Morbidly obese woman: tummy tuck, large volume lipo, BBL, anything? (Photo)

Question

Im 5'1", 270 lbs, in great health and am in the process of trying to lose weight. Given my weight and my bulging stomach though it's been very difficult on my back and ankles, not to mention hard on my self esteem. Am I a good candidate for any sort of fat removal/shaping that could help with my stomach, the fat rolls on my back, and mayve help shap my butt?

Dallas Buchanan, MD · Answer

Thank you for your question and pictures. At your current BMI of 51, you are not a good candidate for cosmetic surgery of any kind. Not only would your results from the procedures you mention not make you happy, but it is also very unsafe to pursue cosmetic surgery at this time. Plastic surgery is not weight loss surgery and should never be viewed as this. If you are really interested in changing your life, you need to consider weight loss (bariatric) surgery. This would get you on the path you want to be a different person and then once you have lost the weight you want to lose, you can then consider cosmetic surgery to remove excess skin. Hope this helps!

George Marosan, MD · Answer

Thank you for your question and photos. Based on your photos and BMI of 51, you are at high risk for any of the procedures you are entertaining. In cases like yours, I offer fat debulking of the abdomen under local tumescent anesthesia only. This will help you with exercise. A physician supervised weight reduction program is a must as well. Other options are looking into bariatric surgery, but you also need to commit yourself mentally to make this dramatic change in your life. Good luck.

Justin Yovino, MD, FACS · Answer

In my opinion, the best surgical procedure for you at this time is thorough liposuction sculpting of your upper and lower abdomen.  This will likely remove 3-4 liters of FAT which will lead to a significant instant size reduction.  If this is performed in the awake setting, you can return as soon as two days later to continue the size reduction around your waist and love handles.  This will produce another 2-4 liters of FAT for even more reduction.  Once you've completed this, then you will have broken the cycle and you will protect your investment with improved diet and the ability to increase your exercise.  I see this all the time in my practice.  Once you shrink down to size, then you can readdress the tummy tuck option to deal with the excessive skin and weakened stomach muscles.

Larry S. Nichter, MD, MS, FACS · Answer

Far more important than deciding if TT is for you is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let him explain why one technique may be better than another and if you need a tummy tuck. Many board certified plastic surgeons provide a free first time consult and you should take advantage of that! See the below link on some suggestions on finding the most qualified Plastic Surgeon for you!
#doyouneedaTT
#TT

Richard J. Restifo, MD · Answer

Thank you for your question. The surgery of a TT and/or BBL would be much safer, and the results of the surgery much better in terms of cosmetic outcome, if you are able to lose weight well in advance of any surgery.  I would concentrate on getting involved with a dietician or nutritionist or other medical weight loss specialist to assist you in your weight loss goals. Best wishes!

Daniel B. Kim, MD · Answer

Thank you for reaching out and posting photos. And a huge congrats on your decision to loose weight! I would suggest you continue on that journey until you are at a healthy maintainable weight. that way once you have your surgery, your results will not be altered by more weight loss. In the mean time, maybe visit a few experienced board certified surgeons to learn about all of your options! Best of luck. Dr. Kim

Curtis Wong, MD · Answer

such as gastric bands or stapling?  You really need to lose weight before you have any kind of contouring surgery and if you do find one willing to do your procedures as you are right now, I would question your surgeon's ethics and credentials.  Focus on weight loss first and then see a plastic surgeon for body contouring after you experience your massive weight loss.  Good luck!

Millicent Odunze Geers, MD, MPH · Answer

A patient with a BMI of 51 (categorized medically as super morbidly obese) is not a good candidate for elective surgery. Surgery for those with a BMI over 30 comes with increased risk of complications. Your self-described "good health" is not consistent with the ankle and back difficulties you mentioned nor is it consistent with the descriptor you used, "morbidly" obese. You may want to consider significant weight loss before considering any type of elective surgery. Whether this weight loss occurs via increased activity and exercise or bariatric surgery will be up to you and your primary care doctor. You would be hard-pressed to find a legitimate, well-trained, safe, competent, and skilled plastic surgeon who would risk your life with general anesthesia and the high risk of poor wound healing with a tummy tuck procedure (or any ELECTIVE procedure) in your current state. As for liposuction, with your curry body habitus, you're now delving into "mega" liposuction, not simply "large volume" liposuction. If you were to have liposuction, ONE, to increase safety, your procedure would have to be staged into many procedures due to the sheer volume of fat that would need to be aspirated to begin to make a difference in your contour. TWO, the amount of volume that would need to be removed with liposuction to make a difference would create a dead space (the empty space between your skin and your abdominal muscle after the fat is removed) so large, you would be susceptible to huge seromas/huge fluid collections after liposuction, even with a compression garment. To combat this vast dead space created by large-volume liposuction, multiple drains would need be placed to evacuate the fluid. Even at that, you still may be subject to needle aspiration of the fluid in the office if the drains don't work or only work partially. THREE, obtaining a compression garment that is suitable for your size may also be a challenge, if not impossible. Compression would be a very important aspect of your postoperative care. FOUR, you will have a significant amount of loose skin afterwards which may appear even worse than before liposuction due to the deflation effect of fat removal. Don't underestimate the increase in self-esteem you can experience with the effort you place into losing weight with increased activity and improved nutrition versus just trying to go straight to liposuction. Liposuction will only help decrease fat volume in the areas treated, whereas weight-loss will decrease fat volume in all areas of your body. You can do it, you just have to decide to make your health a priority. Best of luck.

Tom J. Pousti, MD · Answer

Thank you for the question.  Proceeding with plastic surgical procedures at this time will not in your best interests.
Generally speaking, it is always best to achieve long-term stable weight prior to proceeding with body contouring surgery. Doing so, will increase the SAFETY of the operation, will likely improve the outcome of the operation, and will decrease chances that additional surgery will become necessary subsequently. 
In my practice, I do not ask specific patients to achieve a specific weight prior to proceeding with tummy tuck surgery. I simply ask patients to achieve a long-term stable weight where he/she feels comfortable and does not expect significant fluctuation postoperatively.  ***As you know, recruiting other professionals such as personal trainers, nutritionists, physicians who specialize in weight loss concerns etc. may be helpful to you. 
 Having said the above,  occasional patients do benefit from panniculectomy surgery as a “jumpstart” to achieving their final goals. The panniculectomy operation involves excision of the lower abdominal wall pannus or  overhanging skin/adipose tissue. It is not considered an  aesthetically driven procedure;  it is often performed to help with concerns such as skin breakdown, infections/rashes…You may find the attached link, dedicated to patients who have experienced significant weight loss, helpful to you as you consider your options. Best wishes.

Brian Windle, MD (retired) · Answer

I have to echo the statements of most of the other surgeons here.  With a high BMI you carry a lot of your weight inside your abdomen or so called visceral fat.  This fat along with your high BMI puts you at risk for many surgical complications.  While surgery for medical reasons leaves surgeons with little option other than to proceed, for elective surgery the risks are just far to high.  As a result the benefits do not outweigh the risks.I hope that helps.Best regards.

Morbidly obese woman: tummy tuck, large volume lipo, BBL, anything? (Photo)

Answers (11)

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