Under normal and even moderately abnormal conditions, skin can shrink back. However, this shrinking has limits. In extreme situations such as Pauline's, the skin can be stretched so thin to the point of breaking open (especially when edema is present) and/or stays distended because of large numbers of new skin cells that grew in to cover the volume over time. Skin also naturally loses elasticity as a person ages; this explains why wrinkles form on older persons' face and hands. Combine these factors together, and the patient ends up with a double-whammy of excess skin tissue and subcutaneous fat tissue (however deflated) that chafes easily, is hard to keep clean and healthy, and is aesthetically unpleasant.