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Introduction: Excess skin after bariatric metabolic surgery may negatively impact quality of life. Nevertheless, not every eligible patient undergoes body contouring surgery, which may be explained by differences in quality of life. The objective of this study was to assess the differences in quality of life between patients with and without a desire for body contouring surgery after bariatric metabolic surgery, and to identify predictive factors that contribute to this desire. Methods: Patients completed the BODY-Q and a question regarding any desire for body contouring surgery, 6 months and yearly after bariatric metabolic surgery. BODY-Q outcomes were compared between patients with and without a desire for body contouring surgery and corrected for excess skin. Results: A total of 380 patients who completed 3 years of follow-up were included. Of these patients, 69.5% desired body contouring surgery. Patients who did not desire body contouring surgery demonstrated significantly higher quality of life scores across all domains at every follow-up moment compared to patients who desired body contouring surgery (except physical functioning at 3 years). These associations were largely explained by the amount and burden of excess skin. Younger age was the only significant predictor for desiring body contouring surgery when correcting for excess skin. Conclusion: Patients with a desire for body contouring surgery demonstrated significantly lower quality of life compared to patients without a desire due to a high burden of excess skin, which emphasizes the need for effective treatments aiming to improve quality of life such as body contouring surgery.

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