Consult now vs wait: Combining more procedures? (Photos)

Question

F32 down 212lbs since October 2021, 157lbs 5'7. I workout doing combat sports and conditioning 12-13 hours a week, no chronic medical conditions. I've been on a weight loss and fitness journey for a while now, and have always thought my goal weight would be 150, but that was arbitrary. I recently got a follow up DEXA scan, and found that my torso is at 21% body fat, with my overall body fat of 26%, which was lower than I thought (my legs, however, are at 32% ). With my body fat lower than I expected, I realize that each additional pound I lose isn’t going to contribute meaningfully to an improved appearance. In other words, I keep waiting to “look” fit but now it seems that’s not likely. However, I assume I’ll require a lot of procedures, and know that these types of surgeries are often shorter on those with lower body fat. Is there a world where an additional 8lbs lost might result in being able to bundle one more procedure into a surgery? And if so is that a good reason to delay seeking out a consult until I’ve lost more weight? Or am I not lean enough for that to make a difference? I’ve found the surgeons I’m interested in have (understandably) significant fees for a consult, and I don’t want to “waste” a round of consults only for that additional weight to change the game plan/potential possibilities. Thank you for your time!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding whether you should consult now or wait, and whether you can combine more procedures.  Thank you for your history and your pictures.  Congratulations on your remarkable weight loss.  Great job.  With your current body fat percentage, you should be ready to undergo plastic surgery.  Further weight loss is not necessary in your case.  I would search for plastic surgeons who specialize in reconstructive plastic surgery after a massive weight loss.  There are specialists nationwide who specialize in treating patients who have lost 100 pounds or more.
Regarding the “significant fees for consultations,” there are many very well-qualified
 plastic surgeons who offer FREE consultations.  Many reputable plastic surgeons offer virtual consultations, allowing you to consult with doctors from around the USA from the comfort of your living room.  Virtual platforms include secure networks, as well as Zoom, FaceTime, and WhatsApp.  
Regarding your procedures, most plastic surgeons stage these procedures into two or three surgeries.  The first surgery typically involves a 360-degree circumferential lower body lift.  The 360 circumferential lower body lift includes abdominoplasty (tummy tuck), hip lift/reduction, and butt lift/reduction.  During the procedure, the rectus abdominis muscles are plicated.  The belly button is saved, but the abdominal skin around it moves.  The pubic region is lifted and flattened.  The skin of the abdomen, hips, and buttocks is removed.  If you feel your buttocks are small, fat can be added to create more projection.  If you feel your buttocks are too large, the size of the buttocks can be reduced during the lower body lift portion.  Most experienced plastic surgeons specialize in reconstructive surgery after massive weight loss, combining the thigh lift with a 360-degree circumferential lower body lift.  This would entail performing thigh liposuction on the anterior, inner, and outer portions of the thigh.  This would also be combined with an incision from the groin to the knee.  This thigh procedure is referred to as a longitudinal, vertical medial lift or reduction.  If the extra skin and fat do not significantly bother you around the knee, you could have an incision from the groin partially down the inner third or inner half of the thigh.  This is called a modified longitudinal vertical medial lift.  You could combine the 360 lower body lift with the longitudinal vertical medial lift.  Alternatively, you can undergo the 360 circumferential lower body lift and then wait at least a month before undergoing the longitudinal,  vertical medial thigh lift, thigh reduction, or thighplasty.
Once you have finished with the lower body, I suggest proceeding with the upper body surgery.  The upper body lift would include a brachioplasty (arm lift or arm reduction) as well as breast augmentation.  During your arm lift, arm liposuction is performed, and an incision is made from the armpit to the elbow.  Regarding the breast, this is a personal choice.  You do not necessarily need breast surgery, but if you desire larger breasts, most plastic surgeons would recommend a small to moderate silicone implant.  Since you don’t need much of a breast lift, an incision could be made underneath the breast and the silicone implants inserted.  Breast augmentation and an arm lift can be performed at the same time.  All the procedures mentioned above are performed under general anesthesia with a board-certified anesthesiologist.  All these procedures are outpatient surgeries; however, the body lift and thigh lift typically require a two-night stay at a recovery center.  Before any surgery is contemplated, multiple labs, an EKG, and chest X-rays need to be ordered.
I hope this information helps you in your search for answers regarding the 360 circumferential lower body lift.  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, board-certified plastic surgeon.  Since the body lift is a major procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing lower body lifts.  Do your research.  Ensure 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 (Aesthetic, Cosmetic, and Reconstructive Plastic Surgeon),  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, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)

Camille Cash, MD · Answer

Wow! Congratulations on your impressive weight loss!  At your current stable weight you are ready for surgery.  The eight pounds you are considering losing will not impact your ability to include, nor exclude procedures that interest you.  Nor will it impact how many procedures can be combined. I've included a video about plastic surgery after major weight loss that I hope you find helpful.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. Congratulations on your weight loss and excellent exercise regiment to keep you in shape and at a stable weight. Your BMI is 24.6. Losing an additional 7 pounds will not appreciably change you.  If you are considering surgery to contour your body after your weight loss, it is very common to begin with a lower body lift. The lower body lift improves the abdomen, some of the inner thighs, lateral thighs, flanks, and buttocks. It is a very powerful operation.The weight removed during a lower body lift is likely to be somewhere between 5 to 7 pounds. It may be possible to combine this with another procedure, if your surgeon works with another plastic surgeon to keep your time on the operating table around 6 hours or less, for safety reasons.  I don’t believe that there is any reason to wait to seek out a consultation with a plastic surgeon to discuss your options.  You are at an excellent weight to proceed with any procedures or combination of procedures in line with what your plastic surgeon recommends.  Best wishes.

Mats Hagstrom, MD (license on probation) · Answer

You are correct that plastic surgeons prefer to do skin removal surgery with the least amount of subcutaneous fat.
Removing large areas of skin on individuals with thick layers of fat increase the chance of wound healing problems. 
Based on your pictures, you’re ready to go.
You may have several pounds of excess skin/fat that will be removed with surgery. 
Finding the right plastic surgeon can definitely take some time.
I generally recommend avoiding virtual consultations and always have in person consultations.
Find me the right provider Can definitely take some time.
I would start sooner rather than later vetting plastic surgeons is a major project
Best,
Mats Hagstrom MD

Consult now vs wait: Combining more procedures? (Photos)

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Consult now vs wait: Combining more procedures? (Photos)

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Answer: Bidy fat and skin surgery

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