Which One Should I Do 1st? Arms, Legs, or Butt?

As you can see l need a full body makeover and don't know where to start. I have lost 130+ pounds in the last year and half. I am 35, 6'0, and 190 lbs. I do plan on losing 10-15 more lbs so I can be a normal BMI but those last few pounds shouldn't change my appearance too much. Also I currently wear a size 12/14 and because of my height do not want to be a size 2 but have been told I can get an hourglass shape and wonder if that is true. Thanks in advance.

Doctor Answers 9

What to treat first after weight loss

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The answer depends on what bothers you the most.    Most of my weight loss patients opt for a lower body lift.  This procedure (LBL) is also referred to as  circumferential body lift = belt lipectomy.  This procedure is essentially 3 procedures in one: extended tummy tuck + waist/lateral thigh lift + buttock lift.  The buttock lift can also include buttock augmentation.  The lateral thigh lift will help contour the lateral aspect of your thighs.  The procedure can taken between 5-7 hours depending on the amount of tissue/skin that needs removal/treatment.  Please see a board certified plastic surgeon to learn more about your options.

Dr. Sugene Kim

Body Contouring in stages

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I would rec you do what troubles you the most. Then stage each procedure based on your discussion with your PS.

Which procedure first?

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The answer to your question depends on your goals and your anatomy.   a common first line of attack for patients who have lost weight is a body lift procedure.  Most plastic surgeons refer to a body lift as a circumferential body lift = belt lipectomy.  This procedure is essentially 3 procedures in one: extended tummy tuck + waist/lateral thigh lift + buttock lift (with the option of buttock augmentation).    A physical exam would be needed to make any recommendations.  Please visit with a plastic surgeon certified by the American Board of Plastic Surgery to learn more about your options.

Best wishes,

Dr. Basu

Houston, TX

Lower body lift

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I normally recommend to start with the lower body lift for most patients, do ti the fact that will have an greater improvement on the butt, waist, inner and outer thighs, this operation can be convened with other surgeries fi your health is adequate

Which operation first with a total body makeover?

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Way to go with the weight loss!  I am a big believer in listening to patients and finding out what the most important areas are and treating those first and then combining procedures that will ultimately be SAFE and effective.  As physicians, patient safety is our utmost concern.  My recommendation is to seek out a board certified plastic surgeon who has extensive experience in dealing with massive weight loss patients.  If you are unsure who that person may be in your community, call one of the bariatric surgeons and speak to his or her nurse.  The nurses know who operates on their patients and the results that they achieve.  Every patient is unique in both anatomy as well as expectations.  If you find a surgeon who has an experience team or works with an associate, you may be able to have all three operations at once.

In any event, from my experience with weight loss patients, I want you to know that more than likely you will need some touch up of scars or maybe a little extra skin removed after your primary surgery so a staged approach could be quite a benefit to address secondary concerns.


Good luck with your future weight loss and upcoming surgery.  Seek out somebody who you are comfortable with on both a personality and skill level because you will be spending quite a bit of money and you should absolutely be confident in your surgeons skill and bedside manner.

I would suggest doing Buttock, Legs, and then Arms...

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Congratulations on your weight loss of at least 130 pounds. Great job! I would definitely suggest you have the buttock reduction surgery performed first. This Surgery should eliminate a significant amount of skin and fat. Approximately one to two months later, I would do the leg reduction or leg lift. Then, one to two months later, I would then do the arm reduction. The reason I would do arms last, is that you need your arms to move around, to pull yourself up, and take care of the drains during your buttock lift and your leg reduction. Typically, this is why I encourage patients to do the arms lift last. Please be sure you seek a qualified reconstructive plastic surgeon with a significant amount of experience in body contouring after massive weight loss. Good luck with your weight-loss journey. Sincerely, Dr. Katzen

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Massive Weight Loss Surgery

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 Take a good look at yourself in the mirror and write down the areas/ things you do like. Then, get dressed and rank these conditions from #1 to #3 with #1 being your greatest area of dislike. For instance many massive weight loss patients will write down “ I have these skirt and my buttocks is flat” Or “ I have fans/ flags on my arms?” You have now determined what you do not like about your body the most.
 Now it is time for a Cosmetic Surgery Consult. Express your issues/ concerns, get costs and down time. Also, ask about alternative types of treatment/ surgery and complications. Consider writing down the responses/ answers. You obviously understand this is usually a staged process of restoration.
It might be wise to consider a member of the ASAPS/ ASPS in your area. They are experts in Massive Weight Loss Surgery. Best,



Gary R Culbertson, MD, FACS

Gary R. Culbertson, MD
Columbia Plastic Surgeon

Sequence of Body Contouring Operations after weight loss

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To an extent the sequence of operations is patient preference. I generally ask my patients operation they prefer to do first and what bothers you the most. If you are developing rashes, infections, pain or limitations in your daily activities then start with the most functionally problematic area. Also consider necessary downtime (6-8 weeks), your responsibilities at work or home and the time of year (summer vs. winter). I do not recommend operating on your arms and legs at the same time because recovery can be challenging.

Jason S. Cooper, MD
Jupiter Plastic Surgeon

Which One Should I Do 1st? Arms, Legs, or Butt?

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I don't see much technical surgical advantage to any particular order here, so I would suggest that you choose the one for which improvement is most important to you. That may be the arms since they are most likely to be uncovered by clothing, but the priority should be yours. 

When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.