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**sorry this one's a long one!!!!** Hello everybody, I had an appt with my doctor a few days ago for follow up on my bloodwork and ultrasound on my gallbladder because she thought I might have needed to get my gallbladder removed. Turns out all my labs were perfect, no gallbladder problems but I did have a little bit of a higher cholestoral and I found out that I also have Fatty Liver [emoji45][emoji45] we discussed how it happens and how you treat it and basically... She said I have to lose weight. I finally brought up weight loss surgery to her. She wrote down everything she could to try to get me to get approved. She wrote down how long I've tried diets, what diets I've tried, morbid obesity (she said if she just out obesity it wouldn't get approved), body pains, asthma, etc and she put in a referral for surgery. Since I have medi-cal I guess the referral goes to a referall center then it goes to the bariatric surgeon or bariatric program or something like that and I'm supposed to hear a call back within two weeks. My doctor said the program is going to take 3-4 months and that I can't do it through her, I have to do it through the bariatric office I guess. Like my nutrition appointments and things like that can't be through my personal doctors office. Anyways, I am super excited and hoping I get good news soon! On a side note the bariatric office/surgeon that the people in my county get reffered to (I'm in the central Valley of CA btw) has horrible reviews and someone who went to him is dealing with horrible complications. I do not want that to be me... Is there anyway that I can go to a different county to get surgery but still have it covered by medi-cal? If that place is my only option then I will hold off on surgery until I move or until I can pay out of pocket I guess [emoji45]🤦🏻‍♀️ If anyone has any info that would be great, thanks so much.

**sorry this one's a long one!!!!** Hello everybody, I had an appt with my doctor a few days ago for follow up on my bloodwork and ultrasound on my gallbladder because she thought I might have needed to get my gallbladder removed. Turns out all my labs were perfect, no gallbladder problems but I did have a little bit of a higher cholestoral and I found out that I also have Fatty Liver [emoji45][emoji45] we discussed how it happens and how you treat it and basically... She said I have to lose weight. I finally brought up weight loss surgery to her. She wrote down everything she could to try to get me to get approved. She wrote down how long I've tried diets, what diets I've tried, morbid obesity (she said if she just out obesity it wouldn't get approved), body pains, asthma, etc and she put in a referral for surgery. Since I have medi-cal I guess the referral goes to a referall center then it goes to the bariatric surgeon or bariatric program or something like that and I'm supposed to hear a call back within two weeks. My doctor said the program is going to take 3-4 months and that I can't do it through her, I have to do it through the bariatric office I guess. Like my nutrition appointments and things like that can't be through my personal doctors office. Anyways, I am super excited and hoping I get good news soon! On a side note the bariatric office/surgeon that the people in my county get reffered to (I'm in the central Valley of CA btw) has horrible reviews and someone who went to him is dealing with horrible complications. I do not want that to be me... Is there anyway that I can go to a different county to get surgery but still have it covered by medi-cal? If that place is my only option then I will hold off on surgery until I move or until I can pay out of pocket I guess [emoji45]🤦🏻‍♀️ If anyone has any info that would be great, thanks so much.

It’s wasn’t the pain for me, I actually had very little pain/complications. It was just the fatigue that followed. It took me a good 4-6 weeks to get my energy back. Maybe it was just me though 🤷🏼‍♀️

I have surgery planned on 12/12 and I put in to have off work until 12/18 so 6 days, but I guess it depends on complications. I feel this will be enough time. I work a desk job and will just have to be mindful of getting up and walking.

I had my surgery 9/16, was in the hospital until 9/20 due to complications. I run the front half of non profit medical clinic so I am up and down all day (But only one day a week). I ended up going back to work on October 9th, and it was a little early for me but I got through it. I think it is an individual thing. A lot of things fit into the equation, like age, weight, type of surgery, and individuals pain tolerance etc. I wish you the best on your journey!

I'm thankful that my spirit lead me to give you some words of encouragement. You do know that you've got this, if you don't know consider yourself informed. Your task now is to calm down because it's a hard task for the body to heal while under a lot of stress. We need you to heal for your son and husband, they need you around. Don't be mad at yourself or hard on yourself for making this decision to have wls. Cry, get it out and then breathe, repeat until it gets easier. My friend had revision surgery in July with complications that scared me from almost not having my surgery this upcoming January. She has recovered nicely, we've attended the Obesity Help Conference and I have met wonderful people like you. We deserve a second chance at an amazing healthy life. Bariatric Pal has been my mental and emotional support, because I'm private and less than a handful of ppl know I'm having this surgery. Emma, anything you want to talk about this is a great platform.

