What PS would you (or did you) have first?

yea - that's why I went with someone in Chicago, even though Dr. Zachary is more expensive than some of the other superstars. I'd have to factor in the travel expenses (plane tickets for two, plus a couple of weeks at a hotel), plus I'd only be able to go to maybe two post-op appts, and there's the issue of what do you do if there are complications... Figured in the long run, it was just better for me to stay in the area (Chicago is a couple hours from here, but it's do-able. I made it to four post-op appts after phase 1, and if there was some serious complication, it would be easy enough to drive down there...)

Dr Michaels is wonderful , he worked with me. He might even be able to recommend someone on the west coast for the body work if you don't/cant travel. I am lucky, I live 2 hrs from him.

As for the face, I suggest using a Bd Cert Facial and Reconstructive Sug. They only work on the face. A reg Bd Cert Plastic Surgeon is doing your face one day and someone else's Brazilian Butt lift the next.

First of all, CONGRATS, Cara! You have lost such a tremendous amount of weight. You should be so proud!

Going into RNY, I knew some people had sagging skin but (bizarrely) didn't think that would happen to me. Um yeah, until I got down to 160 from HIGHEST weight 369 (surgery weight, 351). I had the worst deflated tube sock breasts and my stomach was a melted candle, and my arms were bat wings. In my mind, I was going to have a tummy tuck and a breast lift and not do my arms (didn't want visible scars). I had a couple of consults and went with the same surgeon that Cynthia and Erin and Gwen used - he's in Bethesda, MD however...so super far for you. I also had a virtual consult with Dr. Capella in NJ. Their advice and prices varied.

I ended up with Dr. Michaels since he works a lot with plastics and body contouring with clients who have had massive weight loss. Like Laura in Texas said, it's SUPER important to choose someone who specializes in that.

Dr. Michaels helped me see that a tummy tuck would fix the front of me, but then my back and butt would be super droopy, so I needed a lower body lift. He was pretty sure that I could do a breast lift without implants and get fullness by using my own body fat to transfer into my breasts and my butt. I am THRILLED with how it turned out. But once my body was mostly fixed (I don't care about my dimpled saggy thighs - that recovery is something I never want to go through!), I realized I had to fix my arms. Luckily his stitching is so thin and clean that my scars are not super visible.

Plastics did two things for me - 1. They helped me to not be so self-conscious and 2. I feel like they are a bit of an insurance policy. I will be damned if I am going to regain back to 300 lbs after investing that much money into my body!

Here are my plastics posts in case they are helpful :) It's hard to believe I will be five years post-op in a couple of weeks!

Four year surgiversary: http://www.obesityhelp.com/forums/rny/6028857/Four-years-gon e-by-and-RNY-is-still-the-best-gift-I-ever/

that was part of my rationale, too. I figured after blowing all this money on plastic surgery, no way was I going to allow myself to gain all that weight back again!

I know that I will feel the same way, too!

Oh Em, thank you so much! I will read through all that you've linked.

I am proud of myself, in a cautious kind of a way! I feel very confident in clothes, but without them it's a whole different story. I feel love and compassion towards my body, though - it isn't my body's fault that I went through all of that, and despite everything, I remain, thankfully, healthy. I just cannot see comfortably entering a physical relationship looking as I do. Plus, just in terms of my own happiness in how I look, it is important that these things be addressed.

I totally understand the feeling that having plastics adds insurance against ever lapsing back into being so heavy. I know I will view it exactly the same way.

Thanks again for your kind and thorough response.

Hi. Often, I will perform a lower body lift and breast lift (with or without implants) at Stage 1. Stage 2 is to work on arms and legs, plus any touch ups from Stage 1. Hope this helps.

Thank you so much, Dr. LoMonaco! That information is helpful. I know that our Laura in Texas has mentioned you many times, and her happiness with your work is profound. I appreciate your comment.

Hi! I'm 4 weeks post op (Dr. Michaels) for a ETT, BL (w/o implants), and AL. I'd love to go back for my butt and thighs, but can't stomach the thought of paying more money.

My surgeon recommended a LBL and AL, with BL in a 2nd surgery, but I wanted to make sure I got my worst areas taken care of in one surgery in case pain or funds prevented me from additional surgeries.

I must say that my breasts are phenomenal! I can't believe he got those loose floppy things sitting so high and firm without implants!

Wow, that is wonderful! I'd love to feel that way about the girls again! Did he do a fat transfer, or did you have sufficient breast tissue for reshaping?