Everything is going to depend on her skins elasticity. Also, there is no telling how fast she will lose weight once she goes primal. I lost 130 lbs with hCG and being Paleo, and my skin is a lost cause. I am also 45 and was obese for more than 20 years.
If she can afford to do gastric bypass, then my advise is go Paleo/Primal, lose the weight, learn to eat correctly, and once her weight has been stable for a year, use the money for lifts and tucks!
Frankly, I would rather be thin and healthy with saggy skin, then fat and sick with tight fat filled skin.



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I really don't want to volunteer for surgery, though, so it's really going to have to bother me a lot to convince me to put myself through the process of getting it removed.

(and there's always plastic surgery as an option... I'd definitely consider it).



