Skin Removal, age 66, "apron" belly after pregnancies - Options? (photos)

Question

I’m a 66 year old woman who’s had an “apron” since my first pregnancy in 1979. With 3 more kids and years of weight struggles, it only got worse. I had a gastric sleeve 5 years ago. I’m 5’4” at 170 lbs, began at 254. I have excess skin on my stomach, butt, hips, inner thighs, and right above my knees. What surgeries do I need and what weight I need to be before I can schedule them? Even a ballpark on prices as insurance will cover nothing. Thanks.

J. Timothy Katzen, MD, FACS · Answer

Hello! Thank you for your question about what to do after significant weight loss and multiple pregnancies. I appreciate you sharing your history and photos.

Most plastic surgeons would agree that you are an excellent candidate for either an extended tummy tuck or, even better, a 360 circumferential lower body lift. Both procedures effectively remove excess abdominal skin and fat. An extended tummy tuck would involve plicating the rectus abdominis muscles to correct diastasis recti, lifting and reducing the pubic area, and repositioning the belly button for a more natural contour.

The 360 circumferential lower body lift addresses not only the abdomen but also the hips and buttocks. This procedure involves an incision starting at the top of the pubic area, extending over the hips, and connecting at the top of the buttocks. It offers the advantage of lifting and contouring the hips and buttocks, resulting in a flatter abdomen, elevated and reduced hips, and improved buttock shape. This procedure also helps minimize wrinkles on the lateral hips and buttocks.

Regarding your inner thighs, you have some excess skin and fat in the upper inner third of your thighs. A modified longitudinal vertical medial thigh lift would be the best approach for this area. This procedure typically involves liposuction of the inner thighs followed by an incision made from the groin partially down the inner thigh. The incision length is generally 4 to 6 inches, extending slightly beyond the excess skin to ensure smooth results.

Both the extended tummy tuck or 360 body lift can be combined with the vertical medial thigh lift, depending on your overall health and surgical plan. These procedures are performed under general anesthesia, and most surgeons agree that combining them is safe and effective for patients in good health.

While it would be ideal for your BMI to be below 30, many experienced plastic surgeons understand that this may not be realistic for everyone. Most would agree that you can proceed with these surgeries at your current weight of 170 pounds. To determine the best surgical plan for your specific needs, I recommend consulting with multiple board-certified plastic surgeons. Many offer free virtual consultations via Skype, Zoom, FaceTime, or WhatsApp, which can provide valuable insights.

Plan for a recovery period of at least 2 to 3 weeks after surgery, and you’ll likely need to wear compression garments for about 6 weeks. Good luck! I hope this information helps answer your questions regarding your options.

Sincerely,
Dr. Katzen

Ira H. Rex III, MD · Answer

It seems you have a very complicated case as far as timing and how to proceed.  It is difficult to even start to give you any advice without a long conversation regarding your expectations.  When you decide on a plastic surgeon, you should make sure they have plenty of experience dealing with such significant procedures.  Good luck with everything.

Chet Mays, MD · Answer

Thank you for your inquiry and congratulations on your weight loss! You have excess abdominal skin making you a great candidate for an Abdominoplasty procedure at your current weight. We would love to see you in person and help you reach your goals. Schedule a consultation with a Board-Certified Plastic Surgeon like myself and we can create a surgical plan for you!

Daniel Barrett, MD · Answer

Dear Tough829939,

congrats on the weight loss! Generally speaking, you want to reach your goal weight before you consider a tummy tuck, otherwise your results will be suboptimal if you continue to lose weight after the surgery. 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

Arif Eroglu, MD · Answer

HelloFirst, you would need a tummy tuck and thigh lift. Vaser liposuction can be applied to the abdominal area, and fat injections can be used to fill the hollow areas in the buttocks. Since your back and arms are not visible, I don’t have an opinion on those areas. With a BMI of 29, it’s not necessary to focus on losing more weight. Once the tummy tuck is done, you will already lose a significant amount of volume. After that, if you choose to continue, dieting will be easier and more effective.

