Dr. Schulman

In general, implants below the muscle have a slightly lower incidence of complications - infection and capsular contracture. The decision about over/under has to do with many factors that only you and your doctor know. You shold ask your ps why not under, and see if his/her answer makes sense to you. Brachioplasty is best for hanging skin. In some popel with "fat" arms, a staged procedure (lipo then brachioplasty) will give the best results. Again, this needs to be discussed specificallywith your ps. I am sure that even with a brachioplasty, your result will be significant and you will be happy witht he improvement. The question is "are you looking for just 'better', or are you looking for 'best' "?

Moany people never get to "goal" - the main thing is to wait until your weight loss stops. You have to assumet hat you have about 10-20 pounds on skin....and you may never get to goal. I have many people that have a panniculectomy or tummy tuck before they have completed weight loss. If you want to go for it, than do it. Just keep in mind that you will likley loose more weight and you stomach may sag a little again. The need for a revision surgery at a later date will be high for you - but doesn't meant hat you need to have one. Also, focus on body shape and dress size...not the actual number or your weight.

Non-surgical liposuction (lasers and radiofrequency) has the ability to remove fat and reduce cellulite. Studies show that after a series of treatmetents, people can lose 1-3 inches from the torso. If yo have lost siginificant weight and have moderate to severe excess skin, than this may give you only a limtited improvement. If you only need slight improvement or will be satisfied with a few inch reduction, then give it a try.

I recommend a supportive bra, but not a compression bra. Compression may compromise blood flow and may also force the implant into an unnatural position. I suggest a comfortable, cotton bra (without underwire) or a sprots bra that is not too tight. This shold be worn for a minimum of 4 weeks.

In general, 15830 will reimburse about $1800 - $2500 (obviously this varies among insurance providers, but this should give you a "ballpark" idea). It is possible that this will go towards you deductible and you will only get a small amount of reimbursement. Your PS office should have been able to give you an idea about this amount, because they have probably experienced this before.

I do have some panniculectomy pictures on my website, and while the results are not as good as a TT, I think they show a good improvement. It is just the nature of the procedure. You certainly should not "look worse" assuming you chose a good plastic surgeon! You need to find a plastic surgeon who takes great pride in his or her work...even if it is "just a panniculectomy."

There are many reasons to "platueau", and it is impossible to guess why. It probably has more to do with your body and your metabolism "set-point." If there is a nutritionist that follows you, he or she is best to answer this. If you are not followed by a nutritionist, you should strongly consider seeing one.

This is an approach that works well. It allows me to aggressively remove fat and then 6 months later the excess skin is removed. Doing it in separate procedures has the advantage of allowing more aggressive liposuction.

Latisse is safe and it works. It usually takes about 6 weeks to see results and yes, you must use it forever. If you stop, the growth will stop. It is a medicine that is used to treat glaucoma. The side-effect was increased hair growth, but it does not seem to work on the head. Some people are using it off-label to promote eyelash growth, but there is no data to support this use. You can read about it at LATISSE™ Home | LATISSE™ — the first and only FDA-approved lash treatment

It is all about managing expectations. The recovery from a thigh lift is painful, but mostly because the area is sensitive and you will feel sore everytime you move - even laying on a couch or in bed can "hurt". The pain only seems to be a problem in people who did not expect it to hurt at all. Expect it to hurt, and you won't be surprised. The improvement can be significant, but you will not get super skinny, well-defined inner thighs. If you are not expecting this, then you will not be disappointed. The scars can be hidden in the groin crease, but sometimes need to extend down the inner thigh. You should all know my mantra by now - "the more you are willing to expect in terms of scarring, the better shape and contour you can get." Revisions are common, but not anymore common then the other procedures. The above information relates to only my patients and my practice, and I cannot comment about why other people, with other surgeons, have expressed being unhappy with results.

Hopefully you will all be attending the 2009 LapBand Conference in New York, March 20-21. It is going to be a great event with very experienced speakers - nutritionists, psychologists, bariatric surgeon, life coach, and plastic surgeon (ME!). This conference is good for people who are thinking about the band or have already been banded. I hope to see all of you there. I will be offering FREE consultations and 20% discounts on surgery for all who attend. Visit https://www.bandedtogether.net/Events.php for more information and to reserve your spot.

Dr. Schulman discusses the stigma of obesity. In this article, "Obesity Stigma - a heavy burden", Dr. Schulman addresses society's bias against obese individuals. This bias affects many aspects of an obese person's life. In fact, the damage can be so deep-rooted, that they are still affected long after the weight is lost. More importantly, Dr. Schulman introduces the idea that this bias exists even among healthcare workers - even those who specifically work with obese individuals. It is important for healthcare professionals to recognize obesity as a disease, and not simply a reflection of being "lazy" or lacking self control. This article appears in the Jan/Feb, 2009 issue of Advance Healthy Aging. The full article can be read in the attachment below. obesity stigma.pdf

Insurance will cover some procedures if it meets the requirements of medical necessity - check with your specific insurance carrier to see what these are because they vary. The PS themselves usually do not finance, but can help you get set up with outside finance companies that specialize in surgical procedures such as care credit, capital one, etc.

