Ask Dr. Schulman...

[Lap_dancer 8]

Just an update. The doctor has a surgery that will take a little longer than anticipated tomorrow, my appt. is the same time, next day. Consulation on Thursday for the breast reduction, (crossing fingers) and penni-off (my word). Goal: No back pain would be great in 2008!

[ghostbuster 3]

Hi Dr.S, I've noticed that you emphasize getting to goal and staying there for a few months before having PS. My question is this, how much weight is the extra skin? Should I factor that in? My Goal is 130, should I go in for PS around 145? I think I will need a major LBL, a BL, and Inner Thigh. It's a wierd thought for me, but if I waited till I was at goal and lost 15 pounds with the surgery, I could end up too skinny. Also, my arms have not been a big problem, would a little bit of Lipo create loose skin? So it would really be better to do nothing? And for those of us with deflated breats, would getting an implant do anything to creat or add to shoulder and neck pain from a life time of heavy breasts? Thanks for your input!

[Alfie 58]

Hi Dr S,

Thank you for being down to earth, professional and willing to share.

I have a few questions; did you perform all the surgeries in the pictures that you showed us? Also, being that I am 54 1/2 years old, would I also benefit greatly from some of these procedures such as a lbl and bl? Or are the risks increased with age or maybe not as effective?

Lastly, is there a "facial" procedure that can be done simultaineously with one of these surgeries? I am not terribly wrinkled but the part under my eye brows seems to have drooped somewhat to now cover my eyelids. Also, under my chin (although I don't have a turkey waddle) seems to need something or another :thumbup:.

I live in Queens and look forward to meeting you when my weightloss is completed.

Regards,

Alfie

Edited July 2, 2008 by Alfie

[Dr. Schulman 2]

Hi Dr.S, I've noticed that you emphasize getting to goal and staying there for a few months before having PS. My question is this, how much weight is the extra skin? Should I factor that in? My Goal is 130, should I go in for PS around 145? I think I will need a major LBL, a BL, and Inner Thigh. It's a wierd thought for me, but if I waited till I was at goal and lost 15 pounds with the surgery, I could end up too skinny. Also, my arms have not been a big problem, would a little bit of Lipo create loose skin? So it would really be better to do nothing? And for those of us with deflated breats, would getting an implant do anything to creat or add to shoulder and neck pain from a life time of heavy breasts? Thanks for your input!

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!

[Dr. Schulman 2]

Hi Dr S,

Thank you for being down to earth, professional and willing to share.

I have a few questions; did you perform all the surgeries in the pictures that you showed us? Also, being that I am 54 1/2 years old, would I also benefit greatly from some of these procedures such as a lbl and bl? Or are the risks increased with age or maybe not as effective?

Lastly, is there a "facial" procedure that can be done simultaineously with one of these surgeries? I am not terribly wrinkled but the part under my eye brows seems to have drooped somewhat to now cover my eyelids. Also, under my chin (although I don't have a turkey waddle) seems to need something or another .

I live in Queens and look forward to meeting you when my weightloss is completed.

Regards,

Alfie

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.....

[Alfie 58]

Thank you so much for your quick reply

[BeckyinTexas 3]

Dr. S......I have a question that I have been embarrased to ask but lucky you, I'm asking. I'm still fighting my insurance company over the pannicolectomy and will continue to do so. I'm just wondering, when you have a panni, does that do anything for the pubis mound? Is that a separate procedure? Is it ever combined? I know that with the fat apron removed, it would make it look even worse than it does now. After all the weight I've lost, I have lots of "party favors" left over from being so big. They are some of the most annoying places! Thanks for all your support!!!!!