I'm thankful that my spirit lead me to give you some words of encouragement. You do know that you've got this, if you don't know consider yourself informed. Your task now is to calm down because it's a hard task for the body to heal while under a lot of stress. We need you to heal for your son and husband, they need you around. Don't be mad at yourself or hard on yourself for making this decision to have wls. Cry, get it out and then breathe, repeat until it gets easier. My friend had revision surgery in July with complications that scared me from almost not having my surgery this upcoming January. She has recovered nicely, we've attended the Obesity Help Conference and I have met wonderful people like you. We deserve a second chance at an amazing healthy life. Bariatric Pal has been my mental and emotional support, because I'm private and less than a handful of ppl know I'm having this surgery. Emma, anything you want to talk about this is a great platform.

I am revising from sleeve to bypass on Friday. I really never researched the ds surgery until recently. The fact that people that have had it are still able to take nsaids would be a big plus in my case. I am riddled with arthritis. However I have read that it is a much more complicated procedure. Bigger concern of vitamin/mineral deficiency as well. But the chances of not only losing the weight but also maintaining are outstanding. I kind of wish that I had researched it before now. good luck with whatever you decide!

I'm getting "the band" back together! Doing an IF week this week with my complicated ADF routine EOD and an 18:6 TRE thrown in for razzle dazzle. Mr. F. is gonna get in on the action too. Woooohoooo! He's been doing OMAD and has dropped 7lbs in the last 2 weeks, but wants to see if he can turbo charge it with the ADF with caloric restriction. I'm so proud of him. So I thought I would do it too since I haven't been doing any IF lately. After a big weekend of food and a big week of food last week, I'm actually looking forward to today and taking a break. I'll shoot for eating sometime between 3 and 4pm then we'll have a simple light dinner around 7pm. Then that's it lights out til tomorrow! Here are my beginning stats: Maintenance: 5'4" | 57y | F | 20mo PO RNY | 131.8lbs | 18:6 | Goal 500cals | <20g protein | <50g carbs from veggies/berries

I had my VSG December 11, 2018. I didn't experience any gas pains and didn't have any complications. 11 months out and have lost 116 pounds with 18 pounds to go to hit my final goal.

Hi Everyone, I just wanted to thank each and every one of you on these pages for being such a great source of support for me personally. Having family, friends and doctors to talk with is great, but there really is no substitute for speaking with someone who actually went through with the surgery. There are many emotions that go into this process that are very difficult for the average person to understand. I thought it might be fun to start a continuing thread that will allow people to find and connect with others in various stages of their VSG process. Please reply with the following info about you and any pearls of wisdom you wish to share. Also indicate whether you are cool with someone sending you a message directly. I’ll share my info to start the process: Date of VSG: 11/11/19 Location: NY Sex: Male Height: 5’7 High Weight: 311 Weight on Surgery Date: 281 Current Weight: 271 (1 week post-op) Goal Weight: 185 Pearls of Wisdom: (1) Stick to the pre-op diet and try to lose as much weight as you can before surgery. It reduces risks and complications of surgery and helps shrink your liver. I know too well that the temptation exists to have one “Last Fun Meal”, but if you can hold strong for two full weeks before going in, you won’t experience carb withdrawals and your body will become more accustomed to having a stomach that is not full of food. (2) Take a before photo and measurements to create a baseline of where you started right before surgery. It will be helpful to you in the weeks and months that follow. (3) Order things you need at home waiting for you before you go in for surgery. This includes things like a variety of different protein shakes, chewable multivitamins, non-carbonated/no-sugar drinks, broth, sugar free popsicles, comfy clothes, some nice fluffy blankets, a wedge to help you sleep on your back facing up, etc. (4) Force yourself to walk after the surgery. The more laps you do at the hospital, the easier the healing process will be and the less pain and discomfort you will have. It also is an excellent way to prevent blood clots, which are a real risk if you stay in bed for several days. When you get home, gradually increase your steps and avoid lifting anything more than 5lbs. (5) Sip liquids slowly. If need be, use a little one oz medicine cup. Also, try liquids at different temperatures. Sometimes super cold liquids create more discomfort. (6) Heating pads of hot packs can offer some relief from gas and bloating if you experience it in the days following the surgery. (7) Use pain meds only as needed. Although they work great, they also cause other things like constipation, which can add to your pain and discomfort. If you are experiencing nausea, ask your doctor for Zofran or some other anti-nausea medicine. It’s real important that you manage the nausea so you can take in the proper amount of liquid and protein after surgery. (8) Listen carefully to every sign your body sends you. If you experience discomfort or nausea, stop and try to isolate the cause, so you don’t repeat it. (9) Avoid stress after surgery at all costs! Don’t feel obligated to tell the whole world you had the surgery right away. In fact, limiting the people you tell, leaves you free to tell your story however you want it to be told. Focus more on the positive reinforcement you will receive when people begin to notice you losing weight. Sometimes telling people you had the surgery leads them to diminish the real efforts you are undertaking to lose weight. As with any weight loss procedure, the VSG only works if you make healthy lifestyle changes. There’s no reason why anyone should think that you had the surgery because you didn’t have the will power to diet and lose it via traditional means. Actually having the surgery IS a lifestyle commitment far more significant than siting on to a diet. (10) Be proud of yourself and the decision you made to take control of your weight issues. Never be afraid to ask for help or advice if your not sure of something. Looking forward to hearing other people’s stories!