This is a short 3 minute video that I put together about body contouring after weight loss. It is not a professional video by any means...but I think it is a nice compilation of before and after pictures. It shows all the procedures that have been discussed on this site...including the hard to find fleur-de-lis tummy tuck! Enjoy. [ame=http://www.youtube.com/watch?v=G1w0ivEfdG8]watch the video[/ame]

An armlift can be combined with a TT, but I would advise doing the LBL alone because it is the largest of the procedures.

I think you are right that there is a deficiency in this area. There are some books about breast reconstruction from a patient's perspective, but I do not think there is any about body contoring after weight loss from a patient's perspective. I think you would be great at this, and I am certainly willing to be involved as well.

You should ask your surgeon about this because every surgeon is different about when certain activites shold be resumed. At 2 weeks after a belt lipectomy, you make still have a drain, and your incision will still be in the early stages of healing. For my patients, pools and hot tubs are a no-no this soon after surgery. It may be closer to 4 weeks before you are able to be in a pool, and even longer in a hot tub (hot tubs have risks of infection, burns, and the "soaking" can really affect your healing)

a LBL usually runs about 50% more than a TT - but this can vary between surgeons. While many procedures can be combined, I would not recommend performing a LBL and a brachioplasty at the same time...it is way too much surgery. It is possible to "split" the LBL into a TT and a "back side". In this case, a brachioplasty can be combined with either the front half or back half. Most PS (myself included) do give significant discounts when procedures are combined.

Estimating how many grams will be removed is quite difficult, even for your surgeon. It is basically a guessing game and depends on how dense your breast tissue is. Sometimes I remove a large amount and am surprised how little it weighs because it is mostly fat, and fat does not weight as much as breast tissue. Also, keep in mind that pre-authorization is not a promise to pay. Even if the insurance company says they will pay, they still wait until after the surgery to go over the operative report and the weights, and then decide (usually to not pay!). So, your PS can tell them he will remove 700g and they agree, and if he actually removes only 600g, they will turn around and deny it. This is why many PS have decided not to deal with insurance companies - they are very difficult and constantly change the requirements without notice. There are some calculations that the insurance company uses to determine the amoutn of breast tissue required for removal based on your weight, height, and breast size. This may be how they came up with "700 g". The other thing to help your case would be a orthopedic or chiropractric note detailing any back problems. Sometimes xrays are done that show abnormal curvature of the spine related to the weight of the breast.

I do not have experience with Genesis. YAG has been used for pigment for many years and recently gained popularity for skin tightening. I am not sure how well it works, to be honest. There are no good long term studies. Fraxel and CO2 are great for resurfacing, but have limited improvement on skin tightening. Personally, I have gotten great results with a radiofrequency based system (ReFirme) for skin tightening - 3 treatments, 6 weeks apart - combined with a TCA peel for resurfacing. There are many different treatment options. I do not think that lasers harm the skin long term - I think the major downside is that they just may not work and can be quite expensive.

Before and After photos are a good starting point, but there is much more to it. If both are well-respected and well-credentialed, then see how the consultations go. My bet is that after meeting with both of them, the choice should be easy - I am sure that you will "click" with one of the docs, moreso than the other.

It is hard to tell from a picture, but this "angry" appearance is usually how it looks right after surgery and gets better for the first week or two. The fact that it was better, and now is looking worse gives the impression that there may be an infection - probably not terrible but may need some oral antibiotics. In the meantime, put bacitracin on it and open a 4x4 gauze and put it in the belly button. If it get more red or begind to drain pus over the next day or tow, make sure your PS looks at it. Check to make sure you do not develop a fever. Don't panic....you may need antibiotics but is usually not a big deal.

I agree that you and your PS should keep a close eye on this. This may be the first sign of an infection. Any collections will try to come out of any opening like a small hole in the incision or the belly button. Pay particular attention to any "fullness" or "bogginess" of your abdomen.

The chances of this happening are very low if you wait long enough before having a revision. Waiting 9-12 months will allow the vascularity of the area to improve. Scars will also continue to contract, making the area that you don't like get smaller over time and require less of a revision. If your surgeon uses care during the revision and avoids injuring the remaining blood supply, you should be fine. I know you hate the area, but don't rush into things.

Small areas that hela more slowly is quite common - in fact, about 25% of people have these "nuisance" complications. The best way to make it heal quicker is to keep your nutrition maximized, particularly the Protein. I would avoid using betadine unless it is very very dilute - 1/10 betadine to 9/10 Water. Betadine can be toxic to healing tissue and actually slow the healing process. Same thing with peroxide. The areas may be a reaction to some sutures underneath the area.