Not sure which procedure is best? Butt lift, lipo, tummy tuck? (Photo)

Question

I am a 34-year-old female who is very active, I go to the gym daily for two hours at a time. I gained 85 pounds when I was pregnant with my son (3yrs ago) and have since lost all of that weight however, my body is now a mess. My stomach is loose and saggy, I have cellulite in my buttocks and thighs & would like a butt lift. Do I need multiple procedures? Ex: Bbl, lipo, tummy tuck? My goal is to feel comfortable in my body again, and love what I see when I look in the mirror.

Ryan A. Stanton, MD · Answer

First, congratulations on the weight loss and keeping up the hard work in the gym.  Unfortunately, working out does not effect loose stretched skin. That skin needs to be cut out with procedures such as a tummy tuck. Because you are so active and lean, BBL is not an option and will fail if tried, period.  Beware, if a surgeon asks you to purposely gain weight (i.e. fat) before BBL, know that the fat you lose first as you get back to your baseline weight after surgery is that very same fat that was transferred into your buttock, hence your new buttock shrinks first, the fastest, and the most...so please do not fall victim to this recommendation. Even those patients that had adequate amounts of fat pre-operatively, still end up seeking buttock implants after a year or so because most of the fat transferred melted away leaving them with minimal result.  Fillers such as Sculptra are cost prohibitive, provided enough volume is injected (i.e. at least 400 cc of active ingredient costing over $300,000) and last only 12 - 18 months.  So, if you're looking for a reliable, predictable, and long-term permanent option that also provides fullness and projection buttock, buttock implants are your best solution. Please note that an extremely few number of board certified plastic surgeons specialize in buttock or hip implants, so you may need to travel far and away from home to find this particular surgeon. Glad to help.

J. Timothy Katzen, MD, FACS · Answer

Hello DXn87 in Boston,
Thank you for reaching out with your question about the most suitable procedure for you, considering whether you need a butt lift, liposuction, or a tummy tuck.
First off, congratulations on your impressive 85-pound weight loss. This is a significant achievement and it's evident that your skin has responded relatively well given the amount of weight you've lost.
Given your weight loss history and the current state of your skin, it's important to consider the following:
Liposuction: While liposuction is effective in fat removal, it may not be the best option for you as it could potentially worsen your skin condition without addressing any laxity issues.
Butt Lift and/or Brazilian Butt Lift (BBL): If you are looking to enhance the size of your buttocks, you might consider a BBL. This procedure involves liposuction to harvest fat from other areas, which is then transferred to the buttocks. This option also includes an extended tummy tuck as part of the process.
360 Circumferential Lower Body Lift or 360 Tummy Tuck: If increasing the size of your buttocks isn't a priority, a butt lift combined with a hip lift and reduction, and a tummy tuck may be more suitable. This comprehensive approach addresses excess skin and reshapes the lower body, but does not involve augmentation of the buttocks.
Ultimately, the choice depends on whether you wish to increase the size of your buttocks. It's essential to thoroughly discuss your goals and expectations with a qualified plastic surgeon to determine the most appropriate course of action for your specific needs and desires.
I hope this guidance helps you in making an informed decision about your body contouring options. Wishing you the best in your journey towards achieving your aesthetic goals.
Sincerely,
Dr. Katzen

Miguel Mota, MD · Answer

Excellent question. You obviously have excess loose skin. Mostly on the lower half of the abdomen, but also abound your navel. Because your navel is high, the TT scar may not be as low as I would like…. still low enough though. It will be bellow any c-section scar for sure! 
Sometimes when we have a high navel we need a short vertical scar (about an inch) just above the horizontal TT scar, to make sure the skin flap reaches the scar. Not a big deal. This heals pretty well and is easily hidden under a bikini or underwear.  
As for lipo BBL. This can definitely be done….. though you do not have a lot a fat for the bbl. Liposuction will help with your silhouette and the BBL, no matter how small it is, will hell with your butt size and especially butt shape. Actually the BBL will not only help improve the butt, but will give you a more harmonious overall shape.

Best of luck,
Dr. Miguel Mota

Manuel Diaz, MD · Answer

Hi dear , I hope you are ok 
According to your photos you are the perfect candidate for a Tummy tuck , Lipo and BBL, you need tummy tuck to cut skin so you can lose excess skin and close the muscle and Lipo to create a better silhouette and with that fat fill your buttocks and hips. You will have excellent results for your body build.

