My Bariatric Life

How does the massive weight loss patient choose the right plastic surgeon? After all, we present a much more challenging case than women seeking plastic surgery whom had never been morbidly obese. Add to that, there are no rigorous requirements and certification for a sub-specialty in bariatric plastic surgery. What is a patient to do? Choosing a plastic surgeon after weight loss is an important personal decision. Someone told me that you do not buy a procedure, you buy a plastic surgeon (Read: Understanding Post-Bariatric Plastic Surgery). I completely get that now, having gone through a total body contouring and facelift, but it wasn’t always that way. When I was beginning my plastic surgery after massive weight loss, I did not understand just how much obesity had deformed my body. It was later made clear to me that I was a much more challenging case than women seeking plastic surgery whom had never been morbidly obese. Add to that, I was more prone to complications during surgery and recovery owing to my former health conditions (diabetes, hypertension, etc). Dr. Joseph F. Capella underscores the inherent challenge, “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.” How does the massive weight loss patient choose the right plastic surgeon? After all, while there is rigorous training, and requirements for a plastic surgeon to become certified by the American Society of Plastic Surgeons, just as there are for a bariatric surgeon to become certified by the American Society for Metabolic and Bariatric Surgery, there are no rigorous requirements and certification for a sub-specialty in bariatric plastic surgery. What is a patient to do? Dr. Capella recommends “For each of the procedures you’re considering, ask the plastic surgeon: How often do you do them and how many have you done? The doctor should make other patients readily available to you who have had these plastic surgeries done. And, of course, the doctor should have a wide array of images to show you of hopefully body types that are similar to yours.” My additional advice: Travel out of state if you must to find a plastic surgeon who specializes in the massive weight loss patient’s special needs. With all due respect to patients who travel outside the country for their surgery, selecting a plastic surgeon who is certified by the American Board of Plastic Surgery is an essential step to ensure the best training and credentials. I have corresponded with too many bariatric patients who’ve had complications after plastic surgery and had their surgeons ignore them. Don’t let this happen to you. Be sure that your surgeon will be responsive 24/7 during the many weeks and months of recovery, come what may. Of course, all of us gathered here on BariatricPal understand the value of connecting on the Plastic Surgery Forum with patients who candidly share their surgical experiences and discuss their plastic surgeons. Be sure to tap into this very valuable resource. Last but not least, personal compatibility is an essential element in the patient-physician relationship. You must feel comfortable talking to your plastic surgeon about all of your concerns. And you must have that sense of trust that s/he has your highest good as top priority no matter what may come. The bottom line: Plastic surgery should be a life-changing experience for the better. For further reading, I highly suggest my article “18 Insider Tips for Plastic Surgery.” Living larger than ever, My Bariatric Life

The images we have of the perfect body is maybe attainable by 1%-2% of the population. And the perfect body in and of itself is not an easy pass to happiness, per se. I am sure that there are challenges inherent in having a perfect body. Nor is it a given that it equates to having a good sense of self. The grass often appears greener on the other side!

It is a sacred relationship, Jamie. I am glad you have a surgeon you know and trust. Is she planning on the groin incision only?

YES. YES. YES. Yes x 100 the inner thigh lift was worth it for me. I was super concerned about the scar prior to surgery because my plastic surgeon, Dr. Capella, said he would have to run it down to my knees. But the result of not getting crotch wedgies when I wear shorts, having my legs rub together when I walk, and now being able to look great in short skirts and bathing suits, well hell yes it was worth it. I absolutely love my inner thigh lift. Recovery from the thigh lift was pretty easy for me. Surely much easier than the tummy tuck. I, too, am a runner (or at least I was until I injured myself -- still recovering). The inner thigh lift is a difficult procedure that many plastic surgeons cannot well perform. I've talked to, as well as read plastic surgeons say this for themselves on RealSelf, that the procedure doesn't yield good results. When I asked Dr. Capella if it was a hard surgery to do, he told me "not if you know what you are doing." If you do decide to have this procedure done, then choose your plastic surgeon very wisely. Good luck on your decision! BTW you can see my thigh lift pix on flickr https://www.flickr.com/photos/mybariatriclife/albums/72157647436393788

