I had to tap my thymus a few times after reading this thread.
I challenge anyone here to show me a woman with 10% bodyfat that has "loose skin." The fact is that NO one should be complaining about "loose skin" until they are down to "excellent" body fat percentile.
Many think that when they've lost a great deal of weight(say 150lbs), it was all fat that came off of their body. But in reality, you may have lost a tremendous amount of lean body mass. And this is what occurs when people do not adequately monitor their composition, and employ the proper method of exercise and diet.
Yes, it could very well be that a great percentage of the weight loss was indeed muscle mass. This, I believe, is quite often the case with these "loose skin" situations.
Do you think a person with a fat to muscle ratio like Tom Venuto's would have "loose skin"? Could you show me someone in that situation? And I find it humorous that people quote their surgeons as if they are a source of objective information. They are making their luxury automobile payment with the money from your skin removal surgery! Why would they drive away all of that business? I am not suggesting that some kind of evil is at work here, I mean, a lot of people aren't willing to put the work into allieving themselves anyway. For that we do have very competent surgeons available to assist us as we wish. And gladly there are some doctors who will in fact tell you to lose more body fat before ever considering surgical removal. But most probably won't go far down that rabbit hole, unfortunately.
Ron Brown is correct when he says that people are so brainwashed by "before and after" pictures, that they ignore sense and logic. Generally speaking, most won't even challenge what he is saying, they will only attack the fact that he sells an E-book! A book that is not much about "loose skin" at all, in fact! It is a full spectrum program, it is not as if he is selling skin creams or magic pills.
He makes a fantastic point when he uses the example of a woman who appeared on a radio show. She had lost 200lbs in a year. This woman had complained about having a ton of "loose skin." It is highly likely that she needs to lose remaining excess body fat that still resides within these folds of skin. Of course, if she were to lose another 20lbs, she would look(as he said)like an "emaciated stick!" But this is only because she does not have sufficient lean body mass! She is at no fat deficit, therefore the logical plan of attack is to replenish the lean mass that she lost during her weight loss, and then tackle the fat.
Think about this for a moment:
Now, after your severe diet you have returned to your starting bodyweight of 115 pounds, but your internal body composition is altered. You have 20 fewer pounds of muscle and 20 more pounds of body fat, even though you weigh as much as you did before you put on the extra weight! Would you expect your body to look as firm under these circumstances? NO! The remaining excess body fat is now hanging in folds of skin.-Ron Brown
Can you argue with that?
It is all about transforming the body. Not just taking off "weight" in general, but creating an effective plan. One could use the zig-zag method. Part of zig-zagging can be scheduling individual days for fat loss and for muscle gain, by adjusting caloric intake/expenditure accordingly. It is possible to see a gain in muscle mass and loss of fat during the same month(for example), but nearly physiologically impossible to do both with any measure of efficiency, at the same precise moment in time. Though ultimately this approach is not optimal either way. You are chasing after two goals which are opposite to eachother. So your best bet would be to focus on replenishing lean mass first, and then proceed to remove the last bit of fat. Increase your lean mass, and then burn off the excess fat stores, and you will get optimal results.
Generally speaking, "loose" or flabby skin is an issue of body composition. Tom Venuto also strongly emphasizes the need to retain lean body mass for this very reason. Your skin begins to cling to the muscle as you become leaner. Let's talk men. What, then, do you think would happen if you lost a great deal of weight(say 200lbs!) to ultimately reach balanced composition and your ideal single digit body fat percentage? Would you have thin bags of skin hanging 6 inches off of your chest or arms? It is generally acknowledged that this exists, but no one has ever bothered to demonstrate it. How rare and obscure it must be!
For women specifically, a few celebrity examples of 10% body fat are(or were at some point - most don't retain peak condition) Christie Brinkley, Elle MacPherson, Cindy Crawford.
The point here is to give an accurate picture of what that kind of composition looks like. These are people that have roughly 12lbs of body fat, total. Which is very lean, and falls under the "excellent" category. Many people think they have hardly any body fat left to lose, though really, maybe you've lost 200lbs and think you are done, but you might still have a 20 or 30 pound surplus before reaching the leaner digits. And recognizing that possibility is vital to balancing this composition imbalance naturally. Therefore, as Tom Venuto will tell you, don't complain about "loose skin" until you hit "excellent" percentile.
However, I do not know exactly what happens to the skin when you have a person who literally weighs in the neighborhood of 800lbs, as some tragically do. But I don't know if we would ever find out for certain, because before they ever came down to a very lean state, they would have been forced to have surgery. Those people have to, because their ability to function at a basic level is being impaired. So, let it be known that I am not saying that surgery is never needed. But I believe that it is only the extreme of extreme situations in which it is actually the only possible way to alleviate the problem.
At the end of the day, it is all about monitoring composition. It is that people go about weight loss all wrong. Losing weight too fast in addition to burning off lean body mass is a bitter cocktail. Maintaining vital balance requires a degree of management.
Burn the fat, feed the muscle. And in the case that you are where you should be, and you still have loose skin, then considering surgical removal makes sense.