By Dr. Douglas Forman, Board Certified Plastic Surgeon
We are seeing more men than ever presenting with significant weight loss. Fifty pounds, seventy, two hundred. Some have had bariatric surgery. Some are on GLP-1 medications. Many have done both. And almost all of them are arriving in consultation with the same two concerns. They’ve done the hard part. The weight is gone. But the body they’ve uncovered doesn’t yet look the way they expected it to, and they’re starting to realize that no amount of time at the gym is going to change that.
The Abdomen
The first area men bring up is the abdomen, and specifically how it blends into the pubic region.
After significant weight loss, a roll of excess skin develops in the lower abdomen. It hangs. And no matter how many sit-ups, how many sessions in the gym, how many different sports or training programs a man commits to, that skin is not going to go away. Exercise builds muscle. It cannot remove skin that has lost its elasticity after years of carrying extra weight.
What often surprises men is how far down that skin actually extends. It doesn’t just sit at the waistline. It hangs over the pubic area, and the pubic area itself descends, covering the base of the penis. The whole region takes on a shape that feels misaligned with the body they’ve worked so hard to build.
What we do surgically is remove that excess skin and elevate the tissues so the entire area has a cleaner, more proportional contour. The result is something exercise was never going to produce on its own.
The Chest
The second area is the chest, and this one carries its own kind of frustration for men, because the chest is often where they feel it most visibly.
After significant weight loss, the chest tissues descend. The nipples sit lower than they should. Excess skin hangs along the front and sides, and in many cases there is residual fat that no amount of bench pressing will address, because like skin, glandular tissue and certain fat deposits do not respond to exercise.
The procedure we perform is called a pectopexy. It is, in straightforward terms, the male equivalent of a mastopexy or breast lift. We lift the chest tissues, reposition the nipple to a more anatomically appropriate location, remove the excess skin, and address any remaining fat whether it sits on the front of the chest or along the sides.
The goal throughout is to create a chest that reads as masculine and defined, one that reflects the physical effort the patient has already put in rather than working against it.
I want to be clear about something: bench pressing will not fix this. The men I see have often already spent months trying. The issue is structural, and it requires a surgical solution.
One Surgery or Two
When a man comes in with both concerns, which is most of the time, we have a conversation about whether to combine the procedures into one surgery or stage them across two.
Both approaches are valid and the right answer depends on the individual patient: their overall health, the volume of work involved, and what kind of recovery they’re prepared for. What I tell every patient is that either way, we will get there. The outcomes are predictable. And when it’s done, they will be able to wear a bathing suit or a pair of boxers and feel like the body they’re in finally matches the work they’ve done to get here.
That’s the goal. Not to look like someone else. To look like themselves, fully.
If you’ve lost significant weight and are finding that the gym has taken you as far as it can, that’s exactly the conversation to have in a consultation.
Dr. Douglas Forman is a Board Certified Plastic Surgeon at Plastic Surgery Institute of Washington (PSIW) in North Bethesda, MD. He specializes in weight loss body contouring, facial rejuvenation, and aesthetic surgery. To schedule a consultation, contact us online or call 301.359.6747.