Stefan Mark Szczerba, MD · Answer

I would recommend an extended tummy tuck with liposuction of the back.  The fat from liposuction could be used to add fullness to your lower buttocks and help round that area out.   There are other techniques out there such as a "belt lipectomy" aka bodylift or a "flankplasty" that would work well also however an in person exam and review of your priorities is really important to figure which of these options is the best plan for you.  Liposuction of the inner thighs and an energy based treatment to help tighten skin could also be added.  A second stage surgery 3-6 months later may be needed to optimize the outcome such as a thighlift.  At that second stage, other touch up work could be done such as additional skin excision or liposuction.  Best Wishes!!

Daniel Careaga, MD · Answer

Massive weight loss can drastically improve the quality of health of patience. At the same time, it can lead to issues with excess skin such as you have demonstrated in these pictures. Fortunately can make dramatic improvements in these patients. You have what I would expect for somebody that lost as much as you did. To improve the contour of your entire abdomen and back, I would recommend performing what is known as a circumferential abdominoplasty or belt lipectomy. This is an operation which combines a tummy tuck with a buttock lift. Essentially a tummy tuck is performed and extended all the way around the body 360° to address all of the looseness. This will leave the abdomen flat and firm as well as lift and contour the buttocks. you would most likely need some volume as well. This can sometimes be done at the same time through what is known as auto augmentation or it can be done at another time through the use of liposuction with fat grafting. Losing weight prior to body contouring surgery has a twofold benefit. It increases the quality of the result, and it decreases the risk of developing complications. For that reason, I am a strong proponent of my patients getting as close as possible to their ideal body weight. A silent lift would address the loose skin of the lower extremities. You will find some variation in opinions as to what surgeries to combine but I would first address the abdomen and back and return six months later to correct the thighs and hips.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. Congratulations on your weight loss. Your BMI is 29. Any additional weight that you could lose, prior to your surgery, would help you to minimize complications as well as improve your final result.  Your first surgery that I would recommend would be a lower body lift, which would remove the excess skin of your abdomen, flanks as well as lift and shape your buttocks. This also improves, to some degree, the tissue of your inner thigh and outer thigh. This is a very powerful operation for improving patients core. After you have healed from that, you may wish to have your thigh lift done, which would treat your inner thighs.  Pricing will vary, depending upon where this is done but likely would be around $25-$30,000 for the lower body lift.

Leila Kasrai, MD, FRCSC · Answer

Skin and fat that hangs over your waist is known as a “pannus”, and its removal in Canada may be covered by insurance (OHIP). You can discuss this with your insurance provider as it may be the same in the US. However, anything above your waist would probably not be covered. A circumferential tummy tuck would be recommended for this, as it would target the mid-section, sides and back. A thigh lift can target the loose skin on your inner thighs. A butt lift can target the sagging skin on your buttocks. Combining these procedures may be well over $25,000 in Toronto, Canada where my practice is located.

Krishna Vyas, MD, PhD, MHS · Answer

Given your significant weight loss and excess skin after pregnancies, there are a few surgical options that could help address the issues you're experiencing. This depends on what your goals are. Some options to remove the excess skin and tissue as well as improve contour could include a circumferential body lift. This would likely provide the most comprehensive improvement, targeting the abdomen, hips, buttocks, and thighs. This procedure removes excess skin, addresses sagging, and improves contours. 
Alternatively, a staged approach could be performed, starting with the tummy tuck and then addressing other areas like the thighs and buttocks later. It's important to have a stable weight for at least 6 months before considering surgery. Some insurances may cover the panniculectomy if you've lost over 100 lbs, but coverage for cosmetic surgery is limited. Prices can vary widely depending on the surgeon and location. Consult with an experienced plastic surgeon to develop a personalized plan based on your health, goals, and budget.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

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