Excess skin

FitnessTim

It is commonly stated that when a person loses a significant amount of weight they may have excess skin that can only be fixed with surgery. While I agree that surgery may be the sensible solution in some cases, I don't believe it is impossible to get rid of excess skin through dieting and exercise.

I've seen those plastic surgery shows where a person has lost weight and goes under the knife to get rid of the excess skin. I don't have a problem with that and given the option I would recommend it.

What if you don't have the option? What if the amount of excess skin is not enough to warrant surgery and insurance won't cover it? You do have the option of accepting the excess skin as a small price to pay for health, but is that really the only other option you have left?

I am not an expert so don't take what I say as an expert advice. I will try to think about this logically based on my understand of the human body and body fat in general. I believe excess skin will go away if you are able to drop your body fat down to the levels only seen in athletes, even if for only a short period of time.

Skin mostly consists of body fat. When you see those people who have lost the weight and are at an acceptable weight for their height but still have droopy excess skin, that excess skin is mostly body fat. If that a person with excess skin were to continue to lose body fat, that excess skin would eventually thin out and start to droop less. It has nowhere else to go but up.

I have never seen a picture of someone with under 10% body fat with excess skin. As far as I know, it is not possible except in extreme cases. If anyone has a link that proves this theory wrong, please provide it. I have found a few links that contain information that says it is highly unlikely someone with below 10% body fat will have excess skin.

So now I have a question. If a person who was extremely overweight manages to lose 100 or 200 lbs without surgery, wouldn't that same person have the ability and stamina to continue to lose body fat while maintaining a healthy muscle mass? At that point, achieving extraordinary things is nothing for this person, so focusing on losing a few percentage points of body fat should be feasible.

It may be a problem with education. A natural bodybuilder who is trained to lose body fat has an entirely different method of losing body fat than an obese person. With an obese person there is some consideration of maintaining muscle mass, but let's be honest the key focus is on just getting the weight down. In contrast, a bodybuilder works diligently to maintain or even increase his muscle mass as he or she reduces body fat.

I have dropped by body fat down to 10% on a number of occasions. I'm not a bodybuilder so it is difficult to maintain this but as a regular Joe, it is achievable, extremely difficult but achievable. When I get below 17% I find that I have to make a shift in my diet and exercise routine to drop the percentage down further.

A previously obese person may not be aware of the need to make this shift. If they try to lose this body fat with the same methods they used to lose 50 or 100 pounds of unhealthy weight, they will stall. Muscle mass will decrease so much they will no longer have the strength or stamina to see any changes and they may even gain back unhealthy fat.

Even at 19% body fat I would not recommend the same diet and exercise routine that I follow to an obese person. I'm looking to lose maybe 1/2 pound a week so I don't tend to decrease my calorie intake as drastically as someone looking to lose 2 pounds or more a week. Also, I have days where I actually increase my calorie intake to gain back some muscle mass. Trust me, it's complicated. I don't do anything extreme or potentially risky. In fact the extremes that obese people go to to lose 50 pounds is very risky in comparison.

So I suggest that those who have lost a significant amount of weight put down the "Weight-loss For the Masses" books and pick up a book on bodybuilding. You don't need to go to the same level of extremes as they do (I don't), but one thing they know is how to maintain muscle mass while lowering body fat to extremely low levels.

Also, forget the scale as a reliable means of measuring progress. At this point, you need to track your body fat %, not your weight. There are weeks I stay the same weight but make good progress in lowering my body fat. I measure it using 3 methods: 1. Tanita scale with body fat%, 2. Calipers, 3. Visible appearance. That's right, the last method was just plain looking.

As I said before, I'm not an expert so take my advice for what it is, an option to consider. I'm not suggesting that you do anything that jeopardizes your health so you may want to check with your doctor. Most experts suggest weight training, moderate cardio and calorie cycling to lose body fat below normal levels, so unless you have a serous condition most doctors should not have a problem with it.

Calorie cycling is probably the most controversial suggestion to give. I've done it with good results but if you feel uncomfortable and question this method you could probably just stick with calorie moderation. I actually believe maintaining a calorie deficit over a long period of time is detrimental but we each have to make our own decisions about health and risks.

If you disagree with anything I suggest or imply, please feel free to comment. If you think I'm irresponsible for suggesting that people go below the accepted level of body fat percentage, comment on that as well. The goal of this is to have an open an honest discussion.

