Will I need muscle repair or lipo? (Photos)

Hi Practical58681, thank you for your question about whether you will need muscle repair or lipo with your 360 circumferential lower-body lift with FDL. Thank you for your history and your pictures. First, we should analyze your pictures to determine the best procedures. You have cutis pleonasmus (excess skin), dermatochalasis (lax skin), cellulite, and striae (stretch marks) affecting the abdomen, hips, gluteal, and pelvic regions. Based on the provided images, your abdomen exhibits redundant skin and adipose tissue, along with stretch marks in the periumbilical region. I assume you lost a lot of weight. If you did, congratulations on your weight loss! Great accomplishment. With your presumed weight gain, your rectus abdominis muscle was stretched. With weight loss, your rectus muscles tried to contract. However, the rectus muscles lack the skin's elastic properties. In contrast, the rectus muscle is wrapped in firm, non-contractile fascia. Because of your presumed weight-loss history, your rectus muscle should be plicated. You do not need lipo. To comprehensively address the abdomen, hips, and buttocks in a single surgical procedure, most plastic surgeons would recommend a 360-degree circumferential lower-body lift. A 360 circumferential lower body lift encompasses an abdominoplasty, mons lift, mons reduction, hip lift, hip reduction, buttock lift, and buttock reduction. The vertical FDL extension will correct the excess skin and fat of your central abdomen. During the abdominoplasty component of the 360 circumferential lower body lift, redundant abdominal skin and adipose tissue are excised, the rectus abdominis muscles are plicated to address diastasis recti, and the umbilicus is reconstructed. The 360-degree circumferential lower body lift typically takes approximately 6 hours to perform and is performed under general anesthesia. Anticipate a recovery period spanning two to three weeks. I trust that I have adequately addressed your inquiry regarding
I hope I have answered your question about whether you will need muscle repair or lipo with your 360 circumferential lower-body lift with FDL. 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, don't hesitate to get in touch with 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 photos and review their RealSelf profile. 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.)

Hello,
Thank you for the question. You should trust your plastic surgeon. Mention to your surgeon that if in the OR it is determined that MR is needed, they have your permission to do so.
I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Hello, Muscle repair can be an intraoperative decision. If separation is not appreciated before the surgery and it is visualized during the surgery it can simply be tightened. Concern I have is whether a fleur-de-lis abdominoplasty has been discussed prior to the final surgical plan. I think if you do a traditional, one horizontal scar below the belt line, you will have access that will be very visible in the middle of your abdominal wall, a smaller version of what you have now. It does add more visible scar but I think it would greatly improve how clothes fit on you without any sense of excess skin .Good luck.

You clearly have done an excellent job with your weight loss and now only have laxity of your skin. I agree completely with your plastic surgeon that a circumferential body lift with a FDL is going to markedly transform you for the better. I don’t believe any liposuction would be necessary, nor improve your overall result. While your physical examination did not indicate the need for muscle repair, direct examination is best and your surgeon will likely evaluate your muscles at the time of surgery and if they’re separated, would just repair them if needed. Congratulations on your accomplishment.

Dear Practical58681,

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

Hi there! Thank you so much for your question and for sharing this here.
Looking at your photos, it appears that your concern is primarily excess skin rather than fat. You have vertical and horizontal skin redundancy, most likely from prior weight loss, which is exactly what a circumferential body lift / abdominoplasty is designed to address. Liposuction is only effective for removing excess fat, and in your case, it doesn’t seem necessary because your body fat is already low and your excess is mostly skin.
Regarding muscle repair (diastasis repair), even very active and muscular patients often have some degree of abdominal wall laxity or separation. This may be difficult to detect on exam due to the amount of skin present, but during surgery, it is often clear whether a repair is needed. In many patients undergoing body lift procedures, a minor or moderate muscle repair is required to restore abdominal contour and support long-term results.
Every patient is unique — anatomy, history, physical exam, tissue quality, goals, skin elasticity, and surgical risk profile all change what is indicated/recommended.Because of this, this should not be taken as personal medical advice. The next step is always an in-person evaluation with a board-certified plastic surgeon who can examine you and discuss individualized plan options.
Hope this helps!— Georgina Nichols, MD FACS

Based on your photos, the primary issue in your abdominal area appears to be loose, excess skin. Liposuction would not correct this — and in some cases, it can even make the skin look looser. A body lift would be the most appropriate approach in your situation.