make an appointment with a surgeon expert in body contouring and skin tightening who can assess your specific situation and recommend the best course of treatment for you. They can also discuss any potential risks and benefits associated with the procedure. Hope this helps, All the best, Dr Giuseppe Fiore