One patient told me that a plastic surgeon said to her, “I operate with a scalpel, not a magic wand.” While another patient told me her plastic surgeon said, “Let’s go for a 10!” I wonder about these statements. Does the first plastic surgeon lack the skills to deliver the results that the patient wants? Is the second plastic surgeon just telling the patient what she wants to hear? A patient must have realistic expectations going into plastic surgery after massive weight loss. The plastic surgeon must manage those expectations and explain to the patient her realistic outcome. This is done by the plastic surgeon pulling tight her excess skin on each area of the body to simulate her results after plastic surgery. As well, showing before and after photos of other patients with similar body types. Body Image and Media The media has baited the hook, and the public chases after a trophy that will probably never be had. It is similar to purchasing a winning ticket for the lottery: It is possible but not probable. As a matter of fact, the average five foot four inch tall American female will never be tall and slender. She cannot match the media sales image of “desirable.” A major global study concluded that current characterizations of beauty are restraining and normally beyond reach. A current contention is that this unrealistic presentation helps to promote social acceptance of discrimination against obese people. It also sets the bar too high for realistic expectations of what we should strive to look like following post-bariatric plastic surgery. Plastic Surgery Post Bariatric Surgery While I was recovering from my body lift I thought deeply about the body image held by many of the patients I’d interacted with online, as well as my own image of my body. What are the emotional implications of plastic surgery post bariatric surgery? We found our bodies unattractive, or even ugly, after losing 100 pounds or more. We were left with excess sagging skin that could not be exercised or dieted away. Having body image issues about breasts, thighs, and tummy being deflated and sagging is quite understandable. Wanting the sexy body you have always wanted is normal. Body contouring plastic surgery was the only way to restore the body’s normal shape. Read, “Female Body Image and Sexuality.” Reality Check after Plastic Surgery The patient must understand that it takes several months to see plastic surgery results. If months have passed and the patient remains unsatisfied, it is a good idea to pull out before and after photos for a reality check. Improvement is more likely than perfection for a massive weight loss person, but it should be significant improvement. Read my article, “18 Insider Tips of Plastic Surgery.” Body Image after Weight Loss Reeducating people about self-image is a critical component to accepting oneself after weight loss. This will help lessen the extremes people employ as they try to grab a brass ring that is always beyond reach. Your goal should be one of significant improvement in functional mobility, stability, and aesthetics, rather than perfection. One patient told me, “I am not looking to be Barbie or Twiggy, but rather a more compressed me if possible. I feel like a barrel even after the plastics I’ve been able to have via my ***. At some point I have to just accept me for me with my bodily flaws; and every scar on my body has meaning to me!” Self-acceptance is, after all, a state of mind. Self-image is the idea a woman has about her abilities, appearance, and personality.

Thank you

KristenVSG2014 thank you! when I did Whole30 with my daughter, she came upon a recipe for me to overcome that black coffee problem. I still use this recipe to this day and add my Bob Markey coffee flavor Raw Fit Protein powder, a frozen banana, and other healthy ingredients like chia and sesame seeds etc. This makes a nice protein shake/smoothie. The basic recipe is to make a coffee latte using coconut water/juice, black coffee, and coconut milk. I found that the original Trader Joe's canned light coconut milk (which they may no longer carry) and their coconut Water did not have any additives and so these were compliant for Whole30. It really saved me because I needed that coffee boost (I like the flavor of coffee, not just the caffeine). Thanks for the recipe for the matcha smoothie. I will try that soon. I have some ingredients for making a kale, cucumber, and mint smoothie. I think the matcha would be great with that.

Following bariatric surgery, it can be difficult to get the required amount of protein following from foods alone, so many patients supplement their diets with liquid proteins shakes. While this may surprise you, people develop sensitivities or intolerance to traditional whey protein drinks and don’t even know it. I was one of them! Following bariatric surgery, it can be difficult to get the required amount of protein following from foods alone, so many patients supplement their diets with liquid proteins shakes. While this may surprise you, people develop sensitivities or intolerance to traditional whey protein drinks and don’t even know it. I was one of them! It came to pass that I suffered extreme gas and bloating within 30-minutes of consuming a whey protein shake, even high-quality whey isolates. It took a while to this figure out because I’d consumed whey protein shakes for years without a problem. But I have observed that as time goes on, I develop more and more food sensitivities. As well, people have reported low-grade chronic head colds and stuffy nose or mucous-coated tongue after consuming whey protein shakes. These are possible symptoms of food sensitivities. Recently, I stumbled upon two really good protein powders that are not made from whey. They’re now staples in my bariatric pantry. Protein Powder That Repairs Joints, Too The first product is a collagen hydrolysate from Great Lakes — a powdered form of gelatin made from collagen with 11 grams of protein and 43 calories per tablespoon. I buy Great Lakes Unflavored Gelatin Collagen Joint Care on Amazon for about 50 cents per serving. Its also available to order from the Great Lakes gelatin website. Since I’ve been using this product as the protein base in my shakes, my knees no longer hurt when I run. I’m on my third container now and have noticed a major health improvement to my hair and nails, too. Read my full product review on MyBariatricLife.org. Protein and Amino Acids for Vegetarians and Vegans The other product is a vegan protein powder. It is low in carbohydrates and packed with amino acids. This is important because most plant-based proteins are void of certain essential amino acids that our bodies cannot produce. So what this means is that in order to get all the amino acids that are needed, plant proteins will have to be strategically combined. Read my full product review on MyBariatricLife.org. Garden of Life has done all the work for us with their Raw Fit Protein for Weight Loss. Each scoop packs 28 grams of protein and 12 carbs. I buy Garden of Life Raw Fit on Amazon for around $30 for 16 oz. It’s also available at my local health food store. Living life larger than ever, My Bariatric Life

