80 pound weight loss - Tummy tuck WITH or WITHOUT flank lipo? (Photos)

Question

Hi there, I’m interested in getting a tummy tuckand have consulted with a few Dr. And half recommended lipo ad half said lipo is not needed. I’m unsure as to what I should do. I’m worried about flank lipo creating more excess skin laterally on the sides of my abdomen. I’m 28 was a heavy smoker so my skin quality isn’t great and recently lost 80lbs im 5’2 and now weigh 115lbs. my main concern is in the first pic where I push the skin inwards and the wrinkles form I’m worried that removing more fat and lipo would create more excess skin and leave me loose and i cant snap back and be as tight as if I just got a skin only tummy tuck. Please advise

Jacob Carlson, MD · Answer

Based on your photos, I believe you will achieve an excellent result with a tummy tuck alone. In your case, flank liposuction is optional rather than necessary. It can add some contour, but it is not what will define the outcome of your surgery.
When we perform flank liposuction, most of the fat removed typically comes from the back and posterolateral flank area. Since that area was not visible in your images, I cannot assess it fully. However, from the front and side views, I do not believe flank liposuction is required to achieve a strong result.
Your concern about skin quality is valid, especially after significant weight loss and a smoking history. A more conservative approach that focuses on skin tightening and avoids aggressive flank liposuction is appropriate and reduces the risk of additional skin laxity.
Congratulations on your weight loss! You look phenomenal.

Elisa Stein, MD · Answer

Liposuction of the flanks is often combined with tummy tuck surgery. When the excess skin is tightened, skin from the flanks is tightened as well. In your photos, you do not appear to have much excess fat in your flanks, so perhaps liposuction would not be needed,

Martin Jugenburg, MD · Answer

Congratulations on your weight loss.  Based on these photos it looks like you have minimal excess fat and mostly loose skin.  Based on photos alone you would likely be able to get away without liposuction, however we would need to see you in person and feel your flanks before we could say for sure.  
Alternatively, you could chose not to do liposuction of the flanks now and come back and do it later if you feel you need it.  The downside of this approach is that you would be coming back to get a 'touch up' or second surgery and needing to go through recovery for a second time.

Yucel Sarialtin, MD · Answer

I truly understand the complexity of your situation&mdash;especially after such an impressive weight loss and with a history of smoking, which can affect skin elasticity.When deciding between a skin-only tummy tuck and combining it with liposuction, the key factor is your skin’s ability to retract. In cases where skin quality is compromised, aggressive liposuction&mdash;especially in the flanks&mdash;can indeed risk creating lateral laxity or excess skin. That’s why a tailored approach is essential.A skin-only abdominoplasty may be the safest and most effective option to achieve a smoother, tighter contour without compromising skin integrity. However, in some cases, gentle, strategic liposuction can be added to refine the waistline&mdash;if your skin can tolerate it.I would recommend a detailed in-person evaluation, including a pinch test and skin elasticity assessment, to determine the best course. Your goals are absolutely achievable, and with the right plan, we can prioritize both safety and aesthetics.

Sibel Atalay, MD · Answer

You’ve done an amazing job with your weight loss, and it’s very normal to have questions about the best way forward. A tummy tuck is designed to remove loose skin and tighten the abdomen, which sounds like your biggest concern given the changes in your skin quality. For many patients in your situation, a skin-focused tummy tuck alone can give a smooth, tighter result.
Liposuction can be a nice addition if there are still pockets of fat on the flanks, but it doesn’t actually tighten skin. If the skin is already delicate, too much liposuction could risk making it looser. That’s why some surgeons recommend keeping the focus on the skin removal, and only adding a little liposuction if it will clearly improve the contour.
The most important thing is tailoring the procedure to your body. From what you’ve described, a tummy tuck by itself may be the most predictable option, with lipo considered only if it truly adds to your shape. A careful in-person exam with your surgeon will help confirm the best plan to get you the tight, natural result you’re hoping for.

Jeffrey M. Darrow, MD · Answer

Congratulations on your weight loss and thank you for your photos. It does not appear that you have excess fat in your flanks that liposuction would improve. The laxity of your tissue appears to be all in your abdomen, so only a tummy tuck should help you achieve the contour you were looking for.   Best wishes.

Warren Schutte, MD · Answer

Congratulations on your weight loss.From the photos provided, it doesn't seem that you absolutely need flank lipo, although it is hard to be certain without in person consultation. If your main concern is the skin laxity to anterior portion of abdomen, an abdominoplasty alone will give you a great result.

Leila Kasrai, MD, FRCSC · Answer

If flank lipo were to be performed, generally speaking any loose skin that remains would be targeted with the tummy tuck. However, based on your photos, flank lipo may not be necessary.

Gary M. Horndeski, MD · Answer

Fortunately, you are young and your skin should retract. A routine tummy tuck will sometimes result in dog ears or fullness laterally. At the time of tummy tuck, the surgeon may want to do a little bit of liposuction at the dog ear area to minimize it's presence.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

William Andrade, MD · Answer

Hello, your stated concern and photos all indicate your main concern is the loose skin on your abdomen, so it would seem reasonable to avoid flank liposuction.  Based on the photo you don't appear to have dysproportionate flanks or much fatty tissue in that location, plus you already have a defined waistline.   Your best advice will always be achieved during an in-person consultation, because the physical exam provides a lot of important information, such as skin tone, tissue thickness, checking for hernia or spread of the muscles (rectus diastases), etc.  Thank you for your question.

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