Hey guys. I’ve been all over this website and it’s been helping a lot, but I have some complications I’d like to go over before I see my NUT and nurse practitioner this Tuesday. Originally I thought my new blood pressure meds had been making me feel faint and week, but now I’m thinking it’s a deficiency of either iron or protein or even both. So bad to where I was doing great walking after surgery up until I started feeling like this. Now I hardly do anything besides lay down. I mean I still try to walk around the house or do whatever I can but even standing up I feel faint and have a racing heart. It’s just frustrating. I had my surgery 17 days ago if that helps. But now the more this goes on the less I am eating. Im trying very hard to get in protein but nothing’s cutting it. Eggs were doing well but ever since the other day anything I put down is a struggle. I want to get shakes down because it’s the easiest way but I take a sip now and it comes right up. I think it’s just being on the liquid and soft diet that’s making me like this. Hopefully the more i advance it all comes back into play. I don’t even want carbs or sugars, I just want to be able to sit down and eat some meat or whatever and that’s that. No getting sick or anything. I know that’s a lot to ask for only 17 days out and I CAN wait. But I need to find some way of getting in protein right now. Tuna was another thing I reuse but the mayo and the tuna itself was just uncomfortable to eat. I can’t fathom getting behind anything puréed so this is gonna be tough 😕 And before anyone says anything about it, please don’t mention puréed food. I just cannot do it. I’ve tried and the second it hits my mouth I gag horribly. The same way I would with the shakes. If anyone has been through the same please tell me it gets better I’m only 20 years old and weighed 375. Now I’m down to 315. I love the results, but I feel so week and sick