I was going to include links to site that discuss how to remove excess skin by lowering body fat percentage but that may be perceived as if I'm trying to sell something, which is not the case. I'll leave it up to you do a search.

NatalieWinning

I will have to disagree. A woman that has had baby(s) will have had larger breasts and a much stretched abdomen. These will not usually go away completely no matter what your body fat is. It's stretched skin, not fat. Sure it can be empty, like a pouch or wrinkled overstretched balloon, but it's going to remain at least a little. I can only imagine it's the same in a man if there was very stretched skin. Maybe it won't be an issue for the most part, but it might remain all the same no matter what you do short of cutting it off.

becomingsara

Interesting! It does give me hope, as having had a 10 lb baby and then a set of twins, my belly skin is rather stretched, and n0w that I am on my way to losing close to 80 lbs, I hope to be able to lose the saggy skin that may occur down the road...however,doesn't skin lose it's elasticity after a certain while? Especially in the case where (excuse the TMI) if the entire width of skin is now stretch marks? Would elasticity be called into question (as opposed to merely the skin holding extra fat, necessitating a change in focus [to 'body-building]) or no?

P.S. ^^Natalie, it seems you and I were on the same page :0)

melizerd

I tend to disagree unless it's only a minimal amount of skin. If you are REALLY sagging no amount of exercise is going to help it. I'm an RN student and skin is not primarily fat. Skin is for the most part layers of already dead cells with little blood flow except to the lowest alive layer. So while fat does have a part in skin most of the fat is UNDER the skin's layers and when it's gone there's only so far skin will bounce back.

Especially for women, after a baby or excessive weight gain and then loss there are just some things you can't fix. So no saggy skin is NOT a price I'm willing to pay which is why I would save up the $10,000 or more needed for a surgery to fix that final issue. I just can't work it off.

tacticalhippie

You can kind of tell mine is more stretched out skin that just "fat".
I've had 2 big babies and was obese for many years.

Now, I've lost almost 110 lbs, and the pooch is slowly going down.
It's smaller than it was a few months ago, but I think there will be "something" there.

tross0924

Well I agree with you. The skin has to stick to something besides other skin so with no fat it has to cling to the muscle right. I'll let you know, I plan on getting there eventually :-)

fitterpam

I agree with you somewhat (but that may be because I'm in the bucket than needs to lose >100lbs and I need something to grasp on to) but there are a few flaws that I see with the original premise.

1. Most body builders or people that are less than 10% body fat were never morbidly obese (I'm not saying there are none, I'm saying that it's not typical). They would not necessarily have had the skin stretched for long periods of time.

2. Age would play a factor in the skin's ability to "shrink". As people age, they lose elastin in their skin and therefore it would not shrink no matter what. Again going back to stretched skin for long periods of time.

3. Skin is not primarily fat - it is it's own organ made up or dermis cells. When skin is stretched and stretch marks form, it's minute tears between the cells. These do not regenerate.

What I do agree with is that it is possible to continue to tone the muscles beneath the skin to lift the attached skin and remove some of the droop, but if you have a 3" pouch, it's just not possible to lift that much. You'd probably be able to lift as much as the muscle structure underneath. Also losing weight slowly would give the skin time to adjust to the new shape instead of shocking it back into position (as would be the case of pregnancy with multiples, etc.)

michelleducato

I totally disagree with this. I saw a friend after having 3 c-sections with skin that you could pull out from her belly about 6 inches!!! There would be NO WAY for her to loose anymore of anything as she was already down to her pre-baby weight. She had very little fat on her. I don't know what her body fat was, i'm sure it wasn't 10% but there is not a chance that anything but surgery would have removed that skin!!

fitterpam

One more thing....

Most sources agree that the human body requires a certain amount of fat for good health. Fat helps regulate body temperature, store energy, and cushion and insulate organs. The percentage of body weight that makes up this "essential fat" is around 4% of body weight for men and 10% for women. Beyond that, there's a somewhat wide range of what is considered a healthy percentage of body fat.

According to an article from Medscape.com, the American Dietetic Association recommends that men have 15-18% body fat and women have 20-25% body fat. Healthy male athletes might be as low as 5-12% body fat, and healthy female athletes could be as low as 10-20%.

