Lifts After 60 Pound Weight Loss - what surgeries would be best and how should they be prioritized? (Photos)

Question

Ive been taking Wegovy for a litle more than a year and I've lost more than 60 pounds. It's great, and I'm so happy it worked for me. However, I now have loose skin hanging everywhere (neck, upper arms, stomach, inner thighs, butt, boobs, all of it). I have 20-30 more pounds I'd like to lose, so l'm not ready to schedule yet. But, I'd love to get feedback. I'm most self conscious about the "gobble" on my neck, the hanging skin on my stomach, and my deflated, drooping breasts. What surgeries would be looking at? How should they be prioritized? What kind of cost am I looking at? How do you choose a practice/ surgeon? Are there cosmetic procedures other than surgery that would be helpful? I have so many questions.... Any advice would be very much appreciated!

J. Timothy Katzen, MD, FACS · Answer

Hello Considerate725737, 
Thank you for your question regarding a lift after a 60-pound weight loss, what surgeries would be best, and how they should be prioritized.  Congratulations on your 60-pound weight loss.  Thank you for your two pictures that you provided.  Weight loss is a journey.  Most medical personnel suggest weight loss to lead a healthier, longer life.  I’m glad you’re exploring the possibilities of reconstruction after a massive weight loss at this time.  The time to have plastic surgery is when your weight has stabilized and you are near your ideal weight.  However, we can guess what surgeries you may need.
Regarding your “turkey gobbler neck”, you could either undergo VASER neck liposuction or a neck lift.  During VASER neck liposuction, a small incision is made behind your chin.  Tumescent fluid is injected to minimize bleeding, anesthetize the area, and minimize blood loss.  Then, the VASER probe is inserted.  The VASER melts neck fat and heats the neck skin.  Heating the neck skin with the VASER helps the neck skin to redrape.  Then, a cannula (medical grade straw) is inserted, and neck fat is removed with suction.  Ideally, your neck skin should redrape on the underlying fascia.  The potential disadvantage of VASER neck liposuction is that you may have wrinkly neck skin; however, the advantage of VASER neck liposuction is the small incision and minimal downtime.  VASER neck liposuction takes approximately one hour to complete.  The alternative is a neck lift.  With a neck lift, an incision is made around the ear.  Dissection is then carried down the neck, and the neck skin is redraped and repositioned.  Often, the platysma muscle is plicated or brought together.  The platysma muscle plication is also called a neck corset or platysmaplasty.  The neck lift surgery is much more involved and takes approximately 4 to 5 hours to complete.  Either the VASER neck liposuction or the neck lift procedure could be performed under IV, twilight, or general anesthesia.
In regards to your abdomen, you will need either a tummy tuck, extended tummy tuck, fleur-de-lis (FDL), or 360 circumferential lower body lift.  At this time, it is too early to tell.  Lose more weight and then reassess your body.  If your hips and buttocks bother you, you will probably need a 360 circumferential lower body lift.  During the 360 circumferential lower body lift, excess abdominal skin and fat are removed.  In addition, the rectus abdominis muscle is plicated, and the pubic region (mons) is lifted and reduced.  Also, if you undergo the 360 circumferential lower body lift, the hips and the buttocks are lifted and reduced.
Regarding your breasts, you will probably need a breast lift to correct the “drooping” or ptosis.  If you want larger breasts, you will need to consider safe FDA FDA-approved breast implants.
Every plastic surgeon has their own technique and order of procedures after massive weight loss.  However, most experienced plastic surgeons start with the 360 circumferential lower body lift.  This is often combined with a thigh lift, thigh reduction, or thigh plasty.  Several months later, you can undergo the upper body, which would entail breast lift (mastopexy), breast augmentation, and an arm lift, arm reduction, or brachioplasty.  The second stage of surgery may also involve a back lift or torsoplasty.
All these surgeries are dependent upon your appearance after further weight loss.  Most plastic surgeons prioritize body part areas based on what bothers you the most.  In terms of cost, costs vary widely, according to your chosen plastic surgeon.  Costs vary widely based on your chosen plastic surgeon’s experience, geographic location, time in the operating room, and expense for recovery facilities.  You should choose a plastic surgeon based on their experience.  The best way to gauge the experience of a plastic surgeon is by the number of before-and-after pictures they have on their website.  For the time being, most plastic surgeons would advise against any cosmetic procedures other than surgery.  Your body is going to change with another 20-30 lbs loss.  You may discover you have wasted time and money with procedures done before your weight stabilizes.  It’s important to wait until your weight has stabilized before seeking plastic surgery consultations.  This will ensure the best possible outcome for your surgeries.  Good luck.  I hope I’ve helped to answer your question regarding lifts after a 60-pound weight loss, what surgery would be best, and how they should be prioritized. If you have any more questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please contact an experienced plastic surgeon. Since the body lift is a big procedure, please seek an experienced, board-certified plastic surgeon with significant experience performing the lower body lift.  Do your research.  Make sure they have performed at least 100 circumferential lower body lift surgeries and have the before and after pictures to prove it.  Carefully examine their before and after pictures and check their reviews on RealSelf.   If you cannot find an experienced, lower-body lift surgeon in your neighborhood, consider traveling out of state if you must. Sincerely, Dr. Katzen, MD, MBA, FACS, FICS, FASMBS (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 RealSelf Hall of Fame, and RealSelf Doctor Advisory Board for Medical Review and Consumer Panel.)