I saw this on another forum and thought it worthy to share as it has all the great information and advice we all need for the journey! it is written by Mellissa Gangi and what I had wished I had been told from the very beginning. Sleeve Tips: I'm 10 months post op today and along this journey, so far, I've seen a lot of the same questions or concerns from many. I thought these tips could help! 1. Take preop photos... you'll want them! 2. Protein shakes...I used isopure protein powder and scooped it into 2 oz. of water (u can add ice and blend too) to drink in my immediate postop period. It was much less to drink at a sitting and you still got in your protein. It would take me over an hour to drink each one, but way easier to me. Plus, isopure has multiple flavors and it was reasonably priced. I bought off Amazon. Also, Genepro is an unflavored protein powder that is very popular. It can be added to pretty much anything. The scoop is tiny and it gives 30g of protein per scoop. I use it daily in my morning coffee but if adding it to hot liquids you have to add creamer 1st to cool it down or it will clump up or dissolve in a little warm water 1st then add... the directions are on the bag. It is not completely unflavored and it has a smell to it, but most of us get used to it quickly. Your body can only absorb up to 30g of protein per serving, so anything more than that at once will be wasted and it doesn't count towards your daily goals! 3. STALLS happen...stick to your plan and the scale will move again! You most likely will be losing inches during that time. They can last a few weeks...especially the 3 week stall. The further you are out they may even last longer and at that point you may have to shake things up a bit, maybe a day or 2 most increase your carbs then go back to your plan. Don't get discouraged and try to just be patient. 4. No NSAIDS (aspirin, ibuprofen, aleve, motrin, etc...) they can cause ulcers...tylenol products are ok and Excedrin Tension is ok (great for headaches) it has tylenol and caffeine in it, no aspirin like the other excedrin products. Also, peppermint oil rubbed on your temples help for headaches. 5. Fluid intake...atleast 64 oz of non caffeinated, non carbonated, sugar free fluids but the rule of thumb is drink half of your body weight in ounces. 6. Caffeine and alcohol...follow your surgeons orders. They both can dehydrate you and cause ulcers in the beginning of your journey. And alcohol may affect you differently postop, so be careful. Absorbtion changes postop. 7. Transfer addictions...a lot of bariatric patients give up food for other addictions like shopping and alcohol. Be mindful. 8. Increased chance of pregnancy after surgery. You can be much more fertile. Even if you had problems with it preop. 9. Increased divorce rates postop...I have looked into this because I was curious as to why. I have found that it does indeed increase, but the majority of the couples that do have had issues preop and the spouse that had surgery loses the weight, increases their self esteem and simply won't stand for the same behavior anymore. 10. Sugar/Carbs...1st and foremost, follow your plan. There are reasons why your surgeon and/or nutritionist gives you one, especially while healing and it takes approximately 6 weeks for your tummy to heal. After you are advanced to a "regular" diet, usually about 2 month postop, yes you can eat some sweets or carbs but in moderation. Always try to get your protein in 1st, though. I have chosen to stay away from sugar and certain carbs. I don't crave them, so why reintroduce them. I know me, and moderation is hard for me. 11. Everyone's weightloss journey is different. Try not to compare yourself to the next person. It's hard not to, I know! But their weight, height, sex, medical history all plays a part of it. If you do what you should be doing, you'll lose! 12. Dumping and The Foamies... Dumping occurs when your new tummy just doesn't agree with something you consumed. Dumping occurs more in bypass patients but it can occur with sleeves, also. Symptoms can include sudden vomiting, diarrhea, and increased heart rate and last anywhere from 30 minutes to 2 hours. The Foamies... you'll know what this is if you get it. It's a lot of phlegm that is produced in your esophagus all of a sudden. It can happen if you eat or drink too fast, or take in too much, or drink right after eating...wait to drink atleast 30 minutes after eating. Plus, if you drink with eating or too close afterwards you flush the food through your belly too fast and you're not absorbing nutrients. 13. Take your vitamins and get in your protein daily! This will not only help your weightloss and prevent vitamin deficiency but it will help with the sunken in look when you lose weight. I was told 60-90g of protein daily, but follow your drs orders. I take 2 flintstones with iron chewables a day because I couldn't tolerate the prescribed multivitamin, in addition to calcium with d3, and magnesium and b12. 14. Gas ex chewables, heating pads, and walking help big time for your gas pains. When I woke up from this surgery I thought I was having a heart attack because the gas was causing chest pains. Also, use the incentive spirometry in the immediate postop period. Anesthesia affects your lungs and it takes 72 hours to completely wear off so the breathing exercises help strengthen them and prevent pneumonia. 15. Heartburn...omeprazole works so well for me. My surgeon prescribed it from day 1 and I love it. 16. Postop hormones... your body almost goes into shock in the 1st 6 weeks or so after surgery from the major changes to it. You may feel different mentally...it does get better but if it's bad talk to your dr about it. 17. Medications... your body can change postop. The same medications you were on preop may be absorbed differently postop so if you notice changes talk to your dr. They may need to be adjusted. And extended release meds may not work as well. 18. Tracking your intake keeps you honest. I love the baritastic app. It also has recipes for all the stages and reminders. 19. Head hunger vs real hunger. This is a lifestyle change, your body needs much less calories postop but you have to retrain your brain. It may take time and that's normal. If you fall off the wagon one day...oh well...get back on it the next. We are all human. Don't get discouraged. Just pick yourself back up. 20. Complications can happen. If your body starts feeling different...new onset pains, nausea, vomiting, passing out, food feeling stuck in esophagus, etc...call your surgeon. You're always better safe than sorry. 21. Abbreviations... HW your highest weight SW what you weighed on your surgery day GW your goal weight CW what you weigh currently NSV non scale victory Nut nutritionist VSG vertical sleeve gastrectomy (sleeve surgery) RNY roux-en-Y (gastric bypass) DS duodenal switch surgery 22. Hair loss or thinning happens. But, it will grow back. I thinned starting at about 4 months. It can last months. Many take biotin supplements for it, I didn't. 23. Get ready to be cold! You're body is changing, it's almost in shock so invest in a Comfy, like me, or electric blanket to keep warm lol. 24. What to bring to the hospital for your surgery stay...a long phone charger, chapstick, your phone, comfy pjs, slippers, a robe, earbuds, and a list of your medical history, surgeries, allergies, and medications with dosages. Others add gas ex chewables but I'm an RN and don't recommend taking any meds from home without the nurses or drs knowledge. Some also say a heating pad to help with gas pains, but walking is best. Also, remember to hug a pillow if you cough or sneeze. It will help! 25. Constipation! It is a part of this journey, unfortunately. The only thing that helps me, and this is not conventional, is sugar free hard candies. A few of those babies (no more than 5 or you'll hate me) and you'll be going within 12 hours. The sugar alcohols do it for me. But, more conventional approaches are benefiber packets, smooth move tea, or miralax. And there's diarrhea in the beginning...liquids in, liquids out. But your 1st bowel movement may take awhile...its all normal. 26. Ketosis...when you cut out sugar and go low carb you're body goes into a state of ketosis. This is a metabolic state that now uses fat for energy, instead of carbs. It aids in weightloss, but has some side effects like bad breath, body odor, bowel changes, fatigue at 1st but then increased energy the longer you're in it, and insomnia. Those side effects will decrease over time so just invest in mouthwash for the meantime! I know this is a lot, but hopefully it helps! If I missed anything, feel free to chime in. Best of luck to everyone!

