More and more people are seeking methods to remove extra skin and reshape the body after they lose significant weight, particularly because the development of gastric bypass surgery has made sustainable weight loss more achievable, says Dr. Jennifer Capla, a plastic surgeon in New York City who specializes in body-sculpting treatments after massive weight loss.

But more and more people aren’t necessarily talking about the fact that big-time weight loss – think 50 to hundreds of pounds – inevitably leaves people with saggy skin, no matter how many miles they run or broccoli florets they eat. More than aesthetically undesirable and psychologically burdensome for many, flabs of skin can put some people at risk for rashes, infections and even immobility, Capla says.

“A lot of people are hiding,” says Capla, who points out that contestants on reality shows like “The Biggest Loser,” whom she’s treated, go shirtless at the beginning but cover up once the weight comes off. “Everyone will say, ‘Wow it’s amazing – you look so great. But in the meanwhile, they’re struggling with the fact that they’re sitting in multiple kinds of compression garments just to hold loose skin in and be able to function every day.”