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Paralleling the increasing use of bariatric surgery, there is a high demand for body contouring through plastic surgery. If you’re just beginning down this path, the questions are many. Who will do my surgery? How is recovery? What can I expect? Choosing and Evaluating a Plastic Surgeon Many of the surgical procedures performed on the massive weight-loss patient are complex and labor-intensive. The wide spectrum of body contour deformities that can follow massive weight loss often exceed the magnitude of what plastic surgeons have traditionally addressed. That is why weight-loss surgery patients need to work with a surgeon who specializes in bariatric plastic surgery. Dr. Joseph F. Capella, a plastic surgeon in New Jersey, affirms: Post-bariatric body contouring is a relatively new area within the field of plastic surgery, in that bariatric surgery only has become popular in the last 10 to 15 years. And because of that, many surgeons have come through their training not having been exposed to post-bariatric body contouring. Because of that these surgeries are not considered traditional procedures, in the sense that they’ve been honed over decades like many of the other plastic surgery procedures. And so what plastic surgeons may do is use these more traditional procedures and apply them to the post-bariatric patient, which often will lead to sub-optimal results. So, it’s very helpful then, in that regard, to go to a plastic surgeon who has committed to this kind of surgery and does this surgery frequently — and this would be true for any kind of plastic surgery, for that matter. But what’s different about post-bariatric surgery contouring is it is relatively new, and probably greater than 50% or more of plastic surgeons out there right now did not have any exposure to it in their training. Obviously there are on-going conferences to educate surgeons but there’s a difference with having it as part of your training rather than learning about it from a lecture. Read Dr. Capella’s comprehensive list of criteria for choosing and evaluating a plastic surgeon. Healing Body and Mind After a Post-Weight Loss Body Lift Once you’ve removed the loose skin and sagging, is the journey over? Are you obstacle-free? Well, not quite. The Plastic Surgery Center in New Jersey says: You’ve been through a life-altering experience, and with that, your body and mind need time to heal and adjust. It’s important to acknowledge that, so you can assist in your own recovery and eventually move on … Recovery from body lift surgery is extensive, which sometimes catches people off guard. And it can be painful, depending on the extent of the surgery and your perception of pain. You should be prepared for swelling (or even numbness) that can last for weeks and sometimes even months. In fact, most surgeons say that complete recovery and final results take up to a year. Of course scarring is a fact of body lift surgery, and scars are particularly distinct up until the first year following the procedure. Many (if not most) people experience strong emotions following plastic surgery. While excitement and elation are a natural result of such a positive life change, it is also customary that an entire range of feelings can result, including a phenomenon called post-plastic surgery depression which can resemble post-partum depression. Recovery creates the time and opportunity to focus on these emotions. On the plus side, the surgical results of a body lift are apparent almost immediately. They will remain permanent if you are able to maintain a stable weight (although normal aging obviously results in physical changes). And, depending on the person, the body’s healing process should mitigate scarring. Read The Plastic Surgery Center’s great advice for healing body and mind after a post-weight loss body lift. Plastic Surgery Improves Appearance, Mobility, Health and Emotional Well-Being People may not be fully aware of the many benefits of plastic surgery after weight loss. There are aesthetic refinements in the appearance and improvements in functional mobility, as well as an increased sense of emotional well-being. Dr. Edward Domanskis, a plastic surgeon in California, says: I think that the benefits of plastic surgery after weight loss are tremendous. When you’re massively overweight it’s one problem. When you lose the weight I think a lot of times the patient doesn’t realize that the problems don’t really go away; it’s just a different problem. It’s a problem of all this hanging skin. And to some people that can be almost as much of a problem as being overweight and having all this excess fatty tissue — physiologically for sure. In my experience I think it [plastic surgery after weight loss] is a very, very satisfying type of surgery not only to the patient but also for the physician to see the transformation in the patient. To see the reaction of their friends and family to what they’ve gone through and how their overall appearance and psyche tend to change. There’s no question that these procedures are very. very beneficial to the patient. Watch Dr. Domanskis’ video segment, “What to Expect: Improving Appearance, Mobility, Health and Emotional Well-Being through Bariatric Plastic Surgery.”