Douglas Taranow, DO, FACOS · Answer

Congratulations on losing the pregnancy weight. Unfortunately, you are only a candidate for an abdominoplasty to remove the excess abdominal skin. Liposuction of your sides with a BBL will improve your buttocks, I’m just not sure how much fat you have.  Very active patients (“gym rats”) tend to burn off fat post op.

Mats Hagstrom, MD (license on probation) · Answer

The choice of procedure should be based on the underlying ideology or diagnosis.

In aesthetic medicine I called that making an assessment.

In regards to the front of the abdomen there are four variables that contribute to what it looks like.

In other words if someone doesn’t like their belly is always because of one of these for variables in each one as his own unique way of being treated.

The four variables are skin laxity, excess subcutaneous fat, muscle separation from previous pregnancies called diastasis recti, excess visceral or intra-abdominal fat.

In your case based on your pictures skin laxity is by far the greatest contributing variable.  you may have a slight muscle separation but your subcutaneous fat is very thin and you show no evidence of having a visceral fat problem.

A full tummy tuck is going to be your best procedure. If you’re fairly certain you are not going to have more children in the future and that is the right procedure. If you plan or are thinking about having more children than you should wait until you’re done having children before having a fold tummy tuck.

For most women who’ve had children it’s appropriate to do muscle tightening as part of the procedure though it is possible to do a skin only tummy talk without muscle tightening which makes the recovery much easier.  typically women who’ve had children should generally have muscle tight thing as part of the procedure.

Your bottom contour in fact your whole body contour is excellent and I’d see no need for Liposuction anywhere.

Fat transfer to your bottom will make cellulite worse not better.

There are cellulite treatments but they typically give partial or moderate improvements.

Cellulite is one of the more difficult things to correct.

It’s best done with the procedure called Subsicion. That can be done with a device called Celfina though having the device is not necessary.

Sometimes dermatologist have more experience with Subsicion than plastic surgeons.

When the time is right well done full tummy tuck would be the best procedure for you.

The outcome or quality of work depends on who you choose as your surgeon.

I suggest all patients have multiple in person consultations and vet plastic surgeons carefully.

Judge individual providers results by who gets the most natural looking belly buttons(most important)), A very low set scar that follows an atomic contour naturally( 2nd most important), and finally asked to see before and after pictures of patients from all angles including the side and preferably the backside as well.

Top-notch plastic surgeons will take into consideration how the procedure will influence how patients look from all angles and will adjust accordingly not just focus on the front of the abdomen.

During consultations ask each provider to show their entire collection of tummy tuck before and after pictures.

Ask them to show you results that are some of their best, average and less than outcomes.

The key is to get them to show you as many results as possible.

Simply seeing a handful of pre-selected samples which in fact represent the best work of their career is insufficient to get a clear understanding of what the average results look like in the hands of this provider.

An experienced provider should have no difficulty showing you 50 or more sets of tummy tuck before and after pictures.

Highly experienced surgeons will have hundreds.

Look critically at the bellybutton and who gets the most natural looking bellybuttons.

To me it’s the most difficult part of the procedure and surgeons who are talented, detail oriented and willing to spend the time to do quality work will always get the most natural looking belly buttons. if they get that part correct then they usually know what they’re doing and get all the other parts correct as well.

Do not judge tummy tuck results based on how the actual scar looks since that is highly dependent on the amount of time since surgery and how each individual person heals.

Surgeons have very little control over individual peoples genetic make up which determines how people heal and what your scars look like.

Skin scars take 12 to 18 months before they’re fully mature and often after pictures are taken before that time window.  Some plastic surgeons hide scars by having women wear undergarments to cover it in the after pictures. I don’t think this is doing anybody any favors. Patients deserve to know what the scars look like though they do improve and that improvement does take time.

A full tummy tuck is a really major procedure that typically requires two for weeks off work without major home or work obligations.

If you’re ready to move forward and schedule multiple in person consultations with local board-certified plastic surgeons to get a quality assessment and hear what each one has to say.

Don’t commit to surgery including scheduling or paying a deposit during the consultation. Always give you safe time to think and make sure you finished all consultations before doing so.

I also recommend patients read all the reviews on all various physician review websites and avoid providers for the any significant number of justified negative reviews.

The absence of justified negative reviews is more important and more telling than having an abundance of positive reviews.

The plastic surgeons with the biggest social network profiles are not necessarily and are typically not any more talented than those who have lower Internet visibility.

Famous or popular does not equal talented.

Find the right plastic surgeon and everything falls into place.

Best,

Mats Hagstrom MD

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