This 50 years-old female presented to Dr. Siamak Agha from Oregon. The patient weighed 490 pounds when she underwent a duodenal switch surgery. She subsequently lost 260 pounds and remained at a weight of 230 pounds for several years despite rigorous exercise on daily basis. When she presented to Dr. Agha in 2009, the patient weighed 230 pounds and her waist was 60 inches. A comprehensive plan of multiple procedures and stages was planned for her with a commitment that she will stay in Southern California to heal in between. Throughout the one year of her transformation, the patient lost a total of 70 pounds through surgery and exercise. As a result, she required redo of several of her procedures. During patient's last visit, she weighed 160 pounds. This is probably the most extreme plastic surgery transformation. Final total body lift pictures were taken in May 2011. The patient's stages and procedures are noted below. January 2010 Thigh liposuction Fat transfer to the buttocks- 300 mL of fat on each side Buttock lift Lower back lipectomy Bilateral brachioplasty Outer thigh lift February 2010 Bra-line upper body lift Thigh liposuction Vertical thighplasty Dermal-bra suspension breast lift July 2010 Scar revision Crescent upper body lift Fat transfer to upper breasts- 120 ML per side Fat transfer to lower buttocks- 200 mL on each side More liposuction of saddlebags, inner knees, and thighs October 2010 Lower body lift with circumferential abdominoplasty Fat transfer to lower buttocks- 220mL per side Ventral hernia repair Buttock lift redo Outer thigh lift redo January 2011 Vertical thigh lift redo Breast augmentation with silicone implants Scar revisions