Dr. Schulman

Breast lift/reduction and an upper body lift is a perfect combination. They are commonly done together.

1. You can have a brest lift after a reduction. Your lift will use the same incisions as when you had the reduction in the past. I suspect you may have some "reduction" and not just a lift. Remember, a breast reduction includes a lift.....a lift will only raise everything up, but will keep volume the same. 2. There is no true 'outer thigh lift." This is part of a lower body lift in which the buttocks, lower back, abdomen, and outer thighs are improved. An "upper body lift" is completely different and will nto do anything to improve your outer thighs. Which is more difficult? That is hard to say. A LBL is much more complicated, so I guess it is true that it is harder...but it is "apples" and "oranges." To a surgeon experienced in this kind of procedures, you should get a good result with either. Here are some pictures: 1. Lower Body Lift 2. Upper Body Lift 3. Breast Lift 4. Breast Reduction

You should wait on a TT until you are at goal. You may consider a panniculectomy at this stage, which will remove the hanging skin, without tightening the muscle or removing excess skin that is above the belly button. Insurance may pay for a panniculectomy and you should check with your insurance carrier about the specific requirements. Keep in mind, if you have a panniculectomy now, you will likely require a revision at a later date to convert it to a TT.

many procedures are combined, but a LBL is best when done alone. It is the largest of the operations and requires the most recovery. There are blood supplu issues when adding an inner thigh lift to a LBL or TT and will increase the complication rate significantly.

The area between the belly button and the breasts is improved during a TT (not a panniculectomy). There is a procedure called a "reverse TT" that pulls everything up, instead of down. This can work, but it involves an incision that goes completely across theupper abdomen, under the breast fold (think of a breast reduction incision that connects to the other breast). This tends to make a very bad scar in the middle (thick and raised). It also tends to pull the breasts down, more than it pulls the abdomen up. I know this sounds confusing, but my point is that a reverse TT does not work as well as a traditional TT. An upper body lift is mainly for the back and underarms.

Earlier I had discussed an "upper body lift" that will help with the back rolls and underarm rolls....."banana rolls". Here is a link to a picture of a recent patient who had this procedure.

It sounds like a breast reduction is appropriate for you. Your breasts are about 50% fat and 50% breast tissue. As you lose weight, you will lose fat...but not breast tissue. This explains why you have seen some improvement with your weight loss, but not much. A breast reduction will help ease your discomfort and will help speed your weight loss (think about how much easier it will be to get around and exercise). Just keep in mind that you may require a revision in the future depending on your additional weight loss. Regarding you stomach, you may consider a panniculectomy to remove the hanging skin. This will ease the pressure on your pubis and should improve your sensitivity. It will also make it easier to exercise and lose weight. When you reach your goal, you probably will require a revision to a formal TT for the best possible cosmetic result. Many of my patients do not wait until their weight goal to have PS, because the hanging skin becomes such a problem for them.

Care is taken to avoid disruption of nipple sensation during surgery. It is important to talk to your surgeon about your nipple sensation before surgery. In most patients, there will be a temporary decrease in nipple sensation which can last a few months. In some people, nipple sensation can change permanently (decreased OR increased). These changes are more common with breast reductions than with breast lifts.

Not everyone has a problem with excess skin. But, for someone who will lose around 150 pounds, the excess skin is likely. Unfortunately, there is nothing that canbe done to prevent it - it has to do with genetics, the amount of weight you lose, and the speed at which you lose the weight. Fear of thsi excess skin should not deter you from losing as much weight as possible - the health benefits of losing weight far outweigh the cosmetic problems of excess skin (I am sure most bandsters would agree). You will just have to see what happens. You always have options if the skin is excesive.

This question comes up all the time. This is no rule that you should wait until after having children for plastic surgery...but it is true that pregancy comes with increased weight and subsequent weight loss (the very problem that caused the excess skin to begin with). So ieally, if children are in the near future, it may be best to weight so that you get the best aesthetic result possible. With that said, having children after plastic surgery is not dangerous to you or the baby. The worst case scenerio is that some of the excess skin returns and you don;t have as good a result as what you had right after the surgery. You may need a small revision afterwards. Regarding an upper body lift - this is one procedure that will be affected LEAST by pregnancy, so you should be ok. Many of my patients have surgery then get pregnant a few years later - some get a revision, but many are still happy without a revision.

