Having second thoughts about surgery, BBL or tummy tuck first? (Photos)

Question

Hello, I’m supposed to be having surgery in a few months but I’m having a few second thoughts. I was told I didn’t need a tummy tuck but I feel I do as I have loose skin, especially by my belly button where fat is limited, and a tummy pooch. However, I would also like to get a fat transfer to my hips only…I’m just unsure what would be the best action to do first and many surgeons I’ve come across won’t do both unfortunately unless I travel to Miami.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question and for sharing your photos. Based on the images and details you’ve provided, it’s clear that you have some excess skin and fat around your belly button, along with a small tummy pooch and stretch marks. These factors indicate that liposuction alone may not effectively address the skin laxity, as stretch marks suggest that the skin won't shrink predictably without surgical removal.

Given your goals of both enhancing your hips with fat transfer and addressing the loose skin in your abdomen, many plastic surgeons would recommend a combination approach: liposuction of the abdomen, fat transfer to the hips, and a tummy tuck. This would provide the best overall contouring by removing excess skin, tightening the abdomen, and adding volume to your hips for balance.

If finding a surgeon who performs all three procedures together locally is challenging, and traveling to Miami or another location is an option, it may be worth considering. If not, you might need to approach it in two stages. First, you could undergo liposuction and fat transfer to the hips, and then, after 4 to 6 months, proceed with the tummy tuck to remove the excess skin.

Most plastic surgeons in the U.S. would agree that performing these procedures together provides the best and most efficient results. If travel is an option for you, it might be worth considering to achieve your desired outcome in a single surgery.

I hope this helps answer your question and guide your decision.

Sincerely,
Dr. Katzen

Gerald Minniti, MD, FACS · Answer

The surgeon who told you that you weren't a good candidate for a tummy tuck should retire. As for 'one or the other', that has been settled for years: fat grafting to the buttocks (BBL) and tummy tucks can be performed simultaneously without affecting the results of either. You don't have to go to Miami.

Reza Kordestani, MD · Answer

I recommend getting the tummy tuck first if you are planning to do a two-stage procedure. Doing the Lipo/BBL first creates a tremendous amount of scar tissue beneath the skin that makes a future tummy tuck challenging. You are a perfect candidate for a tummy tuck. Alternatively, you could have a combo procedure (VASERlipo360, tummy tuck, hip fat grafting) at the same time which I do very frequently.

Gary M. Horndeski, MD · Answer

You appear to be an excellent candidate for a tummy tuck.  You have excess skin and fat of the abdominal wall.  At the same time, fat can be injected into the thighs if you desire.

Best Wishes,

Gary Horndeski, M.D.

Dana Goldberg, MD · Answer

1. Legal limit of liposuction in the setting of a tummy tuck in Florida is 1000 mL, which is not much to do a BBL. If your surgeon isn’t following these guidelines, they are breaking the law, which is why there are so many fatalities in Miami specifically.
2. You already have stretch marks and loose skin on the abdomen. Doing liposuction will only exaggerate this problem.
3. Since you can’t undo a tummy tuck, I recommend doing the BBL first. There is a chance you would be happy with the appearance of your abdomen after transferring fat to the backside. If you are not, you can always go back and do the tummy tuck. Doing them together just increases the risk of a complication or the chances of your fat dying because the recovery position for a tummy tuck is the exact opposite of the safe recovery position for BBL.

George Marosan, MD · Answer

Thank you for your question and photos. Based on these photos, for best results, you definitely need a tummy tuck. Fat transfer to the buttocks and/or hip dips is done routinely with a tummy tuck. If you were my patient, as a Total Definer surgeon, I would do a full tummy tuck with muscle plication via a low pubic bone level incision (4cm above the labia majora confluence). There's a chance that you will end up with a small vertical incision just above the horizontal scar, to keep your incision low. Fat transfer is done by collecting fat with VASER liposuction 360 degrees and place the fat so your feminine shape gets enhanced. See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. I think you have the right to be nervous and second guess your surgeon on this. To create normal beauty, one must understand the tenets of what is beautiful  within culture and ethnicity. Good luck.

Ronald J. Edelson, MD · Answer

You are an excellent candidate for a tummy tuck. You have plenty of loose skin and stretch marks. I wouldn’t bother with either the bbl or fat transfer. Both a waste of money.

Harry T. Haramis, MD, FACS · Answer

You can safely combine tummy tuck with fat transfer, Spector the hips.

In my experience, liposuction the fat from the belly (the part that’s normally discarded) and waist, use it for the fat transfer- then do the tummy tuck at the same time.

Tummy tuck will tighten all the lose skin best.

An exam and consultations with a/your plastic surgeon is recommended to discuss your options and expectations until you feel comfortable with the plan.

Eleonore Zetrenne, MD · Answer

Since you are at a fairly normal BMI you could do both. If the fat is going to your hips mostly there is no reason not to do both.  Have them start with a Liposuction 360. Prepare the fat and then do the BBL.  After they can do the abdomen.   If the fat is going mostly in the hips there is less pressure to the fat when you sit and more  therefore more viability —meaning the fat will survive.

Connie Hiers, MD, FACS · Answer

Just based on photos only, you ap[pear to have some weakness to your abdominal muscles and some excess skin which can be addressed with the full or mini tuck. I am not a fan of fat transfer to the hips since usually there is excess fat above and below those areas which is best treated with liposuction. Also, it is difficult to do a tuck in front and a fat transfer in back and stay off both areas to heal.

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