allycatt98

I had my first in-person plastics consult on Wednesday. It was definitely interesting. My three previous consults were virtual -- two MX docs one in DR. Wednesday I met with a Resident, Medical Student and Attending Physician over at Tampa General. There is a 50% off Resident option for plastics. I actually really liked the Resident but was less than thrilled with the Attending. At any rate, 5 out of 5 docs agree that I need a breast lift -- an implant alone isn't going to cut it. So the Attending recommended a Mastopexy in two stages occuring 6 months apart. The first for the lift, then the implants six months later. I think I'm going to put it on the back burner for now and just get the Brachioplasty. I hate my arms more than my breasts right now. I can't even buy shirts in my size. Then next year I'm having a circumferential tummy tuck in the DR with a BBL. Rock on Djmohr! Please keep us posted on your surgery and your results.

I called the member services number and told them that I wanted to initiate a Pre-Authorization request. Different Plans use different names. I was able to initiate the request and faxed over the documentation that I had from my physician's office (notes, imaging, etc.). I provided my physician's information for follow-up (name, phone and fax number). Then once the Prior Auth request was initiated, I contacted my physician's office to provide them the info. I've got a Type A Personality, so this stuff comes easy to me. If they won't do it, then dang it, I will get it done.

Well you could always submit the request yourself..... I've done that before too when I got tired of waiting. Just a thought.

Hi Goddess, I'm in Tampa, but just had a consult at USF Health. They offer a 50% discount at their Resident Plastic Surgery clinic and since they are quite familiar with the insurance process. If you're in south Florida, I would inquire about the University of Miami plastic surgery clinic if you discover that the insurance option isn't feasible. I've dealt with them in the past, and they are well versed with insurance payors. I would say that most docs, (if they're affiliated with your insurance plan) are familiar with the Prior Authorization guidelines. The best advice is for you to review, review, review your benefit plan. Some of them have a dollar limit max on procedures related to the weight loss including post-op plastics. This is such an exciting process. I'm still not sure of my next steps....... Best wishes to you! Ally

Hi Amazon, I had a consult with Dr. Sauceda a few weeks ago. I found him to be very pleasant, but was extremely surprised that he seemed unfamiliar with Von Willebrands... even the recommended treatment during surgery. In comparison, I had a totally unplanned phone consult with Dr. Carmena Cardenas last Saturday and she was well versed and familiar with the treatments. Additionally, he made it a point to tell me how African American skin keloids, has poor scar healing, etc. Kind of like he was setting me up for disappointment....

My procedures definitely won't be covered by insurance. However, I'm giving myself additional time to get down to my optimal weight. I've seen some really good results on the big girls (on realself.com), but the best results are on those with a BMI under 25. Well and the extra time to arrange funding helps too!

Snacky, Let you know what you find out about the wife/husband team. I couldn't really get a feel for them yet because they only have a handful of reviews on RS. Ally

Blue, Sometimes you just have to shake your head and laugh. You were reading my mind with your post. The IRS only gives you a hard time with your deductions if you're selected for an audit. Otherwise you just hope for the best and keep it moving. People claim deductions that they aren't entitled to all the time and they fly under the radar unless they had enough red flags to trigger an audit or they were just one of the unfortunate ones selected for a random audit. My heart goes out to ya. My BFF has been in audit hell for almost six months because the auditors are backlogged. Even though hers was a random audit, she has to justify everything and she doesn't even itemize her taxes. Three years of returns and because of the audit, she can't even submit her 2014?? taxes to get her refund. Brutal stuff. But what do we know? BariatricPal has evolved beyond even Alex's expectations: Weight Loss Support, Physician Reviews and now Tax Advice. Ouch. She's a CPA and took the time to answer your post. Is it necessary to blast people who are trying to be helpful? It seems like you are looking for a specific answer. I'm sure if you search long and hard enough you will find all sorts of people claiming and deducting things on their taxes that wouldn't fly if they were audited. In my opinion, the plastic surgery your are speaking of doesn't qualify as a deduction. How about you claim it on you taxes and report back to us if you got audited? I will probably pass as I've already been audited once in my lifetime by the IRS. I prefer to stay under the radar

Agreed! OMG that someone (with a phone and a CPA no less) would want tax advice from random internet posters instead of the IRS.

