139lbs, 5'6, 40, weight lifter, multiple sclerosis, facial melanoma & saggy skin - what do you suggest? (Photos)

Question

At highest weight was 336 while pregnant. Am 5'6" weight lifter with multiple sclerosis and am a disabled veteran. I have a lot of saggy skin. I've had melanoma on my face. right now I am 139 and about 21 percent body fat age forty. Id like to slow down the pronounced sagging and keep weight off so eventually I don't die when nurses don't want injuries caring for me once I'm in a home. What do you suggest

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your background and concerns. Based on your history, including your significant weight loss, weightlifting routine, and multiple sclerosis, most plastic surgeons would likely recommend a combination of procedures to address the sagging skin.

For the lower body, a 360 circumferential lower body lift could be an excellent option. This procedure would include a tummy tuck, pubic lift, hip lift, and buttock lift, effectively tightening and contouring these areas. If your arms are an area of concern, a longitudinal brachioplasty (arm lift) could help remove excess skin, with an incision running from the armpit to the elbow. If you're bothered by the appearance of your breasts, a breast lift (mastopexy) combined with breast implants could restore volume and lift.

Since you mentioned having had melanoma on your face, it's essential to take a cautious approach regarding facial skin treatments. Non-invasive options like laser resurfacing or skin tightening treatments can help slow down the sagging without compromising your skin health. It’s important to work closely with both your dermatologist and plastic surgeon to ensure any facial treatments are safe.

Given your medical history with multiple sclerosis, your surgeon will likely coordinate with your neurologist to ensure the surgery and recovery are safe. As long as your condition is well-controlled, multiple sclerosis shouldn’t pose a major issue during surgery.

A consultation with a board-certified plastic surgeon who specializes in post-weight loss patients will help refine these recommendations based on a full physical examination. I hope this helps provide some guidance on how to move forward.

Sincerely,
Dr. Katzen

Daniel Barrett, MD · Answer

Dear Jubilant2973,

it is hard to tell for sure without an examination. 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

Jeffrey M. Darrow, MD · Answer

You are certainly to be congratulated with your weight loss. If your goal is to remove your loose and saggy skin, there are some very well established procedures to do that. The areas most people target are the trunk, the arms, lateral chest and breast, and the legs. While any procedure can be performed first, many patients start with a lower body lift which corrects the loose skin of the abdomen, waistline and lifts and reshapes the buttocks, in addition to smoothing the lateral thighs and some of the inner thighs. It is a very powerful operation on which to base the remaining procedures. Second procedures can be an arm lift with a lateral chest lift and a breast lift all done at once.  To understand which procedures are best for you and which could be combined to minimize recovery time and cost, you would need to have a detailed consultation with a plastic surgeon to discuss your options. You would also need to discuss the effect of the surgeries on your multiple sclerosis with your specialist doctor and get clearance and best suggestions on how to proceed forward in the safest fashion.  Best wishes.

Carmina Cardenas, MD · Answer

It is wonderful what you have achieved losing all the weight!! Congratulations!! You have achieved a beautiful well defined and toned body. 
The most important goal will be to make you look astonishing! You will be candidate for several stages in order to have a safe procedure. 
Top to bottom:
Botox to your frown. Neck lift to create a beautiful tight well defined jawline and angled neck. 
-Most likely upper body lift which most likely will include arm lift and breast lift and possibly augmentation. 
-Lower body lift which will include abdominal skin resection, mons lift, real buttocks lift and auto augmentation of your buttocks. 
-Inner vertical Thigh tightening. 
Every stage should be 6 hour surgery or less, to be considered safe. 
After every stage you must stay at least 7-14 days at a Recovery center with nurse care 24 hours to have a better safer outcome. 
Be encouraged!!!
Dr. Cardenas.

Camille Cash, MD · Answer

Congratulations on all of your accomplishments!  It appears you would benefit from a tummy tuck to address the loose skin on the abdomen.  An exam would be needed to determine if a standard, extended or circumferential approach would be best.  It appears you have strong, tone arms so I don't see the need for an arm lift.  If the breasts are sagging you could elect a breast lift either with or without implants.  See a board certified plastic surgeon near you to learn more.

Mats Hagstrom, MD (license on probation) · Answer

My best recommendation is to have ongoing follow-ups with a competent dermatologist.
Weight loss patients usually have issues related to skin laxity, and treatment for this is skin removal, surgery a.k.a. body lift or extended tummy tuck.
Your medical history is significant and most likely plastic surgeons will want to get medical clearance from your neurologist.
You should talk to your neurologist now to see how they feel about elective cosmetic surgery.
Other than that, simply start scheduling in person consultations with plastic surgeons in your community.
 Finding the right provider is key and this usually takes a bit of time.
I usually recommend people have multiple consultations before selecting a provider.
During your consultation, you can get a quality assessment, better understanding of your treatment, options and review your medical history with each provider.
I generally recommend people avoid virtual consultations and instead focused exclusively on in person consultations.
Best,
Mats Hagstrom MD

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