Dr. Schulman

I look foward to seeing you soon. In addition to choosing a surgeon who is "qualified", it is also important to find one that feels "right". Thanks for the kind words about my office staff.... I will pass along the compliment. The staff is an important part as well because many patients spend just as much (if not more) time interacting with the staff as compared with the surgeon.

An abdominoplasty is an abdominoplasty. Insurance never ever approves an abdominoplasty because it is always cosmetic. Most likely your insurance approved a panniuclectomy due to medical necessity (just removal of skin). The insurance reimbursement will be for a medically necessary panniculectomy and may be between 1500 and 2000 dollars. If your surgeon did an abdominoplasty (which includes tightening of the muscle and relocation of the belly button) than he likely did it for "free" - meaning that he did extra work and did not get any extra reimbursement. Because it sometimes takes 3-6 months to receive insurance payment, he most likely does not know yet that he did it for "free." Even is he got "pre-authorization" from your insurance company before the surgery, this is not a "promise to pay." Unfortunately I have been down this road many times. I cannot second guess the quality of your surgeon's work. I cannot jump to the conclusion that your surgeon took any shortcuts during the tummy tuck because he knew there was a good chance he would not get an payment for it. So to answer your question, no - the case should be handled the same way. Surgeons must take pride in their work and produce the best possible results, no matter how much (or how little ) they are getting paid for it. No professional should knowingly put out a sub-standard product. I am interested in knowing whether your surgeon really did get paid for a TT - like I said, I am willing to bet that he got paid only for procedure code panniculectomy..... You can easily get this information by requesting a copy of the EOB (explanation of benefits) from your insurance company. You are entitled to see what your surgeon billed, and what your insurance company paid.

Excess skin pulling on the port is a very common source of pain. In rare instances, it may cause slippage of the band or malfunction of the port. This issue should certainly be addressed. You basically have 2 options: 1) revision of the port. The port can be moced to a higher position so that there is no more pulling. This is the simplest approach and can be done by your bariatric surgeon. 2) panniculectomy. This would remove the excess skin, and should be covered by your insurance. Even if you have a panniculectomy, you will almost certainly need the port moved, or the "pulling" can get even worse. A tummy tuck can be done, but this is a larger procedure with more pain and more recovery. Also, insurance will not cover the added cost of a TT because it is always cosmetic (as compared to a reconstructive panniculectomy). Also, you should wait until your weight loss is stabilized before going throug a TT. Keep us posted about what your PS says.

There are no real tricks to picking th right implant size. The key is to try on the sizers and see how you feel. Some docs will let you borrow the sizers for a few days and you can take them for a "test drive" - go to dinner, take a walk, wear them to work, etc, to see how you feel and see how people react. If you can't borrow the sizers, you can fill a baggie with dry rice and wear them the same way. Regarding the port, it is not always necessary to move it. It is best that it be moved if it needs to be in order to get the best cosmetic result, rather than having a sub-optimal result. Your PS should be able to "figure it out" because it is the same port that is used in other things that he is used to (like some breast implants). He should have a bariatric surgeon available, just in case something bad happens to the port and he needs help.

There is a procedure called a "reverse Tummy Tuck" where the skin resection is from the top. The scar is within the breast crease. It is not common, but is done for people who only need tightening above the belly button.

If the video does not play, it may be because of a restriction on your computer (especially if you are using a work computer - not that anyone does that). You should not have trouble viewing the video on my website - www.drschulmanafterweightloss.com

Glad to hear that! Go for it....just keep us posted on how you do.

I think you ahve a good understanding of this and combining a mini with an open hernia repair is a good plan. You may not "need" it, but you already have a scar there, and you do have s small amount of skin laxity. Besides, while a laparascopic hernia repair is common now, doing it open allows them to really see the hole and fix it from the inside and outside. I am not sure who is planning on doing this - ps or the surgeon ding the hernia repair? This is a simple procedure for a ps, but a general surgeon may not be able to (or willing to) just "remove a crescent of skin" and give you as nice a result as you are expecting. There are a lot of "tricks of the trade" that we do during a mini TT, and often there is a lot of work under the skin, even though the incision is small. All these things add up (hopefully) to a discrete scar and flat lower abdomen. We want want we do to "appear" simple, when it is really not. I am sure you can find a ps willing to do this for you at the same time as your hernia repair - it is actually very common to do this. Obviously, I strongly advice against having a non-ps perform any cosmetic procedure on you. I would never remove a gallbladder (even though I was trained in general surgery first and can probabably still do it) and I would hope that a general surgeon would never do a tummy tuck (even a mini).