That's awesome news! I know the type of look I want, but I'm unsure what's required to get it. TT definitely -- more than likely an extensive one. My poor rump is like a pan of Jello. I joke that I pour it into my clothes. I think grafting of some sort will be needed in order to achieve that hourglass/doll figure. I just don't want multiple surgeries. Why can't we have it all? But..... (no pun intended) I am worried about some of the potential complications if I have those two procedures done. I have Von Willebrands and will need to have Iron infusions prior to the surgery (stateside) and require DDAVP right before and after the procedure. I'm going to have a discussion with my Hemo/Onc and the surgeon I select regarding the purchase of the DDAVP. It might be cheaper to purchase it across the boarder instead of with my high-@$$ insurance. I'm going to go check out your pictures. Thanks so much for your post!

No problem Kate. I was thinking about applying for CareCredit, but I don't think they work with the Drs in MX and DR. So I'm still pacing while I try to pick out a doctor. I'm giving myself six months to reach my goal and pick a doc. Sigh...

I thought my response was clear and relevant to the post, but okay. Not everyone interprets things the same way. So I will rephrase this..... We have the ability to apply any of the available deductions when we submit our taxes. It's only if and when we are audited, that your questions would actually become relevant. There could be hundreds (or thousands) of people out there that have applied this deduction. Only the ones that were selected for an audit can honestly tell you if the IRS accepted/allowed this deduction after a manual review. That being said, the results will still vary by individual because there is a medical necessity requirement. Perhaps this is just clear to me because I have experience developing evidence-based criteria. IRS language pasted from your reply: necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease." Notice the key word "necessary." Based upon your health history, can you prove that the removal of the excess tissue was necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease? Is your excess skin (as a result of obesity) so extensive or impairing that it could be considered a disfigurement? Based upon the language you were kind enough to paste in your reply, my previous reply is still appropriate. Honestly, this would be easily remedied by just contacting the IRS and asking about the audit process related to medical deductions: "What type of documentation is required if I'm audited? Do you need documentation from my physician to support my use/application of this medical deduction?" You would probably be better off obtaining this information directly from the IRS (regarding their specific requirements) instead of relying on someone else's results (that are based upon their own personal health history). I hope you're able to get the information you need in order to move forward. JerseyCityGal, I understand your question, but everyone's situation is different. Let's say you took a deduction in 2014 for your Sleeve and were audited, would you be able to prove that it was medically necessary? That's really the issue here. You could definitely attempt to take the deduction. I've done it for dental work that was considered cosmetic. But if I were audited, I have the documentation to prove that my dental work was medically necessary even if it wasn't covered by my insurance. I don't think one answer fits all situations.... It's not the same as an itemization for home office expenses (it would be so much easier if it was ). It gets really murky when you start comparing medical procedures and services. My sleeve was approved by the insurance company on the first submission within 48 hours, but there are tons of people on the board that have been repeatedly denied by their insurance company. I think this one is going to be dependent on the documentation that you have to support your deduction in the event of an audit. I know that's not the answer you were looking for but it's the truth and audits are evil. Ally No offense, seriously, but you are not getting it.. If you have an official medical diagnosis of Obesity, yes, your VSG is deductible (% of AGI and all that). If you had it done for shits and giggles and were not obese, it won't work. "Medically necessary" does not appear in the Cosmetic section of the tax code. What does appear is " if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease." It does not seem to me that Obesity falls under any of those categories, but I did find one US tax court case that allowed a woman with an over 100 lb weight loss whose abdominal skin got in the way of her movement for her job to take the deduction. I am SPECIFICALLY asking: 1) people who have had reconstructive types of plastic surgery after massive (over 100 lb) weight loss; i.e. skin removal/LBL, arm lifts, etc (not a tiny tummy tuck but major surgery) 2) Did you claim these surgeries as a deduction on your tax returns? 3) How did it work out for you? Was it questioned?

