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/

Money is an issue for me too, but it is something that in time I can resolve. If I could only have a few procedures is choose a LBL, BL, and facelift, probably. But my thighs really need help, as do my arms...honestly I would like everything done!

Do you have a surgeon picked out? If not, go to several to see what combinations they usually do. Also, you may need to find a different surgeon for your face. For the body work it is important to find someone with experience with bariatric patients. For face work, it is not.

For me, money was an issue. I had my arms done first because I could hide everything else (I love wearing sleeveless shirts). Arms are relatively inexpensive to fix. I was not sure I would ever be able to afford anything else at the time. Fast forward a few years and I was fortunate to have an lbl and bl (at the same time). My legs are a hot mess, but I have made peace with them and will never get them fixed. In clothes I look good. I may get a face lift at some point, but I'm not sure.

then what you might want to start doing (now or within the next few months) is researching surgeons to figure out your best options so that when you're ready to schedule consults, you'll already have some shortlisted. It took me quite awhile to come up with my shortlist!! I started with realself.com. I also searched OH for names, too..

this is supposedly a complicated subspecialty, so ideally you want someone who does a truckload of these things, or better yet, specializes in it..

I did three consults, and their recommendations and suggested combinations were a bit different (well, two said they would do the LBL first, and then go from there). None of my consults liked doing surgeries more than six hours long, but some surgeons are fine with going longer than that - and some, much longer). You might want to schedule some consults now...or soon....as they'll clear up some of your questions and get you thinking about what you want to do. I'd suggest going on 3-5. You'll learn a lot from them. Plus I liked having multiple opinions. In my case, surgeon A's and surgeon B's plans were so different from each other that I scheduled a consult with surgeon C, too (who I ended up going with, so it's a good thing I did!) just because I had no idea whose plan was "better", so I wanted yet another opinion...

some surgeons don't charge for consults, and some charge a nominal amount - like $100 or $150 - and those who charge usually apply it to your surgery cost if you end up going with them.