Can someone give me advice on getting approval for plastic surgery (arms and TT)

Im only 5 months post-op. But, I know that once I reach goal, I will need plastic surgery on my arms and stomach. Ive lost 130 pounds so far (down from 391 to 258) and my skin is seriously beginning to sag. I have so much excess skin under my arms and on my stomach that I can barely stand to look at myself naked. Im happy with my success so far. But, Im only 30 and know that I dont want to go through the rest of my life with all that excess hanging skin. I just wanted to get some suggestions from those of you out there how the approval process works. Im thinking I will definitely have to pay for my arms out of my own pocket. But, with my stomach, Im already having serious back problems from the excess weight of the hanging skin and unfortunately Im thinking the problem will worsen as I continue to lose. Obviously I wont be giving this a final consideration until at least a year out. Just wanted to get some advice in advance since this is already on my mind constantly. Thanks :)

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