Dr. C. Everett Koop's site, ShapeUp.com, breaks down healthy body fat ranges by both gender and age. Men under 39 years of age should have 8-19% body fat, and women under 39 years of age should have 21-32%. Older men may range from 11% to 24%, and older women may range from 23% to 35%.

Women athletes who lose too much fat risk injury, decreased performance and health issues. The female athlete triad (8%) refers specifically to three related health problems often found in women athletes:

Eating disorders and low energy availability.
Amenorrhea and menstrual disorders.
Decreased bone mass and increased risk of stress fractures and osteoporosis.

NatalieWinning

I am 5'2" and had 3 babies before getting down to 115 pounds, which was extra light for me. I tend toward a 125-130 lb frame at a good weight. My ribs were showing.

I had a nice soft batch of skin where the pregnancies were. And my empty boobs were still there, only less full. You know, like the pictures of the old ladies! Fine if supported, and in my pants no one could ever tell. Skin, not fat. Not enough to save up and get cut off. But certainly not going away--ever.

jcubesmommy

I've heard this before somewhere and yes, it makes sense - but so does "skin being it's own organ" & "stretch marks not having the ability to regenerate" position. Often times the elderly lose weight towards the end of thier "stay" and they have excess skin but it is not in the form a large sheet of hanging skin like sheets on a drying line outside but rather more and smaller hanging flesh pieces similar to sheets on a bed. I admire your willingness to bring this subject up and especially appreciate the way that you have invited counter evidence into the conversation and I appreciate the respect that you've given both camps.

FitnessTim

I will have to disagree. A woman that has had baby(s) will have had larger breasts and a much stretched abdomen. These will not usually go away completely no matter what your body fat is. It's stretched skin, not fat. Sure it can be empty, like a pouch or wrinkled overstretched balloon, but it's going to remain at least a little. I can only imagine it's the same in a man if there was very stretched skin. Maybe it won't be an issue for the most part, but it might remain all the same no matter what you do short of cutting it off.

I'm going to be argumentative just for the sake of discussion. Personally, I feel if a person can have surgery to remove it, go ahead and do it.

However, when you say that a stretched abdomen will not usually go away completely no matter what your body fat is, you appear to be making a generalization based on what is commonly accepted as known truth. If you have any hard facts or references to back up that claim, please elaborate.

I'm challenging that what people typically believe about the persistence of excess skin is not true. In fact most doctors that perform these lift will say that given enough time, excess skin may eventually snap back. What they are doing is giving the patient an option of not having to wait and not having to go to extremes to lose it naturally.

The elasticity of skin does decrease with age, but again I have yet to see a picture of someone with a body fat percentage of under 10-12% with excess skin regardless of the age. I searched the web, nothing, nada, can't find one.

Then again that depends on what you consider excess skin. I did find one picture of a guy with low body fat that had some wrinkling in his belly skin, but even he admitted he knows that if continues working he would eventually lose it.

Back to my original point, if someone has an extreme amount of excess skin, forget getting rid of it with diet and exercise alone. It can be done, but the effort and time would not be worth it. On the other hand, for the person who lost 20, 40 or even 50 pounds, they might consider lowering their body fat while they consider surgery.

I posted this because I have known people who have lost weight and have some excess skin but don't have the means or the desire to get surgery. They all seem to stop when they reach the twenties in body fat percentage. It's almost as if 25% is the new 20%.

Unless it is a medical issue, in which case insurance should cover it, you still have the option to just accept the excess skin. In a way it is a badge of honor for having lost the weight (or had a baby). I'm just saying there may be hope for those who rather not accept it and are willing to do what it takes to lose it naturally and safely if they can.

fitterpam

Fair enough, but back to my point that 10% might be reasonable for men (although it is still quite low), it is certainly not healthy for women do to so. And I think the reason that most people that have enough weight to lose is to be healthy. Maybe this is just my opinion, but my health isn't worth disrupting my hormones, possible bone density issues and low energy. I have the pleasure of all of that now. I'm losing weight to get away from all of those items. If excess skin is what I have to pay for my history, I guess I'll have to do it. It would certainly act as a reminder to not make those choices again for excessive weight gain.

FitnessTim

I knew this would be a heated discussion but I'm glad I posted it. Fitterpam raised the topic of health issues found in female athletes with a low percentage (8%) of body fat. To be clear, I'm suggesting you could reduce your body fat within a safe range (as Fiiterpam lists 15-18% body fat and women have 20-25% body fat).

