Professor Dr. med. Adrian Dragu is a specialist in Plastic and Aesthetic Surgery with an additional qualification in Hand Surgery. He heads the Department of Plastic and Hand Surgery at the University Hospital Carl Gustav Carus in Saxony. His areas of expertise include burn treatment (burn surgery) and hand surgery.
In addition, Prof. Dr. Dragu completed a second degree, earning a Master of Health Business Administration. The Department of Plastic and Hand Surgery provides interdisciplinary treatment for a wide range of injuries and complex cases. A 24-hour replantation service is available for emergencies, such as severely injured or amputated body parts, particularly hands. Once the patient has recovered, plastic surgery is often performed to cosmetically restore disfigured areas of the body, such as burn scars. Skin tightening procedures following major weight loss and breast reconstruction after breast cancer treatment also fall within the scope of Prof. Dragu's department.
Autologous tissue transplants are frequently used in such procedures. The field of Plastic and Aesthetic Surgery, as well as Hand Surgery, is also actively involved in research and teaching. Prof. Dr. Dragu is a member of the examination board and plays a significant role in research projects, including studies on obesity, ischemia and reperfusion of human tissue, and the development of bionic prosthetics.
The editorial team at Leading Medicine Guide spoke with Prof. Dr. Dragu about how to restore an aesthetic body shape after significant weight loss.
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Significant weight loss—whether achieved through surgical interventions such as bariatric procedures or through consistent lifestyle changes—often leads to major health and aesthetic improvements. However, the joy of weight loss is frequently overshadowed by the development of excess skin that, due to the dramatic change, cannot fully regain its elasticity. These skin folds not only cause aesthetic and psychological strain, but can also lead to physical complaints such as skin irritation, inflammation, or restricted movement. As a result, patients often experience serious functional limitations. Body contouring procedures offer the opportunity to remove excess skin and restore body shape, thereby improving both function and body image in the long term. Modern plastic and reconstructive surgery takes a holistic approach to address functional, medical, and aesthetic concerns equally.
Excess skin following significant weight loss is a common phenomenon influenced by several factors.
“First, I have to point out that obesity has become a major problem in societies worldwide. One in three people is overweight, and unfortunately, childhood obesity is also on the rise. People are becoming increasingly obese, which in turn means that morbidity is increasing. Even simple surgeries are significantly riskier for obese patients. The heavier the patient, the more complex the procedure, the longer the hospital stay, the higher the complication rate, and the more medication is usually required. Overweight patients frequently suffer from high blood pressure and/or diabetes,” emphasizes Prof. Dr. Dragu at the beginning of our conversation, and continues:
“Once someone decides to lose weight, the first question is whether to pursue a conservative approach—using diets or medications like semaglutide—or to consider bariatric surgery, such as gastric bypass or sleeve gastrectomy. If one of these paths is followed and a person actually loses a significant amount of weight, it might be just 10–20 kilos—or more than 150. I once had a patient who lost 193 kilos. In such cases, it’s similar to pregnancy: some people’s skin retracts well, others’ does not. Particularly in formerly severely obese patients, the regression of excess skin is often biologically impossible. With extreme skin redundancy, the skin quality suffers greatly. It becomes irritated, fungal infections develop easily, skin folds rub against each other, there’s a constant risk of infection, and massive functional impairments may lead to physical disabilities. This is not about cosmetics—it’s about restoring social participation. Many obese patients are permanently unable to work by their mid-20s, missing up to 150 days a year. If functional impairments are medically documented and assessed from a plastic surgery perspective, a reimbursement request can be submitted to the health insurance provider. Unfortunately, it is still very difficult to obtain approval for such procedures, as insurers and medical reviewers wrongly categorize body contouring surgeries as purely aesthetic. In truth, these are highly complex procedures involving significant risks, such as large scars, wound healing disorders, lymphatic fistulas, or postoperative bleeding—they cannot be compared to a standard cosmetic tummy tuck, which usually involves removing a small amount of tissue purely for aesthetic purposes.”
As we age, the body produces less collagen and elastin—proteins responsible for the firmness and elasticity of connective tissue. Therefore, older individuals are more affected by excess skin than younger ones. The duration of being overweight also impacts skin resilience: prolonged stretching limits the skin’s ability to retract. Particularly rapid and substantial weight loss, such as after bariatric surgery, often leads to pronounced skin redundancy. Genetic predispositions also play a role, as skin quality varies from person to person.
“The most commonly affected areas are those where fat accumulated most during obesity. Abdominal excess skin often forms a so-called panniculus that extends forward and downward, sometimes even covering the entire genital area. The inner thighs are also frequently affected. Next come the breasts—in both women and men—resulting in sagging and loss of firmness, occasionally reaching down to the navel. This constant skin-on-skin friction frequently causes pain, moist areas, and irritation. The upper arms are prone to flabby, hanging skin—often called ‘bat wings’—although they sometimes retract well,” explains Prof. Dr. Dragu.
After significant weight loss, there are several options available to remove excess skin and improve body contours.
