How to divide procedures? TT, thigh lift, fat transfer to breast, rhino?

Thank you for your question regarding how to schedule and prioritize your desired procedures following massive weight loss. The most critical prerequisite is ensuring you're medically fit for the surgeries. Therefore, you should consult with both your plastic surgeon and your internist to review your labs and confirm your readiness for the procedures.

Upon medical clearance, we need to take your weight history into account. Since you've lost a significant amount of weight, it's crucial that your weight remains stable for at least three months before undergoing reconstructive plastic surgery.

I suggest a two-stage approach for your procedures. In the first stage, you might consider a tummy tuck, thigh lift, and fat transfer to your breasts. The fat could be harvested from your tummy and thighs during the tummy tuck and thigh lift and subsequently transferred to your breasts. By performing these procedures together, we can utilize fat that might otherwise be wasted.

In the second stage, to be considered at least three months later, you can explore having a neck lift and a rhinoplasty. Often, a neck lift is combined with a lower 2/3 facelift for optimal results.

In summary, I recommend a two-stage approach, with each stage separated by a minimum of three months. The first stage would include a tummy tuck, thigh lift, and fat transfer to the breasts. The second stage would be a rhinoplasty and neck lift. This plan, however, should be discussed and tailored according to your personal circumstances and goals.

Sincerely,
Dr. Katzen

I would split your surgeries into three: 1. necklift/rhinoplasty, 2. breast lift/fat transfer and abdominoplasty, and 3. thigh lift. The order would depend on your priorities and wishes. I advise waiting at least 3 months between each surgery to allow yourself time to heal and recover prior to the next.

Dear Dazzling13202,
I understand your concern. It is best however that you consult with a board certified plastic surgeon to determine whether you can have several aesthetic surgeries in one session, as this would depend on various factors including but not limited to your general health condition, the type of anesthesia that will be used, and the type of surgeries that will be performed among others.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Congratulations on your weight loss! It is best to break your procedures into stages for your safety and to optimize your results. The number of stages will depend on the extent of what needs to be done. Based on the procedures mentioned it would likely be 2 to 3 stages with 3 to 6 months between them. The best place to begin is a consultation with a board certified plastic surgeon near you. Together you can design a surgical plan that best matches your goals. I've included a video about plastic surgery after major weight loss that I hope you find helpful.

Do the procedure that you want most first or do the one that will make the biggest impact on your life and self-esteem. The breast lift might be done with the tummy tuck. the breast lift should probably be done before the fat transfer. You then need to give your body time to heal before doing the next procedure.

