Devastated with my body and how far it is from what I wanted

Update 08/07/24: I was called today a few days after writing this by one of the nurses (one I especially trusted) asking me to take it down for slander & claiming even BDD being in question would disqualify me from surgery, despite having to get a thorough letter signed by my psych before I even had the pre-OP appt. I have reread to ensure everything I wrote is accurate to what my actual experience was—everything I wrote initially was completely true except I was awaiting a BDD dx (not diagnosed but suspected) that came back negative due to only meeting criteria for generalized body dissatisfaction from an ED. It is possible with mild-moderate BDD, whether diagnosed or only having some symptoms of it, to benefit from surgery when reasonable expectations are assessed for and pre and post OP care and support are strong(S Higgins & A Wysong). I spoke with multiple of my providers (also had to get a thyroid check and letter from my doctor who also assessed my capacity and expectations prior to sending it off). I didn’t include this in my original review as the above is posted on Google which has character limits, and it should be somewhat obvious that an experienced plastic surgeon would require letters when their patient is presenting with an ED history, and he did. He didn’t ask for an assessment of expectations but just that my psych deemed me mentally sound and well enough for surgery, but my psych wrote an entire page depicting their analysis of my decision making capacity and ability to hold realistic expectations next to hope. Even with a BDD diagnosis (which we had talked about but the psych who wrote the letter is not the one who gave me the BDD assessment—that was my FL pysch whom I see in the summer when home from school), the biggest reason all my providers were on board with my surgery was because I was able to articulate how necessary it was to continuing to live in my body and that, much like w/ gender dysphoria and because I can see and identify positive changes in my body when made, it was understood to be just as significant of a life saving procedure as gender confirmation or as even a knee replacement for a ballplayer who couldn’t enjoy his life because he knee held him back from doing what he enjoyed. The issue is not in whether or not I have BDD alone, but if I am able to understand that surgery is imperfect, not guaranteed to be a completely positive outcome, and that I understand the risk associated with surgically altering my body, physically and psychologically, and I was. The point of my review and of my devastation is it is clear that my results could’ve been better had the surgery I wanted been discussed with me for more than the few minutes it was. There are countless experiences on this app alone depicting folks capable of setting realistic expectations being disappointed by the exact same outcome I had. They were given liposuction and came here to express their results and experiences, many asking questions and getting responses from certified Plastic surgeons on this platforms that for the results they wanted and body they had before, a tummy tuck would have been necessary. My issue and contention lies in that my surgeon recommended a surgery that ultimately wouldn’t have taken care of the excess skin, not just the appearance of it (which from before and afters seems to be what Renuvion realistically does as it is non surgical) and this ultimately made the appearance of my abdomen misaligned with what I wanted and what I realistically could have achieved with another surgery. My results are fine, I can see a difference (-2 liters) and the contouring is good, but there was more fat leftover than ideal BECAUSE the excess skin would’ve sagged too profoundly had more been removed, and I wanted as much removed as possible to be as small circumferentially as I could be—all achievable by a tummy tuck. I am more hurt now by the fact that I was told my review had false statements even after going through my consultation appointment with the nurse who called me and articulating what happened and that aligning with my review minus the misdiagnosis which I should have waited to confirm (and included to articulate intense body dissatisfaction, not that I couldn’t see what I look like or would look like). Dr. Soto is a decent and capable surgeon, and, he didn’t handle my case as well as he could have. Both can be true, and my experience isn’t slander because it isn’t 5 stars.

Background: I'm a white, cisgender 21yo female who lives in a larger body. I have severe body dysmorphia disorder (recently diagnosed), and a 10 year duration with a severe eating disorder that I'm still largely struggling with—though I am stable and outpatient. I decided about a year ago just a few choices away from an attempt that the only way I was going to be sure I tried everything to feel safer in my body and improve my quality of life would be if I surrendered to the unavoidable and intractable pull I had to consider plastic surgery. I began vigorous research, poured through thousands of photos honing in on body types that resembled mine, and considered side effects, healing times, and my personal anatomy/characteristics. What led me to Dr. Soto was a nearly perfect rating on Google reviews (4.6) and all the bells and whistle certifications plus his proximity to my house versus another surgeon I was looking at being in Miami (4hrs from me). The first surgery I wanted was a tummy tuck, because my stomach has been at the center of my compulsions and drive to starve myself since my conception of puberty hit the horizon.

