Dr. Schulman

"internal stitches" means that they are hidden under the skin and will dissolve. They are placed so that the skin is completley together and no glue is needed (but some people put it anyway).

It can be difficult when you are trying to "heal" your arms and legs at the same time. It is not an ideal combination, but can be doen as long as you know that it may be difficult for you at times.

It is common to havee breast reduction done before you have reached your goal weight - especially if you are symptomatic from the breasts (which you clearly are). Future weight loss after your reduction may make your breast sag a bit, but it is unlikely to bother you (if it happens at all). It is impossible to say how much weight you will lose without seeing you, but it may be around 5 pounds. Incidentally, make sure to speak with your surgeon about size - most people that want a reduction ask to be a "b" but change their mind when they see how small a "b" really is in comparison to what they start with. There is some data that shows that the incidence of breast cancer is reduced after a breast reduction. It may also make detection of early cancers easier because of there being less tissue to visualize on mammogram. So, if you want this, there is no reason to wait. It will likely make your weight loss begin again because you will be more mobile, have an easier time exercising, and be more motivated to lose weight.

There is no disadvantage to splitting a LBL into 2 surgeries - in fact, I have many patients that choose this route.

The garments arfor swelling. Even though you do not feel swollen at 5 weeks, you still are! It can take 6-9 months for the swelling to go away. This means that if you look good now, you will look even better in a few months. The garments help to speed up the disappearance of the swelling. You should wear it during the day for at least another few weeks.

I use use topical lidocaine jelly inside the mouth and also add local anesthetic to the Radiesse itself. It is not painful at all. I do all my injections myself - I never have a nurse or PA do it. The cost is 1000 for first syringe and 800 for each additional. Most people need 2, but cannot tell you until I evaluate you. I hoep the bruising should be non-existent.... You can call my office to make an appointment.

I have been using this technique for about a year and love it! It allows me to build up the cheek bones and help with the undereye area and NL lines. I use a product (Radiesse) that lasts 12 months. Luckily for me, there are very few doctors performing injections using this technique. When you are in NYC, come at see me - I can do the injection the same day. To help minimize brusing, take arnica starting 3 days before the planned injection and continue taking it for 3 days after. Also, as I have said before, no red wine, aspirin, motrin, ibuprofen for 1 week before.

It usually gets better over time, but may never completely go away without a small revisional procedure. FYI, if your TT incision does not meet in the back, then by definition it is not a "circumferential TT" - not a big deal, just semantics I guess. I have found that if the TT does not go all the way across the midline of the back, there usually remains a puffy area right above the tail bone that can appear "tail-like" that most people are unhappy with. See if it settles down, but don't be surprised if you come to ask your PS to fix it in about a year.

yes. But keep in mind that "IV sedation" is a vague term. It can range from just a little vlium, to more powerful sedation. If you are receiving a deep sedation, then it is still considered "general anesthesia" - just without a breathing tube.

Most of my patients have the first surgery around 6 months after weight loss plateau (may not be "at goal"). This means that many see me as the weight loss begins to slow to just a few pounds a month. I think you are right that it may take about 2 months for the logistics of getting insurance approval, financing approval, etc. But many do not go through insurance (or know they willnot be eligible) so surgery can be booked as soon as medical clearance is obtained.

Don't be nervous. It is a common procedure and safe if done correctly with appropriate follow-up care. It appears that even in NYC, the price will be in the same ballpark.

A LBL is one of the largest surgeries after weight loss and most patients (especially ones that work on their feet) require at least 3 weeks. You are also right to assume that reducing arm movement is important. She needs to check with her surgeon about his specific restrictions on activity, because it varies from doc to doc. I do not think it is a morphine pump - more likely it is a pain pump that gives local (non-narcotic) medicine called marcaine and lasts about 3 days. Be assured that Dr.LoMonaco is an excellent surgeon and well respected among his peers. You should always check to make sure your surgeon is a member of ASPS and can check for complaints against them with the state medical board. She should know that having surgery such a long distance away has certain issues. I also operate on many out-of-town or out-of-country patients, and require that they stay for a substantial amount of time after the surgery, because complications often do not arise within a 10 day period. Also, sometimes the drains remain for 1-3 weeks and I do not allow my patients to return home until the drains are out. She should also be prepared to travel back to Houston for frequent follow-up visits. Again, I am sure her surgeon has specific requirements that she must adhere to. Also, if there is a problem down the road, she must be prepared to travel back to see her operating surgeon. So, it is possible that surgery in Tx is initially cheaper than in NYC (although, I would disagree with that generalization), staying the appropriate time, traveling back and forth for follow-up visits every few weeks than every few months can add significantly to the cost and ultimately make it substantially more expensive.

the best thing is for you to sleep in a flexed position, like you are in a chair (head raised and knees bent), so sleeping on your side in a fetal position should be fine. I still think you should make the trip to NYC - I have nothing against Red Sox fans (I am a Mets guy, not a Yankees guy).

In my experience, mild excess skin in the inner thighs can be corrected with a groin incision only. If the skin is more significant, than a vertical component is needed. The problem is that if you try to do this with onlya groin incision, it looks good for about 6 months, then gravity pulls the scar fromt he groin crease and down. The scar then becomes visible and the labia can be distorted. The weight pulling down can be reduced by adding a vertical incision. As I have said in the past, the more you are willing to accept in terms of scarring, the better the shape will be. Like anything, it is a cost/benefit equation. Your PS should be able to show you exactly what the difference will be in shape between the two. It would be very odd to not have a belly button. Your PS should be able to reduce the depth of the belly button and make one that looks 100x better than what you have now. I always make the belly button a priority, because it is the only scar that is visible. If it is not done correctly (or if it is removed completely) people are very unhappy. In fact, I have many patients who have come to me (after surgery with other PS) to fix their belly buttons.

