Ask Dr. Schulman...

[SuzanneG 1]

Hi,

I have only remotely considered PS since I assumed I couldn't get approved by ins and I don't have major overlapping skin. I've lost 78 pounds in about a year and maintained my weight for 9 months now.

Although I have lots of saggy skin and some bulges I'd love to live without, I haven't had any problems with rashes, etc. until now. I'm getting a rash in my bellybutton. I know how to get rid of it and I have the proper cream, but I'm asking myself if I should see a doctor to start documenting for possible PS in the future.

Two questions, could this small rash qualify me for a TT? If so, can I see my GP for it? We have a derm shortage where I live and it takes MONTHS to get an appt. I'd hate to have to walk around with this painful itchy rash for that long just to show it to him!

Thanks!

[DivaStyleCoach 89]

Hi Dr. Schulman,

I sent you an off-LBT email as well, but thought my question might help someone else, so I'm posting it here with a little more detail.

I was banded in November 08, am now down 69 lbs and looking to lose perhaps another 20 or so. At nearly 6 feet tall, I've been told my original goal of 155 may be too light. Family and friends have already started telling me I'm getting too thin - of course I don't think so...

I wanted to know if now is the time to schedule a consultation with you if I am considering having PS in December of this year. I'm starting to have some side-effects from the weight loss, if you will.

Dropped a few cup sizes in my bra, had to buy new ones recently, but they have shifted my center of gravity or something, because now I'm experiencing muscle soreness and some pain in my shoulders and upper back.

I have a significant 'roll' at the bottom of my torso, what I consider to be 'extra' skin and softness at my sides (below my bra line down to my waist) and the "roll". From all I've ready, I think a LBL (lower body lift) is in my future, but I wanted your opinion on that.

I live in Connecticut, so would be taking the train to come and see you if a consultation is scheduled. My current job has a nice benefit - the week between Christmas and New Year's, our office is closed and it does not affect our sick time or vacation time. That said, I might be able to arrange for up to 3 weeks off after the surgery if I can schedule it for the week before Christmas.

What other things should I be considering?

Thanks in advance for the help and I look forward to talking with your office soon! :thumbdown:

[Dr. Schulman 2]

Dr. Schulman:

Welcome back! Good to see your posts again.

I had a Tummy Tuck in May 2009. Back then I was under a different insurance plan. That insurance plan covered about 1/2 to 2/3 of the cost of the procedure because I was approved for a medically necessary panniculectomy because of rash issues. My former employer switched insurance so now my COBRA plan is very different from the plan that helped with my tummy tuck. They don't cover much of anything, and if they do it's a 20/80 split, or 40/80 split depending on in the network or out. Because I'm unemployed and have already spent almost $7k on my tummy tuck I cannot afford to spend any more at this time.

Now to my questions. I have a dogear on one side. I don't remember when it showed up, but it wasn't there at the end of June when I last saw the plastic surgeon. I have gained somewhere between 7 to 9 pounds (depending on the day) since I became unemployed. Could gaining this small amount contribute to getting dogears? Do plastic surgeon's usually submit a bill if there is a correction made to repair the dogear? Is it usually done with minimal cutting and done in a plastic surgeon's office without anesthesia?

Thanks so much for the time that you give to all of us bandsters.

Sue

A dog ear excision is a relatively small procedure that can be done in office with local anesthesia. Most plastic surgeons will remove this without charging the patient because it is really a "touch up" from the abdominoplasty. They may or may not submit it to insurance, but will likely not get any reimbursement from this "cosmetic" procedure. I do not think that weight gain contributed to this dog ear.

[Dr. Schulman 2]

Hi Dr. Schulman,

I sent you an off-LBT email as well, but thought my question might help someone else, so I'm posting it here with a little more detail.

I was banded in November 08, am now down 69 lbs and looking to lose perhaps another 20 or so. At nearly 6 feet tall, I've been told my original goal of 155 may be too light. Family and friends have already started telling me I'm getting too thin - of course I don't think so...

I wanted to know if now is the time to schedule a consultation with you if I am considering having PS in December of this year. I'm starting to have some side-effects from the weight loss, if you will.

Dropped a few cup sizes in my bra, had to buy new ones recently, but they have shifted my center of gravity or something, because now I'm experiencing muscle soreness and some pain in my shoulders and upper back.

