Post-bariatric/lipedema patient: combined approach to the abdomen and thighs

Objectifs: To present a strategic approach for complex body contouring in lipedema and post-bariatric patients, focusing on combined abdomen and thigh surgery. To define surgical sequencing, prioritize painful adipose tissue reduction before skin excision, and optimize aesthetic and functional outcomes. To discuss complication risks and how staged procedures improve safety and patient satisfaction. Introduction: Lipedema and post-bariatric deformities frequently coexist, creating complex contour problems. Bariatric surgery alone does not resolve lipedema symptoms, and excess skin further impairs function and body image. These patients require more than isolated procedures: they demand a structured, staged surgical plan integrating liposuction and dermolipectomy. Matériels / méthode: Presentation of staged surgical management in lipedema/post-bariatric patients: circumferential thigh and calf liposuction, followed by abdominal 360° abdominoplasty and thigh lifting (including spiral lift and vertical extensions when indicated). Selective use of RF-assisted liposuction. Emphasis on logical sequencing, volume control, and individualized planning. Résultats: Staged liposuction prior to skin resection improves contour definition and reduces tension during lifting procedures. Combined 360° abdominoplasty and thigh lifting significantly enhance body proportions and quality of life. When properly sequenced, functional and aesthetic outcomes are optimized despite the high baseline complication risk of complex body contouring. Conclusion: In lipedema and post-bariatric patients, body contouring is a strategic process rather than a single technique. Painful adipose tissue must be addressed before dermolipectomy. A logical, staged surgical plan combining circumferential liposuction and 360° lifting procedures improves safety, aesthetics, and patient-reported outcomes.