You are very welcome. I hope that it helps you. I think that I went through about a canister when I noticed I could run again. I guess it varies form person to person how long it takes for the benefit to kick in, but it seemed pretty fast to me for joint problems. Dairy kills me. I ate a small amount of gelato at my daughter's house and killed not only myself by my daughter and her family, too. She said NO MORE ice cream for you! Ha! It hurt so bad that you could not pay me to eat it again! I sometimes buy (or make) frozen banana dipped in dark chocolate and it really hits the spot! Hey, can you tell me what health benefits you've derived from the matcha tea? I'd love to know! Thanks!

Pinkgirl1234 Bob Marley coffee is a flavor

Yeah, I am my own lab rat, too, hahaha. Good luck with recovery and results! BTW can you tell me what kind of computer you used to view the article? The ads are a problem on some computers and not on others. It is responsive design so it is supposed to work on all devices. Thanks much!

Stevehud it really was the best carb:Protein ratio that I could find in a non-whey Protein powder, 12g carbs and 28g protein. A bariatric nutritionist long ago told me to balance my protein to carbs at every meal 2:1, so this fits that ratio. All the other non-whey protein powders that I have seen are very high in carbs. I use the Bob Marley coffee flavored Raw Fit from Garden of Life, BTW, not the vanilla in the hyperlink. The vanilla was cheaper so I linked to it. If I buy this at my local healthy food store it is about $10 more per container! Anyway, just keep listening to your body. I think that is something that we as obese people did not do well at. If you notice gas or bloating, or pressure, cramps, problems with BM (either too loose or constipation), anything along those lines, then you may be developing a sensitivity to lactose. It is not uncommon after gastric bypass -- not sure about the other weight loss surgeries. As an FYI, celiac disease is not uncommon to develop following gastric bypass. I have both celiac disease and lactose intolerance. I also read a study yesterday that proved what I have known in my soul all along. The chemicals in processed foods are leading to autoimmune diseases such as celiac disease, RA, diabetes type 1, etc.

I think it is a highly unusual circumstance. A contracted scar or wound opening is not uncommon. But what happened after that is. That said, the arm lift is a surgery with a lot of problems, as compared to the other procedures.

I had a complication with my brachioplasty, a contracted scar that resulted in a range of motion issue, pain, and the incision opened and resulted in an ugly scar. To treat the contracted scar, I had to have a z-plasty done, then lots of PT and OT, as well as treatments by a chiropractor to address the pain and range of motion. It finally was resolved but I was left without full range of motion, permanently. Now the same range of motion and pain has manifested in my other arm/shoulder,. The orthopedists and physical therapist and massage therapist all said it was from the contracted scar in the other arm. The physical therapist said it is like pulling a blanket on the bed, you scrunch up a section in your hand but it pulls everything else. So I am back at the beginning, except a different arm. It is very painful. I am more than two-years out from plastic surgery. As far as the ugly scar, I did not have it addressed.

They aren't as tasty as the sugar laden whey powders. However, I mix mine with coffee and some healthy ingredients to make them yummier. Dairy absolutely kills my GI tract with bloating.

Following bariatric surgery, it can be difficult to get the required amount of protein following from foods alone, so many patients supplement their diets with liquid proteins shakes. While this may surprise you, people develop sensitivities or intolerance to traditional whey protein drinks and don’t even know it. I was one of them! It came to pass that I suffered extreme gas and bloating within 30-minutes of consuming a whey protein shake, even high-quality whey isolates. It took a while to this figure out because I’d consumed whey protein shakes for years without a problem. But I have observed that as time goes on, I develop more and more food sensitivities. As well, people have reported low-grade chronic head colds and stuffy nose or mucous-coated tongue after consuming whey protein shakes. These are possible symptoms of food sensitivities. Recently, I stumbled upon two really good protein powders that are not made from whey. They’re now staples in my bariatric pantry. Protein Powder That Repairs Joints, Too The first product is a collagen hydrolysate from Great Lakes — a powdered form of gelatin made from collagen with 11 grams of protein and 43 calories per tablespoon. I buy Great Lakes Unflavored Gelatin Collagen Joint Care on Amazon for about 50 cents per serving. Its also available to order from the Great Lakes gelatin website. Since I’ve been using this product as the protein base in my shakes, my knees no longer hurt when I run. I’m on my third container now and have noticed a major health improvement to my hair and nails, too. Read my full product review on MyBariatricLife.org. Protein and Amino Acids for Vegetarians and Vegans The other product is a vegan protein powder. It is low in carbohydrates and packed with amino acids. This is important because most plant-based proteins are void of certain essential amino acids that our bodies cannot produce. So what this means is that in order to get all the amino acids that are needed, plant proteins will have to be strategically combined. Read my full product review on MyBariatricLife.org. Garden of Life has done all the work for us with their Raw Fit Protein for Weight Loss. Each scoop packs 28 grams of protein and 12 carbs. I buy Garden of Life Raw Fit on Amazon for around $30 for 16 oz. It’s also available at my local health food store. Living life larger than ever, My Bariatric Life

