J. Timothy Katzen, MD, FACS

Hello Keelyjanep in Great Britain, Thank you for your question regarding at age 42 years, is it sensible to get an arm lift and thigh lift at the same time. If you are healthy and your labs are normal, the brachioplasty (arm lift or arm reduction) can be technically performed at the same time as a thighplasty (thigh lift or thigh reduction). However, most experienced plastic surgeons who specialize in reconstructive plastic surgery after massive weight loss would NOT recommend performing the brachioplasty with the thighplasty. The problem is not in the ability to complete these combined procedures. The problem is in the patient’s recovery process. If you have combined arm reduction and thigh reduction surgeries, all your extremities are “out.” If you have arm lift and thigh lift surgeries, it is very difficult to get out of bed becaues you will need your arms, walk to the bathroom because you will need your thighs, pull down your thigh garment becase you will need your arms, sit on the toiket because you will need your thighs, wipe and keep yourself clean beacuse you will need your arms, pull the garment back on beacuse you will need your arms, walk back to bed beacuse you will need your thighs, and get back into bed beacuse you will need your arms. Therefore, most experienced plastic surgeons would not recommend combining an arm lift and a thigh lift into one surgery. Good luck, I hope that I have answered your question regarding at age 42 years, is it sensible to get an arm lift and thigh lift at the same time. I hope that I have answered your questions regarding the arm reduction. If you have any more questions regarding the arm lift, arm reduction, brachioplasty or arm crease fat grafting, please contact an arm lift expert Since a brachioplasty or arm lift surgery is a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts. Do your research. Make sure your chosen plastic surgeon has performed at least 100 arm lifts. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Sincerely, Dr. Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon), President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, , International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello, and thank you for your question regarding whether you would be a good candidate for a mini arm lift. Thank you for your history and your pictures. The short answer is yes. You would be a good candidate for a mini arm lift. Another name for a mini arm lift is a crescent arm lift or crescent brachioplasty. During a crescent brachioplasty, a crescent-shaped area of skin and fat is removed from the upper inner arm. Usually, the crescent or mini arm lifts are reserved for patients with excess skin and fat in the proximal or upper quarter or third of the upper inner arm. The crescent arm lift has the advantage of a hidden armpit scar. The mini arm lift avoids the more visible arm lift scar associated with the longitudinal medial brachioplasty with an incision from the armpit to the elbow. The disadvantage of the crescent or mini arm lift is that not too much excess arm skin is removed. In addition, the mini or crescent arm left does not truly pull much arm skin from the middle third of your arm, nor remove excess skin and fat around the elbow. Good luck. I hope I’ve helped to answer your question regarding whether you would be a good candidate for a mini arm lift. Additionally, I hope that I have answered your questions regarding the arm reduction.  If you have any more questions regarding the crescent arm lift, arm reduction, brachioplasty, or mini arm lift, please get in touch with an arm lift expert. Since a brachioplasty or arm lift surgery is a difficult procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing these types of arm lifts. Do your research.  Make sure your chosen plastic surgeon has performed at least 100 arm lifts.  Make sure they have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf. Sincerely, Dr.  Katzen, MD, MBA (Aesthetic, Cosmetic and Reconstructive Plastic Surgeon),  President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, , International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and ​member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Hello Considerate725737, Thank you for your question regarding a lift after a 60-pound weight loss, what surgeries would be best, and how they should be prioritized. Congratulations on your 60-pound weight loss. Thank you for your two pictures that you provided. Weight loss is a journey. Most medical personnel suggest weight loss to lead a healthier, longer life. I’m glad you’re exploring the possibilities of reconstruction after a massive weight loss at this time. The time to have plastic surgery is when your weight has stabilized and you are near your ideal weight. However, we can guess what surgeries you may need. Regarding your “turkey gobbler neck”, you could either undergo VASER neck liposuction or a neck lift. During VASER neck liposuction, a small incision is made behind your chin. Tumescent fluid is injected to minimize bleeding, anesthetize the area, and minimize blood loss. Then, the VASER probe is inserted. The VASER melts neck fat and heats the neck skin. Heating the neck skin with the VASER helps the neck skin to redrape. Then, a cannula (medical grade straw) is inserted, and neck fat is removed with suction. Ideally, your neck skin should redrape on the underlying fascia. The potential disadvantage of VASER neck liposuction is that you may have wrinkly neck skin; however, the advantage of VASER neck liposuction is the small incision and minimal downtime. VASER neck liposuction takes approximately one hour to complete. The alternative is a neck lift. With a neck lift, an incision is made around the ear. Dissection is then carried down the neck, and the neck skin is redraped and repositioned. Often, the platysma muscle is plicated or brought together. The platysma muscle plication is also called a neck corset or platysmaplasty. The neck lift surgery is much more involved and takes approximately 4 to 5 hours to complete. Either the VASER neck liposuction or the neck lift procedure could be performed under IV, twilight, or general anesthesia. In regards to your abdomen, you will need either a tummy tuck, extended tummy tuck, fleur-de-lis (FDL), or 360 circumferential lower body lift. At this time, it is too early to tell. Lose more weight and then reassess your body. If your hips and buttocks bother you, you will probably need a 360 circumferential lower body lift. During the 360 circumferential lower body lift, excess abdominal skin and fat are removed. In addition, the rectus abdominis muscle is plicated, and the pubic region (mons) is lifted and reduced. Also, if you undergo the 360 circumferential lower body lift, the hips and the buttocks are lifted and reduced. Regarding your breasts, you will probably need a breast lift to correct the “drooping” or ptosis. If you want larger breasts, you will need to consider safe FDA FDA-approved breast implants. Every plastic surgeon has their own technique and order of procedures after massive weight loss. However, most experienced plastic surgeons start with the 360 circumferential lower body lift. This is often combined with a thigh lift, thigh reduction, or thigh plasty. Several months later, you can undergo the upper body, which would entail breast lift (mastopexy), breast augmentation, and an arm lift, arm reduction, or brachioplasty. The second stage of surgery may also involve a back lift or torsoplasty. All these surgeries are dependent upon your appearance after further weight loss. Most plastic surgeons prioritize body part areas based on what bothers you the most. In terms of cost, costs vary widely, according to your chosen plastic surgeon. Costs vary widely based on your chosen plastic surgeon’s experience, geographic location, time in the operating room, and expense for recovery facilities. You should choose a plastic surgeon based on their experience. The best way to gauge the experience of a plastic surgeon is by the number of before-and-after pictures they have on their website. For the time being, most plastic surgeons would advise against any cosmetic procedures other than surgery. Your body is going to change with another 20-30 lbs loss. You may discover you have wasted time and money with procedures done before your weight stabilizes. It’s important to wait until your weight has stabilized before seeking plastic surgery consultations. This will ensure the best possible outcome for your surgeries. Good luck. I hope I’ve helped to answer your question regarding lifts after a 60-pound weight loss, what surgery would be best, and how they should be prioritized. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 100 circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced, lower-body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Thank you for your question regarding what these white plastic things are trying to work themselves out of my skin. Thank you for your history. Your question is challenging to answer without visual aids or a physical examination. Typically, items used during surgery that are plastic and U-shaped could be sutures and absorbable skin staples. If these U-shaped items resemble threads, then they are likely sutures. If they are white, U-shaped pieces and they feel like plastic, these are often dissolvable under-the-skin staples. You should follow up with your plastic surgeon to determine exactly what these unusual U-shaped white pieces are and what needs to be done. If they are exposed, typically these U-shaped white pieces are removed. Thank you for your interesting question. Good luck. If you have any further questions regarding the lower body lift, 360-degree circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please consult with an experienced plastic surgeon. Since the body lift is a significant procedure, it is recommended to seek an experienced, board-certified plastic surgeon with extensive experience in performing lower body lifts. Do your research. Ensure they have performed at least 100 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced lower body lift surgeon in your neighborhood, consider traveling out of state if necessary. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Hello, and thank you for your question regarding what to do after a 101-pound weight loss, having loose skin, and the fact that you developed body dysphoria disorder and are afraid to consult with a (plastic) surgeon. Thank you for your history and your pictures. Most plastic surgeons would agree that you need to discuss your fears with your psychiatrist or psychologist. It is important to go into reconstructive plastic surgery after massive weight loss with realistic expectations and a clear mind. If you have body dysphoria disorder, even if you achieve perfect plastic surgery results, your brain may not correctly perceive your results. With body dysphoria disorder, you may continue to be troubled by the appearance of your body. You may be more troubled than before your surgery. Your state of mind could lead to depression and rebound weight gain. Thus, if you have body dysphoria disorder, plastic surgery may not be your answer. Therefore, you must consult with your psychologist or psychiatrist before you consider plastic surgery. You must enter plastic surgery with the correct mindset and realistic expectations. I'm sorry that you don't see yourself for who you are but you look healthy and fit. I understand the struggle, as many of my patients experienced body dysmorphia at some point throughout their journey. Thank you for your question regarding what to do if you’ve lost 101 pounds, have loose skin, and have body dysmorphia disorder, and are afraid to consult with a plastic surgeon. Typically, consultations do not hurt. However, before I’m barking upon any reconstructive surgery, I would highly suggest you discuss your concerns with your psychiatrist or psychologist.. If you have any further questions regarding the lower body lift, 360-degree circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please consult with an experienced plastic surgeon. Since the body lift is a significant procedure, it is recommended to seek an experienced, board-certified plastic surgeon with extensive experience in performing lower body lifts. Do your research. Ensure they have performed at least 100 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced lower body lift surgeon in your neighborhood, consider traveling out of state if necessary. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)