Ask Dr. Schulman...

[Dr. Schulman 2]

I thought that this might be a good place to post questions to me, so that other people can see your questions and my answers. I will continue to answer questions from those of you that private message me, but this is a nice way to share the information with others - since many of your questions are relevant to other people.

I will try to answer the questions as quickly as possible, and include links and pictures when appropriate.

I am obligated to add this disclosure.....any information provided by me is my opinion and cannot substitute for an actual consultation with your qualified physician.

[KD8888 0]

Dr. Schulman,

I’m having a belt lipectomy and breast lift in a couple months. The doctor suggested injecting some of the fat from my abdomen or hips into my buttocks. I’ve heard of injecting fat into other areas, but I haven’t seen much info. Is this typically successful? Where could I learn more about it?

Thank you.

[Dr. Schulman 2]

Dr. Schulman,

I’m having a belt lipectomy and breast lift in a couple months. The doctor suggested injecting some of the fat from my abdomen or hips into my buttocks. I’ve heard of injecting fat into other areas, but I haven’t seen much info. Is this typically successful? Where could I learn more about it?

Thank you.

Fat injections have been controversial. The problem is that about 40-50% of the fat does not survive transplantation. In areas such as the face, this can be a problem because it can lead to lumps. Also, there is significant swelling that can last for weeks. This is why I prefer other materials (synthetics like restylane, radiesse, juvaderm, or sculptra) for the face.

In the buttocks, fat works very well. A lot of fat needs to be injected to compensate for about 50% "loss." After this procedure, you would need to stay off your buttocks for 2 weeks while the fat "takes." This means no sitting on your butt or laying on your back. This would be very difficult after a belt lipectomy or Lower body lift. One of the best around at this procedure is Constantino Mendietta in Florida. You can find many articles about fat transfer to the buttocks written by him.

There seem to be 2 options. You can do the lipectomy and then have the fat injected several months later when you are more recovered and can be careful with the newly transplanted fat.

The other option involves autologous buttock implants. I have developed my own technique where the tissue from the lower back is not discarded, but placed in the buttock as an "implant." The key is that the skin and fat is never disconnected from its blood supply, so it is alive, and near 100% survival. It does not need any special care afterwords - unlike fat transplants. I do this on about 75% of my lower body lifts because as many of you know, the butt tends to get even flatter after the surgery.

I will post pictures of this autologous buttock augmentation tomorrow.

[KD8888 0]

Thank you Dr. Schulman. I'm so glad I asked. I'm looking forward to seeing the pictures.

[Frangipani 1]

Hi Dr. Schulman,

Thank you so much for starting this thread! This will be very helpful us :sad:!

I have a question for you, how often do you find that it is necessary for a Lap Banded patient to have their port moved when they have an abdominoplasty?

Also, is it usually preferable for the patient to have and/or switch to a low profile port in conjunction with this procedure?

[Dr. Schulman 2]

Hi Dr. Schulman,

Thank you so much for starting this thread! This will be very helpful us :sad:!

I have a question for you, how often do you find that it is necessary for a Lap Banded patient to have their port moved when they have an abdominoplasty?

Also, is it usually preferable for the patient to have and/or switch to a low profile port in conjunction with this procedure?

Almost every patient benefits from having the port repositioned. The "pulling" of the skin may interfere with the function of the port if it is not moved. Also, even if the port will still work, usually the "pulling" makes the port shift to a location that is not good cosmetically.

Many PS who do a lot of this are comfortable repostioning the port themselves. I routinely do this myself during the surgery. Because I operate ina hospital with many great bariatric surgeons, I know that if a particular port is difficult to move, or if there are any "issues", I can simply call someone and they will be in the operating room to help in just a few minutes. This is a huge advantage in operating at a major hospital.

I also think that exchanging to a low profile port is of great benefit - now that the weight is gone, there is no ned to have a "lump" where the port is.

It is nice to be able to do all of this at the same time, but exchanging the port to a low profile can be done by many bariatric surgeons in the office under local anesthesia. They can do this several months after the plastic surgery.

[Frangipani 1]

Thank you for the info, Dr. Schulman!

[juliegeraci 7]

Hi Dr. Shulman, I had a Tummy Tuck on 4/21. The surgeon did lippo too. I still have quite a bit of upper abdomenal fat. Is this common after a tummy tuck? I can't have lippo revision for 6 months. The swelling has gone down all that it will so its not swelling. Julie

[Frangipani 1]

Dr. Schulman,

Since I imagine that this is a question that comes up often, I pasted it in here from another thread.