Personally, I'm not an athlete but I was able to get my body fat down to 10% for a short period of time with no obvious ill side effects other than appearing gaunt (not attractive). Even as a man that is probably a little extreme.

People can quote statistics and studies that show a wide range of tolerance for body fat percentages. The truth is no one has been able to state with certainty what the healthy range of body fat is. I consider Fitterpam's quote from the American Dietic Association to be the rule of thumb but other recent studies have shown that higher percentages may be healthier.

I'm a firm believer that the best source of health advice is found in our traditional healthcare industries. However they are not infallible and unbiased. How many of us have gone to a doctor for advice and that doctor is overweight? I read one statistic that says 54% of the nations nurses are overweight or obese. (http://www.ncbi.nlm.nih.gov/pubmed/18460166). Huh?!

Someone mentioned the figure of $10,000 to get the surgery done. Yikes! It's definitely worth it if you have that kind of money. I can afford that if needed but are we to tell the majority of hard working Americans out there, "Sorry. Looks like your stuck with flabby skin."?

I would like to see studies done by the medial community with statistics that either prove or discount the possibility of losing excess skin through body fat reduction. If they are out there I couldn't find them. My guess is that nobody would fund those studies as there is no profit to be had and there is no genuine health risk related to a moderate amount of excess skin.

I don't have a personal stake in this. I don't have excess skin and I'm not overweight. I know people that do and I often get asked the question about how to get rid of excess skin. My stock answer is that surgery is typically the only solution.

Thank you all for your input and feedback. At the very least we may help those who considering surgery but may feel like they have not tried hard enough on their own. If you come to a point in your weight loss where you are even considering lowering your body fat below healthy levels, you have already done enough. You've done your part.

As you probably notice, I seem to be on both sides of the fence with this discussion. In truth I am torn. In the absence of hard data I tend to question the status quo.

JDMPWR

i love to argue this topic and i have first hand proof to argue this all day but I am off to bed. tomorrow I will respond.

fitterpam

LOL - I'm not arguing this just to be argumentative, I find it fascinating. This has been a topic of great discussion lately and has gotten me thinking quite a bit. Bear in mind that this is the second time in my life that I've had a huge loss of weight (the first time I was 19 and lost over 40lbs to get to 170 - which was my lowest adult weight and at the top end of my Normal BMI range). I've never given excess skin a second thought until recently. It is possible to lose weight to get to a normal range without excess skin. At >50lbs lost at this point, I still am not experiencing any signs of excess skin although I still have just under 70lbs to go. Now the first time I lost, it was mainly through exercise (19 year olds LOVE their hot chocolate with whipped cream - at least I did) and this time, it has been mainly through food because of health issues.

So I will continue to do research on the topic, but many of the pieces of information I've read seem to point to muscle loss as being one of the main culprits. The article I'm reading now (which has laid it out quite well) http://www.bodyfatguide.com/LooseSkin.htm explains his theory that loose skin is caused by a loss of muscle mass generally brought on by crash diets. This to me makes some sense and touches on one of your points (although he has expressed it differently). His thought is that you need to change the body's composition vs. lose further weight. So rather than trying to get to a % of body fat, you need to up your body muscle%. You may have the same amount of fat% as before, but your muscle% needs to increase. Does that make sense? It's a small difference in the two statements because by increasing muscle% you are essentially decreasing body fat %, but that isn't the primary focus of your efforts.

My favourite quote from the article: "Experienced dieters often take a weekly "break day" from dieting, knowing that it recharges them. Regardless if replenishment occurs daily, every several days, or weekly or more, failure to restore depleted lean body mass is the number one cause of "loose skin."

I do have break days when I need them and always have. This, for me, is a lifestyle change, and going without for the rest of my life is not an option. It's about learning to control my impulses to eat things constantly - I have no sense of "a little bit". I'm glad to hear that these days of indulgence (and ti's not always junk....sometimes it can be a beautiful steak with ceasar salad....mmmmm) are actually one of the reasons that I don't see the loose skin.

