100 pound weight loss - Tummy tuck or lower body lift? Lipo or no lipo? (Photos)

Question

Hi! After losing over 100 pounds, my skin is dripping off of me! Obviously a breast reduction and lift is in order, but what do you recommend for the midsection-—TT or LBL? And would you do no Lipo, Lipo to front only, or Lipo 360? Thanks in advance for your input!

Luis A. Mejia, MD · Answer

Hello, thank you for your question, first of all congratulation on your weight loss, after evaluating your case, if you have good Hemoglobin levels... a Vaser Liposuction Technique, witch will help with the skin retraction,  and a Extended Tummy Tuck with muscle repair will definitely improve your self steam, now depending on your labs values a Breast Lift could be done. Safety First

J. Timothy Katzen, MD, FACS · Answer

Hello, BaldwinBeauty in Chicago, IL. Thank you for your question regarding a 100-pound weight loss and whether you need a tummy tuck or a lower body lift with or without lipo. Congratulations on your weight loss! Great accomplishment. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. On your abdomen, buttocks, and hips, you have cutis pleonasmus (excess skin), dermatocholosis (loose skin), cellulite, and striae (stretch marks). Your best results would be achieved with a 360 ° circumferential lower-body lift (LBL) and liposuction, and possibly a BBL if you want it. An extended tummy tuck will not achieve as good results as a 360 ° circumferential lower-body lift. At a minimum, you would need an extended tummy tuck. However, based on your pictures and weight-loss history, you would have dog ears at the ends of your incisions. Therefore, a 360 circumferential lower body lift will address all areas of concern, namely the abdomen, pubic region, rectus abdominis, hips, and buttocks. In regards to your buttocks, do you want them lifted, reduced, or augmented? If you want them lifted or reduced, do the 360° circumferential lower-body lift. If you want the buttocks augmented, I would suggest doing a 360 circumferential lower-body lift in addition to fat transfer to the buttocks. Another alternative would be to have the extended tummy tuck and fat transferred to the buttocks in a single procedure. At a later date, you could undergo the buttock lift. However, that would mean two surgeries, two recoveries, and increased expenses. I hope this information helps. Good luck. I hope I’ve answered your question about losing 100 pounds and whether you need a tummy tuck or a lower body lift with or without lipo. To get an accurate assessment of what exactly you need, schedule a free virtual consultation. Most plastic surgeons offer free virtual consultations. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy please contact an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Make sure they have performed at least 150 circumferential lower body lift surgeries and have the before-and-after pictures to prove it. Carefully examine their before-and-after pictures and check their reviews on RealSelf. If you cannot find an experienced, lower body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Christine Fisher, MD, FACS · Answer

First of all, congratulations on your weight loss!  Losing 100 pounds is a tremendous accomplishment and a major investment in your health and well being. As a board certified plastic surgeon, the next step is to match your surgical plan to your anatomy and aesthetic goals as safely and efficiently as possible.

From your description, a breast lift, tummy tuck vs lower body lift, and liposuction are all reasonable components of a comprehensive contouring plan after massive weight loss. Given the amount of excess tissue in your lower back, a 360 lower body lift would be recommended to remove and/or rearrange tissue circumferentially, addressing the lower back as well as the front during the abdominoplasty portion. When possible, it is often beneficial to conserve some of the lower back tissue and use it as a flap to the upper buttock to help restore a natural buttock curvature rather than leaving the area flat.
 
Liposuction alone to the back in this setting typically leaves a significant amount of loose, deflated skin, which is why skin excision with a lower body lift is usually preferred. In addition to the lower body lift, liposuction of the flanks with contouring of the upper abdomen can refine the waistline and smooth the transition between the torso and hips. It is also common to include liposuction of the outer chest and armpit area to create a more harmonious contour with the breast and upper torso.

For the breast lift, the use of an absorbable internal support (a surgical mesh that acts like an internal bra) can help maintain the lifted position and reduce the tendency of the tissue and skin envelope to stretch over time, particularly in patients after massive weight loss.