I waited 10-years to have my plastic surgery. I had all kinds of excuses, and I have learned that I am one of the greatest procrastinators in the world (I waited years on my bariatric surgery, too)! The plastic surgery was life changing for me. I will quote another patient who said, "Bariatric surgery saved my life. Plastic surgery saved my soul." Yes. That is how I feel, exactly. Understand that my body contouring plastic surgery was not a walk in the park. I went through some egregious situations and more than two years out I am still contending with complications. And of course, I now have scars in place of the skin. My facial plastic surgery was a cake walk by comparison. Despite all that, I am glad that I did this. The plastic surgery was the completion of my weight loss surgery. If anyone is interested, I have begun to document my journey: Body contouring plastic surgery Facial plastic surgery Good luck to all of you on your journeys!!!

There was a study that was conducted in humans that showed that liposuction results are only temporary, and the fat returned within one-year, particularly to the abdomen: Reference article: http://www.mybariatriclife.org/fat-returns-after-liposuction-plastic-surgery/ Most of my excess skin and fat was removed by excision. I did have some lipo done on my inner thighs but this was in conjunction with a thigh lift in which the skin and fat were excised. One liter of fat was removed. I really cannot say if the fat was redistributed or not. I have gained some weight since my plastics, thus my measurements have been affected. I hope the article is helpful.

I am somewhere 12-years out from my gastric bypass, and today posted an article about mental health and bariatric patients (on my website). It is something that I haven't thought about in a long time, but my eating was very disordered all those many years ago. Mental health/behavioral health counseling wasn't part of my bariatric surgery experience. My surgeon told me, "I do the surgery and the rest is up to you." He did offer a support group but it was not led by a mental health professional. Times have changed, and bariatric centers of excellence offering full treatment programs have emerged. I am curious what others' experiences have been with mental health support pre and post surgery and the impact it had on your weight loss success. Do anyone care to comment? Most of my learning was self taught. I educated myself on where my food came from, factory farming and GMOs, etc, and step by step evolved my eating, and found what I enjoyed as far as physical activity. I did attend OA for a while in the early days to address the emotional issues that I had with food. I have often wondered how a bariatric mental health professional addresses disordered eating and how it impacts patient long term success. I appreciate anything folks are willing to share. Have a great weekend!!!

@@James Marusek she sounds like she had the right credentials and personal experience to lead the group. Its great that you could bring some light into a dark situation, too!

@@tacocat sorry that you had to endure that! @@Kindle way to go! Keep up the great work. We are our own best health advocates. I've often learned more from fellow patients than doctors.

@@Cervidae I am working with a digestive orders gastroenterologist for months and he has not yet figured out why I am having the issues I am having. If it weren't for my naturopath as well as my own research with other patients, then I'd have had no relief whatsoever. I sure hope that this gets resolved because it has been going on since January.

Twelve years ago when I arrived at the hospital to have my gastric bypass, just before going into surgery, the bariatric surgeon suggests removing my gall bladder. Back then, I was not an empowered patient. So I just said, "OK" trusting that my surgeon new best. And now I am having a host of digestive issues, and wondering f the surgeon made a very stupid decision that day. After all, why remove my gall bladder when I wasn't having any gall bladder problems??? Here is a linked article about how to achieve optimal digestive health if your gall bladder is removed http://bodyecology.com/articles/is_your_gall_bladder_removed.php. I do not advocate any of the products listed. I am posting the link so folks can read about the role of the gall bladder in digestion and its vital role with the liver. I have had to take many products to help relieve my severe digestive issues, issues which include constipation, distention, bloating, gas, pain. A gastroenterologist did upper and lower endoscopies and a CT scan. All of that is normal. A naturopath/chiropractor has been doing energy work on me. Despite all these efforts, my digestion is still not normal. It is much better than what it was... oh the constipation was awful... my husband said it sounded like I was delivering a baby... the pain was awful and I seem to have given myself a hernia trying to have a BM. Has anyone had similar problems? I sure would like (love) to get this resolved. Thanks for your help

Makes sense!!!

18-mos sounds like a good deal of time to invest in the support group in order to reap the benefits. And of course you have communities like BariatricPal for online support. Was the surgeon's support group led by a mental health professional?