My suggestion would be for your first surgery to be a bariatric surgery procedure to help you lose the weight you need to prior to any type of cosmetic surgery. There are a number of excellent bariatric surgeons, and I can personally recommend the surgeons at Rocky Mtn Surgeons in SLC. The team of Drs. Simper and McKinlay can talk you through the important considerations prior to surgery.Because of your high BMI, = 42, you should be a candidate for a bariatric procedure based on the usual medical recommendations, and you may in fact be able to have insurance coverage. The improvement in your health and risk of future medical problems would be a fabulous benefit of the surgery.Once you have lost the weight necessary to get you down into a BMI of 30 or below, you will likely be an excellent candidate for body contouring procedures such as a lower body lift, arm lift and etc. Of course, you gotta lose that weight first!!!If you need any help with referrals, don't hesitate to contact us. Be sure to steer clear of any type of cosmetic surgery procedure until you have lost your weight. Good luck and give yourself the necessary time to get ready for things you'd do to improve your appearance.