BMI 36 & down from 49 - best post-bariatric options? (Photos)

Question

Best Post-Bariatric Options? I have had gastric bypass surgery several years ago, and have a current BMI of 36, down from 49. follow a strict keto diet, and do strenuous cardio workouts for a minimum of 30 minutes 7 days per week. My PCP has advised that my body is at it's natural set point, and further weight loss is unlikely. My primary areas of concern are my abdomen and arms/axillary region. I'd like to know if I am a good candidate for surgery, and what would the best choices be for me.

Zoran Potparic, MD · Answer

Based on these photos, you are good candidate for body contouring although with increased risks for some complications. It may be best to start with abdomen, by means of an extensive abdominoplasty/panniculectomy. This should be followed with liposuction of torso to diminish back fulness and folds; liposuction and arm lift should be considered as well. Based on your medical condition and high BMI, it would be best to separate these procedures in 2-3 surgeries. In person consultation with a board certified plastic surgeon, expert in post weight reduction body contouring, is recommended. Good luck.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding the best post-bariatric options after decreasing your BMI from 49 to 36. Congratulations on your weight loss and stabilization of weight. I agree with your PCP that your body is stable, and further weight loss would be unlikely. Regarding your areas of concern and the attached pictures, I suggest an extended abdominoplasty, brachioplasty, and partial vertical torsoplasty. During your abdominoplasty or tummy tuck, the excess skin and fat of the abdomen would be removed. The excess would be from just above the pubic region to the umbilicus. I suggest an extended tummy tuck because you have excess skin and fat over the hips. That means the incision would extend to the outer hip. During your tummy tuck, I would suggest a mons lift and reduction, muscle plication from the umbilicus to the sternum, and recreation of your belly button. During your arm reduction or brachioplasty, I suggest including arm liposuction and an incision from the armpit to the elbow regarding the axillary region. I suggest a vertical torsoplasty with an incision from your armpit down the side of your chest just to where the breast fold starts. If the fold underneath the bra strap also bothers you, the incision can be extended down to where your hourglass figure dips inward. These procedures can be combined. These procedures can be performed under general anesthesia with the guidance of an anesthesiologist. These procedures are performed on an outpatient basis. The abdominoplasty would take about 3-5 hours, depending on the speed of your plastic surgeon. The arm reduction should take approximately 3-4 hours, and the vertical torsoplasty 1-2 hours. Before any procedures are scheduled, labs, EKG, and chest X-ray will be checked to confirm that you are a healthy candidate for these procedures. Please schedule multiple consultations with many plastic surgeons to determine the best, most experienced plastic surgeon for you. Thank you for your question regarding the best bariatric options after gastric weight loss surgery. 
Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, 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 and RealSelf Hall of Fame.)

Gary M. Horndeski, MD · Answer

I recommend you wait until your BMI is at 32 or lower. At this time, you can undergo liposuction. 10 lbs can be safely removed during one session and the sessions can be repeated if necessary. Once you get your BMI to 32, you can consider a breast lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. At the same time, you can undergo a brachioplasty (arm lift). After these have been completed, you can consider a tummy tuck. If you are not planning future pregnancies, I recommend abdominoplasty with mesh reinforcement. The mesh creates a more hourglass figure by compressing the abdominal wall resulting in early satiety and helps maintain a reduced weight.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Carmina Cardenas, MD · Answer

It does not exist such thing as natural set point. 
Your current BMI is high and it will be very risky to have plastic surgery. You must be below 30 to be able to achieve  2 wonderful goals: a beautiful, curvaceous and feminine body shape AND a safe procedure with the least of complications. 
In order to lose weight,  you must break the platou and will be necessary to work out at least 1.5-2 hours daily 6 times a week, focus on cardio and muscle toning and get a nutritionist to guide you and acquire a healthy, balanced eating habit.  Otherwise you won’t continue losing weight. 
After you reach the 30, you will be candidate for lower body lift, next stage upper body lift (breast, back and arms).  
Be encouraged!! You can do it!!!
Dr. Cárdenas

Daniel Barrett, MD · Answer

Dear Maseca2319,
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

Camille Cash, MD · Answer

Congratulations on your weight loss!  For elective plastic surgery it is recommended to have a BMI of 30 or under.  Those above this threshold have higher risk of complications such as poor wound healing, seroma and infection.  I encourage you to continue with your diet and exercise routine to see if you are able to lose further weight before considering plastic surgery.  At that time you would likely enjoy the results of a tummy tuck and liposuction.  You may also benefit from an arm lift.  I've included a video I hope you find helpful.

Arian Mowlavi, MD, FACS (license on probation) · Answer

What you need is a Total Body Lift which will include:
a)Breast lift with fat grafting
b)upper body lift
c)tummy tuck with muscle application
d)Lateral thigh and buttock lift (lower body lift)
e)Buttock Reshaping
f)Liposuciton everywhere
Please consider a consultation from a high definition body contouring specialist.

BMI 36 & down from 49 - best post-bariatric options? (Photos)

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