There is a difference between procedures which "could" be performed simultaneously and those which "should" be performed simultaneously. While they can be performed safely during the same procedure (assuming a 6 hour max OR time), some consideration should given to the nature of these procedures and the anticipated recovery period. In general, it is always best to minimize the pressure on the surgical site. The recommendations for these 2 procedures in particular are in conflict with each other (one necessitating prone (belly) sleeping and the other supine (back) sleeping). There is no perfect solution in this scenario. For this reason, I do not regularly combine these procedures. Side sleeping is sometimes a reasonable compromise. Alternatively, patients can rotate position frequently (on the hour) or use a specialty pillow to offload the buttocks grafted area. However, for best results staging or staggering these procedures is best. With regards to your specific question, stacking these procedures can be safe, staggering them is relatively more practical/sensible (when one considers post op recovery). If one can make the necessary accommodations for recovery, the procedures should have no effect on each other. There are pillows/mattress which may be of help, however, it is up to the patient to decide of these accommodations can be made. There is no perfect order for undertaking these procedures. Undergoing BBL first necessitates fat harvest from areas where skin laxity/excess may already be an issue. Harvest will only exacerbate the problem which will then only be addressed at the time of the abdominoplasty. This does, however, optimize fat harvest. Beginning with an abdominoplasty, will avoid the problem of excess skin but compromises fat harvest. As always, discuss your concerns with a board certified plastic surgeon (ABPS).