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.