Robert H. Gotkin, MD

It does appear from your photos that you may be a good candidate for lipo of the thighs.  This, of course, depends on your general health, your expectations for the outcome of surgery and other factors that would be evaluated during a consultation with a board-certified plastic surgeon.  You have a low BMI and I commend you on your weight loss.  That said, lipo has always been best for contouring areas that are resistant to exercise and diet -- areas that I like to call, F.R.E.D. (Fat Resistant to Exercise and Diet).  You want to get FRED out of your life!  I think that circumferential contouring of your thighs by lipo would be an excellent choice.  Remember that it is not about how much, where or what fat is removed; it is about what is left behind -- you.  And you want that to look great after the procedure.  Body contouring is not just about suctioning fat, but about creating a new and more attractive you -- in your case, with thighs that are more proportionate to your upper body.

Your question is a good one.  Each surgical procedure needs to be customized to the very specific and unique problems that each prospective patient presents.  That being said, a thorough evaluation by a board-certified plastic surgeon is the only way to determine what steps will be included in your TT.  Certainly, you can and should discuss your desires at the time of the consultation, but the plastic surgeon will evaluate your abdominal wall muscle tone, laxity and midline separation of the "sit-up" muscles during that consultation.  Whether or not you need abdominal or circumferential lipo of the trunk, muscle tightening, etc., should all be discussed during that visit.  The plastic surgeon will describe to you what steps he or she feels are indicated during your procedure.  The two of you should absolutely be on the same wavelength in terms of what's necessary and what will solve the problems you have.

There is no reason not to consider such a procedure if you are healthy, undergo medical clearance prior to surgery and you have surgery by a well-trained, competent board-certified plastic surgeon who does these procedures all the time.  I have performed TTs on women into their 70s as long as they are in good health, have realistic expectations and have the appropriate indications for the procedure.  From the photo you submitted, you have skin laxity that can only be treated by a TT.  Lipo will not address this problem and there is no non-invasive method that will either.  Any excess fat you may have and any abdominal wall muscle laxity can also be treated during the procedure. 

Very frequent question I hear during a body contouring consultation.  It obviously depends upon the details of your history and physical examination.  From your brief description, it may be that you would do better with some kind of a TT -- to tighten the lax abdominal wall muscles and treat any skin / fat excess that may exist.  You should set up a consultation with a board-certified plastic surgeon who can properly and thoroughly evaluate you and discuss the range of options that exist.

Hopefully, your TT and your recovery will go smoothly, but I would not put that kind of pressure on myself to commit to something like that only a week and a half following surgery.  You should feel pretty good by then and will be up and around, but I would counsel you to skip the singing this year!

It does not appear, from the photos you submitted, that you have lipedema.  Lipedema is a very specific disorder of fat accumulation that can occur in the upper and lower extremities.  It is often familial.  It never involves the feet and there is a distinct "cut-off" at the ankle.  From your history, you may have muscular legs, but the photo does not demonstrate lipedema.

Most plastic surgeons were trained to do a TT with drains.  Drains evacuate fluid that "weeps" from the tissues following surgery.  Without the drains, the fluid would build up between the abdominal muscles and the skin.  But the drains are often highly annoying for patients after the procedure; they are uncomfortable and are not pleasant to remove.  Some plastic surgeons began to do TTs a different way so as to eliminate the drains -- closing all the opened tissue planes with stitches and eliminating the spaces in which the fluid could build up.  This way, the fluid was absorbed in the tissues rather than building up in an open space between tissue planes.  It has proven to be safe and effective.  I have not used drains in a TT since 2009 and have not had any post-operative problems due to that change.  The patients are happier and more comfortable following surgery.  There is not any increase in swelling and they don't have the apprehension about removal of the drains.  This is part of my Ipanema Tummy Tuck that I started almost 10 years ago.

From the photos your submitted, you appear to be a good candidate for lipo.  Of course, this would depend upon a thorough medical history and physical exam by a board-certified plastic surgeon.  There are many types of liposuction; all, these days, employ some type of tumescent anesthesia, in addition to oral or IV sedation or general anesthesia.  The type of anesthetic management is surgeon and anesthesiologist preference.  Each surgeon employs the type of liposuction technique with which  he or she is most comfortable, that they feel gives the best results, and that they feel gives their patients the best recovery.  There are many different techniques -- from simple tumescent technique to various types of energy-assisted lipo.  Energy-assisted lipo usually involves one of three different types of technology -- ultrasound, laser or radiofrequency.  These various types of energy are used to "melt" the fat -- convert it from a soft solid tissue to a liquid.  The energy may also be employed to treat the undersurface of the skin to yield some additional skin tightening as part of the final result.  "SAFE" is a technique initially described by a plastic surgeon from Texas.  To me, it is a bit of a gimic; any good liposuction surgeon, any experienced board-certified plastic surgeon who has considerable experience in liposuction, doesn't need "SAFE" to perform safe liposuction!  I use Smartlipo -- laser-assisted lipo -- but, again, it is surgeon preference.  You need to trust your surgeon, have a good feeling about him or her and feel that they are giving you sound information that makes sense to you.

From the photos you submitted, you would appear to be a very good candidate for lipo.  I like Smartlipo because I feel it is more gentle -- converting soft solid fat into a liquid and making it easier and less traumatic to suction out.  It appears that you would benefit from circumferential contouring of the abdomen, hips and flanks, as well as contouring of your upper thighs as well.  Smartlipo also gives you some skin tightening, too!  This may be helpful to you in the lower abdomen and the inner thighs.  Of course, all of this would depend upon an in-person exam by a board-certified plastic surgeon.  Good luck in your endeavors.

From the one photo you submitted, it appears that you are a very good candidate for a full tummy tuck with removal of the excess abdominal skin, likely selective liposuction of the hips and flanks -- for circumferential contouring -- and tightening of the muscular abdominal wall.  This should restore the appearance of your trunk to one that more resembled what you had before your pregnancies.  Of course, no one can be sure if you are a good candidate without a thorough review of your medical history and a thorough physical examination.  You should consult with a board-certified plastic surgeon and always be sure to ask the right questions during the consultation:  is the surgeon certified by the American Board of Plastic Surgery? Your surgeon should treat your entire trunk, not just your abdomen -- circumferential contouring.  Tummy tucks are done often without drains and my Ipanema Tummy tuck is a laser-assisted drainless tummy tuck that has a recovery more like liposuction than a tummy tuck.  Very often, no narcotics at all.