Daniel Barrett, MD · Answer

Dear Considerate725737,

it is hard to tell for sure without an examination. Based on your photos and description, it looks like you would need tummy tuck, breast lift and probably facelift. 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

Thank you for your photographs. Congratulations on your weight loss and your goal to lose more.  You may prioritize the procedures anyway you wish, depending upon what concerns you the most. I have found that patients do best starting with a lower body lift which corrects your abdomen, some of your inner thighs, your lateral thighs, your buttock, and your waist all in one procedure. It is a very powerful operation.  It may also be possible to combine other procedures such as your arm lift and breast lift at the same time, to decrease the number of times you would have surgery, if your surgeon works with another plastic surgeon so that all procedures can be completed in under six hours, for your safety.  At a subsequent time, your facelift, and your inner thigh surgery could be accomplished, which would complete the rejuvenation of all the areas that you discussed.  You should consult with surgeons with extensive experience in these operations and who can show you multiple examples of before and after surgeries so you know, they have the requisite experience. The cost of the surgery would depend upon your location and the surgeon that you pick. As I already mentioned, if it is possible to safely combine several surgeries at one setting this helps decrease your cost as well as your recovery times.

Luis Suarez, MD · Answer

Congratulations on the weight loss! I do recommend being at your goal weight before submitting to surgery so continuous weight loss does not affect your outcome.
It would be important to separate face and body because it would be too much for one session. It just depends on what you would like to begin with and for the body most times there are limits to the combination of procedures that can be done as well, so it can be done 2 to 3 sessions as long as you are good and everything is good with your blood work blood pressure and everything like that. You’re an excellent candidate for this new journey!

John LoMonaco, MD, FACS · Answer

Congrats on your weight loss success !

Before plastic surgery, I always confirm that the weight loss is sustainable and at an appropriate goal.  Also want to be sure your iron levels are not deficient, which can affect healing.

Usually, I prefer to address the tummy, front of legs, buttocks, pubic area, and breasts if desired.  This work on your "core" makes lifting the arms and legs easier at Stage 2. It also allows your arms and legs to be used during the recovery phase of your "core."

Next, I will do arms and legs if desired, along with any touchups or revisions from Stage 1.

Face I usually do very last, as patients will often lose more weight once the excess skin from the trunk is gone.

Best Wishes,

Dr L.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  It would be best to address the concerns of the face and neck in a separate stage from the body.  You can have either stage done first as long as you allow adequate time between for healing.  You can combine the breasts, tummy, and liposuction together.  The best place to begin is a visit to a few board certified plastic surgeons near you for consultations once you have achieved your weight loss goal.  The ASPS website can help you find surgeons in your area.  There are links to their websites so you can review credentials and look at before/after photos.  I've included a video I hope you find helpful.

M. Mark Mofid, MD, FACS · Answer

Hi there, and thank you for your question. First off, congratulations on your weight loss. When the time is right, and you feel like you are within 25% of your goal weight, the first procedure I typically recommend starting with is the Lower Body lift (or Belt Lipectomy). This will give one of the greater improvements in a larger area of your body. Once this is healed, you can move on to the Upper Body lift, Arms, Inner Thighs, and then Face and Neck lift. I understand that you have many questions, which is why I recommend consulting with a Board certified plastic surgeon that can responsibly guide you through the process.

Mats Hagstrom, MD (license on probation) · Answer

For your face, a facelift is probably going to be the best procedure.
For your abdomen, it’s going to be a full tummy tuck.
Finding the right provider is by far the most important variable.
There are substantial differences in outcomes in overall experience, depending on who you go with.
 To find the right provider and have an overall good experience I suggest the following.
First get a set of pictures of yourself take the same way plastic surgeons take before and after pictures.
Use pictures of yourself as a reference whenever you’re reviewing before and after pictures.
 There’s no point in seeing results of the patient who had a different surgery potential than your own.
Patient has their own candidacy which determines the potential outcome.
Next make a list of plastic surgeons in your area that seem to be good at the two procedures you’re interested in.
 You may want to consider different providers for different procedures.
Those specialize in facelift surgery may have less experience with tummy tuck and vice versa.
Next schedule in person consultations with each of the providers on your list.
I highly recommend patient schedule in person consultations and avoid virtual consultations.
The outcomes for these procedures are permanent and irreversible.
If not done well, patient can be left with permanent issues that cannot be corrected.
 One of the biggest mistakes I see patients make is having only one consultation and then scheduling surgery.
Having only one consultation eliminates the ability to choose a better provider.
I do not believe patients can adequately vet plastic surgeons by using their cell phone or computer.
 During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients who had similar body characteristics.
Your goal is to get an understanding of what average results look like in the hands of each provider for patients with similar body characteristics.
 Seeing the best results of a providers career or results on patients who were ideal candidates may not be accurate or a good representation.
To get a good understanding of what typical results look like you need to see a lot of results.
And experience provider should have no difficulty showing you at least 10 to 20 previous examples.
 Before having consultations, you should get familiarized with what quality results should look like.
Look at lots of before, and after pictures online until you can recognize and quality results easily.
Ideally, you should be able to tell why results look good.
For tummy tuck results look primarily at surgeons who get natural looking belly buttons And a well designed incision or scar.
The color of the scar is irrelevant to the skill of the surgeon.
Is the design and position of this car that makes the difference
A tax score should be placed low and follow anatomic contour naturally.
 Individuals who have extensive skin laxity and may need a more extended tummy tuck procedure.
Make sure if this applies to you or not.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely you are to find the better provider for your needs.
 Most people do not have a lot of experience consulting with plastic surgeons.
By having multiple consultations, you’ll get better at the process, including the ability to vet providers.
Went out, slow down and scheduled more consultations.
Finding the right provider is time consuming and may involve some financial cost.
The investment is well worth it.
This is definitely one of those things that should be done once and done correctly.
Average plastic surgeons deliver average results.
If you want exceptional outcomes, you’ll need to find exceptional providers.
Good luck,
Mats Hagstrom MD

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