Extended TT or 360 TT after 115lb weight loss? (photo)

Hello and thank you for your question.
Congratulations on your weight loss! Based on your photographs (but without the advantage of a physical examination), I would recommend a 360° procedure ( lower body lift). Your first photograph demonstrates significant fatty deposits and skin excess along the lateral trunk/ thigh that would not be effectively addressed with an extended tummy tuck. The lower body lift also reduces posterior trunk adiposity and corrects gluteal ptosis. Ultimately the decision should be based on your aesthetic goals, keeping in mind that the lower body lift is a more involved procedure with a longer recovery. Good luck. I hope this helps.

It depends what your expectations are. If you can accept a little bit of looser skin at your hips, then I think you could get a very nice result with an extended tummy tuck. Good luck!

Thank you for your question. You are an excellent candidate for a 360° lower body lift rather than an extended tummy tuck. After significant weight loss, excess skin often collects around the midsection, not just the front. A 360° body lift removes this surplus tissue from the abdomen, flanks, lower back, upper buttocks, and lateral thighs. Additionally, due to the amount of weight you've lost and the presence of both horizontal and vertical skin laxity, a fleur-de-lis technique may be necessary. This technique will help better contour the upper abdomen, create a more defined waistline, and eliminate excess tissue in the central area.

Dear a022702,

based on your photos, you look like a good candidate for a TT. Full tummy tuck should tighten your abdominal muscles and remove the excess skin. Flanks liposuction would give you a better shape. I would suggest you to consult a board-certified plastic surgeon because 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

A 360 lower body lift with your tummy tuck is an option, but because we are not seeing a rear view, we cannot see how much drooping of the lower back and buttocks is present to justify a circumferential body lift. It does not appear from the pictures presented, that 360 is needed, but it doesn't matter because it can be done as a second stage if needed.
The abdominoplasty incision has to go the the mid-axillary line to allow elevation and redistribution of the abdominal flap and excess skin without a dog ear or bunching. This may require some extension of the incision past the mid-axillary line, an "extended" abdominoplasty, to begin with, and you should be prepared for some additional revision, usually in the office under local, to take care of any residual dog ear or bunching.
You may get some recommendations for a midline incision or fleur-de-lis to take care of the horizontal excess skin. The upper abdominal skin, despite the significant vertical pleating and excess in the lower abdomen, appears of pretty good quality. It can probably be redistributed after removal of the excess skin and not do a flour-de-lis. That would be a decision between you and your plastic surgeon at an in-persion evaluation.

Thanks for your question! I would probably suggest an extended tummy tuck or possibly a Fleur De Lis (would have to see you in person to determine). I might also add some liposuction to the waist and love handles to help contour. I think a backside lift might be overkill. Best of luck!

You would be an excellent candidate for a lower body lift, which is also known as a circular tummy tuck or the 360 tummy tuck. Otherwise if you had an extended tummy tuck or only a tummy tuck from hip bone to hip bone you will be left behind with dog ears, where the incision stops you will have protruding skin. In addition to that you might benefit also from the Fleur De Lis incision it’s a vertical incision that helps remove excess skin from your upper abdomen. That is a suggestion but otherwise yes there’s 360 tummy tuck would be your absolute best option to get the best possible results. It will help not only lift your pubic area and remove the skin of your abdomen, but also give you a butt lift.

After 155 lbs. weight loss, you have hanging skin anteriorly but also posteriorly. If the posterior hanging skin of the buttocks is an issue for then you will need a 360 lift. Since you have lost so much weight I believe you will need a 360 lift. Also, you have excess horizontal width above the umbilicus and sometimes this requires a fleur de lis incision anteriorly. You may or may not need this. Also, one thing to consider before the abdominal surgery is doing a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. This will also lift the upper abdominal skin and may eliminate the need for a fleur de lis. I prefer to do a breast lift before a tummy tuck because doing a tummy tuck first will pull the breasts lower and make it harder to perform a breast lift.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question and pictures. First of all, congratulations on not only losing 115 pounds but maintaining it! That is an impressive feat. Based on your pictures, a 360 TT or Lower body lift (LBL) would be the best choice for you. I frequently see patients that lose significant weight such as yourself and most have loose skin around the entire midsection, not just the front. I think you will likely be disappointed with an extended tummy tuck only as liposuction to the back will not address your likely skin laxity. Good luck with surgery and again congratulations on the weight loss!

You'll need that 360 TT because your posterior and lateral hip tissue/skin has descended onto the buttock tissue/skin. The appropriate amount of liposuction of that posterior hip fat, which is creating that bulging contour, will leave that area even more deflated with a persistently flat buttock, because the posterior hip area that is a convexity will remain so due to the volume of excess skin and subcutaneous tissue that couldn't be vacuumed. This is an area that needs to be a concavity, or more specifically, the transition of contour from low back to buttock prominence needs to be an S curve, a concavity (the low back and hip) directly above the a convexity (the buttock proper). So, in addition to your need for a lower body lift, you'll need some of that liposuctioned fat placed into the deep tissues of your buttock proper to help it keep it's projection as it gets lifted back up into proper position. As a side note, fat grafting the buttock should never be performed without high resolution ultrasound guidance.