JerseyCityGal, I understand your question, but everyone's situation is different. Let's say you took a deduction in 2014 for your Sleeve and were audited, would you be able to prove that it was medically necessary? That's really the issue here. You could definitely attempt to take the deduction. I've done it for dental work that was considered cosmetic. But if I were audited, I have the documentation to prove that my dental work was medically necessary even if it wasn't covered by my insurance. I don't think one answer fits all situations.... It's not the same as an itemization for home office expenses (it would be so much easier if it was ). It gets really murky when you start comparing medical procedures and services. My sleeve was approved by the insurance company on the first submission within 48 hours, but there are tons of people on the board that have been repeatedly denied by their insurance company. I think this one is going to be dependent on the documentation that you have to support your deduction in the event of an audit. I know that's not the answer you were looking for but it's the truth and audits are evil. Ally

@@JamieLogical, I've been lurking on the RS and "following" Dra. Cardenas. Most reviewers refer to her as the Queen in regards to TTs, but the reviews are mixed with the BBL. What are your thoughts? You had a TT and grafting to the butt done at the same time right? Were you happy with her work (especially the fat grafting) and if you had to do it all over again, would you have a TT and grafting done at the same time? Ally

JerseyCityGal, Everyone will have a different situation. Typically you're allowed either a standard deduction or you can itemize -- not both. So think about your filing status for next year vs. the amount of money that will be spent out-of-pocket (non-reimbursed) on medical care. Just for kicks and giggles, you could go to TurboTax or HRBlock and see which option is recommended. For most people, the standard deduction is usually higher. Also it's not a 1:1 match, there is a calculation utilized. Topic 502 - Medical and Dental Expenses If you itemize your deductions for a taxable year on Form 1040, Schedule A (PDF), you may be able to deduct expenses you paid that year for medical and dental care for yourself, your spouse and your dependents. For years beginning after December 31, 2012, you may deduct only the amount of your total medical expenses that exceed 10% of your adjusted gross income or 7.5% if you or your spouse is 65 or older. The 7.5% limitation is a temporary exemption starting January 1, 2013 to December 31, 2016 for individuals age 65 and older and their spouses. You figure the amount you are allowed to deduct on Form 1040, Schedule A. For more information, see Questions and Answers: Changes to the Itemized Deduction for 2014 Medical Expenses on IRS.gov. Medical care expenses include payments for the diagnosis, cure, mitigation, treatment, or prevention of disease, or payments for treatments affecting any structure or function of the body.

CGJ, I really wish more of his patients would post on Real Self for other hopefuls. It seems like they stick to the rival forum or Facebook. Sauceda has less than 20 reviews on RS, but I don't think any of them are negative -- which is an amazing feat. I really like his work and hope that I'm able to afford him. I guess I'll find out next month in Tyler, TX.... maybe I'm kind of conflicted about going..... Even though he would probably operate on me, I'm not at my ideal weight and I have mixed feelings about the work he's done on some of the bigger girls. Their stomach is flat, but their result would've been so much better with more weight off. I feel like it would be a huge self esteem boost and I wouldn't have to worry about the sound of my stomach clapping every time I work out, but...... I want to be a knock-out after surgery. I don't plan on multiple rounds to address the same body part. I don't know how often he comes to the states, so I think it would be a great experience to have a face-to-face meeting. But still... I don't know if that's worth using my airline miles (I have over 121k, my ticket to London was $70 ) or paying the three to four hundred dollars for the ticket. I may chicken out and just send him some nekkid pictures.

Hello everyone, I still have quite a bit more lbs. to drop but I'm already in research mode for a plastic surgeon. I'm intrigued by the use of twilight instead of general anesthesia for multiple plastic surgery procedures. I've read that Drs. Gutierrez and Sauceda utilize this method. Are there any others that you know of? I have a consult scheduled with Sauceda in Tyler, TX on 6/26. I want to meet the man that everyone gushes over. But I'm still holding out for Alex and crew to provide the promised updates regarding the all-inclusive Plastic Surgery packages too. I'm in Florida, so the DR is much closer, but...... the reviews are so mixed that I just gave up on searching for a doctor over there. I've also noticed that the prices have crept up extensively as the surgeons in MX have gained notariety. At this point, the only reason for me to still consider MX would be the use of twilight, which I think is a safer option for multiple procedures. Any thoughts? Ally

