Dr.JLo

Plastic surgery in Mexico and many other countries is cheaper because they have less regulatory expenses, less malpractice overhead, and building and staffing the facilities is cheaper. So as not to give the impression that I am somehow biased against any other surgeon in any other country, lets assume that I have an identical twin brother surgeon who is equally skilled and experinced in post-bariatric plastics, but he is in Mexico and I am in your hometown. If you want to check your doctor's credentials, it is a simple matter to look up any state medical board in the U.S. and learn about your doctors credentials, years in practice, and any lawsuits. If you really want details on lawsuits, those too can be obtained at the courthouse. You will find it nearly impossible to do the same type of search for doctors in Mexico, even if your Spanish is excellent. If you want to check your surgery center or hospital's credentials again, you can quickly and easily check with JCAHO or the AAAHC(http://www.aaahc.org/eweb/dynamicpage.aspx?site=aaahc_site&webcode=find_orgs) to see if the place where you will have surgery is accredited and meets standards for infection control, sterile processing, etc. If you want to check a facility overseas, your only option in the JCI and they only accredit hospitals. You will have almost no way of having an independant organization check the standards of a clinic in Mexico because there are no such organizations. If you have a problem after surgery and require care, your health insurance may cover it. Or your PS may have Cosmetassure, which for $250 covers nearly all complications after plastic surgery that occur within 30 days. If your surgery was done overseas, you will likely not find a PS stateside willing to take your case, and will have to either travel again or seek care from a doctor who did not do the surgery. Insurance coverage for surgery done overseas may still be available after you return. If your problem occurs while you are out of the country, your chances of coverage are much less. If you have a medical, business, legal, or financial dispute with the doctor, you are protected by laws and regulations here in the states. Remember, your state medical boards, membership societies, and lawyers all exist to protect the public health. Your ability to seek compensation or get help for surgery done overseas is much more limited. If you have a breast implant leak and the implant was placed in the U.S, you are entitled to $1000-$3000 in financial assistance to fix it, and get free implant replacements for life. In Mexico and overseas, you must return to that country for replacement of the implant, and the financial compensation is a maximum of $1000. If you travel before and after a big surgery you are at increased risk for a blood clot. This means extra treatment is required for those who travel. I have aksed on other forums many times what was done for blood clot prevention before and after international travel and have not received an answer to that yet...leading me to believe that no treatment was done. Anyway, these are a few of the things that one must take into consideration and plan for, if you are going to travel. Tummy tuck has the same statistical risk profile as an intrabdominal procedure like open gallbaldder, appendix, hystercetomy, etc. It is NOT a benign procedure by any means. LBL is an even bigger operation. My goal here is simply to inform, not to assail the credentials of any other doctor anywhere.

Hi Kathy. Well, the first thing is to be sure you have no pocket of Fluid leftover or an area where the skin did not stick down to the muscles (a fluid pocket can cause this). You may need an ultrasound or CT scan to clear up this issue. I say so only because you report one-sided swelling in an area where your tube came out prematurely. Absent anything on your scan, lymphatic massage may help. Try online..there are several sources for this. Your local hospital may have a lymphedema center, and they may know a therapist. Also try: ACOLS Find A Therapist I include them in all my surgery packages and am lucky to have a therapist employed by the hospital, who is just great.

Swelling can persist for a long time after surgery, and individuals vary highly in the amount of swelling they develop. A good compression agrment, avoidance of triggers,a nd lymphatic massage all help control swelling. A seroma, or a pocket of Fluid, is a relatively common event separate from swelling. They occur after removal of large amounts of skin. I keep a simple ultrasound system in my office and therfore detect and drain these pockets early on when they are small...if they get too big it's a problem. Persistent pockets may require replacement of a drain, although this is usually not needed with early detection and intervention in my experience.

Insurance may cover removal of excess abdominal skin if it causes infections or rashes that do not repsond to medication over a period of months. Keep in mind that a simple skin removal (panniculectomy) is a far cry from a nicely done abdominoplasty. My website has links to many of the INS companies plans a criteria, plus some useful tips for getting coverage: http://www.drlomonaco.com/plastic-surgery-patient-resources.shtml As for pregnancy, I have a number of young patients who are not comfortable with themselves, much less another person, while undressed. Some have never even dated. For these individuals, a tummy tuck prior to pregnancy is a good option. In general, a tummy tuck will "undo" some of the result, but most patients will never re-develop the amount of skin they had after massive weight loss...assuming their pregnancy weight gain is normal.

It's generally a good idea to have it unfilled for several reasons: Swelling after surgery may make it harder to get your nutrition. Nausea from anesthesia could cause vomiting or heaves, which will aggravate swelling More medications (pain pills, antibiotics,a nd supplements) are going to be needed after surgery. A tight band can cause esophageal backup and possible pill ulcer. Almost all of my bariatric colleagues agree to do the unfill.

