100 lb. loss - Liposuction, or would a lower body lift be more appropriate to achieve a smoother, tighter contour? (Photos)

Question

I’ve lost 100 pounds and have maintained my weight for the past two years. I’m now looking for guidance on the best way to address excess fat and loose skin in my midsection, hips, thighs, and buttocks. Based on my photos, do my proportions or fat distribution suggest possible lipedema, or does this appear to be typical post–weight loss fat and skin laxity? Would I likely get better results from liposuction alone, or would a lower body lift (or combination of procedures) be more appropriate to achieve a smoother, tighter contour? Thank you!

J. Timothy Katzen, MD, FACS · Answer

Hello Jamie473a, Thank you for your request regarding after a 100 lb. loss; would liposuction or a lower body lift be more appropriate to achieve a smoother, tighter contour?  Congratulations on your weight loss! Great accomplishment. Thank you for your history and your pictures. First, 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, from the limited picture, you have excess skin and fat and stretch marks around the umbilicus.  Your body shape is consistent with patients who have lost 100 pounds or more. Based on your pictures, you have skin and fat of the abdomen, posterior iliac crest (love handles), and lateral trochanteric region (saddlebags). Since you have excess skin, liposuction alone (even with the VASER and RF) will not get rid of excess skin. You would benefit much more from a 360 circumferential lower body lift. The lower body lift addresses the abdomen, mons (pubic region), hips, and buttocks in one surgery. In the front, the body lift pulls the abdominal skin down, eliminates excess abdominal skin and fat, lifts and reduces the pubic region, reorients the belly button, and plicates the rectus abdominis muscle.  On the sides, the hips are elevated and reduced. The excess skin and fat in the love handle and saddlebag regions are lifted and made more shapely. The 360 circumferential lower body lift will achieve much better results than liposuction alone. Based on your pictures, it does not appear that you have lipedema. Based on your pictures and without a thorough physical examination or history, it appears that you have residual skin and fat consistent with significant weight loss.  Good luck. I hope my answer helps to answer after a 100 lb loss, would liposuction or would a lower body lift be more appropriate to achieve a smoother, tighter 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.)

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. A lower body lift will remove the redundant skin from your abdomen, improve slightly your inner thighs, your flanks, your outer thighs and lift your buttocks. This is a very powerful operation for contouring the central trunk. Liposuction may be of a small amount of help to contour small areas after the lower body lift but the lower body lift is going to be far more powerful in helping you tighten this lax skin and improve your entire trunk contour. I don’t see any evidence of lymphedema. I do see skin which has lost some of its elastic recoil and would not improve with only liposuction. Best wishes.

Mehmet Ozdemir, MD · Answer

First of all, huge congratulations on losing 100 pounds and maintaining that incredible milestone for two years that takes immense dedication. Looking at your photos, your proportions do strongly suggest the presence of lipedema rather than just typical post-weight loss skin laxity, specifically due to the classic, disproportionate accumulation of nodular, texture-altered fat around your outer thighs, buttocks, and hips that terminates in a distinct shelf, contrasting sharply with your much narrower upper waist. Because lipedema tissue is fibrotic and structurally different from normal fat, relying on liposuction alone will not fix the significant loose skin left behind from your massive weight loss, nor will standard cosmetic skin cutting fully address the diseased tissue. To safely and effectively achieve a smoother, tighter contour, the gold standard approach for your anatomy would be a staged combination: specialized water-assisted or power-assisted liposuction (WAL/PAL) to safely extract the lipedema fat while protecting your lymphatic system, followed by an excisional procedure like a circumferential lower body lift to remove the severe skin laxity and properly hoist the tissues of your midsection, thighs, and buttocks.

Gerald Minniti, MD, FACS · Answer

Only a lower body lift will give you a good result. Liposuction does not address the significant skin excess.

Frank Agullo, MD · Answer

This liposuction would not address your primary issue, two years after a loss of 100 lbs. Your skin's capacity to retract its excess had reached its limits roughly eighteen months ago. Removing additional fat from beneath this lax tissue simply results in a less full version of the same contours that are sagging now. I see this in consult virtually every day. What you are describing, including all of your midsection, hips, thighs and butt, sounds exactly like a 360-degree lower body lift that uses a single, circular incision around your entire abdomen. It will essentially provide the result of a tummy tuck up front and pull the buttock and sides of the thighs up from the back, as well as trim the flanks to make the waistline thinner.

While I routinely incorporate some liposuction into the saddlebags or flanks as an additive measure of sculpted detail during the procedure, that liposuction is the garnish, the lower body lift is the entree. If your problem is lipedema, that would be entirely different. However, judging from the details, it does not sound that way at all.

#StayBeautiful,

@RealDrWorldWide

While I routinely incorporate some liposuction into the saddlebags or flanks as an additive measure of sculpted detail during the procedure, that liposuction is the garnish, the lower body lift is the entree. If your problem is lipedema, that would be entirely different. However, judging from the details, it does not sound that way at all.

#StayBeautiful,

@RealDrWorldWide

Daniel Barrett, MD · Answer

Dear Jamie473a,

it is hard to tell for sure without an examination. 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Darryl J. Blinski, MD · Answer

Based on limited number of post photos, best to do virtual consultation for better, explanations and better examination. Based on those post photos, I would recommend an extended abdominal ectomy with correction of the diastasis recti muscles with combination of libra reduction of areas with fat transferred to areas of blood doing at least those two combination procedures expect the fees to ring for 8000 of $20,000. Most likely we need stage surgeries best of virtual consult with.

100 lb. loss - Liposuction, or would a lower body lift be more appropriate to achieve a smoother, tighter contour? (Photos)

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