It is essential that you meet in person with a board certified plastic surgeon who specializes in post weight loss breast and body contouring so your anatomy, medical history, and priorities can be thoroughly evaluated, and an individualized, staged surgical plan can be created to help you reach your goals as safely and predictably as possible.

Daniel Barrett, MD · Answer

Dear BaldwinBeauty,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because only after a thorough examination you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mehmet Ozdemir, MD · Answer

Hello, this is Dr. Mehmet. You are a good candidate for 360-degree liposuction, breast reduction with breast lift, and a tummy tuck.

David Mateo de Acosta Andino, MD · Answer

Congratulations on your weight loss. Losing over 100 pounds is a major accomplishment, and what you’re experiencing with excess skin is very common after that kind of transformation.
For the midsection, based on your photos, most patients in this situation benefit more from a belt lipectomy (also called a 360 tummy tuck) rather than a standard tummy tuck alone. A traditional tummy tuck primarily addresses loose skin and muscle laxity in the front of the abdomen. After massive weight loss, excess skin usually extends around the waist, hips, and lower back. A belt lipectomy would address the abdomen, hips, and buttocks in a single, continuous contour, which leads to a much more balanced result. 
I almost always recommend liposuction in combination with skin removal procedures, especially after weight loss. Liposuction is not a substitute for removing loose skin, but it complements it by refining shape and improving overall contour. After weight loss, the skin may be loose, but there is often still residual fat that affects definition. Lipo helps enhance the final balance and contour once the skin is tightened. 
When combined with a breast reduction, this surgical plan can restore proportion, improve comfort, and better reflect the hard work you’ve already put into your weight loss. The exact plan should always be customized based on your anatomy, skin quality, and health, but this combination is very common and very effective in post–weight loss patients.

Gregory Lakin, MD · Answer

Thank you for your question. Based on your photos, the best choice is a circumferential lower body lift (LBL) instead of a standard tummy tuck because LBL removes and lifts loose skin all around (abdomen, flanks, back, buttocks, outer thighs) and effectively flattens the front while lifting the back. Pair this with a breast reduction with a lift for your chest. Regarding the buttocks, many patients who have lost a lot of weight are poor candidates for BBL due to limited donor fat and lower graft success; if you have enough fat, consider BBL as well. Stage procedures (for example, LBL first, then breasts, then buttock volume as needed) to keep anesthesia time and wound risk low, and improve nutrition (protein, vitamins A/C/D, zinc) before surgery. You’ll need an in-person exam with a board-certified surgeon to confirm if you’re a candidate, plan staging, and decide on the extent of Lipo 360 and BBL based on your available fat and safety.

Sean Hill, MD · Answer

Answer from Dr. Sean Hill, Board-Certified Plastic Surgeon – Lone Star Plastic Surgery, Frisco, TX:
First off &mdash; congratulations on your impressive weight loss. That kind of transformation takes real dedication and is something to be proud of. When it comes to post-weight loss contouring, choosing between a tummy tuck (abdominoplasty) and a lower body lift depends on the pattern and degree of skin laxity around your torso, hips, and thighs &mdash; and I appreciate you including photos to guide this assessment.
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Leila Kasrai, MD, FRCSC · Answer

Congratulations on losing so much weight! You may benefit more from a circumferential tummy tuck as this would target both the front and sides. Liposuction may be performed at the same time to contour your sides.

Jeffrey M. Darrow, MD · Answer

Congratulations on your weight loss and thank you for your photos. Clearly, your best result will be from a breast reduction, which includes a breast lift at the same time, to rejuvenate your breasts. You have a circumferential excess of skin and the best way to manage that would be with a lower body lift. There may be some spot areas which could benefit from liposuction, however, a reduction and LBL surgery will likely be about 6 hours and increased time under anesthesia has a progressively higher complication rate. Safety first! Liposuction can always be done after you have healed up from your lower body lift.  Best wishes.

100 pound weight loss - Tummy tuck or lower body lift? Lipo or no lipo? (Photos)

Answers (16)

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