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

Question

45f, 100+lbs lost 10+ yrs ago. Wanting tummytuck and thigh lift, 3 seperate drs have given 3 different plans. 1. Two surgeries, first; full TT with medial thigh lift (mid thigh) and second gluteal thigh lift with flap. Lipo at knees, etc 2; 7.5h surgery w full TT outer thigh lift, butt lift with sculpting medial TL (extending to knee) some lipo around knee and legs etc. 3.Full TT with full lower body lift and lipo. Lipo at knee and inner thigh. 2nd surgery, medial TL if needed

Larry C. Leverett, MD, FACS · Answer

If  you ask 10 surgeons, you may get 10 different answers. But in the end, YOU have to be comfortable with the surgeon, his/her rationale for the approach given, the risks, the timeline and the expectations for the chosen sequence. My approach would be to do the lower body lift which includes the tummy tuck, and lifts the lateral thighs and buttocks in your first operation. This is the biggest operation and the most bang for your buck. The inner thighs (medial thigh lift) , which are also liposuctioned, are reduced last. You did the hard part by loosing such massive weight. Now choose the flight that meets your expectations ( and priority) and leave the rest to the surgical team.

J. Timothy Katzen, MD, FACS · Answer

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

Chet Mays, MD · Answer

Thank you for your inquiry!  You obviously have options on how to proceed with this procedure.  Meeting in person would help determine the best course of action.  Typically, a tummy tuck and a Thigh lift would not be done at the same time.  This would be a two-part surgery.  We would love to meet with you to discuss your options. Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

Daniel Barrett, MD · Answer

Dear Forceful769338,

finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).
You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Mustafa Aydinol, MD · Answer

I’ve performed many surgeries like yours, and I completely understand the confusion when different surgeons recommend different plans. Based on my experience, the third option – a full tummy tuck with a lower body lift and liposuction first, followed by a medial thigh lift if needed – tends to yield the best results.
Here’s why: • Staging the procedures into two or three sessions allows your body to heal better and reduces the risk of complications. • Multiple surgeries in one session can be physically taxing for both the patient and the surgeon. Staged surgeries often result in better outcomes, more precise contouring, and smoother recovery. • A lower body lift and tummy tuck address the most significant areas first, and by waiting to do the medial thigh lift in a second surgery, we can see how much natural retraction occurs after the initial procedure.
This approach also allows for better control over scarring and skin tightening, leading to a more refined, natural result. I understand the desire to achieve your goals quickly, but sometimes taking a step-by-step approach leads to the best long-term outcome.
Feel free to reach out if you have more questions – I’m happy to guide you through the process!

Gerald Minniti, MD, FACS · Answer

The first would include liposuction of the torso (abdomen, waist and hips) and a lower body lift (tummy tuck is part of a LBL). The second would include liposuction of the thighs and a full thigh lift. This is the only way to get optimal results.

Rajaie Hazboun, MD, MBA · Answer

Thank you for posting your question here!My answer will be based on the limited information and pictures provided.From the information provided it seems like the plans are essentially similar , it's more about the timing and the sequence of the surgeries. The first surgeon added the flap part which I am guessing he means auto-augmentation of the buttock using a local flap to give you more projection which is not an unreasonable option. When it comes to plastic surgery , it is an art and each surgeon has a different way of looking at things and each surgeon knows how fast they can complete the surgeries and if they can do them in one setting or more . The plans offered to you all sound reasonable , I would go with the person you feel most comfortable with and who is on the same page with you when it comes to their artistic view of things , as you will be the one who will live with the outcome of the surgery.I hope this helps!, best of luck!

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  I would begin by selecting the surgeon with whom you are most comfortable.  Did they listen to your concerns?  Discuss your goals?  Inform you of expected results?  Talk about risks/benefits? The two stage approach is a good one to give you optimal results.  I was featured on the TLC show Skin Tight where patients with significant weight loss had surgery to help restore their bodies to reflect their hard work. I invite you to review my website to learn more.

Connie Hiers, MD, FACS · Answer

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.

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