July 19, 2026 | Body Contouring
A patient sat across from me last year having lost just over a hundred pounds. She had a tiny waist and a real spark in her eyes, and she was also close to tears, because skin was hanging from her abdomen, her breasts, and her inner thighs and no amount of work at the gym had budged it.
I told her what I tell everyone in that chair. You did the hardest part already. What is left is not a discipline problem. It is a tissue problem, and only surgery removes loose skin. Here is the longer version of that conversation, drawn from real consultations and anonymized.
Why the Skin Will Not Go Back
Once skin has been stretched that far for that long, the elastic fibers are spent. You can be at a great weight with a tiny waist and still have skin hanging from the breasts, the abdomen, the inner thighs, and the arms.
That is not something more exercise fixes. The only thing that removes loose skin is surgery, and that is precisely what body contouring after major weight loss is designed to do.
What I Do for the Breasts
After massive weight loss the breast usually still has volume, it is just hanging very low. Most of the time you get a beautiful result from a breast lift alone, without an implant. I bring the nipple up, remove the excess skin, and because your skin has lost its elasticity, I place a mesh on the inside so we are not relying on that skin anymore. Without the mesh, everything tends to drift back down over time.
When the breasts are extremely low, I often recommend against putting in an implant at the same time as the lift. When the nipple has to travel a long way up, adding an implant in the same operation can compromise the blood supply to the nipple. An implant is an easy second step later. One breast is almost always larger than the other, so I trim the bigger side to match.
Tummy Tuck or the All-the-Way-Around Version?
With a standard tummy tuck I make a low incision, remove the excess skin, pull everything down tight, and repair the muscles up the middle and along the sides so you get a corset effect and a smaller waist. I combine it with liposuction.
After massive weight loss, a lot of the looseness wraps around the sides and the back, so I often recommend the circumferential procedure, also called a lower body lift. The incision continues all the way around, which lets me pull the skin down in front and also lift the outer thigh and the buttock at the same time. It is the most complete option when the laxity is not just in the front.
What If You Are Still Loose Up and Down After That?
I will tell you the honest tradeoff. The circumferential lift pulls everything down and in, but if you have a lot of side-to-side laxity, you may still have some looseness up top. The only way to remove that completely is a vertical incision that brings everything in like a corset.
Most people prefer to avoid that scar because it is harder to hide, so I almost always leave it as an optional second stage, to be done later only if it truly bothers you.
And the Inner Thighs
When there is real excess skin on the inner thighs, liposuction alone will not do it. I place an incision in the groin crease that continues just below the buttock and pull everything up, the same way the body lift incision does. If you want it even tighter, that requires a vertical scar down the inner thigh, which I again reserve for later.
I want you to know up front that the thigh lift is the hardest of these to recover from. Right where the tension pulls upward, the incision tends to open a little, almost every time. The good news is we just keep it covered with gauze, it closes on its own in about two to three weeks, and a lot of the time we do not even have to revise the scar.
How Much Weight It Removes, and When to Have It
A procedure like this removes roughly ten pounds. If your BMI is already below thirty you are very close to ideal, so I tell patients to lose whatever they still want to lose before surgery, then simply maintain afterward. Stable weight gives you the best, longest-lasting result.
| Stage | What It Addresses | When I Do It |
|---|---|---|
| Core lower body lift | Front, sides, back, outer thigh, buttock | First, primary stage |
| Breast lift | Low-hanging breasts | Same plan, often paired |
| Vertical scar revision | Stubborn up-and-down laxity | Later, only if it bothers you |
| Implant add | Upper fullness after a lift | Second step, low risk |
Why I Stage It This Way
I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery, with a Mayo Clinic plastic surgery fellowship, and I teach as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Body contouring after massive weight loss is not one operation for everyone, it is a plan. I would rather give you a safe, powerful result now and keep the more aggressive scars in reserve than chase perfection in a single surgery and put your healing at risk. We decide together what is worth it for you.
Ready to Talk?
If you have lost the weight and you are ready to deal with the skin, let us build a plan together.
For the surgeon’s editorial take, see the companion essay on drworldwide.com. For the El Paso treatment menu, see the version on swplasticsurgery.com.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.
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