Is this a safe combination of procedures following a 170 lb weight loss?

Question

I'm turning 40 this year and have lost 170lbs after RNY 8 years ago and maintained the loss. I had an ETT 3 years ago and am looking to have a few procedures done this year. The surgeon I saw a month back said he coule combine an extended arm lift (to remove side breast skin), a revision to FDL, and a thigh lift in one go. He said it would be a rough recovery but doable and would take 6 hours. My ETT took 6 hours alone. I don't have an apron belly, I mainly wanted to torso skin addressed so maybe that part isn't as "big" as it sounds, like a typical "full" FDL if that makes sense? I have a good deal of bicep and thigh skin as ny starting weight was 393 and I am 230 as of now, 5'10". I keep wondering if I should tell him I'd rather break it up and maybe do like, the FDL and arms, then a few months later do the thighs and maybe the bra line since I'd be booking a second surgery? Or should I run for the hills? Is this a red flag? Just curious! Thank you so, so much in advance, any advice is greatly appreciated!

J. Timothy Katzen, MD, FACS · Answer

Hello, and thank you for your question regarding whether it is a safe combination of procedures following a 170-pound weight loss.  Thank you for your history.  Congratulations on your weight loss.  Regarding your specific question, whether it's safe or advisable to undergo an extended arm lift (brachioplasty), torsoplasty, revision to Fleur-de-Lis (FDL), and thigh lift (thighplasty) in one surgery?  Most plastic surgeons would not recommend combining all these procedures.  Even though your plastic surgeon can complete these procedures within six hours, it is not the length of your surgery, but rather the types of surgery you are planning.  Specifically, most plastic surgeons are concerned about combining the arm lift and the thigh lift in one surgery.  Most plastic surgeons do not combine these procedures because the patient's recovery is very difficult.  You have to imagine yourself recovering from an arm lift and a thigh lift.  If you need to use the bathroom, you'll need to use your arms to pull yourself out of bed, which can be a painful process.  Then, when you need to use your thighs to walk to the bathroom, that will also hurt.  Then, you'll need to use your arms to remove the garment and sit on the toilet.  Again, this maneuver will be painful.  Then you will need to use your arms to clean yourself, which will also hurt.  Then you'll need to pull the thigh garment on with your arms, which can lead to more pain.  Then you'll have to walk back to the bed.  All this excess movement leads to unnecessary pain.  Additionally, excessive movement can lead to wound opening due to the shear forces generated by movement.  Additionally, consider the length of all your incisions.  The thigh incision length will be about 24 inches, your arm's incision length will be about 24 inches, FDL  incision length will be about 22 inches.  Your torsoplasty incision length will be approximately 12 inches, corresponding to about 96 inches of incision line.  Your body will have numerous suture lines to heal.  You will need to consume a high amount of protein to help your incision lines heal.  Also, with a longer incision line, the risk of the incision opening and becoming infected increases.  For these reasons, most plastic surgeons do not combine arm lifts (brachioplasty) with thigh lifts (thighplasty) during the same procedure.  It is much better to stage these procedures.  Therefore, most plastic surgeons would perform the arms with the revision FTL and then have you return several months later for a longitudinal, vertical medial thigh lift with a torsoplasty, perhaps even a bra line reduction or a bra plasty.  This question relates to procedures that can be done together but should not be.  Before plastic surgeons recommend these sets of surgeries, the patient's recovery needs must be closely examined to ensure a successful outcome.  I hope this helps answer your question regarding whether it's safe or advisable to undergo an extended arm lift (brachioplasty), torsoplasty, revision to Fleur-de-Lis (FDL), and thigh lift (thighplasty) in a single surgery.  Good luck.   If you have any further questions regarding the lower body lift, 360 circumferential lower body lift, belt lipectomy, belt abdominoplasty, or belt dermolipectomy, please consult with an experienced plastic surgeon.  Since the body lift is a major procedure, please consult an experienced, board-certified plastic surgeon with extensive experience performing lower body lifts.  Do your research.  Ensure 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 necessary.  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.)

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  An exam is needed to know for sure, but from your description of the procedures that interest you it's likely best to have them broken into two stages.  This is for your safety as well as to give your surgeon the opportunity to maximize your results.  I've included a video on plastic surgery after major weight loss that I hope you find helpful.

Ajaya Kashyap, MD · Answer

Thank you for your query. Surgeons vary in their approach, experience and speed. While the procedures mentioned can be combined, i dio not do a thigh lift with an upper body lift. The upper body and arm procedures can be combined with FDL abdominoplasty and this would make your recovery and mobility easier. You can come back and do your thighs later as you have suggested. All the best.

Jeffrey M. Darrow, MD · Answer

If your surgeon is working alone, an extended arm lift with a revision to FDL would be a long procedure. If your surgeon is working with an assistant doing both may be possible within a 6 hour period.  Adding thigh lifts to that would, of course, extend the time you are on the operating table. Another consideration would be if your arms are going to be taken up with the arm lift, and your legs are going to be taken up with a thigh lift, how does the anesthesiologist maintain adequate IV access and monitor you?  For safety reasons, and for you to have a reasonably comfortable recovery, it may make sense to have them broken up into two procedures. Best wishes.

Gary M. Horndeski, MD · Answer

Unfortunately, you have not provided any photographs.  A safe operation time is 6 hours.  If you have had a previous extended tummy tuck then you may not need a fleur de lis.  Sometimes I will do a breast lift using The Bellesoma Method that lifts the upper abdomen and can eliminate the need for the fleur de lis.  I would need photographs to give you a more accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Is this a safe combination of procedures following a 170 lb weight loss?

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Answer: Safety first, always.

Answer: Safety first, always.

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Is this a safe combination of procedures following a 170 lb weight loss?

Answers (6)

Answer: Safety first, always.

Answer: Safety first, always.

Answer: More information needed

Answer: More information needed

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