Dr. Schulman

The article should be coming out soon. The next issue of the magazine for Jan/Feb should be out any day now, and it is probably in that issue. I will let you know when I hear more. Brachioplasty scars always look bad...at least for the first few months. They are usually red and raised (and "angry looking"). If they are hard, likeyou describe, then it may be a sign that you will develop a hypertrophic scar. Steroid injections work really well and you should ask your PS about this. The injections can be given monthly and usually for only 3 injections. It can really flatten out the scars. In the meantime, massaging is great as well as silicone strips. Some people have a hard time with silicone strips so there are some other products that work well. Silicone scar gels (scarphage, kelocote) are easy to apply (and available without a prescription online) Also, some people have had success with a steroid impregnated tape called cordran tape (need a prescription).

This is a tough situation, but unfortunately it is not uncommon. It can take a long time to completely heal (months). It seems like you have seen some improvement over the past few months, but not a huge amount. It may take a few more months to heal completely. In some cases, we can speed the process up, or even "bypass" the process. To speed things up, you should ask your PS about a negative pressure wound dresing that uses a vacuum to help speed healing. It is called a wound VAC (Vacuum-Assisted Closure). It has been a huge advance in wound healing. Also, hyperbaric oxygen therapy (just like they give to divers with the bends) is also used to help speed healing of wounds. Both these are commonly used so you should not have a problem finding a PS experienced with this. To "bypass" the healing, sometimes a wound can be removed and then closed in one operation. If the skin around the area is mobile, your PS may be able to use that tissue to close the wound. This can be done if there is adequate tissue surrounding it and there is no infection. This can also be done in stages (2 or 3 smaller surgeries) if the wound is too big to close in one operation. I would definitely ask your PS about these things. Topical ointments and creams (like SSD and Dakins) kill bacteria...but they can also kill the cells you need to heal. The result can be very slow healing, like in your case. Good luck. I think you have tried the basic things, with some improvement. Fortunately there are other options for you to think about.

This is very common! You lose weight from your face, as well as your body. The result can be lines, sunken cheeks, or a "tired appearance" that you complain of. There are many fillers that can help you. Some of the newer ones last a year or more. If this really bothers you, you should make an appointment with a PS experienced in non-surgical facail rejuvenation. These fillers can be done for a fraction of the price of surgery.

I think that this is one of the major qualifications. It means that your PS has an excellent CV and actively teaches medical students and residents. This means he has to be current in the field and regularly attends conferences for ongoing education. Major teaching hospitals constantly review qualifications and will take titles away if your PS is not adhering to the standards and requirements of the institution. It is not adequate to just have "privileges" at a hospital - it is better if your PS has an academic position like "professor". This is just another way of ensuring that your PS is qualified - because "unqualified" PS will not be able to get an academic position at a major teaching hospital.

Your surgery should be performed by a PS who is experienced in treating post-bariatric patients. You are right, that a true panniculectomy is not cosmetic - it is reconstructive. This is why insurance will usually cover a protion of the surgery. Post bariatric patients have different health isues, different skin qualities, and need multiple procedures. This is why you need a specialized PS. A general PS can do something as basic as a panniculectomy, but may not be qualified to deal with the unusual complications that often arise. The price for a panniculectomy varies greatly by region. In general the surgeon fee is about 6,000 - 8,000. If your insurance covers this, then they usually contribute somewhere between 1500 and 2500. A breast lift can be around the same, and no insurance contribution (totally cosmetic). These procedures can be done at the same time if your surgeon is experieced combining procedures. The recovery he stated seems appropriate. You can expect to have drains in the abdomen anywhere from 1-2 weeks.

A lower blepharoplasty will remove the excess skin and puffiness from under your eyes. It takes about 1 - 1 1/2 hours and is a relatively easy recovery - aside from swelling and bruising that last 5 days to 2 weeks.

My office is currently putting together my 2009 speaking schedule, so if anyone is part of a support group that would like to have me speak about "plastic surgery after massive weight loss" please let me know. You can contact me on this site, or you can call me at my office. I have probably spoken at many of your groups over the past many years and I appreciate the positive responses and the continued invitations to speak again. This topic continues to be one of the most popular topics among support groups - I think everyone just likes all the before and after pictures! Congratulations on your weight loss and I wish you continued success. Have a great and safe holiday season!

Hello New Yorkers, My office is currently putting together my 2009 speaking schedule, so if anyone is part of a support group that would like to have me speak about "plastic surgery after massive weight loss" please let me know. You can contact me on this site, or you can call me at my office. I have probably spoken at many of your groups over the past many years and I appreciate the positive responses and the continued invitations to speak again. This topic continues to be one of the most popular topics among support groups - I think everyone just likes all the before and after pictures! Congratulations on your weight loss and I wish you continued success. Have a great and safe holiday season!

