Body

Congratulations on your weight loss!
Thank you for your story. Unfortunately without a examination I can advise you in general terms, however I hope you will find them helpful.

1) your weight should be stable for 3-6 months
2) a letter and lab from your Bariatric physician that you are cleared for abdominoplasty.
3)your entire medical history would need be reviewed prior to surgery.
4) there are a few technical nuances but nothing a experienced Plastic Surgeon can’t do.

Some additional information:
After pregnancy and/or weight loss several physiological events occur that can not be corrected with just diet and exercise:
1) the skin looses some of its visco/elastic properties (ability to recoil) from being stretched. With further weight loss or liposuction the skin will sag further.
2) the space between two two rectus abdomenis muscles (which run from your rib cage to the pubic bone) become larger and does not return to their pre pregnancy/weight loss position referred to as diastasis recti. This results in the abdominal bulge when the muscles are relaxed.
3) in addition a c-section scar can aggravate the appearance of the hanging skin because of the scar attachment to the underlying tissues.

Liposuction alone will reduce the the amount fat, however the skin will hang more.
Liposuction is often incorporated/included with a abdominoplasty to help contour the flank areas (love handles/hip areas).

However it is not advised to perform liposuction of the upper abdomen at the time of abdominoplasty for fear of injuring the blood vessels that supply the lower abdominal tissue. This liposuction can often be completed under local anesthesia several months after healing of the abdominal incision.

I recommend that you:
1) make a list of your questions
2) make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

Thank you for your story and questions.
Nothing substitutes for a personal evaluation and a face to face discussion of your options. Unfortunately without a examination I can advise you in general terms, however I hope you will find them helpful.

The simple answer is YES attain your goal weight first and the reasons are:

1) your goal weight attainment is very important for not only your final result but your overall appearance.
2)you didn’t mention your height or current weight. Body Mass Index (BMI). A BMI over 30 and greater is associated with progressive increased complications.
3) In most people your face (and other parts of your body) often will change size with weighit fluctuations. Thus, if you loose weight after surgery your underlying normal fat deposits may change resulting in the potential “loosening” of the skin.
5) modern face lifts usually our a combination of surgically tightening the underlying structures, adding fat where needed and judiciously resecting redundant skin where needed. Thus, alterations at the time of surgery are based on the “here and now” and not on “what if” since all individuals change differently with weight fluctuations.

I suggest you make out a list of your questions and select several “model” photos of what your desired goals/look would be and then schedule several different consultative appointments with experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and who are ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

Nothing substitutes for a personal evaluation and a face to face discussion of your options. Unfortunately without a examination and review of your medical history I can advise you in general terms, however I hope you will find them helpful.  In general it’s best to be a your goal weight prior to surgery:
1) your abdomen (and other parts of your body) often will change size with weight fluctuations.
2) we all have internal fat (fat on our internal organs that pushes out the abdominal wall and not accessible to liposuction or abdominoplasty) and external fat (fat that we can pinch between our fingers that can be liposuctioned or surgically removed during abdominoplasty). Weight loss effects both and thus when you attain your goal weight we can optimally tighten your muscles and remove the excess fat and hanging skin.
3)Body Mass Index (BMI) over 30 (which yours is) and greater is associated with progressively slightly increased complications.
I would recommend two stages for safety, and overall better result.

First Stage:
1)Weight loss surgery. After you have attained your goal weight, been stable for 6 months and provide a medical clearance letter then proceed to below.

Second Stage:
1) Extended abdominoplasty: removing all skin and fat between your pubic hair line (or lower) and your umbilicus (tummy button) which would remove most if not all of
your rolls of abdominal skin and scar:
A) Tightening of your your flank areas

B) excising excess fat, hanging skin and scars

C) liposuction of the flanks
D) Insertion non-narcotic paint pump for post op pain control

Based solely on your photos and not knowing your personal health history or medications you required I believe you are a reasonably good candidate and will be very satisfied with your extended “tummy tuck” and its components as stated in above.

I suggest you make out a list of your questions and select several nude “model” photos of what your desired goals/look would be and then schedule several different consultative appointments with experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and who are ideally members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

1)standard brachioplasty- removes skin, fat with an incision from armpit to near elbow

2) mini brachioplasty – usually performed with liposuction and skin resected only near armpit with scar limited to armpit area.

3) minimal scar brachioplasty- liposuction proceeded by Radio Frequency (RF)  (Thermage  an example)

These are the options I give my patients asked on their desires and physical exam.

Make a appointment with a reputable, experienced board certified plastic surgeon.

Your description of what happened is consistent with a possible mild internal separation. In the majority of patients treated there are usually multiple internal sutures this should not be a long term problem.

I would definitely make a follow up appointment with your plastic surgeon.

Depending on the volume to liposuctioned, the area(s) of the body and the patients emotional ability liposuction can be safely completed under local anesthesia
and oral sedation:

1) you will feel a pinprick when initial local medication injected

2) you will feel some moderate discomfort/burning when the tumescent fluid is injected

3) after this there should be no pain but you will feel pressure and movement of the liposuction cannulae .

I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).