"A lot depends on your age, your genetics, level of sun exposure, how evenly the weight was distributed, and, more importantly, how you feel when you look in the mirror," says Colon. "If you're not unhappy about the way you look, you shouldn't be made to feel you need body- contouring surgery."

Those least likely to want or need the procedure, he says, are usually under age 40. "The majority of the patients I see for this surgery are over 40. It's pretty hard to avoid the slackening effect of the skin after that age," says Colon.

What can also make a difference, however, is where you lose the weight. While a loss of 50 pounds that was concentrated in your midsection might leave you with a lot of loose skin in that area, a 100-pound loss that was more evenly distributed on your body may have less of an effect on skin.

If you do end up with droopy, sagging skin and think there's some other way around it, experts say, forget it.

"Short of surgery, there is really nothing that can help. Exercise won't tighten it, and skin creams and lotions won't do a thing to help," says Nolan Karp, MD, associate professor of plastic surgery at New York University Medical Center.

But body contouring doesn't come cheap. The average price of a full-body lift is around $30,000. Arm surgery runs in the range of $8,000, while inner thighs cost about $10,000 a pair. A breast lift and upper back surgery will set you back about $15,000, and a neck and face lift would add another $15,000 to the bill. (As you probably already guessed, insurance rarely covers any of it.)

When you add to this the need for four to six weeks of at-home recovery, for many, spandex can seem like the only viable option.

In an attempt to make things easier, many doctors use finance companies to help patients work out a kind of "plastic surgery mortgage" -- a payment plan that allows you to reduce the size of your midsection without paying an arm and a leg up front.

Doctors say they also help patients rationalize the expenditure, frequently comparing it to the purchase of a new car.

"Many people wouldn't hesitate to spend $30,000 for a new car. So I ask them, after all that hard work losing the weight, aren't you worth the same $30,000 to look the way you want to look?" says Karp.

7 Things to Do Before Having Surgery

If you are considering body-contouring surgery, here's what experts we talked to said you should do first:

1. Stabilize your weight -- at your goal -- for at least three months, and be sure to correct all nutritional deficiencies (which are common after weight loss surgery).
2. Establish a reliable support network of family and friends to help you during recovery.
3. Make sure you can get enough time off from work to recover. It will take 4-6 weeks depending on the procedure.
4. Understand that everything is a trade-off between removing skin, getting a contour, and having a scar. Scars are permanent. They do get lighter, but don't disappear over time.
5. Prioritize your body according to the area that bothers you the most, and concentrate your surgery there first. You may find you don't need additional procedures.
6. Prior to surgery, stop smoking (to reduce complications) and increase your protein intake to 50 to 70 grams per day to speed healing.
7. Choose a surgeon who is board-certified in plastic and reconstructive surgery -- not just a board-certified doctor.

Published October 13, 2006.

SOURCES: American Society of Plastic Surgeons web site. Frances Kuffel, author, Passing For Thin. J. Peter Rubin, MD, director, Life After Weight Loss Center, University of Pittsburgh School of Medicine. Stephen Colon, MD, chief, plastic and reconstructive surgery, Hackensack University Medical Center, New Jersey; Nolan Karp, MD, associate professor of plastic surgery, NYU School of Medicine, New York. WebMD Medical News: "Body Contouring OK after Big Weight Loss." Plastic Surgery Statistics, American Society of Plastic Surgeons.

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