Most patients taking GLP-1 agonists are experiencing positive outcomes for managing type 2 diabetes and obesity. With all the fanfare around losing weight, there is a potential drawback for some patients: loose skin that results from drastic weight loss.

Some proactive instructions can be given to reduce the risk, and there are restorative options as well to help with skin laxity.

Explaining How Loose Skin Results From Weight Loss

Loose skin is a significant concern for patients who have rapid weight loss on a GLP-1. Sometimes loose skin following weight loss can be severe and disfiguring; however, the majority of patients do not experience severe skin laxity but even mild-to-moderate cases can be upsetting for some, said Lindsey Bordone, MD, board-certified dermatologist in the Department of Dermatology of Columbia University Medical Center in New York City.

She said there is often improvement in skin laxity after weight stabilization: a period of 6-12 months of skin remodeling at the new weight.

“This happens naturally since our skin is always remodeling. The degree of improvement can vary with some patients later opting for removal of excess skin in severe cases,” said Bordone.

When prescribing a GLP-1, and during follow-up appointments, to your patients, consider sharing this guidance from Bordone.

Slow and steady weight loss. It is important to lose weight slowly, at a rate of about 1-2 pounds per week, said Bordone. “And if symptoms such as orthostatic hypotension, noticeable skin laxity, or fatigue develop, it is important to take breaks along the weight-loss journey so that the body has time to adjust to a new body composition,” she said.

Encourage exercise. Exercising is important to enhance blood flow to the skin. Opt for strength training to keep tissue under the skin toned.

Stress hydration. It’s vital since weight loss can lead to significant fluid shifts. “Skin sagging is accentuated by dehydration,” said Bordone.

Rely on protein. A protein-rich diet can build muscle.

Loose Skin Can Affect Daily Living

Not only does sagging skin become a vanity and confidence issue but it can also affect one’s health.

“Skin laxity isn’t just a cosmetic issue,” said Bordone. “In cases of severe skin laxity patients can develop intertrigo where skin in folds is chronically damp, warm, and dark leading to an overgrowth of yeast and resulting in painful skin breakdown at times. Further, chronic skin breakdown leaves patients susceptible to bacterial skin infection and often result in a chronic foul odor which is embarrassing for the patient.”

Older patients, particularly postmenopausal women, are most likely to experience skin laxity due to loss of collagen and elastin and also due to both age and a decrease in estrogen, according to the American Academy of Dermatology Association.

Also, weight loss leads to significant skin laxity that accentuates the wrinkled appearance of sun-damaged skin, Bordone said.

Weight loss further exacerbates the wrinkled appearance of sun-damaged skin or cigarette smoke-damaged skin, she said. “Like sun worshippers, smokers have more wrinkled skin,” said Bordone.

What Can Patients Do

“People that undergo such rapid weight loss may be happy when they get on the scale and buy new smaller clothes, but when they look in the mirror, they may discover the rest of their body is sagging and aging prematurely,” said Lyle Leipziger, MD, chief of plastic surgery at North Shore University Hospital in Manhasset, New York, and LIJ Medical Center in New Hyde Park, New York. He reported that the most common areas of sagging skin are the face, chest, abdomen, and buttocks.

Patients can address loose skin with a variety of options, including surgical and nonsurgical procedures. “Depending on the degree of laxity, surgical procedures from the top down may include a face and neck lift, breast lift, tummy tuck, and body lift procedures,” said Leipziger. “These surgeries would be appropriate for significant skin tissue sagging that would not be amenable to nonsurgical treatment; however, if the descent of tissue in the face is not extreme, nonsurgical modalities may be utilized for improved results. Such modalities might be injectables, radiofrequency microneedling, and ultrasound technology.”

Leipziger cited booming use of GLP-1s resulting in weight loss and sagging skin have dramatically increased the demand for face and body contouring surgery in his practice. “I have seen a noticeable increase in facelifts, breast lifts, and tummy tucks after weight loss from GLP-1 type medications,” he said. “It’s important to know that every patient’s journey may be unique and a thorough evaluation of the patient’s condition by a board-certified plastic surgeon should yield superior results.”

Bordone and Leipziger reported having no disclosures.