[mcgreen 0]

Dr. S......I have a question that I have been embarrased to ask but lucky you, I'm asking. I'm still fighting my insurance company over the pannicolectomy and will continue to do so. I'm just wondering, when you have a panni, does that do anything for the pubis mound? Is that a separate procedure? Is it ever combined? I know that with the fat apron removed, it would make it look even worse than it does now. After all the weight I've lost, I have lots of "party favors" left over from being so big. They are some of the most annoying places! Thanks for all your support!!!!!

becky- congrats on your weightloss! sorry you are having skin issues also

[Dr. Schulman 2]

Dr. S......I have a question that I have been embarrased to ask but lucky you, I'm asking. I'm still fighting my insurance company over the pannicolectomy and will continue to do so. I'm just wondering, when you have a panni, does that do anything for the pubis mound? Is that a separate procedure? Is it ever combined? I know that with the fat apron removed, it would make it look even worse than it does now. After all the weight I've lost, I have lots of "party favors" left over from being so big. They are some of the most annoying places! Thanks for all your support!!!!!

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."

[Lap_dancer 8]

UPDATE:

I just got back from the plastic surgeon's office. My trepidation about facing my body isses turned out to be a positive experience and the visit was productive.

Thank you Dr. Schulman, I feel because of some of the things I had the opportunity to discuss here, I was better able to articulate to this doctor what I was hoping to achieve.

The focus for now will be my stomach and not my breasts.

Because I still have quite a bit of weight to go there are alterations that happen to the body not just with the breasts but the back and sides.

*Dr. Schulman could you go into a bit more detail about this. I would like to understand the process.*

I did not realize the various concerns with the skin removal when we have large stomachs and the pennicula that hangs down.

*He spoke of blood circulation and Fluid pooling in the stomach. Dr. Schulman could you expand on that and what would cause that?

My surgeries will occur in stages. The first stage will be a partial Tummy Tuck, no navel involved. I'm going to lose 50 lbs before I have this done. This will give me time to fly back out to Dr. K for another fill in the fall and perhaps lose more than the set goal of 50. My surgeries to get me back to a normal body will come in phases.

Thank you Dr. Schulman I appreciate your distance assistance in helping me with this process.

[BeckyinTexas 3]

As always, thanks Dr. Schulman. That was one of those questions that I didn't quite know how to phrase but you knew exactly what I was talking about. I'm speaking at the National Lap Band Conference in October and I so hope to have the surgery behind me and be able to take the stage strutting my stuff! Heck, even without the surgery I plan on strutting. I've earned that right! Thanks again, Dr. S. You're one of the good guys!

[BeckyinTexas 3]

Thanks, Marjorie! I'm very proud of my weight loss and at times I just can't believe I let myself get so huge. The hardest part for me now is realizing that all the skin issues are the direct result of my giving up on myself. But no more...I've come too far to not complete this journey and have the body that shows what I've accomplished. Thanks for your support. It means so much to me to have people on this forum I can talk to and know they understand all the issues that go along with weight loss. Have a happy and safe 4th everyone!

[Frangipani 1]

Hi Dr. Schulman,

Thank you for starting this highly informative thread!

I have a question about scar treatments. I recently had a full TT and a BL with implants. I'm currently using Mederma in the hopes that it will reduce my scarring over time, but I wondered if there are any better and more effective treatments out there. Also, are any products in particular that you recommend to your patients?

Thanks for any advice and information you might have. :smile2:

[Dr. Schulman 2]

Hi Dr. Schulman,

Thank you for starting this highly informative thread!

I have a question about scar treatments. I recently had a full TT and a BL with implants. I'm currently using Mederma in the hopes that it will reduce my scarring over time, but I wondered if there are any better and more effective treatments out there. Also, are any products in particular that you recommend to your patients?

Thanks for any advice and information you might have. :smile2:

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!

Edited July 14, 2008 by Dr. Schulman

[Frangipani 1]

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!

Thanks for the great advice Dr. S, and for the $$$ savings too! :cursing:

I can see that I need to revamp my whole regime here. I do have paper tape which I'll start using right away. I live on an island so I'll probably have to mail order the silicone gel, but I will definitely do so and give it a try.

Thanks again!