Dear Moosie,
The VAST majority of women prefer to do their tummies first because the transformation is immediate and it gives them a major psychological boost.
I share the opinions of some of my colleagues.
While the Vertical Scar (Fleur de Lis) Abdominoplasty gives a flatter tummy without having to extend the incision laterally and posteriorly, it is associated with potential decreased flow of blood at the bottom of the incision (vertical inverted T zone) and in some people MAY distort the bottom of the breast folds. So - if you are going to need a buttock lift anyway with a resulting belt like scar, I would shy away from a vertical scar anteriorly since any excess skin would be removed anyway without an additional very obvious scar.
As regards the sequencing - it is really up to you. As a surgeon, I would like to break these procedures into shorter procedures to reduce the risk of infection and blood clot formation. The less turning of the patient, the less areas of surgery which result in pain limiting patient mobility and breathing, the better our patients will do.
Please, remember, your skin is NOT normal and may give with time. In staging the procedures 6-8 months apart, not only will you recover better, but any relapses and droopiness could be revised nicely with the next stage.
An unspoken element is how much fat remains and where it is located. One or two (debulking) liposuction procedures MAY need to be done before excisional procedures to get maximal lifting, flattening and contouring.
There is NO ONE ANSWER. But - there are a lot of preferences out there. I would defer to your wishes after you begin to heal from the first procedures.
I hope this was helpful.
Peter A Aldea, MD, FACS
