Tummy tuck and pubic lift? (Photos)

Question

This is so embarrassing to share I had gastric bypass 12/3/15 and I've lost about 125 pounds.I have a consult and will ask if the FDL TT is the best for me but my pubic area is another hugh concern. Is this something that is seen often to many plastic surgeons? Is it fixable? I just want a normal looking pubic area . But, if it's fixable and I have an FDL TT would I have an additional scar from the pubic lift? the scars don't bother me by the way, just wondering if I would have separate wounds.

Jed H. Horowitz, MD, FACS · Answer

hello Tpclark87 This is an operation designed to improve the appearance of the abdomen,which may be overly protruding, or may have excess loose skin and fat.There are variations of the standard operationMost patients with massive weight loss require a more extensive operation. Frequently, additional enhancing surgeries such as liposuction to improve the waist line or other regions, pubis lift or breast surgery can be performed at the same time without delaying your recovery period. Please discuss with your doctor if this applies to you. #options #stomach

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, you are a good candidate for a FDL tummy tuck.  A pubic lift and also be performed.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Don W. Griffin, MD · Answer

I do quite a bit of massive weight loss patients and ptosis or sagging of the pubic area is quite common and is something that can be corrected with surgery. Looking at your pictures, I think that you may be a good candidate for a circumferential mid-body lift type of procedure as your laxity seems to extend far posteriorly. You can add a fleur de lis incision, but I don't think that I would recommend it initially as you will get a nice result from the mid-body lift and can avoid the vertical scar.

Erica Anderson, MD · Answer

Congratulations on your weight loss! And thank you for sharing your photos. I agree a FDL TT is your best approach to recontour your abdomen. The mons will be addressed at that time with no additional scars or wounds. Just be sure to share with your chosen surgeon your concerns and make sure he/she is going to address it. Also be prepared to need revisions after the first surgery. The mons can be difficult to correct completely and if it sags again, more skin removal may be necessary. Best wishes.

Steven Wallach, MD · Answer

More details of your present weight and height would be relevant, but yes you will probably get more "bang for your buck" with a fleur-de-lis because you have laxity in vertical and horizontal dimensions. the pubis can be lifted and reduced at the same time. Good luck.

Tom J. Pousti, MD · Answer

Congratulations on your successful weight loss! It is not unusual for the pubic area to be an area of concern.  For many patients undergoing tummy tuck surgery the pubic area may be an area of concern. This area may be large ( prominent) , ptotic (low), or deflated. Therefore, I think it is important to address the pubic area when performing the tummy tuck surgery.
When planning the tummy tuck incision it is possible to keep the incision low enough that it serves to “raise” the pubic area to some degree. I like to plan this incision when patients are wearing the “cut” of swimming suit that they plan to wear after the surgery.
During the tummy tuck procedure the pubic area may then be “lifted” and/or defatted ( either directly or with liposuction) as the specific patient's needs indicate.  
 
You are very correct in that if the pubic area is not treated during the tummy tuck procedure it may be a source of dissatisfaction afterwards. Revisionary surgery may be necessary to treat the area.
 I would suggest that you discuss your concerns/goals directly with your plastic surgeon, in front of the full-length mirror. Working together you will come up with the best course of action.
Best wishes.

Jack Peterson, MD · Answer

Congratulations on your weight loss. The issues you describe are very common in weight loss patients. You do not need to be embarrassed, you are not alone. A monsplasty would address your concerns and are part of almost all routine extended abdominoplasty that I do in my practice. I would suggest you consult with a board certified plastic surgeon that has specific experience in weight loss patients.

Talmage J. Raine, MD, FACS (retired) · Answer

This is a common issue. When planning the incision in this situation you must put upward traction on the pubic area and mark the incision well within the pubic area, removing the upper portion of the pubic area. If the incision is made higher, the pubic area will be quite large and unusually high in the final result.
All the best,
Talmage Raine MD

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