Second Opinion - Is my skin too loose to remove fat all the way down to the abs? (Photo)

A photograph does not provide enough information as one needs to be looked at and the skin needs to be touched (pinched) in order to determine the amount of looseness or tightness that the skin presents. Given the information that you provided, sounds like liposuction in conjunction with J-plasma might do the trick for you. I hope this helps and good luck from your shitty plastic surgery

Weight loss patients typically have some issue with skin laxity and a 60 pound weight loss is often enough to create enough skin laxity to be of concern.
Skin laxity can be very deceptive because it looks and feels like subcutaneous fat to many people. The easiest way to differentiate skin laxity and get a true assessment of how thick the subcutaneous fat layer is is to put the skin under tension. You can do this by using the timer on your camera taking pictures, having someone else take the pictures or do it while looking in the mirror.
Take both hands and pull up on your domino skin with a moderate amount of tension until your skin is nice and snug. If that changes your contour significantly then that is how much skin laxicity is contributing at your abdominal contour. for men this is usually seen in the lower abdomen and especially in the love handles.
What does skin under moderate tension to measure the skin thickness take the tip of one finger and gently push it into your skin until you feel the muscle wall. It does not take a significant amount of pressure. people often try to assess the thickness of their subcutaneous fat by pinching skin. This is not a very accurate way of doing it since you are recruiting the skin and folding it which creates two layers of skin into layers of fat. People with skin laxity typically think they have more fat than they do.
In 22 years of doing plastic surgery which the last 10 years were devoted exclusively to doing only liposuction and fat transfer procedures I have yet to see a device that actually creates skin tightening beyond what can be attributed to Liposuction itself. well done Liposuction does not create skin laxity nor does it help it. The scar tissue that forms after liposuction has contractile forces that helps retract the skin to some degree and debulking the skin does create skin laxity so the net effect of well done Liposuction is an even wash with no significant change in skin laxity. having skin laxity should not prevent a plastic surgeon from being aggressive and reducing the subcutaneous fat layer to as thin as is appropriate. Generally we can reduce fat layers substantially as long as it’s done correctly. Poorly done Liposuction done in an aggressive manner will leave people with an uneven fat distribution that creates a disfigured appearance. This is not only highly undesirable but also almost impossible to correct.
In the end there are only two variables that matters when it comes to getting Liposuction. The first is understanding your own candidacy for the procedure. This means having a clear understanding of how much other variables like skin laxity are contributing and knowing how much subcutaneous fat you have in different areas. Typically individuals with skin laxity will be disappointing from Liposuction because they weren’t educated to know the difference between loose skin and subcutaneous fat.
The second variable is finding the most talented and experience surgeon.
Do that by having multiple in person consultations. During each consultation ask each provider to show their entire collection of before and after pictures. Ideally you should ask the provider the show previous cases of patients with similar body characteristics to around. I highly experienced surgeon should have no difficulty showing you at least 50 sets of before and after pictures. when reviewing the after pictures look carefully for any evidence of contour irregularities on the skin on all treated areas. Ask the surgeon to help differentiate treated areas versus non-treated areas and point out transition zones between treated and untreated areas. The transition zones should look completely natural. in fact liposuction results should never look like someone has had a surgical procedure with the exception of the small possibly visible scar from the incision.
Being shown a handful of pre-selected pictures which most likely represent the best results of the providers career is insufficient to have a clear understanding of what average results look like in the hands of each provider. this is why patients need to properly vet providers by asking him to open their portfolio and show all or as many as possible of there before and after pictures. you may want to ask the provider to show examples of excellent outcomes, average outcomes and less than outcomes.
Based on your post I think you’re going to be disappointed if you expect any skin tightening device to actually deliver skin tightening. I have done thousands of laser assisted liposuction and literally saw no difference in skin tightening using a variety of different lasers. I also used Renuvion a.k.a. JPlasma for one year and literally saw no improvement in skin tightening including objective measurable differences. I have since sold the device because I could not in good faith recommend it.
The only treatment for abdominal skin laxity is the surgically excited the skin with some form of tummy tuck. Individuals with loose skin especially male patient will often fail to get good results in the love handles because that area has a tendency to bulge after a fat has been removed.
Is difficult to make an accurate assessment based on the single picture.
The key is to get a quality assessment and that should include a very clear understanding of what kind of results can be delivered as shown through multiple before and after pictures of previous patients with similar body characteristics.
The second is to find a provider who can deliver quality consistent results. Delivery consistent quality liposuction results is far more difficult than most people including plastic surgeons believe. The majority of plastic surgeons despite years of experience and board certification aren’t all that good at Liposuction.
It is deceptively easy to do liposuction and remarkably difficult to do it well consistently.
Best,
Mats Hagstrom MD