Guray Yesiladali, MD, FEBOPRAS

It is very common for surgeons to give different recommendations in this situation, because the decision to add liposuction depends on several factors: the actual amount of fat in the flanks, the quality of your skin, the contour you want to achieve, and the surgeon’s philosophy on safety and combining procedures.

If there is very little fat, excision during the tummy tuck alone may give a good result without lipo. If there is more fullness in the love handles or waist, liposuction can help refine the contour. Some surgeons prefer to combine procedures for maximum effect, while others stage them to reduce operating time and risks. Both approaches are valid.

Neither opinion you received is “wrong.” It comes down to whether your priority is to have fewer procedures and combine your arm lift, or to aim for the most aggressive body contouring with lipo included. The key is choosing the surgeon whose plan, safety approach, and aesthetic style align best with your goals.

I have also shared a detailed video where I explain how surgeons decide whether to add liposuction to a tummy tuck, with examples of results with and without it.

— Güray Yesiladali, MD

It is very common for surgeons to give different recommendations in this situation, because the decision to add liposuction depends on several factors: the actual amount of fat in the flanks, the quality of your skin, the contour you want to achieve, and the surgeon’s philosophy on safety and combining procedures.

If there is very little fat, excision during the tummy tuck alone may give a good result without lipo. If there is more fullness in the love handles or waist, liposuction can help refine the contour. Some surgeons prefer to combine procedures for maximum effect, while others stage them to reduce operating time and risks. Both approaches are valid.

Neither opinion you received is “wrong.” It comes down to whether your priority is to have fewer procedures and combine your arm lift, or to aim for the most aggressive body contouring with lipo included. The key is choosing the surgeon whose plan, safety approach, and aesthetic style align best with your goals.

I have also shared a detailed video where I explain how surgeons decide whether to add liposuction to a tummy tuck, with examples of results with and without it.

— Güray Yesiladali, MD

Losing additional weight is unlikely to help in your situation, since you are already lean and further loss would probably make the loose skin more noticeable rather than less. The issue is related more to skin elasticity after pregnancy than to fat.

Non surgical treatments such as radiofrequency, laser, ultrasound based tightening, or microneedling with RF can create some improvement in skin quality and tightness. These can reduce the appearance of looseness or mild cellulite, but results are modest and usually require multiple sessions.

The only way to achieve a dramatic, lasting change is with surgery such as a tummy tuck or in some cases a reverse tummy tuck for the upper abdomen. If you prefer not to go that route, non surgical skin tightening can still offer a subtle improvement and may help you feel more confident.

I have also shared a detailed video where I explain the pros and cons of non surgical tightening compared to abdominoplasty, with examples of what to realistically expect.

— Güray Yesiladali, MD

With sickle cell disease, any elective surgery carries higher risks, including problems with anesthesia, wound healing, and blood clotting. Even if your overall health is good and your crises are infrequent, these risks remain important considerations.

The fact that your hematologist cleared you for bariatric surgery is reassuring, but most plastic surgeons would still be cautious about performing a tummy tuck and 360 liposuction at your current weight. The body mass index is high, which already increases the chance of complications such as infection, wound breakdown, or blood clots.

A safer approach is often to pursue bariatric surgery first if that is appropriate for you, and then consider body contouring procedures after significant weight loss. At that point, both the surgical risk and the quality of results are much improved.

I have also shared a detailed video where I explain how underlying medical conditions like sickle cell disease influence surgical planning, and why timing and safety are so critical.

— Güray Yesiladali, MD

What you are experiencing is very common, even in lean and active patients. The lower abdominal “pooch” often represents a small, genetically resistant fat pocket that does not respond to diet, exercise, or even non invasive treatments like CoolSculpting.

In situations like yours, liposuction is often the most effective option. It directly removes the fat cells in the area and can create the flat contour you have been working toward. If your skin has good elasticity, liposuction alone may be enough. If the skin is thinner or shows some laxity, it can be combined with skin tightening technologies such as radiofrequency or Renuvion.

A tummy tuck would not usually be advised in your case, since there is no significant skin excess or muscle separation.

I have also shared a detailed video where I explain why some fat pockets are resistant to diet and non surgical treatments, and how targeted liposuction can provide lasting results.

— Güray Yesiladali, MD