How would you combine/prioritize procedures for body contouring after massive weightloss? What's the timeframe overall? (Photo)

Question

I lost 165 pounds following weightloss surgery 2 years ago. My weight is stable. I am 57, 5'6" and 150 lbs. I am most bothered by jello thighs and bat wing arms. I don't want breast implants. I have a lot of loose skin in my abdomen and a saggy flat rear end. I want to combine procedures so that they are safe and affordable. I would love to fix it all but that may not be realistic financially. How would you suggest I prioritize procedures?

John LoMonaco, MD, FACS · Answer

Congrats on your accomplishment. The excess skin removal could be the last step to complete your journey and enjoy the "new you."The goal in reconstruction after weight loss is to safely correct as many issues as possible in the fewest number of surgeries. This means less downtime, less time away from work, less exposure to anesthesia, fewer recovery days, lower risk of blood clots, etc.In order to do this you will need a team experienced in post-bariatric reconstruction so that these longer surgeries can be done in a coordinated and efficient manner. And be done in the proper venue. In my opinion, an office or surgicenter is not the place for these longer surgeries with higher risk profiles.That said, here is my usual manner of staging these surgeries. Stage 1 is usually lower body lift which fixes tummy, pubic area, front of legs, back of legs, buttock (possibly with a procedure to add fullness)  and muscle laxity plus lipo as needed.  Breast lift with or without implants is then done. Stage 2 is then arms and inner thighs along with touch ups from Stage 1. I have found that thigh lifts do a lot better when the abdomen has already been tightened.  Also, revisiting a breast lift 6 months later often is a nice chance to perfect and further refine the result.   Best wishes !

J. Timothy Katzen, MD, FACS · Answer

Hello, thank you for your questions prioritizing and combining procedures for body contouring after massive weight loss. Basically, I prioritize based upon what bothers you the most. Since you did not prioritize the areas that bother you the most, I will give you the most common scenario for my weight loss patients. Basically, I divide most significant weight-loss patient’s surgeries into two stages: the lower body and upper body. The lower body in your case would consist of a 360 circumferential lower body lift; this would take care of the abdomen, hips and buttock. I would suggest during your 360 circumferential lower body that a dermal flap be used to reconstruct your buttock. That means your own buttock tissue is used to flip down into the buttock to achieve buttock auto-augmentation. During your 360-circumferential body lift, your hips will be raised and reduced and your abdomen flattened. During your 360-circumferential lower body lift, the rectus abdominis muscles will be sown tightly and excess skin and fat will be removed. If you wish, during a 360-circumferential lower body lift, a medial thigh lift/reduction can be performed. You did not provide pictures of this area so I assume it does not concern you. One month later, I would then suggest a formal brachioplasty which includes arm liposuction and in your case, an incision from the armpit to the elbow. During the second stage with your arms, I would also suggest an anchor breast lift or mastopexy. This would raise your breast. Therefore, I would divide your surgeries into two surgeries. First stage: the 360 circumferential lower body lift with a dermal flap for gluteal or buttock auto-augmentation. Second stage: approximately one month later, an arm lift/reduction (brachioplasty) and a breast lift (mastopexy) . The total time frame for both surgeries would be approximately 2-3 months of healing. I hope this helps to answer your question of how to combine and prioritize procedures after massive weight loss. If you have any more questions regarding reconstructive surgery after massive weight loss, please contact my office. Reconstructive surgeries after massive weight loss include an abdominoplasty, tummy tuck, thigh lift, breast lift, mastopexy, arm lift, brachioplasty, torsoplasty, back lift, buttock augmentation, and buttock lift. Since these reconstructive surgeries after massive weight loss, are big procedures, please seek an experienced, board certified plastic surgeon with significant experience performing these types of lifts. Do your research. Make sure they have performed at least 100 of each procedure you are considering for reconstructive surgery after massive weight loss. Make sure they have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, 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, International College of Surgery, and American Board of Metabolic and Bariatric Surgery, and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Kristi Hustak, MD · Answer

If you ask 5 different board certified plastic surgeons you are likely to get 5 different answers for the same question. Finding the right balance between the art and science of plastic surgery is perhaps the greatest when performing body contouring procedures. In general, pick what bothers you most and combine it with areas that complement it or at minimum, do not impact recovery for the area you are most concerned about. It sounds like you are a good candidate with 2 years of stable weight. While there is no right answer, it is best to choose your surgeon based on what they can offer and how well they are able to meet your desired goals. 
  
Best of luck on your journey!!
  
Kristi Hustak, MD
  
Board Certified Plastic Surgeon

Carmina Cardenas, MD · Answer

It is wonderful what you have achieved after  Losing  the weight!!! Congratulations!!Based on your photos you will be a great candidate for at least two stages: First the Lower Body Lift which will include 360 skin resection, mons pubic lift, implicit the front and out thigh lifting effect, real buttocks lift and a bit of liposuction to lovehandles and waist and use that small of fat to transfer to buttocks and I would also recommend Buttocks flap in order to give more  support  to the butt lift and some projection.Next stage could be Upper body which will include breast lift with no implants and nu a bit of fat to add roundness to upper pole and arm lift.Separating in stages is the safest way to do AWLS and recovery is way less difficult. I am certain you will look astonishing. Dr. Cárdenas

Kenneth Hughes, MD · Answer

Hello, thank you for your question. Congratulations on your weight loss!! It seems like you may benefit from a tummy tuck, thigh lift, Breast lift with or without implants, arm lift, butt lift. I recommend you to schedule a consultation with a board certified plastic surgeon.

Zoran Potparic, MD · Answer

You should, probably, follow your own priorities when it comes to this type of surgery which involves multiple surgical stages. You may start with arms and inner thighs or abdominoplasty with thigh lift, as a first procedure. This should be followed with lateral thighs and buttock lift (possibly buttock augmentation with flaps from skin that would be otherwise discarded). Breast lift could be done at any time. Best would be to discuss this set of procedures with an experienced board certified plastic surgeon and base your decision on recommendation and your own priorities. These procedures should be placed 6 or more months apart to allow for full recovery. Good luck.

Gregory Lakin, MD · Answer

Thanks for your question and photos. I recommend you combine your arm and thigh skin excisions, then  do a tummy tuck and breast lift, then do lateral thigh and butt lift skin excision. I recommend you consult with a board-certified plastic surgeon experienced with these procedures to exam you, discuss your goals, and show before/after photographs to give you a better idea of the type of results you can expect to get. Good luck

Daniel Barrett, MD · Answer

Dear Martiru,
congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider a surgery, otherwise your results will be suboptimal if you continue to lose weight after the surgery. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. 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

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  You can begin the contouring process with the areas that bother you most.  Generally patients are most bothered by the midsection so it is most common to begin with the lower body lift, but if your arms bother you more you can certainly begin there.  You will need to wait a few months between stages to allow for healing.  The first step is to schedule a consultation with a board certified plastic surgeon. I've included a video I hope you find helpful.

Darryl J. Blinski, MD · Answer

WOW! Congratulations on the weight loss. You will need at least 3 separate surgeries to achieve the improvements desired. First could be extended TT with Brachioplasty. Then see results to proceed.

How would you combine/prioritize procedures for body contouring after massive weightloss? What's the timeframe overall? (Photo)

Answers (11)

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