I have lost 100 pounds so far and am planning on a tummy tuck. I have 30 pounds to go until I reach my goal weight of 135. Can I go ahead and get the tummy tuck or wait till I reach my goal? I'm very happy about the weight loss but I can't stand the loose skin.
Reach Weight Loss Goal Before Tummy Tuck Surgery?
Doctor Answers 100
Evaluate weight loss trends before tummy tuck
I may be going against the grain on this one as most of my colleagues in the thread recommend achieving your weight loss goal (losing an additional 30 lbs) prior to considering elective cosmetic surgery. I used to do the same, as this is what we are taught. Historicaly, I saw patients who wanted to lose weight, say 30 lbs, and I told them to excercise, eat well, get a trainer, join a gym and then see me back in 3-6 months. They would do all the above, see me back in the office and say," Well I did it all, lost 15 lbs, then got tired of it, quit and gained 25 back. Now, I weigh more than I did 6 months ago and feel emotionally worse!"
Now, I tell patient to evaluate their current weight loss trends, has it been a continued steady/aggressive loss or a plateau with gradual loss? Surgery during the gradual loss, even if you are not totally at your goal "lowest" weight, can have dramatic effects. Namely, after recovering from surgery you will feel physically, emotionally and spiritually changed. You will want to go to the gym, your clothes (both work out and casual) will fit better and you will typically (I see it all the time) BLOW past your previous weight loss goal of 30 lbs and may lose more and maintain it.
Again, this is not what every plastic surgeon experiences with his/her patients, but I see it all the time in my practice and as such have changed my tune.
Talk with your surgeon and good luck!
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Reach a stable plateau, then have surgery
When patients lose weight as a result of healthy changes in diet and a regular exercise program, that weight loss is real. Fad diets and pills often yield impressive results, but are too often followed by a yo-yo weight fluctuation pattern.
Having said that, healthy active patients often reach a weight plateau. This plateau weight may or may not be the "goal weight". Goal weights can be demoralizing if they are not sustainable. We all have a weight we would like to be, but that weight may not be realistic. Better to be happy at a healthy, sustainable weight resulting from a good diet and exercise.
And that is the time to have surgery.
Tummy Tuck and my goal weight
You should be proud of yourself for losing so much weight!
I tell my patients that they should be within 10 to 15 pounds of their goal weight before they have a tummy tuck, for the simple reason that the more weight that you lose, the tighter that you can pull the muscles towards the center and the more skin that can be removed. If you reward yourself with the surgery when you make that goal, you will feel even better knowing that you are as tight as you will want to be. Remember that you will lose some pounds with the surgery as the skin and fat removed will weigh something also. This is usually in my practice about 3 pounds, but it has been as many as 11 pounds.
To be in a positive nitrogen balance at the time of surgery will help you heal. If you are starving yourself at the time of surgery, you won't have the building blocks to heal the incisions. This can be a problem with those that have had bariatric surgery. Make sure that you are frank about your nutritional status with your Board Certified Plastic Surgeon when you are making your plans for your tummy tuck, as this can really make a difference in your outcome. You need all the building blocks of healing to stack the deck in your favor to have an uneventful surgery. Cofactors of healing are Vitamin A, D, and C, Zinc and Magnesium. But you have to also have lots of protein to heal incisions.
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Do the "Tighten-Up" to Find Your Inner Self
In general, patients should be within 5-10 pounds of their ideal "goal" weight before having a tummy-tuck, liposuction, body lift, or other combined procedure, but there are always exceptions.
In some cases, patients will experience a much greater capacity for, and desire to, exercise and maintain or improve upon their weight loss efforts if the surgery is done sooner rather than later. These patients are stuck at a plateau of their weight loss efforts, because they see no improvement of their body, but rather a worsening appearance because of the loose skin. They need help getting over the psychological hump in their weight loss efforts, and an early "reward" of the tummy tuck or other body contour procedure is just the push they need to get over that hump.
On the other hand, doing the body contour surgery too early in the process is destined to produce an inferior result, which will disappoint the patient and doctor alike in the event that the patient continues to lose weight and more skin laxity results. The surgery may need to be repeated in such cases, in order to achieve the best result possible. Also, surgery in these cases is riskier in terms of the potential for wound healing complications, infections, and DVT or PE.
Post-bariatric patients usually experience a dramatic loss of weight, and any patient who has lost a very significant amount of weight will most likely require a more extensive procedure than a tummy tuck alone, because of the generalized laxity of skin extending circumferentially around the trunk. These patients usually require a full body lift, and often require a brachioplasty (arm lift) and mastopexy (breast lift) as well, and may even experience facial laxity that necessitates a facelift.
