If you're overweight or if you've been overweight in the past, then you know that getting rid of excess pounds is only one of the challenges you face. Once the fat is gone, you are often confronted with an equally frustrating cosmetic problem; Loose skin.

I know this is a big problem because I receive a ton of e-mail from people who have loose skin or from overweight people who are concerned about having loose skin after they lose the weight. Just recently, I received this email from a reader of my syndicated “Burn The Fat” Q & A column:

“‘Tom, I began a fat loss program using your Burn The Fat program and it worked so well I got down to 15 1/2 stones (from 19). However, this has caused me a problem: Excess abdominal skin. I didn't crash lose this weight, it came off at the rate of about 2 lbs. per week just like you recommended. Now I'm unsure of whether to carry on, as my abdomen has quite a lot of excess skin - I feel like I've turned into a bloody Shar-Pei! (You know, that ‘wrinkly’ dog!)

Does everyone go through this? Will the skin tighten up? I was overweight for more than 12 years. Am I going to end up needing surgical skin removal? Can you offer me any advice? I'm a medical student in the UK and my colleagues seem determined to proffer surgery as the only option.”

There are 12 things you should know about loose skin after very large weight losses:

1. Skin is incredibly elastic. Just look at what women go through during pregnancy. Skin has the ability to expand and contract to a remarkable degree.

2. Elasticity of skin tends to decrease with age. Wrinkling and loss of elasticity is partly the consequence of aging (genetic factors) and also a result of environmental factors such as oxidative stress, excessive sun exposure, and nutritional deficiency. The environmental parts you can fix, the genetics and age part, you cannot. Advice: Get moving and change the things you have control over... Be realistic and don't worry about those things you don't have control over.

3. How much your skin will return to its former tautness depends partly on age. The older you get, the more an extremely large weight loss can leave loose skin that will not return to normal.

4. How long you have extra weight and stretched skin has a lot to do with how much the skin will become taut after the weight loss: For example, compare a 9 month pregnancy with 9 years carrying 100 excess pounds.

5. How much excess weight was carried has a lot to do with how much the skin will resume a tight appearance. Your skin can only be stretched so much and be expected to "snap back" one hundred percent.

6. How fast the weight was gained also has a lot to do with how much the skin will resume a tight appearance. Your skin can only be stretched so quickly and be expected to "snap back."

7. How fast weight is lost also has a lot to do with how much the skin will tighten up. Rapid weight loss doesn't allow the skin time to slowly resume to normal. (yet another reason to lose fat slowly; 1-2 pounds per week, 3 pounds at the most if you have a lot of weight to lose, and even then, only if you are measuring body fat and you’re certain it's fat you’re losing, not lean tissue).

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