Super extended tummy tuck or lower body lift? (Photo)

Dear Rainboeone,   Thanks for posting your pictures and congratulation on your massive weight loss on your own. Your BMI of 29 is sufficient for tummy tuck surgery and there is no need to lose additional 25 pounds before surgery, unless when you lie down  on your back, your tummy is still protruding out.   Based on your pictures, you do not need any " super extended tummy tuck" or "360 tummy tuck"  but rather regular tummy tuck that includes muscles tightening and skin tightening with significant skin excision. That procedure will give you flat stomach, tight and youthful looking skin, nice belly button, improved body posture and most likely you will lose significant amount of weight due to the muscle tightening that will reduce the amount of food that you can eat and your sense of hunger.     I do not recommend to combine tummy tuck with liposuction , because of the significant increase of severe complications, including death , when combining the procedures. In Florida, it is illegal to perform tummy tuck with liposuction over 1000 cc (small amount) after state investigation revealed that the combined procedures was the main reason for the large number of deaths and severe complications.   In a recent article in the plastic surgery journal that was based on data from cosmetic surgery only insurance company, it was revealed that combining the 2 procedures in one surgery increases the severe complication rate X 10 , in comparison to tummy tuck alone...   Cosmetic surgery is purely elective ( you do not need it but rather want it) and complication rate should be reduced to a minimum. An ounce of prevention is worth a pound of cure !   Liposuction of the abdomen, hips, waists and lower flanks can be done 2-3 months later, if needed. I have been in practice for over 30 years and performed tummy tuck surgery on well over 1000 patients. Only about 10% of my tummy tuck patients request liposuction.   For the butt dimplings you can do butt lift, however that is a big procedure that requires long scars on the lower back. A much better option are the  sub fascial butt implants that can be inserted through a single small incision, well hidden between the cheeks. The implants will smooth the dimples and give you a nice projection and round hips.  BBL or fat injection to the butt is a total waste of your money and your time, because the fat disappears completely or almost completely within months or even sooner, as I have seen on many patient who came to my surgery center for butt implants surgery after the big disappointment from the BBL that was done by other surgeon. I never performed that procedure !  For the inner thighs, you will need liposuction and skin lift that requires incisions in the groins and the medial buttocks' crease.    In summary, you will need 3 or 4 separate operations. Safety should be your main concern and , obviously,  good outcome. Too long procedures means surgeons' fatigue and consequently compromised result.    You have to realize that not all results are the same, because experience, technical skills and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely. Cost of surgery is important, but quality of surgeon is more so, because if you will require corrective surgery. it will double the total cost and recovery time.       Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive.                         Best of luck,                                              Dr Widder

Congratulations on your weight loss.  The best operation for shape and contour is the Circumferential Belt Lipectomy - which we call the "Around the World" Tummy Tuck.  The downside is a longer scar.  It does 3 things - Improves the Abdomen, Flanks, and Back,  Lifts up the Buttocks, and  Narrows your waist.

Thank you for the question and the fantastic pictures (really helps for answering this type of question)
Additionally i want to wish congrats on all the hard work/effort to accomplish such a dramatic weight loss 
Based on your photo’s there are several options available for you. Due to your history of weight loss you have been left with a lot of loose skin, the area that is particularly problematic for you seems to be the abdomen. 
An extended abdominal-plasty or fleur-de lis could be a great option to address your front (coupled with some contouring with liposuction) however after these procedures there will be still excess skin on your backside that will need addressing. A BBL in my opinion would address volume in the gluteal area but not address the loose skin.  The only way loose skin can be treated on the backside is with surgical excision.
Some surgeons stage the procedures by treating the front sided first and then do the back side later, and others choose to do them all at once (LBL). In my expertise i like being aggressive with lipo-contouring in both my flour-de-lis and extended abdominoplasty so i end up doing a staged approach. 
Regardless make certain to consult a board-certified plastic surgeon who has experience in all facets of body contouring surgery. 
Best
Dr. Waqqas Jalil 
MD FRCSC

