Which one is first? Which ones can be done together? Arm lift, thigh lift, tummy tuck and Brazilian butt lift

Question

Dears, I have done wight loss surgery before 7 years and I lost a lot of wight and I need to make a lift in many places in my body (Arm lift, thigh lift, tummy tuck and Brazilian butt lift) So, which one it can be first which ones can be done together? Thank you

Charles Galanis, MD · Answer

Thanks for your question.  It is difficult to give you an accurate answer without examining the areas of concern to know exactly what you might benefit from surgically and without knowing your overall health.  Lengthy operations subject patients to significant risks so you should be careful not to take on too much in a single operation.  In a general sense, my combo preferences would be as follows but not necessarily in this order:1) BBL should go , with liposuction in a single procedure.  Truthfully this may not be as effective in massive weight loss patients due to skin and soft tissue quality.2) arm lift could go with breast lift (if needed) or tummy tuck (unless you need a full body lift in which case i would do the tummy separately within the context of a full body lift)3) thighs by themselvesThe order should be predicated on that bothers you most.  I would not do arms and legs at the same time as operating on all four extremities at once can really make recovery a bit overwhelming for many patients.Hope this helps and good luck!

J. Timothy Katzen, MD, FACS · Answer

Hi Noooora in Melbourne, FL, Thank you for your question regarding which one is first and which ones can be done together: arm lift, thigh lift, tummy tuck and Brazilian butt lift after significant weight loss. Thank you for your history. Any area can be addressed first. Usually, most plastic surgeons who specialize in reconstructive plastic surgery after massive weight loss would suggest that you undergo an abdominoplasty (tummy tuck) first. If your buttocks need lifting or reduction, you may also consider a 360° circumferential lower-body lift. The lower body lift includes abdominoplasty and a buttock lift. If you do not need a buttock lift or reduction and want buttock augmentation with a slight buttock lift, you may then consider a Brazilian butt lift (BBL). During a BBL, fat is transferred to the buttocks, and the butt is thus lifted. However, to obtain a BBL, fat needs to be harvested. That means you need fat in at least one area. Most plastic surgeon to specialize in reconstructive plastic surgery after a massive weight loss would suggest you undergo the tummy tuck with fat transferred to the buttocks, as in a BBL. If your health is good, consider also undergoing a thigh lift or a thighplasty at the same time. Typically, during a thighplasty, thigh liposuction is performed. This thigh fat can also be added to the BBL. After thigh liposuction, during the thigh lift, an incision is made from the groin to the knee. If you are combining the BBL with a tummy tuck, fat can be harvested from the abdomen and transferred to the buttocks. Please allow at least one to two months to heal before returning for brachioplasty (arm lift). During an arm lift, excess arm fat can be harvested and transferred to the buttocks if you still want larger buttocks after your first surgery. After arm liposuction for the BBL, during the arm lift, an arm incision is made from the armpit to the elbow, and excess arm skin and fat are removed. Therefore, you could do all your surgeries in two stages. Alternatively, you could do your surgeries in three steps. If you wanted to proceed with surgery in three steps, most plastic surgeons would recommend a tummy tuck and a buttocks BBL (fat transfer) first, then a thigh lift or thighplasty, and finally an arm lift or brachioplasty. The reason most plastic surgeons prefer to save the arms for last is that you will need them to change your bandages, medical compression garment, record drainage, and change dressings. Also, you will need to use your arms to put on and take off your garment when using the bathroom. Therefore, plastic surgeons prefer the entire body to be healed before performing arm surgery. Good luck. I hope that I have answered your question regarding which one is first and which ones can be done together: Arm lift, thigh lift, tummy tuck, and Brazilian butt lift after significant weight loss. If you have any more questions regarding combining surgeries after massive weight loss, contact an experienced plastic surgeon. Please seek an experienced, board-certified plastic surgeon with significant experience in reconstructive plastic surgery after massive weight loss. Make sure they have performed many reconstructive plastic surgery after massive weight loss procedures and have the before-and-after pictures to prove it. Carefully review their before-and-after photos and check their reviews on RealSelf. If you cannot find an experienced plastic surgeon in your neighborhood, consider traveling out of state. Sincerely, Dr. Katzen. ( Plastic Surgeon, President of the American Society of Bariatric 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.)

Joshua A. Halpern, MD, PA · Answer

Thank you for your question. You can do the arm lift and the tummy tuck at the same time (if your healthy enough). I would recommend doing the BBL by itself. The thigh lift would be preformed separately as well. It's important when preforming multiple procedures not to do to many together because excessive operating time can be determinantal to the patients health. I hope you find this information helpful.

Samer W. Cabbabe, MD · Answer

I would recommend abdominoplasty with liposuction and brazilian butt lift in the first surgery.  Second surgery would be arm and thigh lift.  You will have your best result in your arms and thighs if you do the liposuction first.  Therefore, it is recommended that you have the BBL in your first surgery with your liposuction.  You could also have a second round of liposuction and fat injections in your buttocks during the second surgery if desired.Best of luck.

Julio Clavijo-Alvarez, MD, MPH, FACS · Answer

Congratulations on your weight loss and thanks
for sharing your question. I can appreciate your concern.

The best recommendation to you is to
make a list that bother you and rank them by priority. Everybody has different
level of concerns.

When doing various surgeries the ideal
combinations are:

Liposuction and BBL.

Tummy goes well with a body lift.

Brachioplasty goes well with torso and
breast lift.

Thigh plasty usually goes last.

Do not combine arms and legs.

Finally, make sure that you have a
consultation with a board certified plastic surgeon that specializes in after
weight loss surgery.

Wishing you the best in your journey

Craig B. Boswell, MD · Answer

Without seeing you I can't tell you what would be best for your specific case.  However, patients that have lost a significant amount of weight following bariatric surgery usually have excess skin of their arms, breasts, entire trunk (front, sides, and back), and thighs.  You may not have issues with all of these areas, but if someone came in with excess skin in these areas and is healthy, then they could be a candidate for skin excision procedures.  Commonly, I will combine a circumferential body lift (that is tummy tuck that goes all the way around like a belt) with a brachioplasty (arm lift) as the first stage and then perform the thigh lift with breast procedure as the second stage.  I don't combine brachioplasty and thigh lifts in one operation because patients seem to recover better if they have at least 2 extremities that work (and don't hurt).  I usually perform the thigh lift as the second procedure because patients will see some tightening of the anterior, lateral, and posterior thigh with the body lift--and not everyone ends up needing a thigh lift that was thinking about a thigh lift prior to the body lift.

Darryl J. Blinski, MD · Answer

Impossible to chose without posted photos or in person consultations with boarded PSs in your area.......

Peter Fisher, MD (retired) · Answer

Hello and thank you for your question. Congratulations on your weight loss. Typically I will do a lower body lift and breast lift and arm lift first depending on your weight and general health. Weight loss patients in general don't get great results with bbl as their skin tone is poor. I therefore use a flap to augment the buttocks. You need to see a ps who specializes in post massive weight loss body contouring. Peter Fisher M.D

Which one is first? Which ones can be done together? Arm lift, thigh lift, tummy tuck and Brazilian butt lift

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