What to Do After Conflicting Advice from Plastic Surgery Consultations?

One PS says I need lipo of the trunk area in addition to my TT, while the other said it was not necessary. Also, I have about 25 lbs to lose before I'm at my goal weight, one doc said to lose the weight first, while the other doc said have the surgery and the weight will come off after surgery. Please advise on the best way to get clarification from the docs!

Doctor Answers 17

Understanding opinions among Plastic Surgeons

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Hi there-

There are many reasons you may be getting different recommendations...

The most important thing is to understand how to get your best outcome, regardless of who you choose to do your surgery...

I would concur with the majority of my colleagues that your best outcome will occur if you are as close as possible to your ideal weight as possible before surgery.

The key is understanding what your ideal weight is, however....

I don't agree with weight charts and insurance tables, because depending on your lifestyle and metabolism, you may not be able to achieve what these tables say should be your weight without dieting and exercising aggressively, and after surgery you may have a very hard time maintaining this- so that after surgery your outcome actually SUFFERS because you lost the weight in a way that was impossible for you to maintain.

I think its much better and safer for patients to establish a healthy lifestyle THAT THEY CAN MAINTAIN over the long term- whatever weight you achieve after doing so is the weight you should have surgery at- provided the surgery is safe in the estimation of your surgeon at that point.

As for the liposuction- ask to see photos of the surgeon's outcomes and speak to a few prior patients. You'll know when you're looking at a pleasing outcome.

How to handle conflicting advice from plastic surgeons

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Hello - From your story, it sounds like it may be beneficial to wait until you're at your goal weight before having surgery. This is because after you lose the weight your skin may sag even more and if you've already had a tummy tuck you'll need more skin excised. Further, I don't think you'll be able to have 25 pounds of skin and fat removed with liposuction and a tummy tuck. It never hurts to wait and take things slowly when it comes to cosmetic surgery. Good luck!

Different surgeons have different opinions, no one way is right or wrong

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There are usually several different ways to achieve good surgical results. What you are describing is a difference of opinion, and this is very common. I don't think it is necessary or even possible to get these two surgeons to recommend the same procedure, but you should be able to ask each to explain his or her reasons for suggesting the particular treatment plan. After getting that information, you have to make the best decision for yourself. If you feel that 25 lb weight loss is an achievable goal, then by all means, try to do that first. If on the other hand you are struggling with weight loss, holding the tummy tuck like a carrot in front of you may lead to alot of frustration if you cannot lose the weight. In my practice, I will operate on a patient who needs liposuction of the abdomen and flanks in addition to the tummy tuck, particularly if they have rectus diastasis. This separation of the abdominal wall muscles will not get better with diet and exercise and in fact may prevent you from being able to exercise safely and efficiently. My experience is that these patients do lose weight after their abdominoplasty.

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Liposuction with tummy tuck

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As my colleagues have mentioned, it is always better to lose weight that you are able to. That being said, many people cannot lose weight easily nor should it be a life struggle to maintain a specific weight because that will not last. And if you are progressively gaining weight, this is not the answer for you.

I believe if you are at a weight that you can MAINTAIN easily (so it will preserve your results), then you can proceed with a contouring procedure. If you have a thick layer of fat at that point, then I would recommend a lipoabdominoplasty procedure where liposuction is combined safely with the tummy tuck. If you have a thin layer of fat, then a more traditional approach will be used but I would advocate trying to spare the flimsy fat that is above the muscle fascia to diminish complications

"Six of one - half a dozen of another?"

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Plastic surgeons by nature are innovative visionaries. Surgeons envision your final result but may have extremely different paths to get to your end result. This is not unusual. You should ask or the surgeon should give you reasons behind why he/she would perform his/her procedure versus another procedure as it relates to your case.

At the end of the day "you" have to trust your "gut". in addition, do your homework about the particular doctors and the procedure(s) that interest you. In regards to the weight issue, personally I recommend patients try to get as close to there goal weight as possible. I encourage healthy lifestyle changes so that weight loss can be maintained hopefully for a lifetime. Additionally, it helps improve the final contour of a tummy tuck and can reduce the possibility of healing problems (fat does not have good circulation).

I hope this is helpful.

Lose weight first before any procedure

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Always lose to your long term stable body weight before having a body contouring procedure. The French and Brazilian tummy tuck techniques which I have used for over 10 years often combine liposuction with skin tightening. And this is done very safely. Sounds like one of your surgeons wishes to operate on you immediately, before you lose weight. The result will not be as good as it could be. "Buyer Beware" applies here!

Conflicting Plastic Surgery Opinions

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Plastic surgeons frequently have divergent opinions, based on how the problem is presented. But, as you can see from the preponderance of posts - the vast majority of us feel strongly that the BEST RESULTS are more easily obtained when our patients are at their ideal weight and their weights are stable.

If you can lose the weight - do so and you will have a great result. If you absolutely cannot do it, go ahead with Tummy Tuck (and if needed flank/back lipo) the results are not likely to be as good but will be much better than your current situation.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Tummy tuck and conflicting advice

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If you feel that you need to lose weight, it is always better to do that before surgery. As for differing opinions, like a chef, everyone makes their chicken soup differently!

In general weight loss first, some lipo could be done in addition to TT safely

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A general advice is to lose the weight first but every patient must be evaluated differently. Lipo could be done in addition to tummy tuck to handle the flank area or as a part of the tummy tuck procedure.

Sometimes it comes down to: whose results do you like better?

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I always recommend losing the weight before surgery IF you can. Some patients tell me that they have tried every diet out there and made a valiant attempt at losing the weight. Some have lost a great deal of weight but just can't get to their "ideal" body weight.... and still others don't want to be at their "ideal" weight. For all of these patients, I believe doing the tummy tuck is very reasonable.

As to with or without the lipo..... That depends on your goals. Plastic Surgery is an ART. Not all plastic Surgeons see things in the same way. Look at their before and after photos. Who's results do you like better?

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.