Dr. Schulman

That is great news! I am glad things are looking better for you. They have a very competent group of residents and you will be in good hands. There may be a several month wait from this point to get an OR date, so keep being patient. Keep us posted.

I was a guest on a radio show Monday, and I specifically discussed body contouring after weight loss. It was an interesting interview and you may find it useful (or at least, interesting). You can listen to it online, or it can be downloaded as a podcast. I hope you enjoy it! Here is the link.

The data is complete and the efficacy has been established. In fact, there are now several companies that market LED technology (it was my associate who did the original research for this technology). Basically, we use visible light for different purposes - Red light stimulates collagen and also is anti-inflammatory (I use the red light on myself to help reduce muscle soreness), and blue light is anti-bacterial and is used to treat acne. It is a painless, visible light. There are many plastic surgeons and dermatologists using this technology - you just have to ask for LED (light emitting diodes). This is not to be confused with IPL (intense pulsed light) which is very different, although based on a similar premise.

The operations are similar for men, but the technique varies a slight bit. Men commonly undergo TT or LBL, as well as chest reduction. The thighs are usually less an issue in men as compared to women because men tend to have the excess skin above the waist. It is important to have your PS with a doc who is experienced working on men who have lost weight. This is because it is important to preserve the "male" shape. You see how women complain about not having a waist, or not having a butt after LBL...well, that is exactly the way we want it to look on a man. So, you can see the techniques are slightly different.

I have never seen a true "foreing body reaction" to drains. This is because the drains are veny inert and are designed not to be reactive. Also, they are in for too short a time (1-3 weeks) to really cause a problem. Sometimes people have a reacion at the skin, where the drain exits. This may become very sensitive and may bleed easily - but this gets better almost immediately after the drain is removed. The more likely cause of an internal FB reaction is the sutures - especially permanent sutures. This may be cause hard lumps and tenderness over the sutures.

I have not heard specifically about Dermatix, but it appears to be a silicone base, which should work well.

A lower blepahroplasty can remove the bags. Sometimes the "blue" is shadowing from the bags, and it will improve after the bags are removed. Sometimes it is staining of the skin, and will require a chemical peel, which can be done at the same time. Sometimes, it is jsut the color of the muscle underneath showing through because the skin is so thin. Here is a lower blepharoplasty

There is no such thing as "bariatric certified." What you want is a PS experienced in post-bariatric patients. Ask our bariatric surgeon who they refer to for this. You can look at American Society of Bariatric Plastic Surgeons (www.asbps.org) - this will list PS in your area that concentrate on this area. Also, check obesity help (www.obesityhelp.com) - this site has a listing or doctors and patient reviews. It is a great site. Next, when you make an appointment, ask if the dr does a lot of weight loss patients. If the person answering the phone is confused, then the answer is probably "no". In consultation, make sure to ask for pictures of similar patients. They should be able to show you pics if it is an area they specialize in. Do your homework. This is a very specialized area of plastic surgery.

First, let me say that it is never "too early" - this is why I discuss plastic surgery with pre-op bariatric support groups! That being said, you should begin consults when you are getting close to goal. You should be at goal for at least a few months before having a TT, but it takes several months to get an OR date, do necessary paperwork, get medical clearance, save money, etc. So....if you are 6 months away from the surgery date in your head, I would recommend starting consults soon, so that you can yourself prepared mentally and physically. Plastic Surgeons usually have a few months wait for surgery anyway.

it sounds like you would do great with an upper and lower eyelid surgery. In terms of facial surgeries, eyelids provide the "biggest bang for your buck". It will instantly remove years from your appearance and will get rid of that "tired" appearance. The recovery is relatively well tolerated, except for bruising and swelling that can last up to 2 weeks. I do not think our age makes you "too young" for this surgery. I routinely do this operation on people around 40 (much younger for those with the "inherited" bags), and the fact that you have been banded and lost weight made you more prone to this at a younger age. Here is a link to pictures about these procedures and more information. I look foward to seeing you in NYC - it is nice to visit and you can recover around family, not your friends from home. eyelid surgery

Congratulations! The key is research research research! Your plastic surgeon should be: board certified (in plastic surgery) a member of the American Society of Plastic Surgeons (ASPS) - look on www.plasticsurgery.org for the directory experienced with body contouring after weight loss - this may include being a member of the American Society of Bariatric Plastic Surgeons (ASBPS) affiliated with a major teachng hospital You should start your consulations early, ask for references, and see pictures of results (and not just the good ones!) You may evenhave to travel out of your area to find a qualified plastic surgeon depending on where you live (may I suggest NYC ) I would also recommend signing up for my bariatric newsletter - you will find valuable information that will help inform you!

