Three consultations and three different plans. How do I know which is the best option? (photo)

Congratulations on your weight loss! All agree that you would do well with the tummy tuck. You need to decide if tight legs are worth the long scars. EMSculpt nonsurgical treatments do build muscle nicely and make very pretty butts. Sculptra can also help later if needed. I suggest going with the surgeon with whom you were most comfortable and confident and liked their photos. I think liposuction of your knees with a vertical thigh tuck would do nicely. We do have some good minimally noninvasive radiofrequency skin tightening like Renuvion as well, but the longevity may not be as good as the surgical excision.

Hello, and thank you for your question regarding the best surgical plan after significant weight loss. I appreciate the history and pictures you provided.

It’s not uncommon to receive different surgical recommendations when consulting with multiple plastic surgeons, especially after massive weight loss. Each surgeon has their own approach, experience, and techniques, which can lead to varying surgical plans. The key is to determine which plan best aligns with your goals, medical safety, and long-term results.

In evaluating your photos, most experienced, board-certified plastic surgeons specializing in reconstructive surgery after massive weight loss would agree that liposuction alone will not adequately address your concerns. You need a formal thigh lift (thighplasty), ideally with an incision from the groin to the knee, to remove excess skin and improve thigh contour.

The optimal approach would be to combine a 360 circumferential lower body lift with a longitudinal vertical medial thigh lift from groin to knee. A 360 lower body lift includes an abdominoplasty (tummy tuck), hip lift and reduction, and buttock lift and reduction, providing full midsection contouring. The thigh lift includes anterior, medial, and lateral thigh liposuction to sculpt and refine the area.

The abdominoplasty portion of the 360 lower body lift will remove excess abdominal skin and fat, tighten the rectus abdominis muscles, reposition the belly button (umbilical relocation), and lift and reduce the mons pubis. Some surgeons may suggest staging the thigh lift separately, but most experienced plastic surgery teams can perform both the lower body lift and thigh lift together safely.

A staged approach (lower body lift first, followed by thigh lift later) is an option, but for many patients, combining the procedures reduces overall downtime and anesthesia exposure. Additionally, most plastic surgeons do not recommend staged liposuction before a thighplasty—if thigh liposuction is needed, it is typically performed at the same time as the thigh lift to avoid excess skin laxity.

Ultimately, the best option depends on your goals, your ability to tolerate a longer surgery, and the surgeon’s experience. Since these are complex reconstructive procedures, I strongly encourage you to choose an experienced, board-certified plastic surgeon who has performed at least 100 thigh lifts and body lifts. Reviewing their before-and-after photos and ensuring they specialize in massive weight loss plastic surgery will help guide your decision.

I hope this helps clarify your options. Best of luck with your surgical journey!

Sincerely,
Dr. Katzen