Ask Dr. Schulman...

[Dr. Schulman 2]

Dr Schulman,

I had a Anchor TT on Oct 23, 2008. I had a large wound seperation, skin necrosis. It has just finally healed after almost 4 months. But it didn't heal smoothly and I will need a revision done to correct this. My question is. WHAT are the chances of having the same problem again??? I see my Ps today to talk about this, but was wondering what your opinion was also. I know it is not as extensive at all as the first surgery, but I am still scared to death of this happening again. But I cannot live with what the healed area looks like...

Thanks,

Kelly

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.

[mrskrzyz 1]

Ok... I am going to try to upload a picture of the belly button that I am concerned about.

This is what it looked like yesterday when I saw my doc. He wasn't concerned and said this was normal. I told him that it wasn't previously seeping or red around the rim.

Today it is even a little more red and tender. Just a little..

Please give me your opinion and thanks for taking your time to address my concerns!!!

[Dr. Schulman 2]

Ok... I am going to try to upload a picture of the belly button that I am concerned about.

This is what it looked like yesterday when I saw my doc. He wasn't concerned and said this was normal. I told him that it wasn't previously seeping or red around the rim.

Today it is even a little more red and tender. Just a little..

Please give me your opinion and thanks for taking your time to address my concerns!!!

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.

[kareyquilts 1]

Dr. Schulman: I'm wondering what you know/think about the Genesis or gentle yag laser. I had one treatment (I know that I should get them spaced a month apart for 5-6 times). I really didn't see much of a difference from the first treatment. I just wonder what you think of this laser, especially when compared to other lasers for the treatment of fine lines, enlarged pores and skin tightening. Maybe I would be better off getting fraxel repair laser or the gold standard CO2 laser? Sometimes, I wonder if some of the stuff could actual injure the skin in the long run. Are there long term studies on the effects of these lasers on the skin? Thanks!

[Sula 0]

I just had a second denial from my insurance company. They said the pics the PS took did not show the shoulder grooves or is there any evidence/history of rash related to pendulous breasts. In addition, they said that his estimate of tissue to be removed, 500 grams, was below what was necessary, and 700 grams needed to be taken out.

I can take new pictures to support the grooves and somewhere in the hx is a notation of the rashing for many years ago. But my question/concern is..if my PS said this is the amount that would be appropriate..eg.500 grams, and 700 grams is what the insurance co says must come out in order to be insured...I'm told this would make me a B cup. And I was thinking a C cup is average. How do you make a decision in this area as far as body proportion or what?

I do have about 25 more pounds to lose. I am thinking that I should just wait until that happens now and maybe the insurance will adjust their numbers based on my weight. Can you give me any thoughts on this?

Thanks

[Dr. Schulman 2]

Dr. Schulman: I'm wondering what you know/think about the Genesis or gentle yag laser. I had one treatment (I know that I should get them spaced a month apart for 5-6 times). I really didn't see much of a difference from the first treatment. I just wonder what you think of this laser, especially when compared to other lasers for the treatment of fine lines, enlarged pores and skin tightening. Maybe I would be better off getting fraxel repair laser or the gold standard CO2 laser? Sometimes, I wonder if some of the stuff could actual injure the skin in the long run. Are there long term studies on the effects of these lasers on the skin? Thanks!

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.

[Dr. Schulman 2]

I just had a second denial from my insurance company. They said the pics the PS took did not show the shoulder grooves or is there any evidence/history of rash related to pendulous breasts. In addition, they said that his estimate of tissue to be removed, 500 grams, was below what was necessary, and 700 grams needed to be taken out.

I can take new pictures to support the grooves and somewhere in the hx is a notation of the rashing for many years ago. But my question/concern is..if my PS said this is the amount that would be appropriate..eg.500 grams, and 700 grams is what the insurance co says must come out in order to be insured...I'm told this would make me a B cup. And I was thinking a C cup is average. How do you make a decision in this area as far as body proportion or what?

I do have about 25 more pounds to lose. I am thinking that I should just wait until that happens now and maybe the insurance will adjust their numbers based on my weight. Can you give me any thoughts on this?

Thanks

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.

[amandamorris27 0]

Becky,

I was going the thread and came accross one that mention your starting weight and it catch my eye because my starting weight was 462 so I was wondering if you could share you journey and advise with. I was banding 12/08 have lost 72 from pre surgery weight loss to currect.

Thanks

Amanda Morris

[kareyquilts 1]

Dr. Schulman: Thanks for your honest reply. So many choices out there. I have often thought that I should write a book with a doc (maybe you?) reviewing all the different procedures from a women's perspective and experience with the pro's and con's and advice from a doctor (like you do on this forum). I've done a prelimanary review of the literature and have found a few books out there on cosmetic surgery with explanations, but not anything on non-cosmetic procedures and what they can and can't do. What do you think?

[Totallytater 1]

Will most plastic surgeons do an arm lift and Tummy Tuck at the same time? Or a lower body lift and an arm lift at the same time? Do you think it is okay to combine these surgeries?

[Dr. Schulman 2]

Dr. Schulman: Thanks for your honest reply. So many choices out there. I have often thought that I should write a book with a doc (maybe you?) reviewing all the different procedures from a women's perspective and experience with the pro's and con's and advice from a doctor (like you do on this forum). I've done a prelimanary review of the literature and have found a few books out there on cosmetic surgery with explanations, but not anything on non-cosmetic procedures and what they can and can't do. What do you think?

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.

[Dr. Schulman 2]

Will most plastic surgeons do an arm lift and Tummy Tuck at the same time? Or a lower body lift and an arm lift at the same time? Do you think it is okay to combine these surgeries?

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

[kareyquilts 1]

DR. S: I am going to seriously think about this. If I decide it's something I can do, I'll pm you my ideas.

[Frangipani 1]

Hi Dr. Schulman,

I am planning to have an inner thigh lift sometime next month -- though I have not scheduled as of yet because I still have some concerns.

My Dr. assures me that all will be well and he has done an excellent job so far, so I'm good with that.

However, as I read postings on the web from people who have this procedure done, it seems to me that there are more people out there who are unhappy with their results than with any other body contouring procedure. I have also read about several instances in which a revision surgery was required.

I was wondering what your thoughts were about this procedure. Also are your patients generally happy that they did it and feel that the pain, expense and scar is an acceptable trade-off for the improvement they gained?

Thanks for any feedback you might have.

[Dr. Schulman 2]

Hi Dr. Schulman,

I am planning to have an inner thigh lift sometime next month -- though I have not scheduled as of yet because I still have some concerns.

My Dr. assures me that all will be well and he has done an excellent job so far, so I'm good with that.

However, as I read postings on the web from people who have this procedure done, it seems to me that there are more people out there who are unhappy with their results than with any other body contouring procedure. I have also read about several instances in which a revision surgery was required.

I was wondering what your thoughts were about this procedure. Also are your patients generally happy that they did it and feel that the pain, expense and scar is an acceptable trade-off for the improvement they gained?

Thanks for any feedback you might have.

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.