Kate, I haven't had surgery yet, so I'm probably speaking out of turn, but what the heck I'll give my opinion. While cost should not be the main priority (cough) it is definitely a consideration when researching a physician. I think if you were going to obtain the funding from a source independent of a physician (i.e. bank, credit union, etc.) that delivers the funds directly to you then it would be wise to secure the funding first. Then you can focus your search to find the best physician within your price range. I would avoid attempting to secure credit with a medical financing company that pays the physician directly (United, CareCredit, etc.) because you have no guarantee that the physician you ultimately select has a relationship with this company. Side note, I've been dying to pull the trigger to find out how much I can get approved for. The only reason I haven't done it yet is that I don't want the hard inquiry until I'm 100% ready to proceed. One of my credit card companies tends to frown on too many inquiries and/or new accounts and I like to keep them happy. Hope my rambling made sense.

Hey Cowgirl! I remember reading that you met a doc that was starting to use twilight. I'm shaking my head, but I get it. We are so litigious. I’m in Florida and we have OBs here that dropped their malpractice insurance (because they’ve proven that they have the financial resources to deal with any lawsuits) because the costs were crippling them. They’ve been using nitrous oxide for labor and delivery in the UK for years. There are a few hospitals up north (mostly teaching hospitals I think) that actually offer it as an option. I think if we weren’t so litigious many alternative (healthier) treatment options would be available. Now back to Mexico. I do think that with the popularity of Medical Tourism the docs’ prices have gone up. It happens. I live in Florida and we have tons of Plastic Surgeons here (remember Nip/Tuck) so the non-snooty ones without TV shows tend to be somewhat competitive. We also have three state universities with medical schools that offer discounted pricing (50% off) hence my comment about there no longer being such a disparity in pricing. That being said, I prefer the work of the MX and DR surgeons. I don’t want to risk life and limb going under the knife to have a boxy, boyish figure. I want to get “snatched” as those RS girls say. In order to get that level of skill here, you are going to pay. That’s what makes things so difficult. I can get competitive pricing, but it’s not necessarily going to deliver the results (i.e. shape) I want. It just seems like the surgeons outside of the US have more of an appreciation for curves and allow you to look like a real woman. Eh, just my 2.5 cents.

Thanks CowgirlJane, Your pictures are amazing. I'm scheduled to meet him next month while he is in Tyler, TX. I wasn't sure if twilight was the anesthesia of choice for most MX and DR physicians or just Sauceda and Gutierrez. I would be thrilled to have my end result similar to yours!

AZDee, I've read so many of your posts that I feel like I know you. I agree with your comments about scaring. That's initially one of the reasons I looked at Gutierrez -- his micro-surgical expertise. But now I'm trying to look at the big picture thanks to all of the honest, open feedback provided by you and others. I'm definitely concerned about scaring, technique (sculpting skills), infection rate and of course price. Because I need multiple procedures, pricing is a concern but doesn't trump the other considerations. I hate, hate, hate general anesthesia and really think twilight is a better option. But that's not enough to make me have the procedure performed in MX. Initially I too thought that affordability was only an option outside of the US, but I'm seeing more and more affordable options. I know the look I'm going for. As the girls on realself.com say, "I want to get snatched!" But..... I'm trying to be realistic about what is possible for my body type. I find that a lot of the drs. here (even in FL) give tummy tucks with a boxy shape. I'm in love with the curvy hour glass sculpting done in MX and DR. So I still have a lot more work to do. I really wanted to chat with you about your experience with Gutierrez since you're having some revision work done in TX. I read a review from someone else that wasn't thrilled with their work. Sigh..... Ally

Hey Tampa, Not sure if you've already picked a surgeon yet (or had the surgery) but I wanted to pass along some info. My initial search for plastics was MX intensive because I didn't think I could afford the costs charged stateside. That being said, we may have some options. USF offers reduced surgical rates (50%???) through their Resident Plastic Surgery division. This means the procedure would most likely be done at TGH, but it may be worth looking into. I have a consult scheduled for June 10 with Dr. Smith. While the surgeon will most likely require up-front payment, sometimes arrangements can be made with the hospital for their fees. I'll post an update after my visit next month. Ally

You all look amazing! Are you tired of constantly buying new pants yet?

Best wishes on that one. I just couldn't bring myself to do it. When I found out the fee, I made tracks out of there.

I'm hoping you get good results. This combo helped me after my daughter was born two years ago.