Follow-up: What do you mean by "realistic expectations"? (referring to question posted from 32 yo childless F) (photo)

I posted this photo and got a plethora of responses from surgeons - all valuable feedback. Most, regardless of their advice, cautioned me on setting realistic expectations. I don't understand what that means. I am 5'11". Healthy diet. Kickboxer. Pilates and yoga. I work out 3 hrs a day everyday. I can't get skinnier than this picture. I volley between 162-165 lbs. What should my expectations be? I'd like to be 145lbs. Is that unrealistic?

Doctor Answers 8

Having realistic expectations?

The benefits of surgery are often profound but still there are limits to what can be achieved.  The nature of your skin's elasticity will affect how tight it remains and the nature of your healing well influence whether your scar is barely visible or possibly prominent.  These factors and others need to be discussed with your plastic surgeon before proceeding to be certain that your expectations are realistic and that you are well informed as to potential limits and complications of the procedure.  For example, when someone has gained and lost 40 to 60 pounds it is unlikely that their skin elasticity is such that their stomach can be made perfectly flat and smooth.  This is just one example that may be helpful to you.
The bottom line is spend some time with a face-to-face consultation with your chosen surgeon to make sure that you understand healing course as well as reasonable expectations of what changes can be accomplished.  Best regards and good luck.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

What do you mean by "realistic expectations"?

Thank you for the insightful question.   Generally speaking, achieving   realistic expectations is an important part of the preoperative "process";  this involves very careful communication between patient and plastic surgeon when it comes to what the patient wishes to achieve and what is ACTUALLY achievable.  In my opinion, this is often best communicated with the help of visual aids such as photographs (for example previous patients). 

 Failure to achieve realistic expectations prior to surgery may be a  cause of patient satisfaction, despite a well executed and complication free procedure. 

   I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Abdominoplasty maybe patient

The reason you are having problems is that you are not a great candidate for this procedure. You have some fat. You have some skin. If you do the abdominoplasty, the skin may be so tight that it may not be possible to close it nicely, and it may leave excess fat behind. If you do lipo, then you may have loose skin. It's actually easier to treat patients with more of a problem, because when you have a LOT of loose skin then it easier to transpose the belly button so that the scar looks good (hard to explain quickly on RS sorry). I think you should work on dropping the fat, through lipo if there is no other way, and then see what the state of the skin is, maybe it looks great and you avoid a big tuck. You can use some of the energy derived lipos as then may do a slightly better job at the tightening, look for "high-def", VASER, slimlipo, and that type of thing, someone ideally who does this a lot. And make sure your doctor agrees with you about your problems, it's weird if they don't agree with you but treat you anyway

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 13 reviews

Realistic expectations from a tummy tuck

Realistic expectations are the ideal result of communication of an honest doctor with a realistic patient.
Unrealistic expectations come from expecting something that surgery cannot deliver.  Often it is the doctor's fault (over promising); likewise it can be the patient's fault if they are overly perfectionistic.
You should always leave a consultation with your prospective surgeon with the impression that they are honest about what you can expect from your surgery.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Unrealistic expectations

means expecting a perfect result or something that no surgeon can deliver with our techniques and technology available to us.  If you must have perfect, you will have trouble finding an ethical surgeon to do this for you.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Follow-up: What do you mean by "realistic expectations"?

That's a really good question. Plastic surgeons, for the most part, are interested in helping their patients meet their goals, but they are not magicians. They have to work with what the patient brings them. If a patient is after a goal that cannot be reasonably reached with our techniques, then that would be an UNrealistic expectation of what we can achieve. That patient is either going to be turned down for surgery (the best option) or spend money and take risk and receive a result short of their expectations (the worst option). It is obvious that you work very hard to achieve a specific level of fitness. If you can't tighten your skin (exercise obviously won't do that) then your request of us to give you tighter skin is realistic. If you expect us to give you the skin of a 20 year old who has never been pregnant, we cannot do that. I see 2-3 patients a year that have very little body fat and minimally loose skin who were talked into laser liposuction to tighten their skin and further reduce their fat. All they got was scarred irregular fat that looks horrible and cannot be corrected. They had an unrealistic expectation and their surgeon, rightly or wrongly, tried to achive an unobtainable goal with disaterous results. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Tummy tuck realistic expectations

Realistic expectations is that a abdominoplasty is a contouring procedure and not a weight loss procedure.  If you are looking for a "six pack" abdomen, just from your photos and because you have somewhat thick skin, it may not be possible. However, after the abdominoplasty and weight loss and exercise,, you can come close.

Malcolm A. Lesavoy, MD
Beverly Hills Plastic Surgeon
3.9 out of 5 stars 11 reviews

Mini tummy tuck

I have read the other answers and both of your questions.  I think what it means is that removing your skin and some lipo will not get your weight down to 145 pounds.  You don't lose that much weight with a tummy tuck... you have mostly skin...probably lose about a 3-4 pounds at most.
From the pics I would offer a mini tummy tuck and lipo of the upper abdomen and flanks.   This is because your belly button appears very high and I wouldn't want to have a verticle component to your scar.  Mini tummy with an incision hip to hip because there is a lot of skin .  Another option would be to do full liposuction of the entire abdomen so you don't have a scar.  You need a good exam in the office to be sure. Just my thoughts from the one pic I see.  i hope this helps.  Look for a board certified plastic surgeon...good luck!

Andrew T. Cohen, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 42 reviews

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.