The National Lap Band Conference is all set up for March 20-21 in New York City. There will be a full day of speakers, including me! I will be presenting on body contouring after massive weight loss and I will also be available for smaller discussion groups where you can ask more specific (and more personal) questions. It should be a great event. For more information about this event and a full list of speakers, check out the events section on Cher's website www.bandedtogether.net I look foward to seeing everyone there. It is taking place right near Laguardia Airport and I think it totally worth the trip if you are coming from out-of-town.

I usually recommend 6 weeks non-stop, then another 4 weeks part-time (about 12hr per day). There is a lot of variation with patients. Some can't stand it and don't wear it, others can leave home without it. I think the longer the better but probably no benefit after 3 months. It will keep the swelling done and make the swelling last shorter, but won't really affect overall result.

There is no problem doing this surgery on someone over 200 lbs - as long as your health is good and there is no contraindication for anesthesia. A TT (anchor) can be done at the same time as a breast lift as long as you are motivated and your surgeon is experienced in this. I think that "one or two weeks" is a bit optimistic. You may have drains for anywhere from 1-3 weeks, depending ont he output. I have some patients go back to work at 2 weeks, but they are still going to be tired - it takes your body a long time to heal itself on the inside. Also, you may lose a decent amount of blood, so your blood count will be low and this will take a few weeks to get back to a normal level. I think it will take you longer to recover. Here are some links to picutres of anchor TT that I have done: "Tummy Tuck" or Abdominoplasty after weight loss | Madison Avenue Plastic Surgery "Lower Body Lift" | Madison Avenue Plastic Surgery

There is only a social stigma because of the poorly done facelifts of the 1980s - too tight, and "wind-swept". A well done facelift results in a natural, youthful appearance that will only make people talk about you because they are jealous! Here is my golden tip......try this one at home.......lay flat on you back and look at your face with a hand held mirror. What you see is what you should expect from a well done facelift! Notice how your cheeks are higher and fuller, and your jawline and neck are well defined. But, there is no overpulling of the skin of the face. I do this with everyone of my facelift patients in consultations and I think it is one of the most powerful ways to illustrate modern facelift techniques.

Thermage works to tighten the skin, without doing much to the fine lines or wrinkles themselves. I find that Thermage is effective - and by tightening the skin, the lines smooth out. But, I do not agree with Thermage's claim that it only takes 1 treatment. Overall, the improvement is less than they show in the impressive photos. The skin always looks tighter for a time afterwards, than it relaxes a bit. This may be what you are seeing. Also, dehydration will make the lines much more obvious. It is possible that after your surgery you have been a bit dehydrated (which is really common) and this may be the reason things look worse. Regarding CO2 and Fraxel - These are better for the lines, but will not really tighten the skin. CO2 is the gold standard but requires significant downtime. This is why many companies have developed fractionated systems - less downtime, but need multiple treatments for maybe a little less result. These are also expensive. Fraxel costs about 1500 per session and most people need 3-5 sessions total. CO2 laser also has a tendency to make the skin look a bit "waxy" or have a wierd shine to it. It is also obvious where the laser stopped, such as along the jawline. New lasers are always coming out, so I caution against jumping on the "next great thing." I think all of them give some improvement, but I am not sure if we are there yet. Still nothing beats a facelift for tightening the skin and getting rid of lines.

It is fairly standard to have to do something to the port during plastic surgery - this "something" may be moving the port which may be in the way during a tummy tuck and/or changing the port to a low-profile one because the high profile ports that most people have placed originally may become more visible/palpable as you lose weight. You should be sure to chose a plastic surgeon who is experienced with lap-band patients and he/she is usually fine changing the port themselves. If not, make sure your PS can arrange for a bariatric surgeon to help in the operating room during this portion of the procedure.

it is really onlynecessary to massage scars if they get firm and raised. If they are healing normally (flat) there is nothing that you need to do. They will remain red for many many months. Regarding the oils, there is no scientific data that it helps. But, it won't hurt so you can if you want to. Most likely, it may help because it is moisturizing, not because of any specific essential oil. That beign said, I have many patients who swear by cocoa butter and who am I to say don't do it. I usually recommend a scar gel that has silicone in it. There are a few on the market and I am not sure if one is better than another. I usually use kelocote in my office, which has silicone and a steroid. It dries in a really thin clear coating. People seem to like it. You can find it on the internet. (I should mention that I have no financial interest in the company or the product!)

