Preventing Loose and Excess Skin When Losing Weight
Some people get loose skin after they lose weight and understandably they want to reduce this. So let us review what may be helpful in preventing loose skin and also what treatments are available if you get it.
The first important point to make is there is sadly a lot we don’t know in this area. Most of this is from expert opinion like skin specialists, bariatric and plastic surgeons rather than high-level clinical trials because lots of big trials have simply not been done in this area.
So let us start with the skin. The innermost layer of your skin consists of proteins, including collagen and elastin. Collagen, which makes up 80-95% of your skin’s structure, provides firmness and strength. Elastin provides elasticity and helps your skin stay tight.
Skin looseness after rapid weight loss usually occurs because of damage to collagen and elastin, which after years of being stretched, the skin becomes inelastic and can no longer retract to fit the contours of the body.
Some studies suggest that 70% of those who undergo rapid weight loss (like in bariatric surgery) have loose skin and this is more likely in women and people over 50 years of age. Furthermore, chronic sun exposure can damage the skin’s collagen and elastin which prevents skin retraction, as does smoking cigarettes. Genetics also contributes, of course, some are simply lucky!
So what can you do about it? Here is a list of things that may help:
- Skin can take up to 1-2 years to contract AFTER a stable weight has been reached, hence give it time.
- Losing weight more slowly OR losing weight periodically may give the skin more time and ability to retract. Hence you could lose 2-3kg a month consistently, or lose it periodically e.g. lose 6kg in a month and then stabilise your weight for a month and then repeat. NB – this is more experience based rather than evidence-based
- Quit smoking!
- Exercise programs including resistance and strength training. So finding an exercise physiologist may be helpful. We review this in more detail in week 5.
- Stay hydrated
- Take care of any skin folds as infections can develop – so keep them clean and dry
As is often the case the evidence for most supplements is very poor and often sponsored by the manufacturer so probably biased. Speak to your doctor or pharmacist about them before starting to check they are safe and won’t interact with any other supplements or medications you are taking. However, these are worth a mention:
- Collagen supplements = Fortunately, we actually have reasonable information about this supplement. A systematic review concluded that oral collagen supplements increase skin elasticity, hydration, and dermal collagen density useful for wound healing and skin ageing. Collagen supplementation is generally safe with no reported adverse events in this study. Doses were collagen hydrolysate, 2.5g/day to 10g/day or collagen tripeptide for 24 weeks, 3g/day for 4 to 12 weeks
- Omega 3 (via algae oil or fish oil and possibly flaxseed oil) = There was one small study of 24 women, (which I strongly suspect is sponsored by the skin care product it was studying, hence susceptible to bias!) showing that ~2000mg-3000mg of omega 3 oil a day increased skin elasticity by 10% after 3 months of treatment compared to the control group who got nothing. I can’t find other studies to back this up, so it is hard to know if this is true or not. Again I would say – up to you whether you want to spend that money or not for theoretical benefits. The American Heart Association says taking up to 3000mg of fish oil daily in supplement form is considered safe but the main side effects are increased bleeding, reflux, nausea and diarrhoea. Speak to your pharmacist or doctor for more information.
- Vitamin C = There are no studies that I can find on vitamin C specifically for loose skin post weight loss. There are lots of studies looking at vitamin C for skin health overall, suggesting vitamin C is important for the production of collagen and possibly elastin as well however the elastin studies are small and lab-based. Interestingly high dose vitamin C supplementation seems to impair elastin production as well so my take from this is don’t supplement with vitamin C, just have foods that are naturally high in it like citrus, berries, capsicum, herbs like thyme and parsley, kale and broccoli. If you must supplement with it, stick to low-moderate doses.
- Supplements like zinc and soy have been mentioned in various articles but I cannot find any actual evidence to show they help. For zinc I found one small study of people who put it on their skin and found less wrinkling but that is a big leap to saying oral zinc will help with loose skin post weight loss. Zinc can cause nausea and vomiting and hence is usually taken after a meal and at night.
- Filming and “tightening creams” are unlikely to do anything but moisturising the skin is always a good idea.
- Laser, intense pulsed light (IPL), radio frequency and ultrasound skin-tightening treatments all stimulate the production of collagen – these can be costly and if you are considering this then find a qualified skin specialist. They may help for mild-moderate skin looseness
- For severe skin looseness – body contouring surgery with plastic surgery is an option. There may be multiple benefits like reduction in pain associated with carrying around excess skin, improvements in self-esteem, ease of movement and less skin irritation