Liposuction removes fat....not skin. It is true that the skin will "shrink" a little after liposuction, but this occurs even less in people who have been banded. It is likely to make your skin more loose. The better option is to discuss it with your bariatric surgeon. If you are no longer losing weight and are not close to goal, than you may want to discuss the options with your bariatric surgeon.

I use Kelo-cote in my office. It is a silicone gel that drys to a clear coating. It also comes in a spray - which is great for those "hard-to-reach" spots. They have a website and it is reasonably priced. You can tape during the day, and apply the gel at night...or vice-versa. "I have no financial interest in this particular product".

I have 3 words regarding Mederma....."Save Your Money" I have nothing against it specifically. It jsut doesn't seem to work. The active ingredient is....onion oil! There are no good studies that show that it does anything to help scars. Studies show that only 2 things can help scars (decrease redness, and flatten them) - silicone and compression. You can buy silicone sheets which can be taped to the scar. The problem is that it needs to be worn for about 23 hours a day (only off for showering) and can be awkward to wear. There are many gels taht contain silicone and can be applied - just search on the internet for a silicone scar gel. Also, compression works - this is why many people notice that the scars are best in areas that are compressed by bra straps, underwear bands, etc. So, my secret of the day is......tape! Just go and get a roll of the paper white tape that your PS uses. Tape over the scar and keep it on as much as possible. You will notice that this makes the greatest improvement. I have my patients tape for 2 months, starting about 2 weeks after surgery when the incision is healed. Maybe one day there will something better, but tape has always worked the best!

Technically, it is a separate procedure called a monsplasty, or mons lift. In my practice, I usually improve the area during a panniculectomy, without calling it another procedure (or charging for it). Most people get significant improvement with "lifting" the area which is easy to do at the same time as a panniculectomy or TT. If someone needs more extensive repair to the area, it may also include an incision in each groin crease - it that case I will charge a small fee. Improvement in that area can also be done at the same time as an inner thigh lift. So, in a very long-winded answer (why do my posts get longer as I get more tired?) YES, you are right that the area can look worse after a panni if something is not done, and the procedure is a "monsplasty."

All the pictures on my website are from my patients. Some of the procedures were performed with my associate assisting me. For the larger procedures, there is an advantage of operating with another surgeon (less OR time, better results because I am less "fatigued", and less cost to you - because you pay for anesthesia by the hour). Facial procedures can be done at the same time. It really depends on what you need. I do avoid doing other procedures at the same time as a LBL becuase a LBL is such a big procedure. But for smaller procedures, it is possible to so necklift, eyelid surgery, etc. Age itself is not a risk factor. I have many 60 year olds who are healthier than some of my 30 year olds. You would need a full medical clearance - blood work, ekg, chest xray - and I will not operate on you if you have any major medical problems......it is not worth risking your health. This is where I tell you that age is only a number.....

One thing i should make clear (because it comes up all the time and is so important) is that it is more important that your weight loss stops than it is that you reach goal. Many people never reach goal, and you are right....the skin weighs alot. On average, I remove anywhere from 10-30 pounds of skin! So you would be correct that 145 is probably pretty close to your "goal" of 130. It makes sense to see a PS at 145. It really depends on when you want surgery - it may take a few months to get an OR date, medical clearance, finances in order, insurance approval (if that is the route you are going), etc. I find that arms do not do well with only lipo.....the slightest looseness of skin will make them look worse. If they don't bother you right now, let them be. You may chose to have something done in the future, but in my opinion, lipo is usually not the way to go. In your case, most of the back/shoulder pain is probably from excess weight (skin) of the back and stomach. I say this becasue you said you are "deflated." Adding breast implants shold not cause discomfort because the size is usually not too large. I guess, in theory, putting in a very large implant can cause shoulder pain - my weight loss patients usually do not want to be so big...that don;t want to go back in that direction. Some of my cosmetic patients do go that big though!

As bad as you want to have the surgery now, you will be happy waiting to December - your result will be much better and your risk of complications will be less. Rapid weight loss right before PS will increase complications - not major life-threatening complications - but smaller, "annoying" complications like wound separation and seromas. It all has to do with nutrition. Your body is already in a state of "malnutrition" from the band itself. This is why it is important to see the nutritionist when you are preparing for PS to test bolood count and Protein level. Multivitamins and high protein diets will be very helpful for the few weeks before PS.

A LBL is the largest of the surgeries. This is one procedure I think should wait to goal (or at leas wait until your weight loss stops). It has a long recovery and is expensive....2 reasons not to want to have to do it again! I am a big advocate of surgery before reaching goal - but only whent he excess skin becomes so problematic that more weight loss would be impossible without surgery. Having a LBL too early will make it very likely that you will have to have a major revision when your weight loss starts again (and yes, it almost always does start again after PS) There is no trick to losing the extra weight before surgery. Rapid weight loss right before a big operation may place you at increased risk for complications - think about how nutritionally depleted you would be, and your body needs the nutrients to heal - this is why many PS prefer that they band is deflated a week or two before, so that you can eat! Discuss with your PS, but my thought is that it might be best for you to hold of on the LBL (maybe consider just a panni). You have a lot invested in your weight loss - don't rush the PS....you will have a much better result if you wait until your body is ready. You shouls be ok with the BL. Your PS should give you an honest answer about waiting - reputable PS should think with their head and not the wallet. more tough love from Dr. S......