Have you had a consultation with a plastic surgeon?
If not then I suggest you schedule five in person consultations with local board-certified plastic surgeons in your community.
Your list of procedures is extensive.
There are advantages and disadvantages for doing combine procedures.
Quality plastic surgery needs to be detail oriented and takes time.
Surgeons the schedule excessive numbers of procedures to be done in one day will inevitably cut corners to get through the day in a reasonable number of hours.
I remember asking one of the nurses at the hospital are used to work at who were the best plastic surgeons and staff at the hospital. this hospital was popular with plastic surgeons and they had at least 50 plastic surgeons on staff.
The nurse looked at me politely and answered the surgeons who don’t look at the clock are always the best.
There are also surgeons who do some procedures better than others.
Typically plastic surgeons to do exceptional rhinoplasty and facial surgery tend to like that type of work while those to do more body contouring tend to focus on that type of work.
Typically plastic surgeons to do exceptional rhinoplasty and facial surgery tend to like that type of work while those to do more body contouring tend to focus on that type of work. very few plastic surgeons specialize exclusively on just one area or one procedure but most have what they end up doing more frequently or have a reputation doing well.
Rarely do plastic surgeons refer any standard procedure to one of their colleagues. there are exceptions.
Some providers may not want to do a thigh lift for example.
I recommend starting with the procedures they’re going to have the greatest impact. in your case it is most likely going to be your tummy tuck. If you have a massive weight loss then you will most likely require an extended or wraparound tummy tuck a.k.a. body lift or perhaps need to consider a fleur-de-lis pattern which adds a vertical scar on the abdomen. Individuals with severe skin laxity have skin laxity in about horizontal and vertical direction.
Individuals with skin laxity are not good candidate for liposuction or fat transfer.
Most likely you need a contouring procedure for your breast and fat transfer isn’t going to do that.
Fat transfer has very little impact on the shape of the breast. It simply makes it larger.
From what you describe you must likely are a better candidate for a different breast procedure.
A full body lift is an all day procedure and it’s probably a pretty good place to stop. Breast surgery is often done in conjunction with a tummy tuck.
Plastic surgeons will vary on what they feel is appropriate regarding combine procedures as well.
I’ve seen plastic surgeons do a full tummy tuck in 90 minutes and I’ve seen plastic surgeons take all day doing the same procedure.
I can tell you that those who operate fast will cut corners and the fastest surgeons are never the best.
The best plastic surgeons are not slow but will take the time necessary to give the patient the best result they can. Quality detail oriented work simply takes time.
Operating room time is expensive but considering that you’ll be reminded of the outcome of the procedure every day for the rest of your life I think it’s worth investing and doing this correctly.
If you haven’t done so already you need to get an assessment for each of the procedures you’re interested in. You need to learn about the procedures and get A good understanding of what it entails to have each of those operations.
You need to find out what your candidacy for each procedure is.
Candidacy determines what is possible and what is not possible from each procedure. Some people are excellent candidates for certain operations and other patients are not good candidates for that procedure.
An assessment or Determining candidacy is innocence simply making an accurate diagnosis.
The choice of procedures should be based on having a clear understanding of what the underlying problem is.
After you’ve gotten to this point you need to then begin the process of vetting plastic surgeons to find out who is the best work procedures.
In my opinion this requires in person consultations and taking an active role during the consultation process.
I recommend all patients begin the process by having pictures taken of their body and face or whatever area they’re having treated.
Look carefully at how plastic surgeons take before and after pictures of each of the procedures. For you if that would include lower extremity for the thigh lift, your torso and face. pictures should be taken wearing small undergarments from about six or 8 feet away. The camera should be held at the same level of what’s being photographed. have someone else take the pictures or use the timer on your camera. Pictures should be taken with you standing in a neutral position showing your front side and backside for extremities and torso pictures. Facial pictures need to include frontal and side views taken at correct angles. Pictures of your torso should be cropped to include your body from your neck to your knees. Thigh pictures should be taken from a thigh level or about 3 feet from the ground.
Whenever you review before and after pictures whether at home or during a consultation you should have a printed copy of the pictures of your own body/face.
There’s no point and looking at results on patients who had a different body characteristics to your own.
There are only two variables that determine quality plastic surgery outcomes. They are candidacy of the patient combine with the skill of the surgeon.
Somebody was an excellent candidate has the potential to have an excellent outcome.
Someone who is an average candidate has the potential of getting an average outcome but not better.
Somebody is a poor candidate is not going to have a great outcome no matter who does the operation.
Someone who is an excellent candidate can end up with you and desirable outcome if they don’t choose the right provider.
I recommend most patients schedule at least five in person consultations to properly vent plastic surgeons and find the right provider.
In your case you may opt to have one provider do all the work well you may want to find individual providers who specialize in different procedures you were interested in.
During each consultation ask each provider to open up your portfolio and show you their entire collection of before and after pictures.
Bring your own pictures with you.
Ask providers to only show you examples of previous patients when similar characteristics that you do.
Ask providers to show you examples of excellent outcomes, average outcomes and outcomes that did not turn out as well as they had hoped for. ask providers what the revision rate and revision policy is for each of the procedures you’re interested in.
When reviewing risks and complications you should ask the surgeons which complications they’ve had and how they managed each of those. you should also have a good understanding of the frequency of the complications.
When it comes to before and after pictures providers are more likely going to prefer to show you preselected images representing the best worth of their career. well these pictures may look more impressive they do not represent what average results look like and they certainly don’t represent what undesirable outcomes look like.
Recognize that you are the person paying for the procedure and you’re hiring a professional to provide a service for you.
You are hiring the surgeon and you have the right as the consumer to assist I’m getting support of information to make a good decision. This includes seeing enough before and after pictures to get some idea of what the average results look like in the hands of each provider and how many of these procedures they’ve actually performed.
For reference in my opinion and experience plastic surgeon should have no difficulty showing you at least 50 set of before and after pictures of commonly performed procedures like the ones you mentioned.
I mentioned this previously but from what you describe I don’t believe for breast fat transfer.
Liposuction and fat transfer does not work well on individuals who have skin laxity. both Liposuction and fat transfer also has more variation based on who does the procedure than any other plastic surgery operation.
Doing both Liposuction and fat transfer well on a consistent basis is more difficult than most people believe.
Being board-certified in plastic surgery with an overall good reputation and years of experience does not mean somebody has mastered liposuction.
A substantial number of well intended well trained caring plastic surgeons simply aren’t good at this procedure.
Some providers believe Liposuction has a simplistic procedure with a low learning curve.
In reality liposuction is a highly complex procedure that is difficult to learn and takes decades of committed excellence to master.
Patients should be more selective than they think they need to be when it comes to choosing a provider.
Like I mentioned earlier. There are only two variables to determine quality outcomes. Patient candidacy on the skill of the surgeon.
There’s no correct number of consultations patients need to find the right provider. I suggest patients start with at least five in person consultations for some people more consultations may be needed to find the right provider.
Find the right plastic surgeon and everything falls into place.
I do not believe virtual consultations are a good substitute for in person consultations.
I also do not recommend people travel long distances for elective surgical procedures unless they absolutely have to.
When in doubt slow down and schedule more consultations.
Trying to schedule too many operations in one day.
Surgeons who are enthusiastic about doing a lot of operations in one session are sometimes motivated by financial gain rather than patient advocacy.
There are advantages to having combined procedures but your well-being should be the number one priority for both you and your provider.
Best,
Mats Hagstrom MD