I want several procedures. Which should be first and why? (photos)

My main concern is my belly? I look like I'm still pregnant after 4 kids. I've always wanted a bigger butt and fuller breasts. I weigh 190lbs and I'm 5'8". I would like total upper body liposuction, bbl, breast lift with possible gummy bear implants, facial liposuction in neck and cheeks, Botox in lips. I'm unsure if I would need a TT or will the bbl be enough. Which procedures can be combined? Or which can be done first with how much time between?

Doctor Answers 11

I want several procedures. Which should be first and why?

Thank you for the question and picture. I would suggest that you meet with board-certified plastic surgeons who can demonstrate lots of examples of achieving the types of outcomes you would be pleased with. Then, communicate your goals carefully. Working together you will come up with a good plan to achieve your goals. Best wishes.

Best order for multiple procedures?

You will probably get the  most improved outcome by combining a tummy tuck ( includes liposuction of the adjacent flanks and upper body) and a breast lift or reduction. If you like, the fatty deposit under your chin can be removed at the same setting. Botox can be injected in the office to save you on expenses. Plan to consult a Board Certified plastic surgeon to learn what your best options are.

Tad Grenga, MD, FACS
Norfolk Plastic Surgeon
5.0 out of 5 stars 11 reviews

Combining a Mommy Makeover with Additional Surgery Sites

It's difficult to suggest without a in-person one-on-one consultation. The Mommy Makeover is a combination of procedures to bring a woman’s body back to the way she looked prior to pregnancy. Most commonly some variation of a #TummyTuck and #BreastSurgery are performed. Additional procedures can include liposuction, umbilical hernia repair.  The most common #breastprocedures include #mastopexy or #breastlift, #breastaugmentation, or #breastreduction.  

#Combined operations are often performed with our #Gynecology colleagues. Tubal ligation is a common post pregnancy procedure which is done at the time of many of the surgeries included with a #MommyMakeover. If you require a gynecologic operation or study (laparoscopy) and are considering a plastic surgery procedure, discuss these issues with your physician and board-certified plastic surgeon. Also, combining these #procedures may decrease anesthetics, costs, and recovery time.
In addition to a one-on-one consultations with a board certified Plastic Surgeon, patients always need to be seen by their primary care doctor prior to such procedures.  We screen every patient and their medical records for risks of blood clots (DVT) and then take appropriate measures.  MWL (massive weight loss patients of  75 lbs or more) tend to have poor skin elasticity and will frequently need additional tightening even afte 6 -12 months regardless of who or how their surgery is performed. This is simply the nature of such body tissues and the ability to heal with the lack or limited elasticity. 

Your procedures should be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

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Several procedures which ones and why?

Thank you for your question along with your photos. I would recommend liposuction of your upper trunk in combination with a BBL. Liposuction to the neck and buccal fat excision to reduce facial roundness. You may or may not want a tummy tuck in the future. I would suggest starting off by finding a board certified plastic surgeon who then will give you a proper in person evaluation of what you should have done. 

Hope this helps,

Dr. Newall 

German Newall, MD
Houston Plastic Surgeon
4.4 out of 5 stars 50 reviews

Making a mommy-make over plan

Thank you for your question about your mommy make--over planning.

  • You can definitely have the tummy tuck, flank liposuction, breast lift and implants at one session.
  • Time permitting, neck liposuction can be done then too.
  • Facial liposuction is not a good idea - it can leave visible track marks and damage nerves.
  • Botox is not used to plump the lips but filler is - it is usually best done in the office, not at surgery, because the pressure of the anesthetic breathing tube makes it difficult to get your best result.
  • The total body liposuction and BBL can be done at one time - and usually are done first with a 3-6 month wait between surgeries depending on how much liposuction is done on the abdomen.
  • So find a surgeon who is right for you and come up with a final plan.
  • Be sure you understand the limitations of the fat transfer to the hips -
  • Results are unpredictable compared to buttock implants placed in the muscle which are permanent.

Always consult a Board Certified Plastic Surgeon. Best wishes, Elizabeth Morgan MD PHD

Where should you start?

You may not like this answer, but your first goal should be weight loss.  5'8" and 190lbs is not a bad weight, but your fat is distributed in your belly.  It appears as though you have quite a bit of visceral fat (fat surrounding the organs and under the muscle wall).  That fat can't be treated with a tummy tuck or liposuction.  If you are able to lose some of that fat, which is typically the first to go, I think you will make a good candidate for a tummy tuck with liposuction.  Good luck!

Which Procedure should be First?

It is all about your priorities. From what you said it sounds like the list is tummy, breasts, face in that order. Aggressive liposuction to define a waistline and slim your tummy someone would be first recommended. Following this, one might be happy with the final result or want to go on for a tummy tuck to tighten the muscles and further flatten the abdomen. Your breasts appear to be good candidate for implants. I doubt you will need a breast lift. Liposuction under your chin will make you look 20 pounds lighter. Fillers rather than Botox would be nice for your lips. I hope this helps.

Mommy Makeover

Congratulations on your four children! Thanks for your questions and helpful photos. 

I would suggest getting within 10-15 pounds of your ideal body weight prior to surgery. Your results will change if you lose weight after surgery. Also, you decrease risks of complications during surgery and recovery if you have a healthy BMI.

If you don't plan to lose weight and have been stable for 3-6 months, I would recommend doing upper back liposuction and tummy tuck first. The tummy tuck should include liposuction of the flanks.

A few months after these procedures, you can shift gears to your breasts and face. Of course a physical exam + breast measurements will be necessary for a formal diagnosis, but it appears as though you would benefit from a mastopexy and breast augmentation to lift the breasts and increase volume. 

Botox is rarely injected in the lips, though sometimes it can be administered around the lips for smoker lines. I don't think you would benefit much from this. Botox helps prevent muscles from forming active wrinkles; fillers (we use Juvederm most often) help increase volume in wrinkled areas or areas with diminished volume (such as your lips). That said, I would recommend a syringe or two of filler to your lips if you want a more youthful appearance. I would not recommend liposuction in the cheeks; but liposuction to the neck, as well as a necklift, would give you a more chiseled and youthful profile.

I recommend an in-person exam and consultation with a board certified plastic surgeon to achieve your goals. Best of luck, and please do keep us posted!

Which first? Mommy makeover

I would find a board certified plastic surgeon in your area who can give you options for combinations that she/he is comfortable with.  I usually tell my patients to start with the area that bothers them the most and then work from there.  However if you are set on doing multiple procedures then there are certain combinations that make more sense for recovery.  If you are set on definitely doing all the things you stated then I would recommend BBL (taking fat from the abdomen, back, flanks, and thighs if needed).  Then at a second surgery do the tummy tuck, along with lift and implants.  That way you can use the fat from the abdomen for the BBL prior to excising the extra tissue at the tummy tuck.  I do think you would benefit from a tummy tuck more than just lipo so the rectus muscle can be tightened and the extra skin removed.  The facial lipo is probably best saved for the second surgery since you'll be lying on your stomach for the BBL and don't want the extra swelling in your face from lying on your stomach.  Botox is performed in the office.   Some surgeons will perform a BBL and tummy tuck at the same surgery but the recovery is more difficult since you'll need to stay bent at the waist for the tummy tuck and need to keep off of your buttocks for the BBL.  Best wishes!

Maida Parkins, MD
Milwaukee Plastic Surgeon
5.0 out of 5 stars 34 reviews

What should be first and why?

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for a consult.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.