What procedure(s) do I need for abdomen, sides, back, thighs? (photos)

Question

Hello, 34yo female, 5'10", 250lb. RNY gastric bypass in 2008, lost a total of 130lb. I had a brachioplasty in 2009 but held off on abdominal skin removal due to wanting children. I've had 2 C-sections, 2015 and 2017. I want a flat stomach, smooth sides and back. Thighs would be a secondary procedure in the future. Abdominal area and back is main focus at this time.

Leila Kasrai, MD, FRCSC · Answer

A circumferential body lift would remove loose skin and fat on your front, sides and back of your mid-section. Abdominal muscle separation in your front could also be performed. Liposuction may be performed at the same time to enhance your results.

Gary M. Horndeski, MD · Answer

The technique I recommend is a circumferential body lift. This can be done in 2 sessions: front and then the back. Liposuction can also be added or done separately. At 5'10 and 250 lbs, your BMI is 36 which puts you at a higher risk for complications. I recommend you begin a low fat diet, core exercises such as sit-ups, planks, pilates and wear a compression garment. This may help with the skin recoil.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Carmina Cardenas, MD · Answer

It is awesome what you have achieved after the weight loss, it takes courage. Congratulations!!
Based on your photos  you have developed a severe degree of saggy skin on your abdomen, sides of abdomen, outer thighs,  lower back and buttocks. 
So you are candidate for a Lower Body lift and possibly with Fleur de Lis  in order to remove the 360’de excess of skin but also the excess of width on your abdomen. A body lift means also to lift below the incision: mons pubic lift, front and outer thigh lifting and real buttocks lift. I would also recommend some liposuction to back and waist and use that fat to do buttocks enhancement. 
Results are fantastic after this combination of procedures!!! but it is important for you to acknowledge that your BMI must be a bit lower because you carry a lot of weight on your mid central body and have a lot of visceral fat, which can only be reduced by losing weight. You should probably be at 190 Lbs for surgery. I encourage you to lose weight the natural way:  nutritious diet and exercise. 
Be encouraged!!! You will look astonishing after all!!!!
Look for a board Certified Plastic Surgeon who is expert in After weight loss surgery. 
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear lauramj1987,
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

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  Once you have reached your goal weight and are able to maintain it you are ready for plastic surgery.  To achieve your stated goals you will want to consider a fleur de lis tummy tuck, liposuction of the back, hips, and flanks.  I encourage you to begin by meeting with a few board certified plastic surgeons in your area for consultations.  Your concerns about your thighs can be discussed at that time as well.

Jose A. Munoz, MD - Account Suspended · Answer

Hi and welcome to our forum!From your photos, I note excess fullness of abdomen, hips, and flanks. From height and weight data, your BMI is 35.87, in spite of your efforts to control your weight with a Roux-en-Y procedure.It is on the "high side" for safety. For safety reasons, you would most likely require at least an overnight hospital stay.BMI (body mass index equals weight in kg / square of height in meters) is one criterion to determine the anticipated results of a cosmetic surgery. You can find BMI calculators on the internet. If your BMI is greater than 30, the cosmetic result will not be optimal. If your BMI is greater than 35, your operative risk will rise. In our practice we recommend a BMI of less than 30. We recommend that you be at a healthy comfortable stable body weight at the time of surgery. The cosmetic effect improves with lower BMIs. A beltectomy requires a circumferential excision of skin and underlying soft tissue in a belt-like fashion at the waist. This usually includes performance of abdominoplasty as well. Another option would be to revisit your bariatric surgeon to determine your candidacy for revision of your Roux-en-Y prior to removal of excess skin / soft tissue to ensure an optimal result.Visit a board certified plastic surgeon for evaluation, examination, and discussion.Best wishes

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