Patty, I am sorry this have turned out to be such a bad experience. Many PS have "rules" about not operating on people with BMIs above arond 32. This is because the risk of complications dramatically increases. It is not uncommon to then suggest a revison bariatric surgery, such as conversion of a band to bypass. I have had this same conversation with several patients. The problem with this "rule" is that is fails to recognize the specific situation of each individual. This is where the "art" of plastic surgery comes in. The fact that you are having so much pain makes you an candidate for a panniculectomy. You have a higher risk for complications - usually not serious ones, but more like wound healing problems, fluid buildup, etc. I like to call these "nuisance" complications. Having the surgery will take a compromise on both you and your surgeon. You have to accept the increased risk of complications, and the surgeon has to be able to perform a panniculectomy in an efficient manner in order to limit anesthesia time and minimize risks. This may mean that you will have a slightly less than perfect cosmetic result - but that is ok because this is not a cosmetic procedure in your situation. Don't be discouraged, and keep looking. Try looking on obesityhelp.com for surgeons (they have listings by states and patient reviews). Also, you can look on the american society of bariatric plastic surgeons (www.asbps.org) for a listing. When you think you have a few names, have your primary doc (or bariatric surgeon) call the doctor BEFORE you see them, and explain your situation and your necessity for a panniculectomy. You can then choose the PS who seems most "open" to operating on you. Good luck, and continue to keep us posted.

The surgery can take about 3-4 hours. I use a combination of sutures and staples. The staples are only placed in areas covered by hair. I understand not wanting to travel for the follow-up. Most of my out-of town patients stay overnight after surgery in a local hotel and then will be seen by me the day after surgery. They are then seen 5 or 6 days later to get the sutures out, and then again the next week. After that, no followup is needed for a few weeks.

I am really happy for you. All your persistence paid off. A panniculectomy is an easier recovery than a TT because there is no muscle repair. Obviously, everyone has a different pain threshold, but I suspect you will be surprised by how little pain you will feel. I tell people that they will feel lousy for a few days and then pretty good in 2 weeks. You should expect drains (probably 2) and they usually remain about a week. You should make sure that your PS gives you all your prescriptions in advance so that you do not have to get them after the surgery. Congratulations and good luck. I know you will do great!

Thank you for the kind words. I can't take all the credit for your great results - you had a lot to do with it also. I will see you soon.

Scar adhesions are common and they can cause pain. Insurance will usually cover the procedure (which is relatively minor and can be done under local anesthesia in an office) if there is pain involved. I don't think that you will have a tough time getting it covered, but you never know. The prices will vary, but a ballpark fee of 1000-2500 is reasonable - just a guess, because it obviously depends on a bunch of other factors like size, etc.

Patty, I am not entirely clear about waht you are asking. I think that you have lost a significant amount of weight - even though you are still well shot of your goal. The fact that you are experiencing back problems is likely due to your pannus - or at least exacerbated by it. There may be some truth that the weight loss re-districuted the weight and now you have back issues. Either way, I think that removal of this pannus is indicated and will probably help your back symptoms. You should look into a panniculectomy, knowing that you will need a formal TT when you are at goal. You should find a PS experienced in this. The fact that your PS has said that he has done 30 patients and ALL had problems is very hard to believe - this is a 100% morbidity rate, and probably exagerated because he wants to disuade you from having it done. If this complication rate is true, than you don't want him to operate on you anyway! Hope this helps. Again, I was not sure of what you were specifically asking, because I think we both know that a panniculectomy is what you need to help your back pain.

There has been some success with lasers for stretch marks. Fraxel works by resurfacing the skin and blending in the stretch marks. It works fairly well, but requires multiple treatments. It costs anywhere from about $500 to $1500 per treament, depending on the amount of area. There are some UV Light machines that claim to help white stretch marks by giving them color - beware of this technology because it uses concentrated UV light to "tan" the skin - like a very concentrated tanning booth.The concern for future skin cancer is a legitimate one!

Redness is common and often occurs a few months after the surgery - this is because the scar is "maturing". A scar gel may help. Usually those products help withe raised and thickened scars, and do nothing to help reduce redness - but it is not too late to try it. The redness usually fades. One thing that does make the redness worse (and last longer) is sunshine. So make sure to keep sunscreen on the scars while they are healing - even in the cold, because the UV rays can penetrate some clothing. After about a year, if there is still redness, you might consider a laser treatment (YAG laser) to help get the red out.

This is very common and it is because of using different muscles of your back. Your back was used to large breasts pulling and now the weight is removed. Ask your doctor for the name of a physical therapist who can help you with stretching and strengthening exercises for your back.

It is basically impossible to predict how your skin will respond to weight loss. The possibility of excess skin should not determine whether or not you have bariatric surgery. The most important thing is your health, and no one can dispute the effects of obesity and obesity-related illness. I am sure that others will agree that your friend should be more supportive of your needs.