INTRODUCTION: Excess skin after bariatric metabolic surgery may negatively impact quality of life (QoL). Nevertheless, not every eligible patient undergoes body contouring surgery (BCS), which may be explained by differences in QoL. The objective of this study was to assess the differences in QoL between patients with and without a desire for BCS 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 BCS, 6 months and yearly after bariatric metabolic surgery. BODY-Q outcomes were compared between patients with and without a desire for BCS 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 BCS. Patients who did not desire BCS demonstrated significantly higher QoL scores across all domains at every follow-up moment compared to patients who desired BCS (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 BCS when correcting for excess skin. CONCLUSION: Patients with a desire for BCS demonstrated significantly lower QoL compared to patients without a desire due to a high burden of excess skin, which emphasizes the need for effective treatments aiming to improve QoL such as BCS.