Steady weight loss after a tummy tuck, will my skin retract and can I get lipo?

Question

I lost a lot of weight before I got pregnant and had a lot of excessive skin. I have now had two children and two C-sections. I am wondering if I lose weight steadily after a tummy tuck if my skin will retract nicely. I've contemplated losing the weight first, but it is very difficult with my current stomach. I am also wanting lipo, pretty obviously, around my entire abdominal area.

Finny George, MD · Answer

Hi, thank you for sharing your question. 
You would be a great candidate for Tummy tuck with liposuction of your flanks. If you are close to your goal weight and have a BMI around 30, you would be able to proceed. Skin retraction after tummy tuck can be unpredictable, but a healthy lifestyle will help. The best way to determine the right procedure is after a formal evaluation of your soft tissues. 
Consult with a board certified plastic surgeon to discuss your options. I hope this helps. Best of luck!

Jason Emer, MD · Answer

you will need a tummy tuck for the best results, with liposuction and internal heating, I would suggest BBL/braziilian butt lift fat grafting to buttock at same time.
You need a formal evaluation by an expert in body shaping and contouring to determine what is best.  Traditional liposuction awake and smart liposuction are old methods and do very poorly for tightening skin or significant skin tightening or contouring.  Small problem areas can be improved slightly by these methods.  The best in body contouring not only removes fat with energy devices like VASER ultrasound but also internally heat the skin with radio-frequency devices such as J PLASMA/RENUVION, InMode BodyTite, ThermiRF to heat the under surface of the skin and tighten it at the same time as fat removal. These combinations are called 4D HIDEF VASER contouring and can only be done by a well . trained body contouring specialist. At the same time fat should be harvested, PRP and stem cells added and injected into muscles or indentations/cellulite to get body shaping and contouring.  This is known as a Brazilian butt lift when you inject the fat to the buttock for contouring and lifting, but fat can also be used in areas such as the chest/breast, arms/shoulders, calves and face.  Cellulite should also be treated with cellfina, sculptra, subcision and/or fillers such as bellafill, renuva synthetic fat, or sculptra.  If skin is very loose before surgery then it will need to be removed such as lower abdominal skin (tummy tuck/abdominoplasty), breast skin (breast lift), arm skin (brachioplasty).  Overall you need a full assessment, but simple liposuction alone will not tighten skin and needs a combination of various methods -- fat removal, skin tightening, defining, fat grafting, skin removal -- to get the best in body contouring and body sculpting.  Dr. Emer.

Robert M. Tornambe, MD · Answer

I appreciate your concerns and frustrations, however you must lower your BMI to at least around 30 before considering any type of cosmetic body contouring surgery. It’s just safer! Statistics show a much higher increase of complications in patients with a BMI over 30. Choose a reasonable diet and exercise regimen to lose the weight and then consult with a board-certified plastic surgeon in your area to explore the best options for you. Good luck.

Daniel Barrett, MD · Answer

Dear RovingRosy,
generally speaking, you want to reach your goal weight before you consider a tummy tuck, 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

Steven M. Camp, MD · Answer

Hello there Roving Rosy,Thanks for your question and photos.  Your question about skin retraction is a good one and best determined in office to analyze elastic tone.  In general tummy tuck patients do best when they are 10-15 pounds over their goal weight or ideally at goal weight and with loose skin.  In my practice we check height and weight of each patient to determine BMI (body mass index) of 30-32 or less.  This is a very important consideration to make sure you heal well from surgery, because patients with higher BMI have more complications.In today's world it is possible to have either in person or virtual consults and I would recommend this as your next step with a board certified plastic surgeon. Best Wishes

Robert L. Kraft, MD, FACS · Answer

It is very important to get your weight down before having an abdominoplastY. You have a great deal of visceral fat in the abdomen which is not amenable to liposuction.   After two C-sections, you need the abdominoplasty. Skin retraction of the magnitude required is not possible.  Best wishes.

Mats Hagstrom, MD (license on probation) · Answer

being obese makes someone a poor candidate for a cosmetic surgery but especially procedures such as a tummy tuck.In every regard you’re better off losing weight before having this surgery.There is no good argument for moving forward with a full tummy tuck with the intention of losing weight after.Mats Hagstrom MD

Arian Mowlavi, MD, FACS (license on probation) · Answer

You would benefit from high definition VASER liposuction 360 and a tummy tuck. The tummy tuck would help resolve excess skin and fat in the abdominal region, as well as tighten the abdominal muscle. Lipo 360 would work to remove fat from stubborn areas. The Gold Standard for superior liposuction results requires use of the advanced technology of ultrasound assisted VASER liposuction. As an official trainer of VASER liposuction, I perform full body liposuction cases every week. VASER liposuction has been the only modality that has consistently resulted in outstanding liposuction outcomes. VASER liposuction ensures a smooth contour regardless of degree of excess fat by virtue of being able to remove any and all remaining fat comprehensively and uniformly. If skin redundancy is observed, Renuvion technology can be simultaneously applied to tighten your skin to optimize your overall contour outcome. A Skype or FaceTime consultation with a VASER specialist will help you get an accurate recommendation and pricing.
Respectfully, 
Arian Mowlavi MD, FACS
Realself 100 Hall of Fame Inductee

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and photos and you will get your best result after an abdominoplasty with or without liposuction if you are at a stable lower weight prior to surgery.   Weight loss after may adversely affect your result.Dr Corbin

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