Is this a realist expectation? I understand I'm heavier than most surgeons likes & that's ok (Photos)

Hello and thank you for your question. I actually answered your similar question from 8/17/23 as well. This is a pretty reasonable expectation, but it's impossible to tell preop how wide your trunk will be after the liposuction (i.e. how much of your current appearance is due to subcutaneous fat vs internal fat). For the benefit of other patients with similar body types and questions, I have copied my response to your other post below.
From the pictures you have provided, you have some striae (stretchmarks) present throughout your entire abdomen and extending to your flanks and around to your back. This is associated with a moderate/severe amount of excess subcutaneous fat and skin present diffusely throughout your trunk. There are skin folds across your lower abdomen extending to your flanks, and at least on your right mid back. It would be safe to assume that there is also a significant component of internal/visceral fat as well, which would not be correctable with any surgical procedure. Having had 4 kids, you most likely have some degree of diastasis (separation) of your rectus abdominis muscles located centrally in your abdomen (the "6 pack" muscles). Based on all this, you would definitely benefit from an abdominoplasty (tummy tuck- includes muscle repair) and 360 liposuction to best help improve your abdominal/trunk contour.
The difference between a "standard" and "extended" tummy tuck is just how far your incision extends to the side, and this is based on how much excess skin and fat needs to be removed to produce an aesthetic contour. They are essentially the same procedure, so no need to be concerned here. Generally, every surgeon tries to keep their incisions as short as possible so they can be easier hidden, but the goal here is improved body contour at the expense of scars, so this is important to keep in mind throughout the process. Regarding the transverse lower abdominal scar, it should be well hidden within your bikini or underwear, and if you adhere to proper scar care and sun avoidance after surgery, it should eventually heal to be minimally noticeable.
Liposuction is a great adjunct which would definitely provide additional benefit, particularly to the contour of your flanks and back, and can be done at the same time as your tummy tuck procedure for the best possible single operation results. Keep in mind that for you, given that there are stretchmarks and a skin fold present on your back, you likely have lax excess skin on your back which is not addressed with the 360 liposuction. This excess skin can become more noticeable and even appear deflated after liposuction, as it does not have the proper ability to fully recoil after the underlying fat is removed. Therefore, you would likely need another procedure to address your excess back skin at some point in the future, to further improve your overall trunk contour.
With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. You already have a surgeon and reasonable sounding operative plan, which is great- one less thing to worry about! I hope all this helps!
Best wishes,
Dr. Donald Groves
Plastic Surgeon

Hello Mrs. Davis19. Thank you for your question regarding the realism of your expectations.

As other doctors have mentioned, the outcome of your tummy tuck, muscle repair, 360-degree liposuction, and Brazilian butt lift (BBL) will largely depend on the amount of visceral fat you have in your abdomen. Visceral fat, which surrounds your internal organs, cannot be removed through surgery and may impact how small your abdomen can become post-surgery.

Regarding your back rolls, these could potentially become more pronounced with liposuction. If this bothers you, you may want to consider a back lift. There are two main types of back lifts: a horizontal back lift, which addresses the lower back, and a vertical back lift, which extends from the armpit partially down the side to where your bra strap lays horizontally. Either of these procedures could help to smooth out back rolls.

During your BBL, your surgeon will focus on transferring fat to the buttocks and hips to enhance your curves and achieve your desired shape.

I do not think your desired result is unrealistic. However, it's important to remember that many factors will influence the final outcome, including the amount of visceral fat, the quality of your skin, and how your body responds to the procedures.

I hope you are happy with your results and wish you the best of luck with your upcoming surgeries.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS

I would start with liposuction to remove excess fat from your abdomen, flanks and back bra roll areas. Going straight to the tuck will not remove the excess lower abdominal or mid upper abdominal fat. Once healed, then you can address excess skin of the abdomen. You might only need a mini tuck.