I'm an obese (BMI = 39) client interested in plastic surgery (BBL, lipo). Are there approaches that would work for me? (photos)

I'm certain you can find a surgeon whose zeal to receive a surgical payment exceeds his or her need to be safe and avoid complications or death (yours). Do you really want the lowest possible safety in order to have surgery you perceive as "no big deal?" You could indeed be that one who suffers a blood clot and dies, or simply develops pneumonia or other minor or major complication.
Most surgeons are wise and ethical enough to not be swayed by insistent patients who are less concerned about their own safety than an anticipated outcome!
Don't be silly; you need to lose weight. And your doc is either mistaken or being misquoted--you may be healthy in some ways, but a BMI of 39 is never healthy. Best wishes! Dr. Tholen

You are probably better to lose weight to get to a BMI below 35 or close to 30, though this is just one measure of health.Kenneth Hughes, MDLos Angeles, CA

Thank your for this question. As the previous answer stated, your current BMI places you into a category of high risks! I would encourage a medically supervised weight loss program to lower your BMI. As you lose weight, you will see your body change and will likely experience more sagging abdominal skin, but your figure will get smaller. Once a goal weight is reached and your risks are lower then it will be time to see which procedures will fit you best.

Your request is reasonable and may be possible. Based on the pictures, a tummy tuck would be the way to go. See link below for an example of a similar patient. 

Actually, from the pictures, it doesn't look like you're a BMI of 39.  The best way is to check out the websites of doctors and look at the before/afters, and see if there are doctors who have experience operating on "larger" clients.  I would then see those doctors for an in-person evaluation and a discussion of your goals.Best,Dr. Dan KrochmalMAE Plastic SurgeryNorthbrook, IL

BMI should be less than 30 prior to elective surgery for health and safety reasons. Then I would recommend an in person consultation to assess the appropriate treatment to achieve your goals. 

Your first step with the information given should be to loose weight in order to be at good BMI so that you are healthy for a procedure.  The recommended BMI is less than 30. This is the recommendation of the American society of plastic surgery. The reason simply, is increased chance of complications. These include but limited to, pulmonary embolus, deep venous thrombosis, delayed wound healing and increase infection rate.
Choose a board certified plastic surgeon who has done a ton of Brazilian Butt Lifts and has privileges to do this surgery at a local university hospital. This says his credentials have been checked out by fellow Drs. All surgeries carry risk, talk to your plastic surgeon and choose one wisely.Many surgeons, including myself, offer online virtual consultations where you send us your photos and we can estimate the cost. I, like many surgeons, also offer free consultations so that you can be examined and given the most accurate quote.

Greetings.  In terms of having a BMI of 39, I would not recommend surgery as the risk of complications is higher with an elevated BMI level.  Ever surgeon will have a different threshold and comfort level on what the cut off level would be for a maximum BMI number.  Even though you mentioned not beginning a weight loss program, it may be beneficial to lose weight to minimize the chances of any complications.  Good luck!