The most effective and lasting method is surgical removal of the excess skin, performed as part of plastic surgery procedures. These operations aim to enhance the aesthetic appearance and, more importantly, alleviate functional issues like skin irritation or restricted movement. “It is often mistakenly assumed that these complex reconstructive procedures are just simple ‘fat-cutting’ surgeries. Unfortunately, we also see non-specialist surgeons—from general surgery, dermatology, or even oral and maxillofacial surgery—irresponsibly attempting these procedures. It must be clearly stated: body contouring reconstruction belongs solely in the hands of certified plastic surgeons. The treating physician must hold the title of specialist in Plastic, Reconstructive and Aesthetic Surgery. Only then can patients be assured that the required level of expertise is met, and that appropriate surgical techniques and safe management of large wound areas are guaranteed. An experienced plastic surgeon must know exactly where to cut in these compromised soft tissue conditions to avoid or minimize complications. Sometimes a combination of methods—such as liposuction and resection—is required. It’s also crucial to consider any previous surgeries, especially in the abdominal area, such as appendectomies, gallbladder removals, or C-sections, as scar tissue can complicate surgery or require a modified incision pattern. A skilled plastic surgeon will know how to adjust accordingly. Standard resection techniques involve scalpels and are often combined with liposuction, particularly in the abdomen and thighs,” Prof. Dr. Dragu clarifies, offering an illustrative example:
“The largest abdominal panniculus I’ve ever removed weighed 25 kilograms. Typically, they weigh between 3 and 5 kilos. For the thighs, it’s about 500 to 1500 grams per side, and for the breasts, between 500 and 1000 grams per side on average. However, weight isn’t usually the decisive factor—it’s the surface area that matters. This varies greatly from patient to patient.”
To perform a body contouring procedure after weight loss in a medically appropriate way, certain criteria must be met to ensure both the safety of the operation and the long-term success of the treatment.
“It is absolutely essential that the patient is psychologically stable. If someone has a distorted body image—for example, a condition known as body dysmorphic disorder (BDD)—they must first be able to realistically assess their own body weight. Obese individuals o
Before the procedure, the patient undergoes a comprehensive assessment, including a physical examination of the skin excess, a thorough medical history, and, if necessary, imaging studies. The goal is to tailor the surgical strategy to the individual and to minimize the risk of complications such as wound healing disorders or infections. Taken together, these criteria ensure that the procedure is not only aesthetically meaningful but also medically sound, sustainable, and safe.
Body contouring procedures after weight loss are complex surgeries associated with specific risks and potential complications.
“In addition to the usual surgical risks such as embolisms, bleeding, and infections, patients may experience long, visible, and sometimes unattractive scars. Asymmetries can also occur—especially around the navel—simply because it’s difficult to precisely identify the midline during surgery. Of course, we always strive to make everything as symmetrical and gentle as possible, but perfect symmetry is not always achievable. Overall, however, the complication rate is quite manageable—provided the surgeon knows exactly what they’re doing. In terms of duration, breast procedures take about 3 hours, abdominal surgeries around 2 to 3 hours, and thigh lifts approximately 1 to 2 hours. Hospital stays typically last 7 to 10 days,” says Prof. Dr. Dragu.
A close postoperative follow-up is also crucial. Regular check-up appointments help detect and manage complications early. Patients should receive comprehensive guidance on aftercare, including the proper use of compression garments, avoiding physical strain during the first eight weeks, and scar care. In the long term, a healthy lifestyle—featuring a balanced diet and moderate exercise—helps maintain surgical outcomes and reduce the risk of complications.
Aftercare plays a key role in securing long-term surgical success following body contouring procedures, as it supports the healing process, prevents complications, and optimizes both aesthetic and functional outcomes.
“Postoperative care follows a very structured protocol. Patients undergoing abdominal surgery wear an abdominal binder for eight weeks. Sometimes compression garments or compression shorts are also required. Sutures are usually removed after about two weeks, and for the first eight weeks, patients should not lift anything heavier than five kilograms. In some cases, thrombosis prophylaxis is necessary. Manual lymphatic drainage can help relieve the lymphatic system. As for future healthy eating habits, those ‘homework assignments’ are handled beforehand—either in obesity centers or in collaboration with dieticians—because plastic surgery is ultimately the final step,” Prof. Dr. Dragu explains.
Aesthetic measures such as scar care also play an important role. The targeted use of scar creams, silicone patches, cortisone injections, or laser therapy can improve scar appearance and prevent hypertrophic scarring. Depending on the patient’s healing process and skin type, these treatments may be needed for several months to achieve optimal results.
For follow-up, Prof. Dr. Dragu states: “Of course, we see our operated patients after surgery—and then again at around six and twelve months for follow-up evaluations. In most of these check-ups, we observe a dramatic improvement in the patient’s quality of life. Previously elevated blood pressure has often normalized, and the need for medication has decreased. Self-image also improves significantly. That said, a small number of patients relapse after five or six years, falling back into old patterns and habits. The initial positive effect of the surgery fades for them. That’s why it’s so important to help patients understand that maintaining their results is a lifelong responsibility. Many of them have endured 15 to 20 years of suffering before coming to see me,” and he adds a wish for the future:
“It’s essential that patients are well informed. There should be a legal requirement that body contouring surgeries may only be performed by board-certified specialists in Plastic, Reconstructive, and Aesthetic Surgery. After all, I don’t perform allergy testing, extract teeth, or remove appendixes or gallbladders. Unfortunately, many doctors wrongly claim expertise in plastic surgery—it’s purely profit-driven, without concern for patient safety or specialist training. Clearer and stricter regulations are needed. Patients also need to compare options more thoroughly when choosing a surgeon—just like when buying furniture. You go to several stores, compare, and ask tough questions! I recommend asking: 1) Are you specifically board-certified in Plastic, Reconstructive, and Aesthetic Surgery? 2) Since when? and 3) How many of these procedures have you performed? At the same time, it would be helpful if health insurers had greater understanding for the physical suffering of patients who have lost significant weight but are left with excess skin. These are severely ill patients with a long journey behind them who want to return to social life and employment. Their limitations are severe and medically verifiable—this has nothing to do with cosmetic surgery.”
Thank you very much, Professor Dr. Dragu, for this informative interview!
