Loose skin from pregnancies & weight loss - Is it better to do a lower body lift, or a BBL followed by a tummy tuck? (Photos)

Question

I'm 38, have had 5 pregnancies (1 c/s), and have lost about 100 lbs. This has resulted in significant skin sagging everywhere, and loss of volume in my butt. I'm 5'4" and about 120 lbs. I initially was thinking of getting a BBL, followed by a separate tummy tuck - the main reason being concerns about recovery (how to sleep when you can't lay on your tummy OR your butt?). It also seemed logical to me that you would want to have some fat in your abdomen to harvest for the BBL, so I was planning to do the BBL first. But when looking at patients with similar body types after significant weight loss, it seems like lower body lifts are being recommended. I'm fairly certain my butt is too saggy to "re-inflate" from BBL fat transfer alone, and that no matter what, some kind of traditional "lift" will be necessary for my butt, due to all the loose skin. Would I be a candidate for a lower body lift? Can a lower body lift be combined with BBL? The loss of butt volume is my priority concern (TT would be secondary), and it seems like a lift alone would help tighten up the skin, but would not help with butt volume. What procedure(s) might help give me the results I am looking for?

Mehmet Ozdemir, MD · Answer

Based on your history of significant weight loss and the photos provided, it appears that the main issue is not only volume loss but also substantial skin laxity in the lower trunk and buttock area. In patients with this type of tissue quality, a lower body lift is often the most appropriate primary procedure because it removes excess skin, tightens the tissues of the abdomen, flanks, and back, and simultaneously lifts the buttocks. A traditional BBL alone usually cannot correct the degree of sagging you describe, since adding fat does not address loose skin. However, in many cases a lower body lift can be combined with modest fat grafting to the buttocks to restore some volume and improve contour, depending on how much donor fat is available after your weight loss. Your BMI suggests you may have limited fat reserves, so expectations for BBL volume should remain conservative. The best approach is typically a body lift with possible adjunctive fat transfer, sometimes staged for safety and optimal healing. A thorough in-person consultation would allow evaluation of your skin quality, fat availability, and surgical goals to design the safest plan for achieving both tighter skin and improved buttock shape.

Semih Yildiz, MD, FEPOBRAS · Answer

From your photos and history, I would generally think of this as a loose-skin and tissue-descent problem more than a simple volume problem. At 5'4" and about 120 lb after 100-lb weight loss, you may also have limited donor fat for a large BBL. A BBL can improve shape when there is enough fat to transfer, but it does not reliably tighten or lift heavy loose skin. In this setting, a lower body lift or circumferential body lift is often the more powerful operation because it removes loose skin around the abdomen, flanks, and back while lifting the buttock and outer thigh area.
I do sometimes see lower body lift combined with modest fat transfer or buttock auto-augmentation, but it depends on skin quality, blood supply, donor fat, and how much surgery can be done safely at one time. Many surgeons would stage this: first address the skin and lift problem, then consider fat grafting later if more volume is still needed. An in-person exam with a body-contouring plastic surgeon can show whether a lower body lift, tummy tuck plus buttock lift, auto-augmentation, or staged BBL is the best sequence for your anatomy and recovery priorities.

Daniel Barrett, MD · Answer

Dear Dana4488,

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

Ned Snyder, IV, MD · Answer

Thank you for submitting your questions/photos!  Congrats on your weight loss!  I would definitely recommend a lower body lift in order to remove the excess skin and contour your waist.  This will also help with glute definition.  You don’t seem to have too much excess adipose for fat harvesting to use for a BBL.  You may be a better candidate for injectable adipose filler, which can be used at the same time as the body lift procedure.  I highly recommend you seek out a board certified plastic surgeon to review all of your options.  Good luck and thanks again for reaching out!

Zoran Potparic, MD · Answer

Based on these photos you need extensive abdominoplasty (fleur-de-lis), followed with lower body lift and thigh lift. It does not seem that you have enough fat tissue for meaningful fat grafting/augmentation. Buttock augmentation can be done during body lift using upper butt tissue, which would be otherwise discarded, as flap filler to augment buttocks. Limitted amount of fat that can be harvested in your case may be used to contribute to buttock shaping and augmentation. There is a lot of planning and information you need before you start this long adventure of reconstruction. In person consultation with an experienced board certified plastic surgeon is a good starting point. Good luck.

Loose skin from pregnancies & weight loss - Is it better to do a lower body lift, or a BBL followed by a tummy tuck? (Photos)

Answers (5)

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