It sounds like what you need is called an "upper body lift". This will remove the bra roll and the excess skin on your upper back. The incision is kept beneath the bra line and is a very powerful way of improving the upper back contour. This is a standard procedure that an experienced PS in body contouring will perform.

The insurance companies have goten very tough, unfortunately. Generally, they require that the the pannus hangs to the level of the pubis (your PS should take pictures and send it in to them). Also, they require taht you have rashes, not responsive to topical treatments for a period of at least 6 months. You should get a prescription for an anti-fungal cream or powder. It should be a prescription (even if you chose to not use it and only use your gold bond) because your pharmacy and insurance company will have a record that this was prescribed. The only other thing to try is to see a chiropractor that will document back pain and radiographic changes in your spin consistent with the weight of the pannus. Try the appeal. Sometimes it works. If this fails, and you cannot afford to self-pay, you might want to consider finding plastic surgery residency programs in your area - they perform cosmetic surgery at greatly reduced prices (likely under 2,000 -3,000 for this procedure). Make a call to the local teaching hospitals (UTSW, BAylor, UTSA, etc.)

There should not be any risk of damaging the abdominal wall. You may have to wait a few more months for things to heal, though, before having the band placed. I suspect that the "spare tire" will decrease with weight loss, but the excess skin will remain. It probably has more to do with your body shape, and not necessarily the weight. Some women store most of the fat in the hips and thighs. This is what we refer to as a "pear shape" - as opposed to men who store the fat in the abdomen (the "apple" shape). Usually, this shape remains, even after weight loss. Luckily, there are many experienced plastic surgeons who can help you with this. Good luck on your weight loss

I think you have the idea....the buttock augmentation (when done with a LBL) just adds volume back that is lost during the procedure. It will restore "normal" proportions, and is not intended to give you a "J-Lo" butt. If you look at the pictures and think to yourself, "the butt is not that big," than that is the result I was going for!

I use this technique more for restoring a normal buttock volume....not really for increasing the size. As you know, when you lose weight, you lose fat in the buttock as well. After a LBL, the butt get even flatter. Try this out.....turn around, grab the lose skin just above your buttock, and lift up as much as possible - this will simulate the LBL. Now, look in the mirror and see if your butt gets even flatter. I bet it will. If it does, then you are a candidate for an augmentation at the same time as a LBL.

Liposuction around the port can be done, if done carfully. Your PS should be prepared to change the port if it is damaged in the process - or have someone available that can do it right away. This is not common. If it is damaged, it will likely be the tubing to the port and can be fixed without having to do anything with the band itself. I find that another good solution is to remove the port, do the liposuction without having to worry, then replace it with a low profile. This would involve a small incision over the port (which will not be any larger than your laparoscopic access port)

tear trough deformties are very common. It results from a descent of the malar (cheek) fat, which leaves a groove between the cheek and the eye. Fillers work well for this area, but make sure your PS is an experienced injector because this area requires advanced technique. Hyaluronic Acids like Restylane and Juvaderm will last 6 months (Juvaderm may last up to a year). I find that these materials are a bit too thick and can be lumpy when placed int his area (because the ski is sooo thin). I prefer to use Sculptra or Radiesse. Sculptra requires 2-3 sessions and will last 2 years. Radiesse needs 1 sesson and will last about 1 1/2 years. Here is a picture of someone with a similar problem. This picture was taken immediately after putting Sculptra beneath only one eye (yes, I did then put it in the other).