I have a significant 'roll' at the bottom of my torso, what I consider to be 'extra' skin and softness at my sides (below my bra line down to my waist) and the "roll". From all I've ready, I think a LBL (lower body lift) is in my future, but I wanted your opinion on that.

I live in Connecticut, so would be taking the train to come and see you if a consultation is scheduled. My current job has a nice benefit - the week between Christmas and New Year's, our office is closed and it does not affect our sick time or vacation time. That said, I might be able to arrange for up to 3 weeks off after the surgery if I can schedule it for the week before Christmas.

What other things should I be considering?

Thanks in advance for the help and I look forward to talking with your office soon! :seeya:

Congratulations on your weight loss. Regarding the consultation, as I have said in the past, it is never too early. If you are considering surgery around Christmas, then you should certainly come see me in October so we can work out a surgical plan for you. Without seeing you, it is impossible to say what you may need, but a LBL is among the most common needs of someone who has lost weight like you have. I am unclear from your post if that extra roll under your bra line is in the front or the back. If it is in the back, you may need this removed from the upper back with an incision that remains in the bra line. Also, you mentioned that your breasts have gotten smaller, so you may be interested in a breast lift with implant.

A three week recovery should work well for you. You will need to stay in the area for a little while afterwards, and my office can help you in arranging a nearby hotel. Obviously, after I see you, we can come up with a very specific plan that meets your needs. I look foward to seeing you.

[Dr. Schulman 2]

Hi Dr. Schulman,

I was 10 days away from my lower body lift surgery and it has now been cancelled due to my hemoglobin and ferritin count. My hemoglobin is 113 g/L and my ferritin is 12 ug/L . This is lower than the normal range and I was told there can be a fair bit of blood loss with that surgery so it was too risky until my numbers come up. I have been taking vit. C and Iron tonic 3x a day to up my iron but it hasn't helped too much. My health is good I don't feel tired, I have a fair appetite and I exercise regularly. My doc says it is iron deficient anemia. Would iron shots bring my level up fast? I am back on the iron now that surg. was cancelled (told to stop 2 weeks benfore surg) and vit. C and Multivitamin. What more should I do it up my iron. I don't eat much beef..mostly chicken and fish. I am very disappointed as I was preparing for this for the last 6 months and have worked very hard to lose a significant amount of weight. Any suggestions you could give me would be most appreciated. Than you for all your help.

Barb

It is true that there can be a moderate blood loss during a LBL and being anemic can affect your healing. Iron deficiency anemia is very common, and even with iron supplementation, it can take several weeks to get your count up. This is because it takes your body that long to produce blood cells. If you have not seen a hematologist, make sure you do. He/She may have other recommendations that may help you. make sure they have checked your B12 and folate levels as well. One other thing to consider if your count still remains at a safe, but low level is that you can always split the LBL into 2 operations - a front and a back. This will greatly reduce operative time and blood loss.

[Luu2008 2]

Do you have any recommendations for surgeons in Albany or Syracuse NY? Wish I could come all the way to NYC. I would prefer a surgeon that will (if safe or me) combine a Tummy Tuck w/ Lipo and a breast lift at the same time.

[DivaStyleCoach 89]

Hi Dr. Schulman!

I will give your office a call tomorrow - I'm anxious to start this process...thank you so much! :seeya:

Congratulations on your weight loss. Regarding the consultation, as I have said in the past, it is never too early. If you are considering surgery around Christmas, then you should certainly come see me in October so we can work out a surgical plan for you. Without seeing you, it is impossible to say what you may need, but a LBL is among the most common needs of someone who has lost weight like you have. I am unclear from your post if that extra roll under your bra line is in the front or the back.

I have some softness and a roll at the bra line in the back, but my major area of concern is in the front and around the sides of my body...

If it is in the back, you may need this removed from the upper back with an incision that remains in the bra line. Also, you mentioned that your breasts have gotten smaller, so you may be interested in a breast lift with implant.

We'll definately have to talk about this...I am currently wearing a 38DDD bra (down from a 40K) so I'm not sure if I will want implants, or just to "tighten and lift"...

A three week recovery should work well for you. You will need to stay in the area for a little while afterwards, and my office can help you in arranging a nearby hotel. Obviously, after I see you, we can come up with a very specific plan that meets your needs. I look foward to seeing you.

I'm so excited about this - thank you, thank you, thank you! :blushing:

[Dr. Schulman 2]

Hi,

I have only remotely considered PS since I assumed I couldn't get approved by ins and I don't have major overlapping skin. I've lost 78 pounds in about a year and maintained my weight for 9 months now.