Paperwork and Documentation Photo ID. Credit card, checkbook, and/or cash. List of contacts. List of questions and notebook to take notes. Insurance card, letter of reimbursement acceptance, or any other paperwork. A list of your medications. Passport or passport card Visa Bring a photo ID and any money you will need. You may not need any if you are going to a local hospital and your insurance covers your surgery. You may need a lot if you are self-pay and payment is due at the time of service. Bring money for any incidentals, such as a taxi ride home or to the airport. Bring any insurance paperwork you have if your insurance is helping to cover your surgery. Also bring a list of contacts such as family and friends that you can call if you need help. Include your doctor on the list. You or your surgeon may need to ask about medical conditions or medications that you are on. You need to bring the proper documentation if you are going outside the country for your bariatric surgery. At the least, you need a passport or passport card, and to be on the safe side, you should be sure it expires at least 6 months after your scheduled return date. You may need a visa for some countries, although not for Mexico if you are American. Clothing Slippers or socks with non-slip rubber soles or grips. Loose-fitting clothes to wear home. A change of underwear. You will wear the hospital’s gown, but should bring something loose-fitting to wear when you are discharged. Be sure the waist is very loose and the outfit is easy to slip on since you will be in some pain and will not be very agile after surgery! A gown or dress can be best. Non-slip slippers or socks will let you walk around when you can without needing to put on shoes and without risking falling when you are tired and weak. Do not take expensive clothes, tight fitting clothes, or accessories. Toiletries Toothbrush, toothpaste, deodorant, soap or body wash, shampoo, and conditioner. Lip balm and lotion or Vaseline. Hair ties. Baby wipes Just take the basics. Keep your teeth clean, and take what you need for a shower, if you have time to take one. You might feel very dry after surgery. Lip balm can keep your lips from getting too chapped, while lotion can keep your skin moisturized. A scrunchie or elastic hair band can keep your hair out of your face if you have long hair, and baby wipes can help you freshen up without much effort. Go light with your toiletries. Do not bother taking makeup since you will not have time to put it on, and you probably will not have the energy, either! Electronics and Entertainment Phone and charger. Book or eReader with books on it. Crossword puzzles or other paper or electronic games. Movies. Do not forget your charger for each device! Time will probably pass very quickly in the hospital and you may not have a chance to get to any of your entertainment. You may also be too tired or distracted to focus on it. Food and Drink Tea bags and water enhancers. Protein powders and shakes. Water bottle. Protein blender bottle. Your first priority after weight loss surgery will be to stay hydrated. Water can taste funny, so you might want to pack some water enhancer powder or flavor drops. Decaffeinated herbal tea bags are easy to pack, too. Just make sure you let the tea cool before you sip it so it does not hurt your surgery scar. A water bottle and protein blender bottle can be useful for the trip home. You do not need to take any solid food since you will not be eating it for several days to weeks after weight loss surgery. For Your Health and Comfort Pillow. Medications. Ear plugs and face mask. CPAP machine. Gas-X. Throat lozenges. A pillow on your lap can make your ride home much more comfortable. It can also help you sleep better in the hospital if you are fussy. Ask the hospital about which medications to bring, whether you should bring your own CPAP machine, and how they feel about you using GAS-X to combat your post-op flatulence. Do Not Bring Jewelry. Irreplaceable keepsakes, such as photos. A simple rule of thumb is if you do not need it and do not want to lose it, do not take it. This goes for pricey items, such as designer handbags and jewelry, and for anything irreplaceable, such as family photos.

Over the 8 years I have met with weight loss surgery patients, the one concept I find myself going over and over is this idea of becoming full from within. The idea that if we don't fill ourselves up intrinsically- we will always need some thing to fill the void, whether it be food, gambling, sex, drugs, or alcohol. The problem is- we always end up on empty, psychologically. The next question often becomes, "ok so how do I fill myself up psychologically? I don't think I will ever be fulfilled because I have never been truly happy. I was not born a naturally happy person? I've spent most of my life feeling empty- how do I turn it all around now? I grew up with unhappy parents, how am I to unlearn all of that early programming?' "Wondering if you're happy is a great shortcut to being depressed." - Annette Bening, 20th Century Women I think, unfortunately happiness gets a bad rap. There is a wide misconception that for us to be fulfilled, or full from within- we need to be blissfully happy all the time, and that's just not the case. Not only is it untrue, but it is an unrealistic standard and one that sets people up for disappointment. Rather than always questioning how we SHOULD be feeling, we should just practice acceptance of whatever temporary state we happen to be in at the moment with non-judgement and non-attachment. Like busses, moods come around every five minutes. Even therapist's aren't immune to life's ups and downs. Believe it or not, as a psychologist who literally wrote a book on Happiness, I have to remind myself certain mantras that help me keep my own life in balance and my happiness and fulfillment sustained. I actually have a list on my phone that says "things to remember," and page through it daily, when I'm feeling off track. So if you're feeling off track yourself- first understand that you're human and give yourself a break + then thumb through my personal list of happiness tips, little pearls I've gained in my 37 years on this planet, and see if any of them might help to increase your happiness quotient today: 1) In silence, the heart begins to finish its unfinished business. I think I picked this up from a book I read about Sufism. In any case, I liked it and it stuck. Oftentimes, we think that we must actively and aggressively pray, yet Sufis believe that it is in the stillness that God comes to us. Whenever my life gets a bit too chaotic with all the "should-ing" all over myself- I