Experience: I had done the research and come to terms with my loose skin making me a candidate for one...yet when I had my consultation, Dr. Soto was convinced that all I needed was VASER lipo on my abdomen to achieve my goals (which were to be as small and flat as possible). Something deep down in me felt this couldn't be right, but who was I to question such an established surgeon, and one that I genuinely wanted to and did trust. He looked at my abdomen—not to say the exam was thorough—and I proceeded to ask if he was sure and he said he was. Flash forward to my pre OP appointment, where I stepped on the scale for the first time. I thought it was interesting they didn't have me do this at my consultation, but chalked it up to my ED history and the assumption that they don't care until you've paid them a deposit fee. When my weight was higher than the estimated one I gave them in my paperwork (which I guessed on because I didn't know my exact weight as it's a huge trigger for my ED), they became extremely concerned despite my knowing that I had actually lost some weight since my consultation 4 months prior—I attend college out of state and had my consultation in early feb and pre OP/surgery in June. After accidentally stumbling upon my January weight in some test results for my GI, my weight loss was confirmed (~15lbs) but not after Dr. Soto and one of his nurses expressed concern for what they deemed to be newfound skin sagging that they insisted Renuvion for an extra $2000 would be advisable to add to my treatment plan AFTER I'd already paid the full amount for the surgery. Not only does this abrupt concern for my weight suggest you cannot know someone's health/weight/body status by merely looking at them, but it also vaguely hints at the unfortunate bias medical providers have when knowing someone's BMI while assessing them. As someone who knows every square inch of their body because they spend hours a day checking it, I can truly guarantee that my skin elasticity hadn't changed. A weightloss of 15lbs was not enough to make the shape of my abdomen so different that an entirely new treatment plan was warranted, yet only AFTER knowing my weight and briefly assessing the same abdomen I had months prior did Dr. Soto see it completely differently. Meaning, not only had my weight been significantly higher than assumed at my consultation where liposuction was the steadfast recommendation, but even at that higher weight my skin wasn't great, my stretch marks were no more or less apparent. The truth is, I always needed a tummy tuck, and I'm genuinely not sure why it was suggested that I didn't. Yes, I'm young, but a simple "do you ever plan to have kids?" would've resolved the preliminary concern most PS's have regarding young women wanting a tummy tuck, the results of which would be completely undone by a pregnancy. Also, is a tummy tuck not more expensive? Were my goals and extensive history of extreme body dissatisfaction not enough to warrant the most technically sound and definitively altering body procedure? On another note, in some of my appointments post OP, I'd be made to take off all my clothes to pose for photos (very hard), and others I'd be allowed the dignity of paper underwear and my bralette—depending on the nurse I had taking my photos, which was not the only inconsistency. I wasn't made aware before my surgery that they wouldn't have the post surgical waist trainer in my size, so for 6 weeks I was told by nurse after nurse that they'd order it, call me when it came in, have it for me next time, only to be told at my last appointment that they don't have the size I'd need, AND, against the word of my previous appointment 2 weeks prior stating that I should wear compression as long as possible, I wouldn't need it anyway because I didn't need to wear compression anymore!(at only 6 weeks post OP?) This was extremely confusing as someone who took their post OP care extremely seriously, who wanted the best result, and who was already really struggling with the lack of results consistent with my goals and the expense of the procedure. Ultimately, the nurses were some of the kindest I've met, and Dr. Soto's accolades and reviews and before and afters are very impressive, but I'm not sure he's as highly successful at body contouring procedures as he is at breats and skincare. I am devastated with my body and how far it is from what I wanted, despite it being aligned quite soundly with what liposuction could give me, which I can only absolutely confirm now after all of the healing and costs, was not the right procedure for me. If you are already in a beautiful body and want chest care, or truly ONLY need liposuction, then Dr. Soto is probably a safe bet who will deliver, but if any of your story relates to or mirrors mine, I would not recommend him for your care; this process and the cost is too great to find out in the end that you're still stuck with the very fear (and plenty of leftover fat and skin) than you should've been for the price you paid. If anyone would like to reach out or needs clarification/advice, I'm happy to make someone feel less alone in this process, as it's been a long one for me and I'm only at the beginning (multiple surgeries are part of my ultimate hope for better body image)