I'm 5'5 and 275lb. Weight comes from my stomach. What is the best procedure for me? (photos)

YWith a BMI of 45.8, you are within the range for bariatric surgery, specifically for procedures like the gastric sleeve. Typically, gastric sleeve surgery is considered for individuals with a BMI between 35 and 50, especially when weight loss through diet and exercise alone has been difficult.
Since you carry most of your weight in your abdominal area, a gastric sleeve would likely offer the most comprehensive long-term results. Unlike procedures such as liposuction or a high BMI tummy tuck, which focus only on fat removal in specific areas, gastric sleeve surgery targets overall weight loss, appetite control, and metabolic improvement. It also addresses the health risks associated with obesity, not just the cosmetic concerns.
Many patients who successfully lose weight with the gastric sleeve find that they no longer feel the need for additional cosmetic surgery or can achieve better results if they decide to pursue body contouring later.
Regarding anesthesia:Anesthesia is generally safe, but like any medical procedure, it does carry risks. A full preoperative medical clearance is required before bariatric surgery. This helps ensure that your heart, lungs, and overall health are thoroughly evaluated to minimize any anesthesia-related risks. If you’ve undergone anesthesia for previous procedures without complications, it’s a good indicator that you would tolerate it well again, but a proper evaluation is always necessary.
It’s important to work closely with your healthcare team to determine the safest and most effective plan tailored to your needs.

I recommend performing a gastric bypass because it lasts longer to lose weight, that's my opinion.The surgery lasts between 1 hour and 1 1/2, it's really very little anesthesia time

Each of the procedures you mentioned – bariatric sleeve, high BMI tummy tuck, and liposuction with BBL – addresses different aspects of weight and body contouring, so choosing the best one depends on your goals, overall health, and the outcomes you're hoping to achieve.
If your primary concern is overall weight loss and improving health, a bariatric sleeve (gastric sleeve) is typically the most effective option. This procedure reduces the size of your stomach, limiting how much you can eat and helping with long-term weight loss. It’s often recommended for individuals with a BMI over 40 or those with significant weight to lose. Since you mentioned most of your weight is in your stomach, the sleeve can help reduce visceral fat, the type that surrounds internal organs and contributes to metabolic issues. Beyond aesthetics, it can improve conditions like high blood pressure, diabetes, and joint pain. While the surgery does involve anesthesia, it is generally shorter and safer than more invasive forms of bariatric surgery.
On the other hand, if you are primarily looking for body contouring without significant weight loss, procedures like a high BMI tummy tuck or liposuction with BBL focus more on reshaping your body rather than addressing the root cause of excess weight. A tummy tuck removes excess skin and fat, which can provide a flatter, more contoured abdomen. However, this is not a weight loss procedure, and it won’t address internal fat around the organs. Liposuction with BBL can redistribute fat to enhance your curves, but it is typically better suited for patients closer to their goal weight.
One important thing to keep in mind is that for individuals at a higher weight, results from contouring procedures may be less dramatic if the underlying issue is significant excess fat. Additionally, these cosmetic procedures don’t offer the same long-term health benefits as bariatric surgery.
If anesthesia and surgery duration are major concerns, it’s worth discussing minimally invasive options like the gastric balloon or endoscopic sleeve gastroplasty (ESG). These can offer weight loss benefits without permanent alterations to your stomach, and they involve less time under anesthesia.
Ultimately, if weight loss is your main goal, I would recommend having a consultation with a bariatric surgeon to discuss the sleeve in more detail. They can assess whether you are a candidate and address your concerns about surgery. If your focus is purely cosmetic, consulting with a plastic surgeon who specializes in high BMI procedures could help you explore tummy tuck or liposuction options.