I recommend arnica, starting 3 days before the procedure and for 5 days after. It probably does not work for everyone, but it certainly is not harmful. I recommend a simple compression binder for after the TT - this will be worn for about 3-4 weeks, and then it can be changed to a surgical girdle. For reductions, I recommend a soft sports bra that has a zipper in the front - it should not be too tight and youi can get it in any sproting goods store. This will be worn for 4 weeks and then can be changed to a regular bra without underwire. You surgeon should be able to show you exactly the type of garment to purchase (if he/she does not suppy it for you).

Congratulations on taking the first step to better health. Unfortunately, there is no way of knowing how lax your skin will beand what surgeries you will need after your weight loss. As I have said before, peopel with bands tend to have less loose skin than people with bypasses - this is because the weight loss is more gradual. But, givent hat yuo expect to loose over 100 pounds, you should expect to have significant skin. There is nothing you can do to prevent it, but keeping healthy diet and high protein will make you better prepared to heal after surgery and make your recovery smoother. I haev many african american patients and keloids (more correctly, hypertrophic scarring) is always a concern. I use special techniques to avoid this, but much depends on how your skin will heal. My experience is that event hough you may have had keloids from a previous procedure, it is usually much better after plastic surgery using the tecniques that I use. It is also possible to "revise" the scars at a later date if they heal thick - I have a larger number of people that come to see me specifically to revise thick scars that they have from other surgeries with other doc. I look foward to seeing you as you approach your goal. Make sure you have signed up for my newsletter so you can take advantage of my latest special promotions and hear the latest news.

Blood clots are not very common. Your surgeon should take precautions in the OR with compression boots, and you should be up and moving as quickly as possible. With your plannerd surgery, you will likely be on 1 -2 days of bed rest, so you should "pump your calves" by moving your feet. You may also be on a blood thinner afterwards.

This is not very common, but when it develops can obviously be a big problem. It can happen after any surgery that interrupts the lymph flow (the flow of Fluid back into the blood stream). Ironically, there are some reports in the plastic surgery literature that use liposuction as a treatment for severe lymphedema - usually the kind people are born with and not the result of a surgical procedure or injury. Also, some plastic surgeons have been successful by performing microsurgery to repair the injured lymph vessels (they attach them directly to veins). You husband may be correct to some extent. If it is the result of your surgery, then it may continue to get better over the course of the next several months. Using compression garments will certainly help int he meantime. I would wait it out a bit longer. I cannot promise ti will get better (it amy not), but you need to give it more time. Also, this is so uncommon, that it is usually not specifically discussed pre-operatively. I do tell my patients that there is a small chance of prolonged swelling, but do not use the term lymphedema specifically. I am sorry you are going through this. Be patient and hopefully your body will regrow the necessary lymph vessels. If not, there are some other options to explore later. And I agree that you should not have any mroe procedures until this works itself out.

I apologize for letting the questions pile up... I am catching up now, promise.

Pre-authorization is specific to the operating surgeon, so technically, yes, each doc needs to do it. You can tell the office that you have had the procedure pre-authorized with another doc and you are not sure which surgeon you will choose. You can just suggest that they not bother getting it done until you notify them that you have selected them (in reality, it is sometimes nothing more than jsut a phone call to insurance that they wil probably do anyway).

swelling and bruising is normal and can be extensive. Because of gravity, the bruises will go "downhill". Also the itching can be a reaction to the prep used during surgery. If you haven't done so already, call your surgeon. You may require steroids if the reaction is bad.

lasers resurfacing may be able to help you.

My patients are on restricted activity for 4-6 weeks after a TT. This includes no swimming for a minimum of 4 weeks. You should ask your PS about your planned activities and see what he/she says. If you were my patient, either the surgery or the vacation would need to be changed...

It is ok to get a TT before yo reach goal, if your weight has stabilized but are still some amount short of goal. It is common for people to lose about 100+ pounds but still end up 20-30 pound short of goal. But your situation is different - you are still actively losing weight and you are not even halfway. If you want to do something sooner, then you can consider a panniculectomy. This will likely have to be converted to a formal TT after the complete weight loss. My advice is to wait it out, but if the hanging skin causes problems for you, consider a panniculectomy.

Ideally you should be plateaued for 6 months before having plastic surgery (note that I say"plateaued" not "at goal" because many will never reach goal without plastic surgery). This means that you should start seeing plastic surgeons much earlier. I think that when you get within 30 pounds of goal, or see your weight loss slowing down, yo should start making appointments. A LBL is the biggest surgery and the recovery can take up tp 8 weeks - this means 1 week feeling lousey, 2 weeks feeling sore and maybe still having some drains, feeling much better at 3-4 weeks (but tired), begin exercise by walking at 4-6 weeks, and back at the gym (without heavy lifting at 6 weeks)....ths is just a guideline and depends on your recovery and your ps. A breast reduction/lift is a much smaller procedure and if done alone, you should be cleared to go to the gym in 4 weeks (with a supportive bra).