I am a 49 year old male, who has lost 245 LBS, I have seen four doctors, two think I could get by with a tummy tuck, one thinks a lower body lift, the other a tummy tuck with a horizontal cut. I have had three past surgeries for hernia repair, only one doctor said he would like to see reports from those surgeries. I like him and the one who would do a lower body lift and tummy tuck, he is also much cheaper, will have chest done as well, here is my photo any advise would be nice.
Will I Need More Than a Tummy Tuck?
Doctor Answers (15)
Tuck or lift
To me it looks like you will get the best results by doing a Lower body lift. That means a scar circumferentially aroung your body at the suprapubic level. I agree with doin your chest. I would discuss extending it to under your arms or more as it looks like your skin is loose at the sides of your breast as well.
The lower body lift helps pull your lateral thighs and buttocks. If your buttocks have lost all there volume and you wanted more, an auto-augmentation ( enhancing your butt ) can then also be performed with this technique.
Good luck with your surgeries.
More Than a Tummy Tuck?
Thank you for the question and congratulations on your weight loss!
Based on your history and picture I am sure you have excess skin/ at this issue circumferentially around the abdomen, back and flank areas. A lower body lift will be necessary to treat these areas appropriately. You may find also that a upper body lift will be necessary to treat the chest, infraxillary areas and upper back areas.
I hope you choose your plastic surgeon based on experience and expertise as opposed to costs.
I hope this helps.
Body lift surgery must be Individualized
Surgery after massive weight loss must be individualized as each patient is different, and therefore, the corrective body contouring surgery, body lift, or tummy tuck will be determined after examination and thorough discussion of your concerns and goals, and the treatment options that meet your budget and time constraints.
The picture that accompanies your question shows an patient that has multiple areas that may need to be addressed. These include not only the lower abdomen, but also the thighs, flanks, chest and upper arms. Other likely areas that may warrant treatment but are not visible on the photo are the face and neck, and the buttocks.
Therefore, the answer to your question is that some type of a body lift will be needed, and will provide a better result than a tummy tuck, if your are simply addressing the abdomen.
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Lower body lift
It really is difficult to determine without looking at your back and buttocks. If there is adequate tighness posteriorly than an tummy tuck or fleur de lis abdominoplasty may be good.
Lower body lift vs abdominoplasty with massive weight loss
If you have lost 245 lbs and you are in good health, you would probably benefit from the lower body lift. If sagging of the buttocks and posterior and lateral thighs is not a great problem, the abdominoplasty may suffice. With either procedure your surgeon may want to consider removing skin both vertically and horizontally - this would result in the additional inverted "T' scar over the abdomen, but I believe the result would be worth the added scar and would give you a better overall result.
Is a tummy tuck or a belt lipectomy/body lift better after massive weight loss?
Lets start out by delineating what it is that occurs during weight gain and subsequent weight loss. The lower trunk, which is the area that starts from the ribs and spans down to the pelvic region gets inflated by the process. One gains weight, not only in the front, but also on the sides and the back. When deflation occurs it affects the front, sides and back as well. So here are the problems that one ends up with: 1.excess belly skin and fat, 2.looseness of the abdominal wall muscles, which in your case actually had hernia's develop within it, 3.your pubic area is lower and fuller than it should be, 3.the front and sides of your thighs are redundant and have dropped, 4.your lower back runs down and has no distinct point at which it stops and your buttocks begins, 5.your buttocks have dropped. As a male you may also have some remaining excess fat in the love handle area, but it is difficult to tell from the picture.
So you have to ask yourself the question, do I want to take care of everything, or just the front. You also have to consider that you have a signficant amount of vertical excess of skin in the front and because of the mechanics involved in doing a regular tummy tuck, you can not remove all that you would like in a tummy tuck prcedure alone because the more vertical excess you remove, the more you will have to extend the incision on the sides, past what you would do in a regular tummy tuck.
So you take two identical twins with your body and you did a tummy tuck on one of them and a well perfromed belt lipectomy on the other, the difference should be stark. I always tell people that a tummy tuck is like a conventional weapon and a belt lipectomy/body lift is like a nuclear weapon. The belt lipectomy should create a starkly better contour of your turnk.
So if you want to flatten your tummy, lift your pubic area, lift the front and the sides of your thighs, lift your buttocks and create the best possible truncal contour, then you would benefit from a body lift ( I prefer "belt lipectomy" as a name). I am an expert in post massive weight loss plastic surgery so I will leave it to others to advise you on checking out the hernia history.
If you would like to see pictures of tummy tucks compared to belt lipectomy, please email me. You will be amazed at the difference between the two operations.
Tummy tuck vs. body lift
Congratulations on your weight loss. The best procedures for you depend on your concerns. Typically with your amount of weight loss you will have skin laxity that extends all the way around your midsection. If not contraindicated, in addition to a belt lipectomy you may need a vertical resection of skin on your anterior abdomen. If you choose a doctor who commonly does massive weight loss body contouring they can delineate your options. Besides your abdomen you may also want your arms, chest and inner thighs addressed.
After 245 lbs. weight loss your loose skin requires more than just tummy tuck.
Congratulations on your weight loss! If you look at your hips, lateral thighs, and buttocks, you will certainly find that the loose skin extends all the way around your body. Tummy tuck alone will address only the loose skin of the abdomen, and the tapering incisions leave progressively more of the loose skin remaining near the hips, and ALL of the loose skin of the lateral thigh and buttocks. A full beltlift will remove loose skin completely around the entire circumference of your lower body.
I wonder if those surgeons who felt that you could "get by" with tummy tuck alone have experience with lower body lifts. I would suggest asking point blank of they DO lower body lifts, and (if they do) whether they perform this operation in a hospital, outpatient surgical center, or accredited office surgical facility (such as my partner and I operate at). You might be surprised to find out that their recommendation for "tummy tuck only" is based on what they are comfortable with rather than what is best for your situation. This is fine in itself (you don't want a surgeon unfamiliar with or inexperienced with a beltlift doing that procedure for you), but often the recommendation is phrased as "You don't need this," or "You can 'get by' with this" rather than "I really don't have experience with that operation." Too bad, since there are surgeons who do, and yet you have been made to feel as if you don't "need" the very operation you are best suited for!
As far as needing a vertical scar in addition to the horizontal scar of tummy tuck and beltlift, some patients with extremely loose skin may require this. While this can be added later in a separate operation, it makes sense to address this (if needed) at the time of the initial operation. This is often termed a "fleur-de-lis" incision pattern. Any surgeon who has extensive experience with major weight loss patients has those who would benefit from this modification. Determination is based on actual physical examination by your plastic surgeon. Best wishes!
Post Weight Loss Body Lifting
After 200+ lb weight loss it is possible that you may need a circumferential belt lift. Whether or not you do an abdominoplasty or full belt lift would depend on how much loose skin you have in back and what your expectations are. Choosing a BC plastic surgeon should be based on experience, results(talk to other patients and ask to see photos) and your comfort level. Price should be very low on your list of reasons in my opinion. Reviewing past surgical records is very wise in my opinion as well. I would make sure your surgeon has appropriate training in difficult hernia repairs(which it sounds like you have) and maybe even having a general surgeon involved as well. Good luck. Aloha.
Most people in your situation would elect to have a lower body lift but some do not mind the laxity in the back. Each patient is different physically and also mentally (meaning what he or she might find acceptable.) This is what you need to sort out with your surgeon.
You could elect to have an extended tummy tuck and see if the back laxity bothered you later. I have had some patients go this way.
John Di Saia MD
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.