remind myself that it is often when I take pause, let go, and let God- that what is truly important, rises to the surface and I begin to reclaim my life instead of it claiming me. 2) Do more want-to's vs. have-to's every day. Someone once told me that the "have-to's" will never be done. I repeat- they will never be done. So we might as well splice in some time for the things that we thought we were going to do once they were done. Take the scenic route to work, take a long walk and listen to that book on audible that you have been wanting to read for the last few months,go shopping with a friend, get a massage, take an extra long lunch and sit out in the sun, or just curl up with your loved one or pet. A wise man once said "time you enjoy wasting, is not wasted time," and I couldn't agree more. 3) Happiness is not the absence of problems, but the ability to deal with them. I remember when I was in grad school, thinking "if I can just finish school- then I'll be the relaxed, happy go lucky person I want to be," then it morphed into, "once I get licensed," then "once I get married," then "once I have kids..." You get the idea. It is not the situations or circumstances in our lives that determine if we are a happier person or not. It truly is the way in which we approach them as they come, that determines what type of person we are and how happy we will be. In the "car of life," that we all have to drive, will you wear stilettos or uggs? 4) Connection with others is key to fulfillment. I am an introvert by nature. I enjoy my downtime, and require coming back to my home base in silence, to relax and unwind. However, there is something inherent in our very nature about the need to feel connected to the world around us- introverts included. My best girlfriend from childhood came out for a week a while back, and so I was unable to get caught up in the hamster wheel of daily activity. I was forced to be fully present and engaged with her for four days in a row. As a result, I was actually more grounded, more at peace, less anxious, and more optimistic about the future. Whenever we notice our egoic drives propelling us towards isolation, judgement, rumination, or comparison- we should remind ourselves to get out and connect with our fellow man, and fakebook doesn't count. 5) Like attracts like. Happy attracts happy. When we find ourselves feeling left out, isolated, or out of touch with those around us- it is important to look at our recent focus. Are we always dwelling on the negative, gossiping about someone? You know the saying "what sally says about susie, says more about sally than susie." Although, many of us sub-consciously believe that if we can just "get it out" about whatever is chipping away at us- it will somehow allay our negative feelings- it really doesn't. In fact, research supports that when we ruminate on negative feelings, it actually increases our negative feelings. This doesn't mean we should all be superficial and "surface-y" towards everyone, but that we should work a bit harder to find the happy. 6) To receive abundantly, ironically we must give abundantly. It is engrained in our DNA to wake up each morning with a needs list: "when will I get that bonus?" "when will I hear back about that promotion," "when will she call me back?" Yet, spiritually I truly believe that when we make the shift from "what can I get," to "what can I give?" It is a complete gamechanger. It's almost as if the universe aligns with us and says "yep you finally figured it out." 7) Choose your thoughts like you choose your clothes. Our minds are quick and fast like ferraris. They are an intricate and complex machine designed for ultimate performance, but just like we must use the right fuel for a Ferrari, we must also carefully select and filter which thoughts we allow to permeate our consciousness. When you notice yourself feeling down, take a cognitive step back and look at what thoughts you were having. Most are unproductive. Choose to let them go. The same tool that created the problem (our mind) is not likely going to solve the problem. 8) Legitimately and truly don't care about what others think or do. I can honestly say that this is still a work in progress for me. I was born a people-pleaser, but as I get older, I realize the more I try to make others happier with me, the less happy I am with myself. 9) Go out into the world with your heart, not your brain. Yes, our brain is required for some part of our days. Otherwise, our bills wouldn't be paid, our tasks wouldn't get done, and our goals wouldn't be met. But, other than that- when we greet people, meet people, share with others, observe, smile, walk- it is quite a different experience to live in our heart space, in that emotional space that is more visceral than verbal. 10) Relish in the remarkable ride. I watched a movie a while back called "about time," and it was all about a man who had time travel figured out. He lived his day once all hurried and bothered about the little stressors of life, but then went back to live it again. He said he would just rest in the moment, relax, and relish in the remarkable ride that was his life. I love this. After all the late notices have come, all our debt has fallen or risen, our weight has gone up and down, our kids get a failing grade in school, our lover breaks our heart, our cars break down... it always ends the same: none of us get out alive. So why not just sit back and enjoy the ride?

“Ricing” refers to vegetables cut up into small pieces about the size of rice. Cauliflower has gotten the most attention, but other veggies are getting in on the trend. Years ago, the South Beach Diet included a recipe for mashed cauliflower to take the place of mashed potatoes. The new kid on the block is riced cauliflower. The color is similar to rice and can be cut to look like rice. Some say it has a similar taste to rice, but use your own taste buds to figure this out. For bariatrics patients, riced cauliflower doesn’t have the type of carbohydrate that can swell in your stomach pouch, like regular rice does. Once you can add vegetables back to your food choices, you’ve now got a vegetable choice that can be seasoned many ways. Click here for a Riced Cauliflower recipe from www.whatscookingamerica.net, which also includes several flavor options. For an easier version, Green Giant and Birds’ Eye already have riced cauliflower and other riced vegetables in the freezer section. You’ll be able to whip up a vegetable side dish in a jiffy! Pizza crust recipes with riced cauliflower have also been enjoyed by our patients for several years. Yum! You now have a trendy, fun and tasty way to eat your veggies. Enjoy!