Aspects of excess skin in obesity, after weight loss, after body contouring surgery and in a reference population

Surg Obes Relat Dis. 2019 Feb;15(2):305-311. doi: 10.1016/j.soard.2018.10.032. Epub 2018 Nov 5.


Background: Excess skin is well known after massive weight loss but, there is missing knowledge from various groups.

Objectives: To describe and compare excess skin in a reference population during obesity, after obesity surgery, and after reconstructive abdominoplasty.

Setting: University hospital, Sweden.

Methods: The following 6 groups were included: the reference population, obese adults before obesity surgery, obese adults after obesity surgery, adolescents after obesity surgery, super-obese adults after obesity surgery, and adults after abdominoplasty. All groups filled in the Sahlgrenska Excess Skin Questionnaire (SESQ). Some groups also underwent measurements of ptosis/excess skin on 4 body parts.

Results: All groups scored significantly higher experience of and discomfort from excess skin compared with the reference population. SESQ scores were significantly higher for obese adults (10.5 ± 8.5) and even higher for adults and adolescents (12.3 ± 8.1 versus 14.4 ± 7.7) after obesity surgery compared with the reference population (1.5 ± 3.5). Abdominoplasty resulted in significantly reduced scores (2.9 ± 5.2). Those undergoing obesity surgery and weight loss had significantly less excess skin measured on arms, breasts, and abdomen compared with before surgery, except for the upper arms on the adolescents. Excess skin increased on inner thighs in both age groups after weight loss. Correlations between objectively measured ptosis/excess skin and the patients' experience of and discomfort were .16 to .71, and the highest correlations were found among adolescents.

Conclusion: Excess skin is not a problem for the vast majority of the normal population but is linked to obesity and massive weight loss. The SESQ score illustrates major problems related to excess skin both for obese adults and after obesity surgery for adults and for adolescents, who have problems similar to or worse than adults. Abdominoplasty markedly decreases symptoms.

Keywords: Abdominoplasty; Excess skin; Obesity; Postbariatric plastic surgery; Questionnaire; Weight loss.

MeSH terms

  • Abdominoplasty*
  • Adolescent
  • Adult
  • Bariatric Surgery*
  • Body Contouring*
  • Body Image
  • Female
  • Humans
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*
  • Skin*
  • Surveys and Questionnaires
  • Sweden
  • Weight Loss*
  • Young Adult