63 lbs lost here and dealing with similar issues. Here's what I've tried and my honest assessment:

Things that actually helped (somewhat):

• Resistance training — building muscle underneath loose skin helps fill it out. My arms look significantly better since I started lifting. This is the #1 thing.
• Collagen peptide supplementation (15-20g/day) — jury is still out scientifically but I think it's helped my skin texture. At minimum it's a good protein source. I use Vital Proteins.
• Tretinoin 0.05% cream on face/neck — prescription retinoid, proven to stimulate collagen production. My derm prescribed it for "Ozempic face" prevention. Takes 3-6 months to see results.
• Adequate protein intake (>100g/day) — protein is the building block for collagen. Undereating protein while losing weight fast is a recipe for poor skin elasticity.
• Staying hydrated — dehydrated skin has less elasticity. Sounds basic but it matters.

Things that didn't help:

• Body wraps — complete waste of money
• Skin firming creams (drugstore brands) — did nothing detectable
• Dry brushing — felt nice, did nothing for loose skin

Things I'm considering but haven't tried:

• Red light therapy — some evidence for collagen stimulation, but the home devices are likely too weak to be effective
• Microneedling — my derm says it can help with skin texture but won't fix significant laxity
• Surgical options (abdominoplasty, brachioplasty) — the nuclear option. Probably where I'll end up for the abdomen.

Let me add some science to this discussion:

Why rapid weight loss causes worse loose skin than slow weight loss:

Skin elasticity depends on the structural proteins collagen and elastin. When skin is stretched by excess fat for years, these fibers are damaged. Slow weight loss gives the skin time to partially remodel — fibroblasts produce new collagen, elastin fibers reorganize. Rapid weight loss (like 71 lbs in 10 months) doesn't allow sufficient remodeling time.

Factors that predict loose skin severity:

• Amount of weight lost (>50 lbs significantly increases risk)
• Speed of weight loss
• Age (skin remodeling slows with age — elastin production drops significantly after 40)
• Duration of obesity (longer = more collagen damage)
• Genetics (collagen composition varies genetically)
• Sun exposure history (UV damage destroys elastin)
• Smoking (impairs collagen synthesis)

Evidence-based interventions:

Collagen supplementation: A 2019 meta-analysis of 11 RCTs found that hydrolyzed collagen supplementation (2.5-10g/day) significantly improved skin elasticity and hydration.[1] The evidence isn't perfect but it's reasonable.

Vitamin C: Essential cofactor for collagen synthesis. Most people get enough from diet but supplementing 500mg/day is cheap insurance.

The honest truth: for significant laxity (like abdominal apron after major weight loss), no cream, supplement, or non-surgical treatment will produce dramatic improvement. Surgery is the only definitive solution. But many insurance plans will cover abdominoplasty/panniculectomy if there are documented skin infections, rashes, or functional impairment.

The insurance coverage for skin removal surgery — what does "functional impairment" mean exactly? Like, my abdominal skin fold traps moisture and I get rashes constantly. Does that count?

YES. Recurrent intertriginous dermatitis (rashes in skin folds) is one of the most common justifications for insurance-covered panniculectomy. Document everything — photograph the rashes, see your derm or PCP for each episode so it's in your medical record, track how many times you need antifungal cream.

Most insurance companies want to see: documented skin infections/rashes, failed conservative treatment (keeping area dry, antifungal powders, barrier creams), and medical necessity letter from your surgeon AND your PCP. The process usually takes 3-6 months of documentation.