(However, if for some reason you don't want it here just let me know and I can delete it or have it deleted.)

Thanks again for all of your help! It's really great to have a place where we can have our questions answered by a professional.

Quote:

Originally Posted by Frangipani

Hi Dr. Schulman,

I have a question for you, when you are doing a breast lift with silicone implants, is there a particular type of incision that you find yourself using more frequently than others? If so, what would that be?

When performing breast lift with implants in a weight loss patient, I almost always use an anchor incision. Yes, this is a more extensive incision, but most weight loss patients require more extensive "remodeling" of their breast tissue. In other patients (not weight loss) I am usually able to do the surgery with just an incision around the nipple-areola-comlex. There is an occassional weight loss patient that will do ok with the smaller incision, but in my experience, this often leaves them "undercorrected."

__________________

Matthew Schulman, M.D.

Board Certified Plastic Surgeon

Specializing in body contouring after weight loss

Attending Plastic Surgeon, The Mount Sinai Hospital, NY

Professor of Plastic Surgery, Mount Sinai School of Medicine

Member American Society of Plastic Surgeons

Member American Society of Bariatric Plastic Surgeons

Sign up for FREE email newsletter www.madisonavenueplasticsurgery.com

[Dr. Schulman 2]

As promised....here is a picture of a patient who had a lower body lift with buttock implants using the fat and skin from her lower back - this is not the same as fat injections!

This is only a few weeks after surgery, so the incision is still red.

This technique works well to help with flattening of the buttocks - which always gets even flatter after a lower body lift.

The pictures are in the attachment (sorry, I tried to put it in the message but failed miserably!)

[Dr. Schulman 2]

Let's try this one more time...

[Dr. Schulman 2]

Hi Dr. Shulman, I had a Tummy Tuck on 4/21. The surgeon did lippo too. I still have quite a bit of upper abdomenal fat. Is this common after a tummy tuck? I can't have lippo revision for 6 months. The swelling has gone down all that it will so its not swelling. Julie

That is a tough question because it depends on what your body was like before the TT, the specific technique the surgeon used, how "tight" he/she made the muscle, and the amount of Lipo that he/she did.

Even though you think you are no longer swollen...you still are, just not like you were right after. . Most people are swollen for at least 6 months. I tell my patients that they will continue to get better contour for up to a year after the surgery. That is why you should wait to have lipo revision. It is not advisable to do significant liposuction at the same time as TT because it increases your changes for complications.

[Frangipani 1]

Hi again Dr. Schulman,

As you might be able to tell, I'm a lady with a lot of questions -- always!

Regarding the buttocks lift, is it usually the case that the patient would benefit from some sort of augmentation after a lift?

I'm having a hard time wrapping my head around this augmentation concept, because my backside has always been WAY more than ample -- and even though it has gone south as of late, its pretty hard to imagine that I will need to have anything more added to it.

[Dr. Schulman 2]

Hi again Dr. Schulman,

As you might be able to tell, I'm a lady with a lot of questions -- always!

Regarding the buttocks lift, is it usually the case that the patient would benefit from some sort of augmentation after a lift?

I'm having a hard time wrapping my head around this augmentation concept, because my backside has always been WAY more than ample -- and even though it has gone south as of late, its pretty hard to imagine that I will need to have anything more added to it.

No, not everyone needs a buttock augmentation. After massive weight loss, many people lose fat from their buttocks. During a LBL, the buttocks are lifted. This can often make the buttock look more flat (I know it sounds strange, but turn around, look in the mirror, and lift your butt with your hands - does your butt get flatter?)

When I first began doing LBLs, I did not appreciate this phenomenon. As time went on, I began to see patients after body lifts (my own as well as others) who desired more volume to the buttocks - this was because the butt was now flatter, or because when they were heavy, the only part of the body that they liked was the butt. I did things like implants and fat injections - whioch work well - but realized that it was better to anticipate this happening and address it during the LBL.

There are no hard rules for plastic surgery. Everyone is different and everyone needs a different surgical plan - this is the "art" of plastic surgery.

[ellen 0]

Hi Dr Schulman

I had an armlift in March this year. The scars are at the back of my arms (I wasnt given any reason for this but had expected them to be on the inside of the arms) and the arms themselves are not as slim as I would have liked given the extent of the scarring. The measurement pre-op was 15 inches and post op is 13 inches. The scars are positioned at the back but close to the inner side. In such circumstances where there is still a significant amount of excess skin, do you think a revision op might be possible to remove the excess and reposition the scar on the inner side of the arm so that it's not immediately visible from the back?

Thanks for your advice.

Ellen