Usually drains remain until there is about 30cc or less per 24 hours. After a LBL, the drains can remain up to 3 weeks. The color is usually tea-colores or clear yellow. Dark color may mean that there is blood - old bleeding or new bleeding. I recommend discussing this with your plastic surgeon to make sure there is nothing that needs addressing. I understand the surgery was done a distance away, but you should at least be able to speak to your ps on the phone. He may ask you to come see him. I know this may be a huge inconvenience, but as has been discussed in the past, this is the major reason why people should really understand what is involved with traveling out of the country for surgery - the prices are less, and usually the surgery goes well, but sometimes you can develop small (or major) complications that need to be dealt with by your ps.

Arms and breasts can be combined into one operation if you are willing to go through a larger recovery process. I don't think it is "too much" in terms of recovery, but combining arms with anything is difficult because you will need to use your arms to take care of your breasts (change dressings, bathe, etc.) The prices vary. In general, armlifts will run about 6,000-8,000 and breast lift (with implants will run about the same. You may have to pay an additional fee depending on whether you choose silicone or saline (silicone is about 1000 more). Combining these procedures should save you money but that is up to your individual surgeon. Good luck. Make sure you select someone qualified to do this.

Arm swelling after a brachioplasty is common. Watch your salt intake - too much can make the welling worse. Avoid cold cuts, Soups, sauces with salt (barbeque), etc. Also, sometimes wrapping your arm with an ace bandage fromt he fingers to the shulder will help - but make sure to check with your PS before doing this. Generally the swelling takes several weeks to go away, but some people may see swelling that lasts for months.

While I can't comment specifically on your back pain, I would like to point out that it is important for everyone to be able to get in touch with their surgeon at anytime, for any questions...no matter how small they may turn out to be. Patients should always be given a pager or cell phone of the operating surgeon, or covering physician. Most questions/issues occur in the middle of the night or on weekends. At the very least, your PS should have an answering service that can page him or her. I know this doesn't really help you at this moment, but everyone reading this should know this and make sure they discuss this with the surgeon ahed of time. This is another important criteria for selecting your surgeon.

While my interaction with Dr. Davis only consists of a few phone conversations, I have operated on several of his patients after they lost weight. All these patients have had nothing but positve things to say about him and his staff. I also agree that his entire bariatric team is very professional as well. I have met most of them, because I have spoken at several of his support groups at both Valley Hospital and Lawrence Hospital.

I think in this situation, lipolite may be a good option. While it is not the best option for primary liposuction in post bariatric patients, it works pretty well in secondary (revision) cases (it is really good at breaking up the scar tissue that develops after regular liposuction), and also for those small "problem" areas. The skin may not respond as well as in non-bariatric people, but you should see some improvement. It is all about realistic goals -which I know you have!

Regarding your neck, there are several options aside from a necklift and lower facelift (which, when done correctly by a skilled surgeon, should NEVER look overdone). The double chin may be due to a combination of weak chin, excess fat, and loose skin. Sometimes liposuction of the neck and placement of a chin implant can really improve the appearance of your neck, without a full necklift. Lower face jowling can be helped wtih fillers and skin tightening lasers. There are many many options for you. Pseudoptosis can be corrected by removing a wedge of tissue from the lower breast. This will help the shape of the breast, but will not do anything for upper pole fullness. For that, you will need placement of a small implant.

LipoLite is similar to smartlipo, from a different company, and using more advanced technology (my experience is that is is better than smartlipo). You are partly correct about how I feel about smart lipo (or any of the laser lipo technologies). It is a good procedure in very select individuals. I do not think it is good in the post weight loss population because the improvement will be limited and most people will be disappointed (especially given that it can be more expensive than traditional lipo). This is why it was not mentioned in my bariatric newsletter. Body contouring after weight loss is so specialized - many of the techniques and procedures that I do in my regular cosmetic patients do not always apply. This is why I have 2 separate newsletters and each features different information. The LipoLite was featured in the cosmetic newsletter, but not in the post bariatric newsletter.