Insurance may cover removal of excess abdominal skin if it causes infections or rashes that do not repsond to medication over a period of months. Keep in mind that a simple skin removal (panniculectomy) is a far cry from a nicely done abdominoplasty. My website has links to many of the INS companies plans a criteria, plus some useful tips for getting coverage: Plastic Surgery Pateint Resources and Articles - Dr. John Lomonaco

No surgery, no downtime, no pain and you lose multiple inches ! Sounds too good to be true ! Oh, and no refunds either.

Here's a link about swelling: Swell Hell...what is normal ?, Message Boards, Cosmetic Surgery Message Boards, Forums, Skin Care, Chats

Here's the link if you want to listen. We talked about Timing of plastic surgery in bandsters vs other WLS Goal weight with a band Preop preparation for surgery Surgery overseas My new website's patient resources Insurance coverage for plastic surgery CLICK HERE to listen: http://www.blogtalkradio.com/BTRPlayer.swf?file=http%3A%2F%2Fwww%2Eblogtalkradio%2Ecom%2Fplaylist%2Easpx%3Fshow%5Fid%3D725693&autostart=true&bufferlength=5&volume=100&borderweight=1&bordercolor=#999999&backgroundcolor=#FFFFFF&dashboardcolor=#0098CB&textcolor=#FFFFFF&detailscolor=#FFFFFF&playlistcolor=

Tonight at 5pm "Tonight's special guest is TLC's Big Medicine Plastic Surgeon Dr. John LoMonaco. A talk show created with all band patients (LAP-BAND & REALIZE Band) in mind. Be sure to tune in every Monday to hear from experts and or patients as they share their wisdom/experiences. We want you to have the best band journey ever. " The Band Banter Talk Show 10/19/2009 - Coach Cher & Krys on Blog Talk Radio

My vote is for Dr Scott Kasden in the DFW area. He is well-versed in WLS patients, kind, and contributes a lot to the WLS community.

Hi. We are hoping to bring Big Medicine back...there will be a pilot episode of what we hope will be Season 3 on November 18th !. The show ahs helped so many patients, but we need EVERYONE to watch ! Meanwhile, reviews on plastic surgeons (incl yours truly) can be found at: Plastic Surgeon Directory, Doctor, Reviews, Ratings, Plastic Surgery, Cosmetic Surgery and Houston Plastic Surgeons and Plastic Surgeons Practicing In Texas Of course, call us anytime at 713-526-5550 and we are happy to ansswer your questions. Best

Nipple sensation can be lost or reduced with any breast surgery, but the more aggressive surgeries (like large reductions where tissue is removed) have a higher chance of loss. Also, my opinion and experience is that the short-scar breast lifts (John LoMonaco M.D., P.A.) have a lower chance of reducing sensation than the older anchor-scar techniques.

Yes...rashes and recurrent infections are the best way to get approval. But you do need to go in and get scripts filled. The INS company will be billed for these visits and know about the issues taht way. Be sure your PS is willing and experienced in going through the INS process too ! Best wishes, John LoMonaco, M.D., F.A.C.S. Plastic Surgery Houston, Texas www.DrLoMonaco.com www.BodyLiftHouston.com

Skin texture changes and irregularity are the most common cosmetic complication of lipo, and weight loss patients will be at higher risk as their skin has been stretched and damaged by the obesity and weight gain-loss cycles. Plusa there is just a whole lot more of the skin ! Not to sound crass or disrespectful but just doesn't sound right. But if you have seen before and after photos of other patients who look like you do, and you like the results then go for it. My recommendation has always been to seek out a board-certified PS for a PS procedure as that is the only way you can be sure your doc has had formal training on the technique.

SmartLipo, or for that matter any form of lipo, is great for removing fat but does not tighten the skin much. My extensive experience with weight loss patients confirms that they mainly have excess skin, not so much fat. So I feel there is a limited role for lipo alone. These days, most practitioners follow smartlipo with regular old lipo because if the fat is not physically removed there is prolonged swelling. My question is why use the laser then ? A lot of feedback on smartlipo on some other boards: Liposuction Message Boards - DISAPPOINTED IN SMART/VASER LIPO - Plastic Surgery, Cosmetic, Forums, Chats As for the band...your surgeon needs to know where the port and tubing is so as not to disturb it during the procedure. Best wishes, John LoMonaco, M.D., F.A.C.S. Plastic Surgery Houston, Texas www.DrLoMonaco.com www.BodyLiftHouston.com

Yes, it is nice to have one downtime, one recovery, and one exposure to anesthesia as Dr. Schulman points out. One of our hospitals will also agree to lower the room fee a bit as well as cover the overnight stay. Be sure your OB-Gyn and PS talk...a "simple" hysterectomy or fibroid removal can become a very involved case with blood loss if the fibroids are large, or if your OB-Gyn is going to try and preserve the uterus. I always tell patients that the PS portion of the procedure will be done only if the OB-Gyn portion goes smoothly !