Congratulations on your weight loss!!!  Yes, combining procedures is great as you've listed as it saves recovery time and money (you get discounts on professional, anesthesia, and facility fees when doing more than one procedure.)  However, it looks like you just need a standard tummy tuck at this point.  You may want to add an upper back lift, but doing a 360 tummy tuck may take away from your buttocks.
Thank you for your question!
Dr. Schreiber, Baltimore plastic surgeon

It is wonderful what you have achieved by yourself!! Congratulations.After weight loss you have developed a significant degree of saggy skin on abdomen, pubic area, laterally and buttocks (cellulite dimples are sign of flaccid tissues), plus your muscle loose which make you look a bit protruding,  so you will be a wonderful candidate for a Lower Body Lift which means: 360 Tummy Tuck to remove the skin, pubic lift, Muscle repair, and Real Buttocks Lift and definitely some liposuction to lovehandles and waist.Your breast have lost a lot of the volume and it also have developed a 3rd degree of flaccid breast tissue, so you will be a great candidate for a Major Breast Lift and maybe some augmentation if this is your desire. In my hands, the LBL is already a super long and invasive procedure, 5-6 hour procedure and I will recommend to do breast lift (4 hour procedure) separated, at least 5-6 months in between.You will look wonderful after the correct procedure, be encouraged!!Dr. Laura Carmina Cardenas 

The best procedure for you depends on if you want the buttocks to be lifted in addition to the abdominal area. A lower body lift will address front and back and the extended abdominoplasty will only address the front. You would obtain a good result with either. It depends on what you want and your goals. A breast lift also will give you considerable improvement. Best of luck.

You are to be commended upon the loss of 120 pounds!  There is no question that you can have a very dramatic result.  A circumferential body lift could be performed at your current weight.  I would seek out a plastic surgeon certified by the American Board of Plastic Surgeons with great reviews and great before and after pictures who performs hundreds of body contouring procedures each year.Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

Hello and thank you for your question. Congratulations on your weight loss.  Based on your photograph, you are a
great candidate for a extended tummy tuck with liposuction.  This can be done
through a low  incision, all completely below the bikini line.  The belly button can be designed to look
natural and have no scars on the exterior. 
Your muscles can also be plicated resulting in a flat abdomen.  A breast lift can be performed at the same
time for improved shape and contour of your breasts. Make sure you specifically
look at before and after pictures of real patients who have had this
surgery performed by your surgeon and evaluate their results.  The most
important aspect is to find a surgeon you are comfortable with. I recommend
that you seek consultation with a qualified board-certified plastic surgeon who
can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D. FACS
Harvard-trained plastic surgeon

Thanks for your question and congratulations on your massive weight loss. Stay the course and get to where you want to be before surgery. Your surgery will likely be more gratifying. Depending upon your examination the surgeries you are considering do make sense, In general I favor a tummy tuck, in your case as extended as possible followed by a staged back excision (completion body lift) at a second setting. I personally find you get a tighter tummy if you pull in one direction at a time. While it is certainly done if you pull back and front at the same time you are pulling against yourself. Staging will allow you to get more tissue out of each side. If you haven't heard of it you should at least know about a fleur de lis tummy tuck which removes tissue in the midline and addresses horizontal laxity of the abdomen in the weight loss patient. We are not just loose up and down, we are also loose side to side. You are correct that not everything can be done at once. Safety must come first, but your PS can help guide you so that you have a forward thinking plan and help to ensure one surgery does not inhibit the next. I have include a link to post wight loss information. I hope it helps too.Best wishes.

Thank you for your question.  First of all, congratulations on the weight loss- that is an amazing feat in of itself.  As you have already said- it is best to have your surgeries when you are at your goal weight.  I would concur with a breast lift for the breasts.  For the abdomen/ lower body- my preference is to not do the front of the abdomen and the back at the same time as I feel if I do both together- 1) its a lot of surgery at one sitting and 2) I can't make either very tight.  I would recommend doing the front with an extended tummy tuck which can be made as tight as possible and then coming back after you are healed and doing the back with a lower body lift to remove the redundancy there if you are not happy with how it looks after the extended tummy tuck.  Best to speak to a board certified plastic surgeon in person after you have lost your weight.  All the best,