Sleep is for the weak! Ablative Lasers are the gold standard by which everythingis measured (CO2, Erbium). The problem is that there is significant "downtime" and the face may be left with an unnatural appearance that is shiney and may be hypopigmented. Fractional Ablative Lasers may work.....they are very new and the data is not conclusive. They probably work well, but need multiple treatments (more than most doctors will tell you). And this can get very expensive - figure about 1000 -1500 per treatment with anywhere from 3-6 sessions. Deep chemical peels work really well (TCA) and have less downtime than ablative lasers. The cost is also much less (around 2000 and only 1 session required) I am not the type of doctor that "jumps" on the newest technology. I let other people prove that it is not just a "gimmick." Remember SmartLipo? Regarding a facelift....here is my tip to tell if you "need" it. Lie on your back, and look at your face in a mirror. Like what you see? This is the result you will get with a facelift! This will reduce lines, but may not get rid of the very fine lines that you have. This may still need some "spackle" in the form of microdermabrasion, chemical peels. etc. I routinely do facelifts on women in the 50s. This seems to be the most popular age to have this done. Most people are happy with the results for about 10-15 years. It is a nice age because you are still young and can "enjoy" your more youthful face.

NYC is not so far..... If the Juvaderm looked OK right after, than it is probably just swellng and not over-corrected. The most swelling is at 24-48hrs after injection - right where you are now! The Juvaderm (like all other hyaluronic acids, ie. Restylane and Perlane) will absorb Water and appear to be fuller...this improves as the Juvaderm settles into place. For all you who love to see pictures... Lip augmentation with fillerNasolabial line reduction cheek augmentation with filler And for those who think fillers are only good for the face..... An article featuring the use of fillers to help in breast reconstruction (The Breast Journal)

Generally, scars after armlifts are kept along the inside of the arm so that with your arms at rest at your side, the scar is invisible from the front, from the back, and from the side. The scar would only be visible when the armis lifted. I am nto sure why your scars are in the position that they are. You should not place too much emphasis on the measurement of your arms. It can be very deceptive. The most important thing is appearance of your arms and that they are in proportion to the rest of your body. It is very possible that a revision would help to remove more tissue (especially when combined with liposuction) and the scar can be repostioned to a more aesthetically pleasing location 9along the inner aspect of the arm). Here is a picture of a typical armlift.

As with most weight loss patients, you have several areas that you want improved. I think you will need 2, possibly 3 surgeries. A good way to start might be with a Lower body lift - this includes a butt lift, outer thigh lift, and tummy tuck. Next an arm lift and breast reduction (lift is part of a reduction) go well together. Experienced plastic surgeons may also perform an inner thigh lift at this time also, or thigs can be split up for a 3rd procedure. I think that you should wait about 3 months in between, although I have done similar sequences with only 6 weeks in between in very motivated patients. if you are interested in having these procedures done in as few operations as possible, make sure you chose a surgeon who specializes in body contouring after weight loss. Here are some links to pictures that you may find helpful: Lower body lift arm lift (brachioplasty) inner thigh lift breast reduction

No, not everyone needs a buttock augmentation. After massive weight loss, many people lose fat from their buttocks. During a LBL, the buttocks are lifted. This can often make the buttock look more flat (I know it sounds strange, but turn around, look in the mirror, and lift your butt with your hands - does your butt get flatter?) When I first began doing LBLs, I did not appreciate this phenomenon. As time went on, I began to see patients after body lifts (my own as well as others) who desired more volume to the buttocks - this was because the butt was now flatter, or because when they were heavy, the only part of the body that they liked was the butt. I did things like implants and fat injections - whioch work well - but realized that it was better to anticipate this happening and address it during the LBL. There are no hard rules for plastic surgery. Everyone is different and everyone needs a different surgical plan - this is the "art" of plastic surgery.

That is a tough question because it depends on what your body was like before the TT, the specific technique the surgeon used, how "tight" he/she made the muscle, and the amount of lipo that he/she did. Even though you think you are no longer swollen...you still are, just not like you were right after. . Most people are swollen for at least 6 months. I tell my patients that they will continue to get better contour for up to a year after the surgery. That is why you should wait to have lipo revision. It is not advisable to do significant liposuction at the same time as TT because it increases your changes for complications.

Let's try this one more time...

As promised....here is a picture of a patient who had a lower body lift with buttock implants using the fat and skin from her lower back - this is not the same as fat injections! This is only a few weeks after surgery, so the incision is still red. This technique works well to help with flattening of the buttocks - which always gets even flatter after a lower body lift. The pictures are in the attachment (sorry, I tried to put it in the message but failed miserably!)