Lower Body Lift vs FDL? Can I maintain glute contour? (Photos)

Question

I have had 4 children (1 cesarean) and lost 40kg with regular SIPS surgery. I have 8 years of weight training experience, and I would like to pursue body contouring for my excess skin. I Do I have enough tissue for a breast lift to give me adequate size to not appear overly flat (especially with my large pec muscles)? know I have a tremendous number of stretch marks and a lift would likely have to be done separately to an augmentation. I just don’t want my pecs to show through so much. Regarding the body. I don’t know if a LBL will address my upper abdomen issues. But the extensive incision with the addition of FDL makes me worry about wound healing given my skin quality. I do not like the vertical scar, but would prefer it to ongoing loose skin envelope. Will I end up with a boxy shape due to the extra horizontal laxity ? Is there any hope to maintain my glute contour somewhat ? It would be sad to go flat.

Siamak Agha, MD, PhD, FACS · Answer

You can get excellent results without FDL based on your anatomy.  For the breasts, we would do an internal dermal bra breast lift, a procedure that was pioneered by Dr Rubin and I in 2005.  For the lower body, I routinely perform our High-Definition lower body lift with buttocks enhancement using lower back fat flaps, liposuction and and fat transfer.  Please look at our extensive body lift gallery to see many patients from different angles.

Don W. Griffin, MD · Answer

Congratulations on your weight loss. Like many weight loss patients, you have skin laxity affecting multiple areas of your body that no amount of exercise will improve. I will address each area separately and offer general opinions. 
Breasts: The decision for mastopexy alone or mastopexy/augmentation is entirely dependent on your desired breast size. Some surgeons stage the mastopexy and augmentation, but many do it in one stage with excellent results and safety. At your consultation, your surgeon should be able to give you an idea of your expected breast size with a lift alone. If this is adequate and/or you are unsure about placing an implant, you can do the lift alone first, then decide on the augmentation. 
Trunk: While I do believe you need a circumferential body lift, a flour-de-lis is usually not necessary and can also be done as a secondary procedure once you've healed from the body lift. In my experience, less than 15% of patients return for a vertical incision after a lower body lift. The vertical scar is more prone to hypertrophy and you are less able to hide it in clothing. Based on your pictures, I don't believe that the lower body lift will negatively affect your buttock contour. If it does, secondary fat grafting can be done.

J. Timothy Katzen, MD, FACS · Answer

Hello, thank you for your question regarding lower body lift or FDL, and can you maintain glute contour? Thank you for your history and your pictures. Congratulations on your weight loss! Great accomplishment. First, let’s discuss your breast. You have excess skin and fat and grade 3 ptosis of the breast. That means the nipple areolar complex is at the bottom of the breast. In terms of the breast, you need an anchor or inverted T mastopexy breast lift. That means an incision will be placed around the areola, down the front of the breast, and underneath the breast. The areola will be made smaller and elevated. Most plastic surgeons would agree that you do not have adequate breast tissue to give you a good result. Your best results would be achieved with a small- to medium-sized breast implant. Breast implants can be placed over the muscle under, over, or in between the muscle. The muscle we’re talking about is the pectoralis major muscle. If you’re looking for more cleavage, go with an implant above the muscle; this will also help to camouflage your pectoralis major muscles. 
Second, we should analyze your pictures to determine the best procedures. On your buttocks and hips, you have cutis pleonasmus (excess skin), dermatocholosis (loose skin), cellulite, and stria (stretch marks). On your abdomen, you have excess skin and fat and stretch marks around the umbilicus. You would do best with a 360 circumferential lower body lift. Most experienced plastic surgeons would not suggest the FDL. You do not need the vertical scar. You will get an excellent result with a low-to-high lateral tension 360 circumferential lower body lift. During a 360 circumferential lower body lift, the excess skin and fat from the top of the pubic region to the belly button will be removed and eliminated. The pubic region, or mons FUPA, will be lifted and reduced. The rectus abdominis abdominal muscles would be plicated, and any rectus diastasis or separation of the rectus muscle will be repaired with two layers of permanent sutures. The lateral hips will be lifted and reduced, and the buttocks will also be lifted and reduced. To preserve the buttock volume, you can either consider a propeller flap with the upper buttock fat turned down into the buttock like a propellar or have fat harvested from the abdomen and transferred to the buttock like a BBL. The fat transfer from the abdomen to the buttock can be performed before or during the 360 body lift. You could have the 360 circumferential lower body lift and anchor mastopexy breast augmentation at the same time. To avoid the boxy shape, you may also consider fat transfer into the hip dips. In general, most people get significantly improved buttock shape with the 360 body lift without the BBL or propeller flap. The best way to maintain gluteal contour is with squats and stairmaster starting approximately four months after your body lift. I hope that I have answered your question regarding lower body lift vs. FDL, and can you maintain glute contour? To get an accurate assessment of what exactly you need, schedule a free virtual consultation. Most plastic surgeons offer free virtual consultations. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact an experienced plastic surgeon. 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. Make sure they have performed at least 150 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 if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (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.)

Emre Guvercin, MD, FEBOPRAS · Answer

For the breast and upper torso, I would recommend a Push-Up Lift combined with a J-torsoplasty. This allows us to reshape and redistribute your existing breast tissue to maximize projection and upper-pole fullness while simultaneously addressing the significant lateral chest and back skin excess. An implant does not necessarily need to be the first step and can be considered later if you still desire additional volume. For the body, given the amount and distribution of skin laxity after a 40 kg weight loss, I would favor an FDL abdominoplasty combined with a belt lipectomy. The FDL addresses the horizontal laxity that a standard lower body lift cannot adequately correct, while the belt lipectomy treats the circumferential excess. Importantly, the posterior portion can be designed to preserve and even improve your existing gluteal contour rather than simply flattening the buttocks. Although this means accepting a vertical abdominal scar, it generally provides substantially better control of the skin envelope and waist definition in patients with significant post-weight-loss laxity.

Zoran Potparic, MD · Answer

There is no doubt that you need significant body contouring. This should include breast lift with implants, lower body lift, possibly back folds excision. In person consultation with a board certified plastic surgeon with extensive experience with body contouring surgery should be your next step. Good luck.

Manuel Diaz, MD · Answer

Hi. Judging by your photo, you have significant skin laxity following weight loss, so I recommend splitting your body contouring into two separate surgeries rather than trying to correct everything at once.
Regarding your breasts, it appears you have enough tissue for a breast lift, but this procedure alone will reshape and reposition existing tissue rather than create significant volume in the upper area. If you desire more volume and better coverage of the pectoral muscles, you could consider a breast lift with implants.
For your abdomen, I believe a traditional abdominoplasty with a horizontal scar would be sufficient to remove the excess skin and significantly improve your abdominal contour. I don't think a Flash Dexter (FDL) procedure or its additional vertical scar is necessary in your case.
For your first surgery, I would consider two possible combinations: tummy tuck + breast lift (with or without implants), or tummy tuck + 360 fat transfer + BBL if maintaining and enhancing the contour of your buttocks is a priority.
The remaining procedures could then be addressed during a second surgery. This phased approach allows us to prioritize your concerns while keeping the number of surgeries and recovery time manageable.

Lower Body Lift vs FDL? Can I maintain glute contour? (Photos)

Answers (6)

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