8. There are exceptions to all of the above; i.e, people who gained and then lost incredible amounts of weight quickly at age 50 or 60, and their skin returned 100% to normal.

9. There are many creams advertised as having the ability to restore the tightness of your skin. None work – at least not permanently and measurably – and especially if you have a lot of loose skin. Don't waste your money.

10. If you’re considering surgical skin removal, consult a physician for advice because this is not a minor operation, but keep in mind that your plastic surgeon may be making his BMW payments with your abdominoplasty money. (It’s possible that surgery may be recommended in situations where it's not 100% necessary). Surgery should be left as the ABSOLUTE FINAL option in extreme cases.

11. Give your skin time. Your skin will get tighter as your body fat gets lower. I've seen and heard of many cases where the skin gradually tightened up, at least partially, after a one or two year period where the weight loss was maintained and exercise continued.

12. Know your body fat percentage before even thinking about surgery. Loose skin is one thing, but still having body fat is another. Be honest with yourself and do that by taking your body fat measurement. This can be done with skinfold calipers or a variety of other devices (calipers might not be the best method if you have large folds of loose skin. Look into impedance analysis, underwater weighing, DEXA or Bod Pod).

Suppose for example, a man drops from 35% body fat all the way down to 20%. He should be congratulated, but I would tell him, "Don't complain about loose skin, your body fat is still high. Press onward and keep getting leaner.”

Average body fat for men is in the mid teens (16% or so) Good body fat for men is 10-12%, and single digits is extremely lean (men shouldn’t expect to look “ripped” with 100% tight skin on the abs unless they have single digit body fat, and women low to mid teens).

Except in extreme cases, you are very unlikely to see someone with loose skin who has very low body fat. It's quite remarkable how much your skin can tighten up and literally start to “cling” to your abdominal muscles once your body fat goes from “average” to "excellent." Someone with legitimate single digit body fat and loose skin is a rare sight.

So... the key to getting tighter skin is to lose more body fat, up to the point where your body composition rating is BETTER than average (in the “good” to “great” category, not just "okay"). Only AFTER you reach your long term body fat percentage goal should you give thought to "excess skin removal." At that point, admittedly, there are bound to be a few isolated cases where surgery is necessary if you can’t live with the amount of loose skin remaining.

However, unless you are really, really lean, it's difficult to get a clear picture of what is loose skin, what is just remaining body fat and how much further the skin will tighten up when the rest of the fat is lost.

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