I also constantly monitor my body composition (once every 50lbs professionally in a water tank thingy) and I have a scale that seems pretty accurate too that I borrow monthly to view. When I learned that I had lost 15% of my body weight, I stepped on the scale and it read a 13.5% body fat drop (from 44.5% body fat to 31%) - and the 1.5% difference was closely related to the # of lbs I'd lost that first week which was mostly water weight. I may have lost a little lean muscle, but it's not a huge amount. I'm going to continue to focus on the food aspects until I get to a more comfortable weight - only 10lbs away from that now and then go gang busters on the muscle development exercises. I wanted to be in the 50lbs lost for a week before I go do it again....need to make my appointment for later this week now

Thanks for bringing up the topic. I've been saying for the last 2 weeks that I need to look into it and your claim (at the time of the initial post, I thought was ridiculous) really has made me look at my beliefs. If that was your intention, thank you. If that was not your intention, thank you even more

NatalieWinning

In my case I was very low body fat with a large weight loss at 35 years old. I had my babies at 22, 24, 26 yrs old. If there was time involved I would have thought that would be enough. The results were the proof, there was soft empty skin. Not elderly skin without elastin, but normal adult skin without fat under it. More noticable if I tightened my muscles it was more pronounced.

All said, it happened, but it wasn't the end of the world. For me it wasn't bad just soft rumpled empty skin. I can imagine for others it may be cumbersome to move around and they might need to get it off to be comfortable in their new bodies if they were especially large before weight loss. It can interfere with movement.

I didn't consider getting it removed. I considered it part of having babies and weight loss. Just like the other parts that get permanently stretched and don't go back. Medically speaking some parts do not shrink back to their original shape and size. The uterus is a muscle, The parts that get stretched having babies do not snap back like a 16 yr old. This is not the forum for that, but the women will understand without much elaboration if they have had babies. :-) It's part of life. We will each find out how we turn out when we loose weight, then decide if it's an issue.

fitterpam

Nammyl, I agree - if it happens, it's just a matter of fact. It's what happens. I'm okay with it. Maybe it's time we do change our perceptions of our bodies. I don't think I'd consider surgery...I would, however, consider Spanx.....LOL

NatalieWinning

Those that mind don't matter, those that matter don't mind

melizerd

I have to wonder how many people that end up with THAT low of body fat ever were more than 100lbs or more over weight? How many had surgery and didn't tell anyone? How many are airbrushed?

As a medical student you won't convince me otherwise since I do know what skin is made up of.

FitnessTim

I have to wonder how many people that end up with THAT low of body fat ever were more than 100lbs or more over weight? How many had surgery and didn't tell anyone? How many are airbrushed?

As a medical student you won't convince me otherwise since I do know what skin is made up of.

Other posters claim to know what skin is made up of but when we say excess skin we really aren't just talking about skin. The outer layer of skin, the epidermis, is thickest at the bottom of the feet and that is only 1.5 mm thick. The layer underneath, the dermis, is thickest on the back at 3 mm thick. This may vary, but typically "excess skin" is much, much thicker than 4.5 mm.

I measured the "skin" on my belly and even as lean as I am it ranges from 11 mm thick to 22 mm thick. It's actually 11 mm at the thickest since it is a fold of two layers. Even if I had extraordinary thick skin (I don't - I'm extremely sensitive) that still doesn't account for 13 mm at the thickest of folded layers.

So what else is there but subcutaneous fat? I've seen pictures of people with excess "skin" that looks to be 6 inches or more thick. It is logical to assume excess "skin" is mostly fat.

I've seen plastic surgeon shows where excess skin is removed and I admit the actual skin does look thick, but it is attached to what appears to be fat. While the doctors don't explain in detail they do say things like "We are now cutting away these sections of skin and fat.".

Fat is fascinating when you considering it from a intellectual point of view. It sits on your body as reserved energy ready to be used if needed. The problem is that in modern society we typically don't need most of our body fat's capacity to store energy.

We often say that people overeat due to emotional issues or low self esteem but really the act of storing away excess fat is a natural and useful mechanism. Or was useful before we perfected agriculture and distribution.

As recommended by experts, I eat six small meals a day. I read the explanation once but looking at it holistically it makes sense. By feeding myself regularly, I'm telling my body that food is readily available so there is no need to store it as fat. By exercising regularly, I'm telling my body to please release energy from fat and have it available for use.

By getting surgery, you are getting rid of skin and fat that you have no intention of using again. Even if you could work off the excess skin, which is doubtful, there is no reason other than to avoid the cost and risk of surgery. If you consider the time, effort and quality of life you would have to sacrifice for a chance to lose the excess skin and fat, surgery is the cheaper option.