Patients should try to reach their goal weight before a tummy tuck or body contouring operation and should be in optimal health. When you are ready, prepare to meet the "mini me" who has been hidden under your fat aprons for all these years.
Two schools of thought regarding preop weight loss
The conventional concept is that you should be as close as possible to your ideal weight prior to undergoing body contouring surgery. This approach results in the optimal aesthetic outcome and avoids the need for touch up surgery if you were to continue to lose significant amounts of weight after the surgery.
Having said that, it may be very difficult to lose that last 30 lb, and, in your efforts to do so, would be delaying the rewards of body contouring surgery, maybe for years. Having the surgery now would make you look and feel better. You will be more comfortable in your skin and look better in your workout clothes, encouraging exercise and additional weight loss. If you are willing to accept the chance that you may need a touch-up surgery, this approach may be better for you.
Talk to a board-certified plastic surgeon about your goals and your realistic chance of losing those last 30 lb to decide which approach is right for you.
You may be closer than you think
My experience is that weight loss patients often mistake the large, overhanging excess skin for fat. They do not understand their weight loss plateau as a result.
So I advise an early consulation with a plastic surgeon experienced with weight loss patients. This way you can get an idea of how much further you need to go. Being close to your ideal weight is always best for any type of plastic surgery !
Patience will pay off
I know that after your tremendous accomplishment, you must be eager to pursue a tummy tuck to reward yourself- and you do deserve to look your best for the effort.
It is important to understand what happens to skin after weight loss however. When you lose weight, the skin will contract, or shrink a variable degree- obviously after a large weight loss the skin's elasticity (or capacity to shrink) will have diminished due to the stretching of the weight gain that came before, but nonetheless some amount of skin contraction may occur over a few months after you reach your target weight. Having your surgery before this time period has passed may mean you are having a larger or different operation than you may need once things have settled a bit.
Also, because significant weight loss obviously affects the metabolism, waiting 3-6 months after your weight has plateaued will give your body to find its balance, if you will.
These two reasons are why most experienced body contouring surgeons would recommend waiting this time period before having surgery.
I do think it would be appropriate to begin planning and interviewing board certified plastic surgeons though.
Congratulations on your weight loss!
Weight loss before a tummy tuck
First of all congratulations on your weight loss. There are several factors to consider when contemplating when to have your tummy tuck procedure.
- First, are you still actively losing weight or have you plateaued for several months? If you are still losing weight, I would try to get as close to your goal as you can (as long as your think it it realistically obtainable) and then do your procedure. If your weight has stabilized, then it's probably okay to proceed.
- One thing with massive weight loss patients (and many patients for that matter) is that their bodies have a set point for their weight and it may be unrealistic to achieve that, despite your goal of losing 30 more pounds.
- While the concern of your skin relaxing after additional weight loss is a valid one, I have found that many massive weight loss patients all have some relaxation at some point despite pulling their skin tighter than the average tummy tuck patient- and some may benefit from additional excision at a later time, although certainly not to the degree that they had before.
- One other thing to consider is the extra hanging skin impeding your ability to exercise and lose weight - i.e, are you developing rashes under the skin fold, is it causing any degree of pain, etc, etc. If so, then I would probably consider your procedure at this time.
As long as your weight loss goal is realistic, you are...
As long as your weight loss goal is realistic, you are best to have your surgery when you are closer to the goal weight. Additionally, it helps to be stable at the new weight for 6 months.
When you lose additional weight after a tummy tuck, you may diminish the nice tight appearance attained at the time of surgery with your skin becoming loose again.
One other thing to consider if you are losing large amounts of weight (massive weight loss >100 lbs), then a tummy tuck alone may not tighten your skin enough on the sides and will not address the excess skin of the lateral thighs and buttock. In those cases, a lower body lift is the best answer.
On a final note, the body mass index is an important number to keep in mind with cosmetic body contouring surgery. Patients that are above a BMI of 30 have been shown to have much higher complication rates including wound infection, seroma, delayed wound healing and DVT.
In general, a patient should ideally be within 10-20...
In general, a patient should ideally be within 10-20 pounds of their goal weight and maintain that for a few months before proceeding with surgery. The risk of losing more than 25 or 30 pounds after surgery is that you will develop loose skin again and need a revision done. It is nice to have lost all of the weight but it isn't necessary as long as you are close.