Where do I start post-bariatric surgery? (photo)

Thank you for your photographs and congratulations on your weight loss. As pregnancy could modify the results of any breast surgery or abdominal skin tightening, it makes sense for you to reserve these for when you are finished having children. The incision for an arm lift would not impact any future surgery that you wish to do for your upper back or breasts and could actually be blended into those incisions at a future date. Therefore, doing your arm lift first would be a good option. Doing a thigh lift before an abdominoplasty or a lower body lift can potentially be problematic for the following reason. The upper portion of the incision for a thigh lift runs directly in the crease between your trunk and your leg. If this is done first, when you’re abdominoplasty or lower body lift is done the upward pull on your lower abdominal skin can shift that thigh lift scar upward, and make it appear that it’s on your lower abdomen. If the abdominal plasty or lower body lift is performed first, the upward traction is already done, and then the thigh lift can be performed so that the upper portion of the incision stays exactly in the leg crease. Discuss this possible sequence with your plastic surgeon. Best wishes.

Thanks for this excellent question. Treatment sequencing following massive weight loss is driven by patient priorities, minimising the number of procedures / recoveries where possible, keeping total operative time for each procedure within reason, and avoiding complications. There are some combinations to be avoided (e.g. thighs & abdomen at the same time) due to opposing vectors of tension on your wounds, and some that are fairly typical (e.g. breasts and abdomen). It is a good idea to address the abdomen / back before the thighs as the former can impact the surgery required for the latter. If you wish to avoid abdominal surgery (and possibly surgery to your breasts if you are considering breast feeding), then arms could safely be performed in isolation initially. This could also be combined with breast surgery in an initial procedure. Consult a surgeon with expertise in body contouring.

Thank you for your inquiry! Prioritize your areas of concerns. Most procedures can be done together. We would love to meet and discuss your concerns. Schedule a consultation with a Board-Certified Plastic Surgeon to discuss your goals.

Hello, congratulations on your weight loss. Your heart, lungs and joints thank you!

I perform many combination procedures on patients like yourself with multiple areas of excess skin that need to be removed as there is no other effective treatment. The trade-off of course is scarring. I council my patients to simply make a list of the areas that bother them, in order, and approach it that way. You may be able to combine your number one and two procedure or even all three, depending on what they are.
For example if arm surgery requires two weeks recovery to get your back to the office and a breast lift required two weeks, doing them together doesn't necessarily increase the amount of time needed as you are recovering from multiple procedures simultaneously, not adding the recovery times together. When I perform multiple simultaneous procedures we tend to add a little bit more to the recovery time overall. Good luck!

As long as you are when you postop and no locker losing weight, you can begin your process! You can decide which procedures you want to begin with if it’s arms and thighs that’s a wonderful decision and later on you can finish up with your abdominal area and your breasts! It is best to divide them in sessions so it’s easier for you and your recovery!

If you do decide to begin with your arms you would benefit from a brachioplasty. The incision is kept inside your upper arm so that when your arms are at your side it is hidden. Congrats on the weight loss! Best of luck with your health journey!

I typically advise clients that body transformation does not occur after just one surgery following massive weight loss. I usually divide the body into three sections: Upper, Mid, and Lower.
For the Upper section, I recommend an upper body lift, which includes an extended arm lift, bra-line lift (thoracoplasty), and breast lift. These three procedures effectively address skin laxity in the upper body.
In the Mid section, I often perform a body lift, fleur-de-lis (FDL) lift, or Brazilian butt lift (BBL).
Finally, for the Lower section, we focus on either an inner or outer thigh lift. I do not combine all three procedures in one session, as it would require too much time under anesthesia. I typically avoid performing both upper and lower procedures together, as it restricts movement during the postoperative recovery.

Congratulations on your weight loss journey. Where you start matters and Dr. Agha has developed an algorithm for staging skin removal surgeries that he has lectured about at major meetings. We will be happy to discuss this further with you virtually or in person. Below you can take advantage of our extensive library on weight loss procedures. Best of luck!

Hello, thank you for your question about where to start post-bariatric surgery. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. Usually, plastic surgeons begin with the abdomen, hips, and buttocks. This is called a 360 circumferential lower body lift. The thighs are usually treated at the same time. This would include thigh liposuction and an incision from the groin down the inseam of your inner thigh. The incision would extend partially down the inner thigh. If you have excess skin and fat around the inner knee, the incision extends slightly past the knee. This type of thigh reduction is called a vertical longitudinal medial thigh lift. If you do not have excess skin and fat od f the inner knee, the scar can be shorter. This is called a modified longitudinal medial thigh lift. The 360 circumferential lower body lift and the thigh lift can often be combined during the same surgery. During the second surgery, the upper body is addressed. Most experienced plastic surgeons suggest a longitudinal brachioplasty ( arm lift or arm reduction) combined with arm liposuction. You could combine your arm reduction with your breast surgery. You did not provide breast pictures or indicate what you are seeking for breast surgery results. However, most women need a mastopexy or breast lift after such a massive weight loss. You probably require an anchor mastopexy since you have lost so much weight. If you are happy with the size of your breasts, all you would require is a breast lift. If you want the breast smaller, you would need a breast lift and breast reduction. If you wanted bigger breasts, you would need a breast lift and breast augmentation. In regards to your back, you need a torsoplasty. There are two types of torsoplasties, namely vertical and horizontal. During a vertical torsoplasty, an incision is made from the axillae or armpit down your side. The incision sometimes extends to the bra line or below. Sometimes, the vertical torsoplasty extends to the upper superior iliac crest or hip bone. Alternatively, the horizontal torsoplasty extends across your back. The horizontal torsoplasty is also called a bra strap plasty or a bra plasty because the incision is hidden under the bra strap. You could undergo the brachioplasty, mastopexy, and vertical or horizontal torsoplasty at the same time.
Since you do not want abdominal or tummy surgery at this time, most plastic surgeons would suggest you undergo the longitudinal brachioplasty and thigh reduction surgeries. You could undergo the longitudinal brahcioplasty and the thigh reduction simultaneously.
I hope that I have answered your question regarding where you should start post-bariatric surgery.
Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift. Do your research. Ensure they have performed at least 100 circumferential lower body lift surgeries and have the before and after pictures to prove it. Carefully examine their before and after pictures and check their reviews on RealSelf. If you cannot find an experienced lower body lift surgeon in your neighborhood, consider traveling out of state.
Sincerely, Dr. Katzen. (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, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Since you want several things done, you will need several stages. The safe operation time is 6 hours for cosmetic surgery. The upper part of the body heals quicker than the lower part of the body. Most surgeons will want to do a breast lift and brachioplasty (arms) at the same time. The breast lift will also pull up the upper abdomen and make it easier to do the tummy tuck later. 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 brachioplasty can be done along with liposuction. Both of these operations take 6 hours. Once you have recovered from this, you can consider your abdomen. If you are planning future pregnancies, you may not want to have the fascia tightened but may want the excess skin removed. At that time, you can undergo circumferential lift and the last thing to do would be a thigh lift. A thigh lift takes more time to heal and is a slower process.

Best Wishes,

Gary Horndeski, M.D.