I just had my revision on October 24 and honestly, it was no more difficult than the band surgery. My surgery even ended up being more complicated than they thought it would be and it was still pretty easy. I was able to manage my pain with Tylenol and the pain completely resolved pretty quickly. I still have one incision that is being hateful, but that's been the worst of it for me. I work a desk job and went back 6 days after surgery, but probably could have gone back sooner. I have been having complications from anesthesia, so that's been a pain in the butt. All that said, I handle pain very, very well, so your mileage may vary.

It will all be worth it. This is coming from someone who had a leak in their sleeve and spent 3 months in hospital having multiple surgeries to fix it. Didn't feel so grateful at the time, but now 120+ pounds down and it's the best thing that ever happened. For anyone who has complications in their journey, I think you just have to put your head down and move forward, one foot in front of the other. Well done for getting through it and having a great outlook! I am looking forward to seeing your progress ❤️

Thank you!! Yes I’ve seen so many people who say they wanted this so bad, regretted and now are grateful for it. As well as the other way around, were scared but ended up with no complications and hardly any pain. I’m a pretty strong person and have a great support system BUT I know this is a life change and I pray my strength continues mentally. I’m trying to prepare myself for “the worst” (as far as healing, pain, learning to use my new tool, transitioning into a new phase, etc.) but hopeful for the best experience!

Well the first round my spouse was supportive. Fairly so when I had my arms done. By round 3 thigh lift he dropped me off at the hospital and I had a private duty nurse for a few days. The last one there were complications and he came through bringing me back to the doc, the ER and running to the pharmacy. ... overall I suppose he has been supportive if not for the last Surgery - he is my emotional rock. He is awesome and clearly does not fully understand but does except. He was less understanding of the WLS which was very very scary for him. As for the money aspect... I used mostly the money allocated for my extra expenses. All said it was the price of a car. I do not think my spouse ever fully understood how uncomfortable it was for me physically. I spread the surgery out over three years and you better believe he has a new car.

Sounds a lot like the WLS clinic I go to here in Springfield MO. I really appreciate how I can call anytime with questions or concerns. I really like my Nut also! Aside from some complications I am very happy with my surgery.

