360 TT or extended with lipo of flanks waist & back? Can it be done and will it help the upper rolls? (Photos)

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could likely be
achieved with 360 circumferential procedure.  I would not recommend a drainless procedure you.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

hello ZNYC Depending on the selected procedures, some may be performed at the same time in either an “upper body lift” (arms, breasts, face) or “lower bodylift” (abdomen, thighs, buttocks). The specific procedures necessary are to be determined on a case-by-case basis; the patient will discuss the areas of concern with the PS. You should schedule an in-patient consultation with a certified PS. #options #360

Thanks for your question and the photos. There are some thing that your pics alone will not answer but I'll try to share some thinking until you can have an in person exam with your PS.First concept:Everyone wants a " one and done" no one wants more than one surgery, but sometimes staging certain surgeries will give a better and more predictible result.Second:Fleur de lis tummy tuck-- no one wants that scar- I totally get it, but follow me here....While a standard tummy tuck is a downward or vertical pull, when we loose weight post partum or otherwise we actually get loose in more than one direction. A fleur de lis tummy tuck tightens us both horizontally and vertically.When muscles are tightened in a tummy tuck, more that the muscles are brought into the midline. The skin on either side of the abdomen is brought into the midline too. In a patient without too much horizontal laxity this extra skin can be released and spread out flat from underneath. In a patient with a lot of horizontal laxity such as a massive weight loss patient there is too much skin to lay out and it will bunch up in the middle. If they are having a fleur de lis tummy tuck it doesn't matter because the skin will be cut out anyway. If no fleur de lis is planned your PS will have to decide wether to tighten the miscles just a litte or not at all to prevent this bunching. There will also be residual horizontal laxity after the TT that the patient must expect.From your photos I belive that you do have a lot of muscle separation and a lot of horizontal laxity, but only an in person exam could confirm this. It is probably why at least one PS suggested fleur de lis to you. You simply have to be aware of the outcomes with fleur de lis or not.Third:Circumferential tummy tuck or "belt lipectomy". I think you  will be a good candidate for removing skin from the lower back, but it will not solve all the back rolls you have. The back has a different blood supply than the tummy. You can lift up the whole central abdomen and pull it down tight like the sheet on a bed. In the back you can only take a wedge (or slightly more ) at a time. This belt wedge will affect mainly the lower back not the upper (more on the upper later).My two cents: I generally prefer not to cut skin out of the back and front at the same time even though it can be done. When I focus in a tummy tuck I want to give that patient the best tummy I can. If I am pulling a patient backwards at the same time I am pulling them forwards I personally feel like I am fighting my own goals. I prefer to give the tightest belly I can, let it heal, and then give the tightest back I can. If I stage these surgeries I think it does a better job. Fourth: Back rolls.Many people think that liposuction is the be all and end all for back rolls. For the right candidate with good skin tone it is a good solution. For patients where the skin is loose and there are deeper folds it is less gratifying. The back rolls are a combination of skin and fat, liposuction removes the fat, but not the skin. There is a better operation that almost no one wants called a bra strap excision. Bra strap excision cuts out both the skin and fat togther in the upper part of the back. It is like a limited tummy for the upper back and leave a scar under the bra strap, but ost patients though do not want that scar even if hidden under the bra stap. In a patient with less than perfect skin tone if we consider liposuction I use the term  "Soften the rolls" because lipo remove no skin.Summarizing this lengthy post:From your pics I think there is more than one surgery in your future. It looks as though you have lost a large amount of weight and skin is loose in multiple areas. It looks at though you will benifit form TT, flank and upper back excision which I would favor staged. Fleur de lis is certainly at least somthing to consider.As you approach your surgeries. Be healthy, be at a good weight before you start and have stable nutrition prior to starting. Be sure that you feel well educated by yout PS about the consequences for what you choose to and not to do.I hope this discussion has been helpful and makes sense.Best wishes.

Drainless tummy tucks may or may not be more costly based on whether or not the surgeon uses tissue glue or not.  A 360 procedure would definitely be needed to address the extra skin on your lower back.  It is even likely that if you want your upper back excess skin addressed you would need to remove skin there and add scar separately there as well.  In the end, scars are the trade off for traumatic skin tighteningBest of luck!
Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

You are best served with a circumferential approach to skin resection. Liposuction alone will not help. To address the back rolls, you may also need a back lift which is essentially a body lift within the bra line. There are no shortcuts in your case. Best wishes. 

First, you have to be evaluated in person.  If your BMI is very high then I would wait until you lose more weight. You have a lot of loose skin on the back.  The lowest rolls will be treated with a circumferential procedure. The upper back rolls will require an upper body lift. Lipo alone will not help. Good luck