Laser lipo (aka "smart lipo") was very very popular about 1 year to 6 months ago. The theory is that it was minimally invasive and the skin tightened. The problem is that it is not "as advertised." The fat still needs to be sucked out, and the skin does not tighten as much as the proponents claim. Basically, it is no different (in my hands) than well performed, careful traditional liposuction. There was a large "gimmick" factor and the company put tons of money into advertising directly to consumers (as opposed to the doctors). It is an incredible example of the power of marketing overriding the power of evicence-based medicine. Most plastic surgeons never started to use laser lipo because they get great results with regular liposuction. The down-and-dirty truth is that the people using laser lipo were the family docs, gynecologists, dermatologists, and podiatrists! As you notice, you hear much less about laser lipo now.....makes you wonder, huh? Believe me, i am all for technological advances, but I am not going to jump on the latest fad until it can be proven safe, and more effective than what I already use. It is only fair to my patients. Regarding the HCG diet, I can't comment too much on it because I only know a little about it. There may be something to it, but the data is not strong enough yet. I get concerned of the side effects. I am also not convinced that the rapid weight loss does not lead to as much loose skin.....seems to defy logic. Either way, I know Dennis and he is an excellent surgeon and physician, so he may be onto something. Time will tell. You had to get me all worked up over laser lipo, didn't you? I should also mention that I do research for several laser companies, so I am definitely openminded about this stuff. I just haven't seen anything that can give a better result than traditional liposuction. And when they say you will be back to work teh day after laser lipo.......yeah, right!

I don't think that he needs to see the card. He should be able to feel where the port is. I fyou have any documentation about rashes, back pain, etc. you should bring it with you because he will need it to include in a letter to your insurance company. Good luck.

A panni only removes the skin that is below the belly button and hanging down. It does not move the belly button or does not tighten the muscle. A TT removes the skin, moves the belly button, and most importantly tightens the muscle. A TT is ALWAYS COSMETIC. Insurance may reimburse for a panni, because of rashes, pain, etc. But insutrance recognizes that a TT is above and beyond what is medically necessary. If insurance will cover a panni, but you opt to have a full TT because the cosmetic outcome is much better, you will be responsible for the difference. Obviously, price varies between surgeons and regions, but the panni reimbursement may be about 25% of the cost of a full TT. I think it is a good idea to wait 3-6 months after reaching goal before having a TT. This will allow your skin to "shrink" as much as possible. As I have stated here many times, some people may be candidates for a panni even before they are at goal if the lose skin is causing significant problems.

I remember from your last question that your abdominal pannus and breasts are causing your discomfort. Sounds like everything you describe supports that you shuld have something done soon, rather than wait for you to reach goal (which we all know won't happen without the skin beign removed...it's the old chicken or the egg question) Your weight loss has essentially plateaued. So you have 2 options as I see it. 1) consider converting your band to a bypass 2)have the excess skin removed now so that you can exercise, feel better about yourself (don't underestimate the motivational power of this) and jump start your weight loss again. Meet with a PS. He or she should be familiar with your situation and be sensitive to your complaints. If they tell you that you should "suck it up and come back when you lose more weight", run away...very quickly. That would be the response of a PS not experienced with working in this area. Like I said earlier, I think you would do great with a breast reduction and panniculectomy at this stage (even though you have more to go). If your search for a PS ever leads you to NYC, make sure you look me up!

Too soon.... When you say "breasts augmented", I assume you mean implants. However, most people after weightloss will also require a breast lift in addition to implants. This is because your breasts will likely sag a little as you lose weight - breast implants alone will only make them bigger, and will not correct the sagging. What you will probably need is called an augmentation mastopexy (lift + implants). The specifics will really depend on how your breasts react to your weight loss. If you want to see a PS, then go ahead...it is never to early to have a consultation, but I suspect he/she will tell you to wait until you are closer to goal. If he/she tells you to go ahead and have it now, without even mentioning that there would be a high liklihood of needing a revisional surgery (and having to pay for it), then I would find another PS immediately.

The 2 things are totally unrelated. A hernia should be fixed, and you should discuss with your surgeon having a lap band and the hernia repaired at the same operation. Depending on the size, the hernia can be repaired laparoscopically. Another alternative is to wait to have the hernia repaired after you lose weight and during your plastic surgery (assuming of course that the hernia is not at risk for strangulation or incarceration....speak to your surgeon about this issue).