Making this review because I didn't see my doctor listed in the group of surgeons and I don't see a lot of other Oklahoma people around here. I actually started my journey with another medical group, not affiliated with a hospital. I wouldn't call them fly by night but close. Did a lot of self pay type patients. Anyways, I did their seminar to see what I qualified for, if anything, insurance wise. Turns out I qualified for nothing at that time (due to poor coverage, not my weight or co-morbidities). I did their non-surgical weight loss and it was fine, nothing special. I saw my GP (part of the OU system) and he recommended I look into WLS and recommended the group at OU. I took his advice and went to the required seminar in February of 2019. After the seminar I signed up to get more info and have my initial appointment with the WLS group at OU. About a month later I had my first appointment and went over everything that would need to be done before surgery. It was much more extensive than the other place I had visited! PT, Psych, Nut, blood work, chest x-ray, EKG, pre-op scope - made me feel quite confident in their program! I was also required to go to 2 group sessions which were great! So I got in the program in February. I got my weight loss goal that I needed to hit for surgery and they worked on things from the insurance end. I had to meet with them monthly until surgery. Then the problems started. First my work made it very hard (read impossible) to leave for my appointments. I couldn't take early lunches or skip lunch in lieu of an appointment. The WLS group was great about working through that and around things. Then came my trip to Europe. I went wild. I came back 20 pounds above my starting weight and they wouldn't budge on my goal. My final hurtle was that my insurance plan year ran from 11/1/18 to 11/1/19. Meaning I had to hit my goal and get everything done by and surgery scheduled BEFORE 11/1/19! It was June at this point! I went into psycho mode - walking miles each day, eating nothing that wasn't on my list and I made it! They saw my work and that I was getting close to my goal and gave me my surgery date of 10/22 on Aug 22. Surgery was great! I had no complications and they fixed my hiatal hernia when they were in there. I'm just over 3 weeks post-op now and everything has been going swimmingly. I've lost 33 pounds since my surgery date. The surgeon and her group are great. They know everyone by name. I don't have much access to the surgeon but I get it when I need it. I mostly work with the PA. I can see the nut or psych whenever I want, which is nice. If anything the office is TOO busy. My one month post-op has to be 6 weeks after surgery due to her being busy and only having one day for office hours. If anyone has any questions about this group feel free to ask me!

I told my parents, knowing my dad was pretty staunchly against it. He's had people he's know that have had the surgery and either failed at the weight loss or had complications. I'm his kid so obviously he was worried about it. I told him to ask more people about it and he did, got some good responses and he wound up being ok with my decision and supporting me, even coming up the week of my surgery to help me recover. Deep down I still think he was just worried about me but I did a good job of articulating why I needed it and ignoring him when he made snarky comments lol.

Thank you for the follow up. It clarified a lot. Did your doctor instruct you on what you were to do pre and post op? I know that I had a nutrition class section that was 3 hours and we went thru every page of what we are to eat and drink pre and post op. In speaking to the Dr.'s assistant, I told her about a lot of the complications that some people here have said they experienced and she told me that in the majority of the cases, it's due to not following the instructions given.

A quick google search gave me this program, where you don't need a lot of machines, but your gym should have what you need. https://www.shape.com/fitness/workouts/strength-training-beginners Not too complicated, explained well and works everything. Strength is such an important step for your success. Good luck.

Hi!! Thanks so much for ur post!! I need to do some very deep soul searching before my next Dr.’s visit because as much as I want and need to lose the weight I am still conflicted. I am truly afraid of certain risk factors and long /short term side effects of the surgery. ( I think more than most because I have been through 7 surgeries and have had post op issues with all except one). I realize that staying at my current weight is also a health risk. I do nothing but think, research, and complicate about this 24/7.

Sorry for the complications but glad you're still here and doing well!

it seems like a lot of people here and on other forums use Dr. Carmina Cardenas in Tijuana or Dr. Francisco Saucedo in Monterrey. For other names, check www.realself.com It's a site where people rate doctors - all specialties - but most seem to be plastic surgeons. A lot of the patients post before/after pictures, too. people usually stay in the area for a couple of weeks after surgery to make sure everything is OK. Dr. Cardenas has a place where patients stay for the first week that is staffed by nurses. Not sure about Dr. Saucedo - if not, he has them stay in a hotel near his clinic (can't remember - but I did do an email consult with him and I'm pretty sure the price included this stay). as long as you do your homework and pick a reputable surgeon, it should be safe. you'll have to ask your insurance company if complications are covered. I had to have my PCP remove a staple that was sticking out (I had my surgery in the US, but out-of-state), and insurance covered it. I don't know if that's universally true, though. also, payment up front vs payments would depend on the surgeon. I suspect most would want it up front, but you never know...