Although I have lots of saggy skin and some bulges I'd love to live without, I haven't had any problems with rashes, etc. until now. I'm getting a rash in my bellybutton. I know how to get rid of it and I have the proper cream, but I'm asking myself if I should see a doctor to start documenting for possible PS in the future.

Two questions, could this small rash qualify me for a TT? If so, can I see my GP for it? We have a derm shortage where I live and it takes MONTHS to get an appt. I'd hate to have to walk around with this painful itchy rash for that long just to show it to him!

Thanks!

Sorry Suzanne for the delay - I must have missed your post!

Massive weight loss is the first criteria for insurance coverage. Usually this means 100 pounds, but it also depends on your height and original weight (100 pound weight loss in someone who is 5'10" is not as much as 75 pounds in someone who is 5'0"). You should get documentation of the rash, even if it is small. See your GP first and usually this is sufficient. There should be precriptions that can help you. Also, if you call your insurance carrier, they should be able to give you a detailed list of requirements to prove medical necessity for a panniculectomy.< /p>

[SuzanneG 1]

Thanks Dr. Schulman!

[mrgrta 0]

Dr. Schulman, I was just wondering how successful thigh liposuction is. I am considering having this procedure done, but I am worried about being left with hanging skin. My thighs are pretty muscular now and I do work out 6 days a week, but I can't seem to get rid of the inner thigh flab near the groin area. I am also wanting some Lipo done to the outer thighs as well. I have heard that some people have this done and then wish they would have just left their legs alone because of hanging skin. I am 37 years old and didn't know if age makes a difference or not with lipo. Also, could this be done with local or iv sedation vs. general anesthesia? Thanks for your time.

[kareyquilts 1]

Hi Dr. Schulman: I'm wondering if you have heard of French liposuction? There is a local doctor advertising that he is now doing the latest technique in liposuction. The French Liposuction. I'm googled the term and can't find much. It's probably some kind of come on?

[Dr. Schulman 2]

Dr. Schulman, I was just wondering how successful thigh liposuction is. I am considering having this procedure done, but I am worried about being left with hanging skin. My thighs are pretty muscular now and I do work out 6 days a week, but I can't seem to get rid of the inner thigh flab near the groin area. I am also wanting some Lipo done to the outer thighs as well. I have heard that some people have this done and then wish they would have just left their legs alone because of hanging skin. I am 37 years old and didn't know if age makes a difference or not with lipo. Also, could this be done with local or iv sedation vs. general anesthesia? Thanks for your time.

You are right to be concerned about saggy skin remaining after inner thigh liposuction. This is a very common result if liposuction is done in someone who needs a thigh lift to remove the excess skin. Yes, age does matter, so the younger you are, the better chance you skin has of recovering and tightening. But, in my experience, even the young patient who has had significant weight loss has skin that lacks elasticity and will not tighten up fully. I have been very happy with laser liposuction in this area in particular which helps the skin tighten up a bit more than traditional lipo.

[Dr. Schulman 2]

Hi Dr. Schulman: I'm wondering if you have heard of French liposuction? There is a local doctor advertising that he is now doing the latest technique in liposuction. The French Liposuction. I'm googled the term and can't find much. It's probably some kind of come on?

Never heard of it!

[kareyquilts 1]

Wondering if you have heard of the new Body Tite liposuction procedure that works on radio waves as well as laser Lipo? There are several clinics doing trials for FDA approval. I would like to get lipo on my thighs, but I don't want to cause more sagging skin. I don't want to have a thigh lift. I'm fresh out of courage and think that the possiblity of sagging incision lines is just creating a new problem. Do you think that Body Tite is a viable option for bariatric patients. Is there an alternative for someone who doesn't want to under go another surgery?

[Desiree1970 0]

Hello Dr. Shulman :w00t:

I had the lapband in 2006 and started at 289 lbs. I've gone as far down since then as 201, but today I'm at 203.

My panni did develop a nasty rash this summer and I had been given a prescription topical powder from my doctor. Recently I've been having extreme back pain. This pain seems central in the small of my lower back. Could this be due to the panni hanging more and more and also my breast that are dropping significantly?

I will be 40 in April and am not in a committed relationship; I still want children, would the panniectomy be smart to do?

Thank you in advance :tongue2: