Lower limit of BMI range for post MWL body contouring?

Question

200lbs down with a current BMI of 26.7 and a tentative goal weight that would put me around 24.3. I often see doctors discuss a maximum BMI limit, but there seems to be less discussion of an ideal BMI For body contouring (and if it might be higher than a calculated “ideal weight.” ). Is there any truth to the idea that BMI body contouring results might be better slightly above a BMI of 25 than below? It's hard to go by look alone when you have so much excess skin.

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding the ideal BMI for post-weight loss body contouring. First, let me congratulate you on your incredible 200-pound weight loss—what an achievement!

To address your question, it's true that body contouring at a slightly higher BMI can sometimes produce more noticeable and dramatic results due to the amount of excess tissue removed. However, I don’t recommend striving for dramatic results at a higher BMI. Instead, I encourage patients to focus on reaching and maintaining their lowest achievable and stable BMI before surgery.

Operating at a lower BMI is generally safer and allows for a smoother recovery. Additionally, reducing your BMI as much as possible will minimize the amount of visceral fat, making muscle repair easier and improving the overall contour of your body. Even though your current BMI of 26.7 is within a healthy range, achieving your goal weight and a BMI closer to 24.3 will likely provide a more refined, natural outcome after surgery.

Excess skin can sometimes make it difficult to gauge your true frame. For this reason, it’s important to consult with an experienced board-certified plastic surgeon who can evaluate your body composition and help you develop a plan tailored to your goals. With your weight loss success and thoughtful approach, I’m confident you’ll achieve fantastic results.

Sincerely,
Dr. Katzen

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there,First, congratulations on your extraordinary transformation &mdash; losing over 200 lbs is a huge accomplishment, and your attention to detail in planning body contouring is commendable.
Let’s talk BMI and body contouring outcomes:You're absolutely right: while most surgeons discuss a maximum BMI for safety (usually

David Branch, MD · Answer

Thank you for your question, and congratulations on your weight loss.  Massive weight loss certainly impacts your BMI-which can be a helpful tool.  However-as long as you are healthy and a good candidate for surgery this should bot be a problem.  The question when BMI is discussed generally is if there is a concern about safely under anesthesia.  Results can certainly be better with a BMI slightly above 25 than below.  It's important to manage expectations however, and therefore it is important to discuss with a provider that can do a full in person assessment.  Hope this helps.

Daniel Barrett, MD · Answer

Dear Persistent123642,
congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider a surgery, otherwise your results will be suboptimal if you continue to lose weight after the surgery. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Jeffrey M. Darrow, MD · Answer

The reluctance of surgeons to operate on people who have a BMI greater than 30 is secondary to the fact that there are increased complications in these patients as well as the results being less than ideal, On the opposite side, trying to push one’s BMI too low could leave you nutritionally depleted and may increase your complication rate as well. Targeting for a BMI of approximately 25 is the safest way forward. After surgery, your BMI will dip slightly more because there will be some weight removed at the time of the skin removal. It’s best to be nutritionally robust going into the surgery so you heal well and the skin contours over a healthy skeletal/muscular framework.

Gerald Minniti, MD, FACS · Answer

BMI and elective surgery is focused on safety and upper limits. Lower limits is not as important because it is not associated with perioperative complications or morbidity in general unless it is very low, indicating emaciation or malnutrition.

Daniel P. Markmann, MD · Answer

Thank you for your question.   There really is no "lower limit of BMI''.  A healthy BMI is considered being between 18 and 25.   If you have lost 200 lbs, I would have to assume that you have a lot of excess skin.  I have had some patients that I have removed 20-30lbs or more of skin after losing that much weight.   So, when you consider your BMI, don't forget to take into consideration the weight of skin that will be removed with surgery.

Camille Cash, MD · Answer

Wow! Congratulations on your impressive weight loss! BMI is only one consideration when determining if someone is a candidate for surgery.  Those above a 30 BMI carry a higher risk of complications such as poor wound healing, infection, and seroma compared to those below this threshold.  If you are near your goal weight and are able to maintain it then you are ready for surgery.

Mats Hagstrom, MD (license on probation) · Answer

Personally I don’t rely on BMI as being an accurate assessment in regards to determining the candidacy for surgery.
Too much has to do with fat distribution and other variables.
I’ve seen individuals carry 30 pounds of skin and fat just from the skin redundancy.
The thickness of subcutaneous fat is much more important.
That’s what plastic surgeons are in the end more concerned about rather than total BMI, but some plastic surgeons really rely on numbers rather than got instinct or physical examinations.
Without including pictures, we can’t begin to make an assessment.
Each plastic surgeon will have their own way of doing things.
Some plastic surgeons really like relying on numbers while others just make a more subjective assessment based on clinical findings.
I find plastic surgeons who overly rely on numbers and measurements to sometimes not deliver the best Aesthetic outcomes.
Perhaps I’m biased because I am more visual than number based. 
I think all plastic surgeons agree that we much rather operate on people who are not obese especially for skin procedures.
Best,
Mats Hagstrom MD

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