Amir Ghaznavi, MD, MBA, FACS

Thanks for your question—this is a really common scenario among my patients who’ve experienced massive weight loss.
Due to the nature of the weight loss, the skin laxity and tissue deflation typically occur around the entire midsection—not just the front, even if that’s where it may be most noticeable to you.
I often see patients opting for the extended tummy tuck, which can be a suboptimal choice in some cases. Sometimes that’s because they want to avoid the scar that goes all the way around, or because the surgeon only offers certain procedures.
A lower body lift (also known as a 360 tummy tuck) is a more comprehensive procedure. It not only tightens the abdomen, but also lifts the pubic area, anterior and lateral thighs, and buttocks. It’s often the ideal choice for someone who has lost a significant amount of weight and has skin laxity all the way around.
Whatever option you choose, make sure you’re working with a surgeon who specializes in post–massive weight loss body contouring. The difference in expertise can have a big impact on your results.

Choosing the right implant is critical to getting a natural result. Typically, implants with lower profiles are flatter and can "reach" the upper pole of the breast. In contrast, higher-profile implants project more fullness in the front of the bra. Above or below the muscle, a subfascial breast implant above the muscle is ideal for giving more upper pole fullness while maintaining the pocket created. It is unhindered by the contractile forces of the pectoralis muscle and subsequent animation deformity. In some cases, an "internal bra" composed of absorbable biocompatible mesh can also be used to stabilize a large implant.

I typically advise clients that body transformation does not occur after just one surgery following massive weight loss. I usually divide the body into three sections: Upper, Mid, and Lower.

For the Upper section, I recommend an upper body lift, which includes an extended arm lift, bra-line lift (thoracoplasty), and breast lift. These three procedures effectively address skin laxity in the upper body.

In the Mid section, I often perform a body lift, fleur-de-lis (FDL) lift, or Brazilian butt lift (BBL).

Finally, for the Lower section, we focus on either an inner or outer thigh lift. I do not combine all three procedures in one session, as it would require too much time under anesthesia. I typically avoid performing both upper and lower procedures together, as it restricts movement during the postoperative recovery.

Correcting contour defects of the upper arm is not uncommon. Upper arm liposuction. ( and medial thigh) are synonymous with irregularities after liposuction. To fix these, usual options include invasive (Lipo/fat grafting), excisional (arm lift), or non-invasive (bio stimulators like Renuva, Sculptra, dilute radiance). An excisional procedure is typically reserved for clients after massive weight loss with significant loose hanging skin. A standard arm lift(stopping at the axilla) or an extended one ( into the armpit and down the chest) effectively creates an appealing contour. Of course, the expectation should be that the upper arm will always be smaller than the forearm and taper like a cone from the hand to the upper arm. The correction of contour defects can be improved with fat grafting or biostims but may never be 100%. Doing an arm lift simultaneously as fat grafting posterior arm defects is the most aggressive approach. The trade-off is the scar of the arm lift starting from the elbow and going into the armpit. Some clients would instead get more benefit from liposuction/renuvion( jplasma) than a formal excisional procedure.

Yes! You are a candidate for Augmentation without a lift, but it's important to pick the right implant. Too often, I see women choosing high-profile implants with too much volume when a lower-profile implant, such as a moderate profile, would better serve them. A moderate profile would give them more upper pole fullness while providing a more natural look. Correctly done Augmentation using biometric analysis of your breast footprint and size should give you a natural and rejuvenated breast.