Your questions are not rudimetary at all! Most people ask abotu specific procedures, but choosing the right surgeon is even more important. First, make sure your PS is trained appropriately (look at where they went to medical school, and where they did there residency and fellowship). Next, make sure they are board certified (IN PLASTIC SURGERY). Don't be fooled by doctors that say "board certified in cosmeticd surgery" - this means nothing. In fact, anyone can get a certificate stating that they are board certified in cosmetic surgery simply by applying. Make sure your PS is a member of ASPS (American Society of Plastic Surgeons). These are the basics. Next, the best way to chose your surgeon is through referrals from otehr doctors and patients. Ask around. Ask your bariatric surgeon who they like, ask the other people in your support groups. Don't be embarrassed to ask others - I am sure you are realizing by now how common plastic surgery is, so no one will judge you for asking about it. Other bariatric patients will be much less judgemental. You should plan on getting several consultations to see who you "click" with. Don't skimp on consultations because of the money. It is well worth it. Also, you should look for a good price for the surgery, but remember you often get what you pay for. Many surgeons will raise their prices as they get more experience. Don't overpay, but sometimes there is a reason for such low prices. Ask to see pictures, ask about how often these procedures are done (not just how many you have done, because it is more accurate if they say they do this 5 times a months rather than say "I've done hundreds"). Regarding pics on websites - there are rules for PS who are members of ASPS that include the understanding that all pictures msut be un-retouched, and be the doctor's actual patients...unless specifically marked otherwise. This relates to the ASPS code of ethics and truth in advertising. A PS who is not an ASPS member does not have to abide by these standards! Lastly, if requested, your PS should be able to provide you with a name and number of a patient who had a similare procedures so that you can speak with them about their experience. As I said before, make sure your PS specializes in bariatric patients....it is truly a specialized area of PS. I hope this helps.

Scar migration is always a concern with a medial thigh lift. Ideally, the scar should be hidden in the groin crease (there also may be a vertical scar). Your surgeon should be familiar with techniques to minimize migration. This includes deep sutures to the periosteum of the pubic bone - this helps minimize migrations. This is also what causes so much pain after the surgery, but it is worth it! Discuss this with your PS beforehand. It is fairly common for me to see people who have had this operation elsewhere and are unhappy about 6 months later whent he scar migrates out of the crease.

That area is called the mons, and a lift/reduction of the area is a monsplasty. This is usually done at the time of a TT. You will have to check with yor particular PS about whether a monsplasty is considered part of the TT. Some PS consider it to be an essential part of a TT and do not charge extra, and others will do it at the same time for an additional fee.

It is possible that the weight loss will make your breast sag more than usual - this is due to the weight of the breast implants which will hang down. Also, you can't really tell where the implants are sitting based on the MRI. The MRI is taken withyou laying on your back and the implants are designed to move around. It is better to see where they are when you are standing up - it is possible that they are inthe same location. Breast asymmetry is actually very common. I suspect the larger breast was always a tiny bit bigger, but as you gained weight, the asymmetry got more pronounced. This may improve with your weight loss. It is possible though that there is some implant asymmetry that may need to be fixed at some point down the road.

It is always best to lose all your weight before undergoing body contouring procedures. That being said, it is not always realistic given the pain/rashes/etc. Usually insurance determinations are based on the amount of breast tissue removed (check with your specific carrier). Also, many times the insurance will deny a reduction, BEFORE you lose significant weight. This is because they argue the symptoms of breast pain/back pain should be improved with weight loss. I would wait this out as long as possible.

I agree with Dr. LoMonaco's post 100%. While there are many capable surgeons in Mexico (and many success stories), there are also complications. Many of these complications don't surface until weeks after the surgery...when you are already home. One of the main reasons why the prices are significantly cheaper than in the US is because the surgeon does not have to perform any follow-up care. Frequent visits during the first few weeks and months is necessary to make sure you heal safely. Unfortunately, it is all too common for me to be called to the emergency room to help someone who has a complication after plastic surgery in another country. Complications can add significant expense and actually make your "cheap" surgery much more expensive than if you had it done in this country. I completely understand the need to find a more inexpensive surgeon, but be careful where you cut costs - your safety should be priority number one!

Is it possible for your mother to stay with you in NY during your recovery? This might solve many of your problems. Traveling for the surgery is certainly an option, but you are correct in your concern about possible complications and distance from your surgeon. You will also need periodic follow up months after your surgery. Remember, your health and safety should be your top priority.

Insurance will not pay for a TT, because it is entirely cosmetic. There may be some advantage to getting it done at the same time. You only have to recover from one surgery. Also, insurance may pay for you to stay overnight in the hospital because an overnight stay is customary with a fibroid removal. It is common for people to elect to have cosmetic surgery at the same times as another procedure, but it does not absolve you of any obligation to pay.

I doesn't matter too much. I usually suggest a champion brand - they are relatively inexpensive, comfortable, and have velcro or zipper in the front. You may want to pick up a few, because they may get dirty from leaking, blood, etc. For the same reason, I would avoid white color!