HIM
Published on July 2025
Weight loss medications such as Ozempic (semaglutide), Wegovy (semaglutide), Mounjaro (Tirzepatide), and Retatrutide have led to significant body changes for many patients. While these medications have proven effective in reducing body fat, rapid or substantial weight loss can result in excess sagging skin. This is a common and expected outcome, especially in those patients who have lost a large percentage of body mass or who have experienced weight fluctuations over time.
Understanding what causes skin laxity after weight loss and the available options to address it can help patients make informed decisions about the next steps in their body contouring journey.
Why Does Skin Become Loose After Weight Loss?
Skin has elastic properties designed to accommodate weight gain by stretching over time. However, when the skin is stretched beyond its natural limits for prolonged periods, the collagen and elastin fibers that support it can become damaged or permanently weakened.
Rapid weight loss, such as that seen with GLP1-1 medications like semaglutide and Tirzepatide, decreases the underlying fat volume, but does not address the stretched skin, often leading to a deflated or sagging appearance.
Common areas where sagging skin is reported include:
• Face and neck
• Upper arms
• Abdomen
• Inner and outer thighs
• Buttocks
• Breasts and chest area
What Influences Skin Retraction After Weight Loss?
Several factors influence whether skin will tighten naturally or remain loose:
• Age: Younger patients tend to have better skin elasticity.
• Genetics: Some individuals are predisposed to better collagen support and skin elastic properties
• Amount of weight lost: Larger amounts of weight loss increase the likelihood of excess skin.
• Duration of prior weight gain: Skin that has been stretched for many years is less likely to retract.
• Speed of weight loss: Rapid changes in body size, common with GLP-1 medications, increase the risk of skin laxity.
In many cases, the skin does not return to its original shape and must be contoured with surgery.
Surgical Options for Skin Removal and Contouring
Plastic surgery offers effective and long-lasting solutions for excess skin following significant weight loss. Procedures are tailored based on the patient’s anatomy, goals, and overall health. Common procedures include:
• Facelift or Neck Lift: Restores definition to the jawline and removes sagging in the lower face or neck.
• Brachioplasty (Arm Lift): Removes loose skin from the upper arms.
• Abdominoplasty (Tummy Tuck): Tightens the abdominal wall muscles and eliminates excess skin and tissue from the midsection.
• Thigh Lift: Removes excess skin from the inner or outer thighs.
• Lower Body Lift: Addresses circumferential skin laxity affecting the abdomen, flanks, buttocks, and outer thighs.
• Breast Lift or Reduction: Elevates and reshapes the breast contour after weight loss-related deflation.
Combination procedures may be performed in stages depending on recovery, safety, and the areas of concern.
Non-Surgical Skin Tightening Options
Non-surgical treatments may be beneficial for patients with mild to moderate laxity who are not candidates for surgery or who prefer minimal downtime. These treatments stimulate collagen remodeling and improve skin tone over time:
• Radiofrequency-based devices (e.g., Morpheus8, Thermage)
• Ultrasound therapy (e.g., Ultherapy)
• Microneedling with RF energy
• Laser skin tightening
It is important to note that while these treatments can enhance skin quality, they do not remove excess tissue and cannot replicate the results of surgical excision.
Timing Considerations
Skin tightening procedures are typically recommended once a patient’s weight has stabilized for at least three to six months. Operating before weight stability increases the risk of additional skin changes post-surgery, which can compromise long-term results.
Conclusion
Semaglutide and similar GLP-1 medications offer powerful tools for long-term weight management, but patients should be aware of the potential for sagging skin following weight loss. While some degree of skin retraction may occur naturally, especially in younger patients, body contouring procedures remain the most effective method for removing excess tissue and restoring body shape.
A consultation with a board-certified plastic surgeon, specializing in post-weight loss body contouring, can help determine the most appropriate treatment plan based on the extent of skin laxity, overall health, and personal goals.