Especially with today's economy, I thought I'd share a few items we discuss with our patients who have financial obstacles to overcome before they can move ahead with their PS. Remember the value of what you are getting and what you are risking. This isn't a car your buying...it's your health, and your body...you have come a long way to get where you are ! Using price alone to chose your surgeon does not make sense. Consider financing. Companies like CareCredit have various programs that may help. If your credit is shot, enlist the help of a reputable repair agency. It works. Also, your doc may be willing to finance a portion of the surgery through a promissory note without a credit check and with easier terms. Use your FLEX spending plan at work if you have one. Talk with your HR person if you are unsure about this. Get a tax break. Medically necessary surgery may entitle you to a deduction. Combine covered and non-covered procedures. if you have a hernia, or even will need an OB-Gyn procedure, your PS may be willing to work on you at the same time. You can often have the overnight stay and several hours of surgery covered this way, and save thousands. Use insurance. This is harder these days, but learn about your plans criteria for removal of excess skin. Find a PS who is willing to accept insurance, but also expect out of pocket expenses. Consider a University Program. Some training programs offer discounted rates if you consent to the residents doing part of the procedure. Be sure the supervising doc will be there before, during, and after surgery and have a comfort level with his or her qualifications first. Plan ahead. Remember, Rome wasn't built in a day. It took you a few years to gain the weight and develop the excess skin, and at least a year to get the weight off. Don't think of PS as an overnight fix. Patients often tell me they saved for the surgery just as they did for a new car. A more modest vacation, budgeting...all these things can help. BTW patients tell me without exception that they love their new bodies way more than any car ! If anybody wants to be on my newsletter mailing list just email Sari from my office directly at sari@drlomonaco.com. We include tips and other useful info in most issues. Hope this helps

Hi, I realize that the cost for PS here in the states is much higher than in Mexico, and I make the following comments only because I have patient safety foremost in my mind. There are skilled and talented surgeons all over the world, but the simple fact is that the larger PS procedures require long term followup and care. Not to be critical of ANY doctor, here or elsewhere, but a big surgery with lots of possible postop issues many months after the procedure is just not a good thing to do. Travel after a major surgery may raise the chance of blood clots also. Read through the boards here (or check out makemeheal.com) ... you will see that many patients have issues that require the surgeon's care weeks and months later. An LBL and many of the other post-WLS procedures are hands down the biggest PS procedure imaginable. The low prices are nice, but you don't get what you don't pay for in terms of long term followup. You also may have no insurance coverage, and have no legal protection for sure. If you had a PS close to home agree to manage and follow you afterwards, that would solve at least some of the problems. Also consider some of the items I mention to help defray the costs..Ill post them separately. Again, I say this only from a patient safety standpoint and in no way mean to be critical of the care rendered by other doctors.

One good predictor of your scars is the ones you already have. That being said, arm scars tend to be more obvious and the quality is lower than other areas. The arm skin is very thin and does not scar as well in many patients. As always, scars are a tradeoff for the excess skin, so you'll have to determine what is best for you. I have some photos of arm scars at 6 months (raised, red and thick) and then again at a 14 months (white, and flat) that I'll post soon.

Congrats on youe weight loss so far ! I agree that Dr Caridi is a well known and respected surgeon in the Austin area. Also, OH.com has a list of surgeons plus patient reviews in Texas: ObesityHelp.com - Plastic Surgeons in Texas As part of your research, you may want to consider the new book Dr. McNemar, Kreiger, and I authored especially for weight loss patients: John LoMonaco M.D., P.A. Best wishes, John LoMonaco, M.D., F.A.C.S. Houston, Texas www.DrLoMonaco.com www.BodyLiftHouston.com

Hi. Insurance can help, but you must have documented medical problems from the excess skin. By documented I meandoctor visits and prescriptions for skin problems. You will also need to find a PS willing to go through the insurance process for you, and in many cases you must be prepared for out-of-pocket expenses. My websites have a downloadable document called "Tips for getting insurance approval" under PATIENT RESOURCES plus another article in the NeWeigh newsletter you may find helpful. Best wishes, John LoMonaco, M.D., F.A.C.S. Houston, Texas www.DrLoMonaco.com www.BodyLiftHouston.com

Well after 9 months or work, we finally have our book dedicated to advanced body contouring. It's titled "Bariatric Plastic Surgery" but the tummy tucks, breast procedures, and arm/leg rejuvenation applies to all patients. We have it available in hardover directly from my office at Bodylifthouston but you can also get it on Amazon. [/url] Best wishes, John LoMonaco, M.D., F.A.C.S. Plastic Surgery Houston, Texas www.DrLoMonaco.com www.BodyLiftHouston.com

Hi all. Finally after months of hard work by Drs. Kreiger, McNemar, and myself we have our book. Its designed for patients who are considering plastic surgery, and is geared towards individuals who have lost weight. All the latest lifting techniques for breast, body, arms, legs, and face are discussed. Give us a call at 1-877-897-4221 if you want the hardcover version, personally inscribed by yours truly (if you want :thumbup:) priced at or below the Amazon trade paperback copies. Best Dr. L.

I wouldn't say so much explode...:wink2: Its more like a flat tire...:cursing: