Had Consult with Assist. Prof/VA PS and am unhappy

Last week, I had a consult with a Veterans Affairs plastic surgeon who is an assistant professory at a local university and I was very unhappy with that he said my results would be.

In an nutshell, he said with a Lower Body Lift, I would end up with a flat arse and my waist... basically I would be trunk-like. With a Belt Lipectomy, it would retain my hourglass but really do nothing for the bum and thighs.

He did agree it is totally medically necessary, especially the lower body lift. I have sores from sitting and abrasions from chafing. It needs to be done as I have a Lupus variant and my immune system does not fight infection well.

He said I have very little body fat to work with. I have tried gaining some back but it is not happening. My body is firmly set at 140-145. I am 5'7 1/2"

The boobs - I need implants. I have been a DD most of my life and he said I would barely be a B cup post op. Um, yah, no.

Does anyone know any really good surgeons who work with Veterans Medical Centers? I am totally willing to travel to get results that will not make me cry every time I look in the mirror. I like having curves!

I have done my research. I have seen the results of others who had near identical body types to mine, including weight and height. What he is telling me he can do is just not what I have seen from others, and it is frustrating me to the point where I would rather not have the surgery rather than looklike a boy with fake boobs. Many many tears have been shed about this.

I wish I had the winning lottery ticket. I would be on my way to see Dr LoMonaco in a heartbeat!

Any help and advice is welcome.

Most of us end up with a flat rear with a lower body lift (LBL) unless you opt for additional surgery. I paid extra for auto-augmentation - the surgeon used the skin that he might have removed during the LBL, removed the outside skin then formed a flap which he plicated (pleated) and sewed into place under the newly lifted skin to form a curvier shape. I'm very happy with my shape and I'm glad I had this additional procedure. Perhaps this is an option for you?

I was borderline in need of the anchor cut in addition to the LBL - I had lost almost 200 pounds so I clearly had plenty of extra skin. I went into surgery with the understanding that the surgeon would make the final determination as he saw how things were shaping up. Turns out I didn't have the anchor cut and I do have a nice shapely waist - and probably part of that is due to the auto-augmentation mentioned above.

Not all surgeons perform auto-augmentation so you may need to continue your search, that's why it's usually recommended to see several surgeons who specialize in patients with massive weight loss.

I do have curves, but even if I didn't it's a heck of a lot better than all the hanging skin and you can always chose your clothes carefully to make it look curvier. One last thing to consider - when we are overweight and obese we have exaggerated curves: we may need to readjust our thinking as to what curves mean for someone who is normal weight.

I did mention auto-augmentation with my own tissue to him and he said I did not have enough tissue for it. I am not buying that. I am thinking he just does not do/know how to do auto-augmentation in that area. I also brought up auto-augmentation of the breast and he said that would not be possible. His version of auto-augmentation seems to just be fat transfer, which he said I did not have extra of. 

He said an anchor cut would not give me any more definition. He said (and I agree) that I do not have that amount of excess there. While a flat tummy would be nice, the melted hips, bum and thighs are my main medical problem.

I have always had curves, even when I was a young dancer, which I think is what shocked me most about him saying I would be trunk-like. From a seamstress's point of view (I sew), the tailoring job he is describing is not what would flow on my frame. If that makes sense. I am not asking for miracles... just tailor the skin suit to fit my frame better. I do not need to be something  I never was.

I guess I am just perplexed... him being an assistant professor at a school with a plastic surgeon residency program, having done a 3 year residency in plastic surgery and listing one of his areas of focus as being "body contouring after weight loss", I expected him to be more well versed in different procedures, especially ones that are becoming more well known, such as auto-augmentation.

I'm confused.  Isn't a Lower Body and Lift Belt Lipectomy the same thing?   Are you talking LBL vs. extended tt?

I was under the impression  that they are the same but he said they were different. Insert the major confused look I gave him HERE because all my research said otherwise. I had a list of what is generally included in the Lower Body Lift - information I had taken from the websites of a number of plastic surgeons (including Dr Sauceda and Dr LoMonaco)  who do a lot of post massive weight loss surgeries - and that's the list he said would make me look like I had no shape. 

I want/need the full Lower Body Lift. An extended Tummy Tuck would not take care of most of the "needed" areas.

"Isn't a Lower Body and Lift Belt Lipectomy the same thing? "

They're essentially the same procedure with a slight different position of the posterior incision and resuilting scar. A belt lipectomy is a higher incision so it tends to address the waist more then the buttoch. A body lift incision is lower and will address the buttoch more. We do lower body lift incisons much more frequently b/c that's where most people's problem area is and the scar is easier to conceal at a lower position. It is very rare I suggest a true belt lipectomy (as originally described by Dr. Al Aly) unless people have a very full fat pad in their lower back.

Thank you for the clarification. That makes sense. I definitely do not have much fat in my lower back, so that would not be a good move for me.

Auto-augmentation of the buttoch is a very finicky operation. It looks either excellent or freaky. I think some surgeons shy away from it because it's so unpredictable

Ah, that makes sense. A freaky looking booty would be a bad thing.

With auto-augmentation, does that tissue usually come from the back or can it be taken from the stomach? I am contemplating the merits of having him do a Abdominoplasty and the Breast Lift/Augmentation and then have someone else to do the rest of the Lower Body Lift. Admitedly, finances are playing a part because I have coverage with what he does but have to pay out of pocket for someone else.