Flabby Belly After Teen Weight Loss - How to Tighten Up?

Question

Hi, I am male, 25, 5'6" and I weight approx 8.5 stone (119 lbs). I was overweight as a child and lost it all in my mid teens, becoming borderline anorexic. I now have very skinny arms, collarbones, shoulders etc, but my belly remains very flabby despite situps and the skin sags and rolls when I bend or sit. I also have stretch marks on my lower abdomen. Please can someone tell me whether this is loose skin or fat and if I could get it looking tight and toned? Cheers.

J. Timothy Katzen, MD, FACS · Answer

Hi Si,

Thank you for your question regarding a flabby belly after teen weight loss and how to tighten it up.  Initially, we must evaluate your photographs to determine the most effective methods.  Your lower abdomen is affected by dermatocholosis (loose skin) and cutis pleonasmus (excess skin).  You are not affected by lipodystrophy or excessive body fat.  Consequently, you are experiencing a skin issue rather than a fat issue.  Liposuction would not be the optimal procedure for you, as it removes fat rather than skin.  Consequently, an abdominal tuck or abdominoplasty would be the optimal course of action for you.

A tummy tuck is conducted under general anesthesia and typically requires three to four hours to complete.  An incision is made in the abdominal wall at a low level.  The umbilicus is the site of tissue dissection.  The navel button is dissected from the abdominal wall after an incision is made around it.  Dissection of tissue proceeds to the sternum.  The rectus muscle is examined.  Typically, the rectus muscle is plicated or sutured together to remedy for rectus diastasis and flatten the abdomen.  Your rectus muscle is in excellent condition; therefore, muscle plication is unnecessary.  The excess abdominal wall skin and adipose tissue are removed, and the abdominal wall skin is redraped.  The two drains are typically removed after 10 to 14 days.  After approximately 2 weeks, most patients are able to resume their daily activities.  After approximately six to eight weeks, the majority of patients are capable of resuming their typical exercise regimen.

An alternative to plastic surgery is exercise.  Weight lifting to increase bulk may be an option.  However, due to your genetics and age, your skin may not completely bounce back.  Most plastic surgeons would agree that you should give yourself 8 to 12 months for dedicated weight lifting.  If you do not achieve your results by then, you may want to consider plastic surgery.   If you have any more questions regarding tummy tucks, abdominoplasties, or abdominal liposuction, contact an experienced plastic surgeon   Since the tummy tuck surgery is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience in performing tummy tucks.  Do your research.   If you cannot find an experienced tummy tuck plastic surgeon in your neighborhood, consider traveling out of state.  Sincerely, Dr. Katzen, MD, MBA, FACS, FICS. ( Plastic Surgeon, President of the American Society of Bariatric Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery, RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Raj S. Ambay, MD · Answer

Consider removal of skin to tighten area. If you have lower belly looseness then you could get a mini-tummy tuck where just the lower section fascia is tightened. If fascia is not loose then lipo. good luck!

James Knoetgen, III, MD · Answer

Congratulations on your weight loss!  Loose skin after significant weight loss is very common. Some people claim that intense (cardio) exercise can tighten loose skin. You didn't mention if you exercise, so it certainly wouldn't hurt to try exercising for a few months and see if that helps.  

	If exercise doesn't help, then I suggest visiting with a board certified plastic surgeon to discuss your situation in more detail.  A tummy tuck (abdominoplasty) is the procedure commonly performed to tighten the front of your abdomen.  I hope that helps and wish you all the best!

Robert L. Kraft, MD, FACS · Answer

A substantial weight loss can result in loose skn.  An abdominoplasty could correct such s condition, which would not be improved by exercise.

Tom J. Pousti, MD · Answer

Thank you for the question and pictures. Congratulations on your weight loss!

	I think you would likely benefit from the tummy tuck procedure. A word of caution may be in order... In my opinion, For patients with your history,  liposuction or mini tummy tuck surgery are  operations that  produce very limited results and are very rarely indicated.  The mini  tummy tuck procedure involves a shorter incision but does not address the majority of the abdominal wall issues present for most patients who present consultation. For example, the area of skin excised is quite small. The abdominal wall musculature is addressed below the umbilicus leaving the upper number wall potentially lax. The appearance of the umbilicus is not necessarily addressed sufficiently.

	For most patients who have had pregnancies and/or weight loss a full abdominoplasty is necessary to achieve the desired results. Of course, there are downsides (including a longer scar and probably a longer recovery time) but for most patients the benefits outweigh the downsides. It is not unusual to see patients who've had mini tummy tuck  surgery present for  revisionary surgery.
	It is important to work with a well experienced board-certified plastic surgeon to obtain advice (based on good ethics and judgment) to  improve your chances of a successful outcome and minimize the need for further surgery.

	I hope this helps.

Neal Goldberg, MD · Answer

If you lost significant weight, then it is possible that your skin has lost elasticity and will not tighten with excercise. Your photos suggest this. It would be worth discussing body contouring/skin reduction procedures witha surgeon by you.

Jonathan J. Staiano, FRCS (Plast) · Answer

The situation you describe is usually related to the skin having been stretched when you put the weight on and failing to recoil when you have lost the weight.  It is the same mechanism that causes the excess lower abdominal skin in women who have been pregnant. 

	The problem is the loose skin, not fat.  It is difficult to make the skin look tight and toned, because it may have lost its elasticity.  You should avoid smoking and too much sun damage to the skin as these things adversely affect the quality of the skin.  Excercise will help to tone the muscles but will not tighten the skin.

	A tummy tuck will tighten the skin and will remove some of the stretch marks, but it does involve scarring and carries other potential limitations and complications.  Your photo is not very clear because you are bending forwards and your lower abdomen is not visible, but it does not look like you have a significant lower abdominal apron to warrant a tummy tuck.  Obviously, this could be properly assessed with consultation with a plastic surgeon.  Look at the BAPRAS and BAAPS website to find a plastic surgeon in your area.

Delio Ortegon, MD · Answer

Your scenario is quite common for many patients who have lost a considerable amount of weight. Pt with weight loss tend to lose elasticity of the skin and also commonly have excess skin. A tummy tuck is often needed to reduce this extra skin and provide for a tighter abdomen.

Flabby Belly After Teen Weight Loss - How to Tighten Up?

Answers (8)

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