Why would some surgeons recommend adding lipo/360 lipo to a tummy tuck and others not think it's needed? (Photos)

It is very common for surgeons to give different recommendations in this situation, because the decision to add liposuction depends on several factors: the actual amount of fat in the flanks, the quality of your skin, the contour you want to achieve, and the surgeon’s philosophy on safety and combining procedures.
If there is very little fat, excision during the tummy tuck alone may give a good result without lipo. If there is more fullness in the love handles or waist, liposuction can help refine the contour. Some surgeons prefer to combine procedures for maximum effect, while others stage them to reduce operating time and risks. Both approaches are valid.
Neither opinion you received is “wrong.” It comes down to whether your priority is to have fewer procedures and combine your arm lift, or to aim for the most aggressive body contouring with lipo included. The key is choosing the surgeon whose plan, safety approach, and aesthetic style align best with your goals.
I have also shared a detailed video where I explain how surgeons decide whether to add liposuction to a tummy tuck, with examples of results with and without it.
— Güray Yesiladali, MD

Congratulations on your weight loss and maintenance of your weight loss. Also, thank you for your photos. After your weight loss, there is likely to be very little fat underneath your skin that would benefit from liposuction, and your skin may not have enough elasticity to snap back to an improved contour. Therefore, I would favor a TT, perhaps an extended TT to contour the entire abdomen, and the flanks as much as possible. You get the benefit of getting an arm lift done at the same time so you can recover from both procedures at once. As to why you got five different answers from five different surgeons, there is likely no 100% correct answer, but each surgeon is giving you their best judgment on what they think would give you your best result. Some surgeons may be more comfortable and experienced at certain procedures as opposed to others. If you haven’t already, you may request the surgeons to show you their before and after photographs so that you can see what type of results they are achieving and if that would be satisfactory to you. Best wishes.

Dear Peaceful538618,

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

From your photographs, it looks like in your case liposuction of the lower and mid back may improve the contour. There is nothing special about the term 360, and I think liposuction of your back would complement a newly contoured abdomen!

Thanks for your question. From your pictures, it seems like you're a good candidate for a tummy tuck with liposuction of the flanks or a tummy tuck with lipo 360. It all depends on the results you're looking for. The lipo 360 is lipo of the upper and lower back, the upper and lower abdomen and the flanks so it all depends on the target areas you want to address. I recommend scheduling a consult for a proper evaluation. Please always consult with a board certified plastic surgeon. Take care, Dr. Moises Salama, board certified plastic surgeon.

After 100 lbs. weight loss, it is highly probable that your breasts have descended as well. I usually like to do a breast lift prior to a tummy tuck because if you do the tummy tuck first then it will pull the breasts further down making is harder to lift the breasts as high as possible. If the breasts are done first then this will pull up the upper abdominal skin and can minimize the amount of dissection necessary for the tummy tuck. The breast lift technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. At the same time, a tummy tuck can be done. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight. After these have been completed, then you can consider liposuction and possible fat transfers to the breasts, if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Liposuction can help enhance body contouring when combined with a tummy tuck, especially in areas like the flanks or lower back. However, not all patients require it. The decision to add liposuction depends on factors such as fat distribution, skin quality and the surgeon’s technique or philosophy.

Wow, nothing like going to all the effort to see different surgeons and be diligent, only to have so many different suggestions. I have been in private solo practice for 33 years. I now do lots of corrective surgery. You need at least a tummy tuck. You have extra skin and an apron of skin that can only be gotten rid of with excision of skin. I don't believe you need skin excision except on the front. I am NOT a fan of combining liposuction of the abdomen along with a tummy tuck. In my career, I have seen TOO many complications, and too much dead skin when combining tummy tuck with liposuction of the abdomen. I have also been pleasantly surprised at how good a well-done tummy tuck does without any liposuction. And a full tummy tuck would allow tightening of the upper abdominal skin, and muscle if needed, as well.
I would recommend full abdominal tummy tuck, and liposuction of the flanks at one procedure. You could do liposuction of the tummy after a tummy tuck, but you may not need it if the tummy tuck corrects your tummy adequately. I would then reserve any additional liposuction of the abdomen for a second procedure if needed. My guess would be you wouldn't need it!
In the end, go with who you are most comfortable with, who has good post-op pictures, and who addresses your concerns. And other patient referrals helps.
Good luck to you!

Based on your nicely series posted photos there was no right or wrong answer. If possible, with the understanding that plan surgeries sometimes cannot be completed due to interoperative findings. I.e. length of surgery blood loss combinations of other issues therefore, planning multiple surgeries can usually be done, but is not a guarantee. Based on the photos you posted my initial plan. Recommendation would be an extended tummy tuck with muscle repair, Lipo of the back waist flanks, bilateral upper arm lift in combination fee $35,000. If all suit procedures cannot be done a secondary procedure, which would also include more life of necessary would be planned approximately 4 to 6 months after the first Procedure With all this in mind all the surgeons you saw or essentially saying this, but best to do a virtual consult so if you want more detailed information, try reaching me regards and good luck

I often add liposuction as part of the tummy tuck procedure. It helps to enhance the new contours created by the tummy tuck and get my patients a more complete result. The hips/flanks and back are generally safe areas to combine with the tummy tuck. The surgeon will assess how much excess fat you have but a little extra sculpting can make an impressive difference.