I'm 45 yrs old with a BMI of 40. Is there any procedure I can have done to reduce my 50 inch waistline? (photos)

I've contacted a plastic surgeon regarding a tummy tuck only to be stopped at the receptionist and told, the doctor would not operate on a patient with a BMI greater than 30. This is my last resort. The weight around my mid section was brought on by Cushing's Disease 4 years ago. The pituitary tumor was removed but left my body wrecked. I exercise daily and a dietician is following my eating habits. We have determined, it's not me...it's my body. I have constant backaches. Can someone help me?

Doctor Answers 8

Help at BMI of 40

Thank you for your liposuction and tummy tuck question.
  • I am so sorry about the pituitary tumor -
  • I assume all your hormones are now back in balance, including your thyroid
  • And that you are being followed by an endocrinologist.
  • Your appearance is 'Cushingoid' by which I mean the fat is around the torso, not the arms and legs.
  • Your photo suggests that the excess overhang of skin can be surgically removed.
  • But the photo also suggests that most of the 'waistline' fat is internal, not under the skin.
  • Get a face-to-face consultation with a Board Certified Plastic Surgeon to see if in addition to removing the excess skin, any around your waist could be removed with liposuction or tummy tuck.
  • If not - then you should consult your endocrinologist to see what other treatments are effective for fat remaining after tumor removal in Cushing's syndrome. Best wishes.

Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Tummy tuck with BMI over 40

I think it is hard to set hard and fast rules.your overall medical condition is important in determining whether to do surgery.You could decrease your midsection with some lipo and a tummy tuck.whether it would be enought to make you happy is another thing.I think it is important for people to have realsitic experctations.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 64 reviews

I'm 45 yrs old with a BMI of 40. Is there any procedure I can have done to reduce my 50 inch waistline?

Hi and thanks for your question. I hear your frustration and understand. There comes a time when I will perform surgery on patients with a BMI greater than 30. In our deal world we would like everyone of our patients to be in their ideal weight. Unfortunately, we do not live in an ideal world. I personally have a very practical approach to cosmetic surgery and weight reduction. It is always preferable for patients to be as close to their ideal weight as possible prior to surgery. Many times there are outside influences, such as yours, that prevent a patient from losing any further weight. The patient may be peri or post-menopausal and then it really becomes hard to lose weight. The patient plateaus.

Weight is distributed differently in patients. There may be two patients who weigh the same yet, their fat is distributed completely different. There is visceral fat ( that fat between the internal organs and intestines) and fat locate between the abdominal wall ( muscle layer) and the skin. Some patients may be top heavy whereas others may have very large thighs and behinds. So, my approval for surgery is individualized as long as the patient is healthy otherwise and is seen by her private MD and given a complete medical clearance.

At our institute we see many patients from the middle of the State. I would suggest you get a second and third opinion if need be.

Always seek out the opinion of a surgeon certified by the American Board of Plastic Surgery with years of experience in tummy tucks. Furthermore request to see before and after photos of previous patients by that doctor....not a clinic or surgery center. Do your homework......research and verify the doctor's credentials. Have they had problems with the Board of Medicine, disciplinary or otherwise. Any law suits?

How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.

How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgery, no matter how simple it may be to the patients, are invasive procedures and as such carry certain risks and complications.

In our office we use TouchMD which is a web based program in which patients have the ability to load their picture unto the program. I then evaluate them and can actually draw on the picture to show a potential patient where the incisions would be located and how the procedure is to be realized. It's all done to comply with HIPPA which is the federal law that protects the patient's medical information. Look them up.

Give yourself the highest percentage of a sucssesful operation. Good luck

Jose Perez-Gurri, MD, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 233 reviews

Breast and Body Contouring with high BMI

A BMI is not always an absolute contra indication to body contouring surgery. However, further weight loss if possible-- may be preferable at this point. You may consider a gastric banding or bypass. If, however, you wish to proceed- it appears you are a great candidate for a breast lift and abdominoplasty ( Tummy Tuck)-- provided you can obtain clearance from your endocrinologist. 

Thomas Trevisani, Sr., MD
Orlando Plastic Surgeon
4.9 out of 5 stars 64 reviews

Help for you midsection

Based on your pictures it is difficult to determine how much of your abdominal protuberance is due to intra-abdominal fat versus subcutaneous fat.  Plastic surgery procedures can help with subcutaneous fat, but are not effective for intra-abdominal fat.    Generally, subcutaneous fat can be grabbed in one's hand, while intraabdominal fat is not.  Also, when you "suck in", that can help determine possible improvement with muscle tightening, but does not tell the whole story.

Determining these different factors may require a visit to a plastic surgeon for further evaluation and couseling. To help treat intra-abdominal fat, weight loss would be required; seek a medical weight loss person or help with exercise to increase this possibility.

Roxanne Sylora, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 18 reviews

Patients with BMI over 30 are sometimes satisfactory candidate for liposuction.

Ideally patient sitter thin make the best candidates for liposuction. However in carefully selected individuals a BMI over 30 is not a contraindication in many patients are happy with the procedure.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

BMI is too high

Thank you for your pictures. I agree with my other colleagues that you may consider seeing a bariatric surgeon concerning surgical weight-loss. This will give you your best options for plastic surgery at a later date with out the increased complication rate.

I'm 45 yrs old with a BMI of 40. Is there any procedure I can have done to reduce my 50 inch waistline?

You might consider a Gastric Banding operation to obtain weight loss. Otherwise only 4 liter liposuction might help. Fee from $4,000 to $6,000. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 174 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.