Ask Dr. Schulman...

[Queen of Hearts 2]

Dr. Schulman! Just listened to your radio interview and THANK YOU!! You hit the nail on the head. There are a lot of us that never realized how much excess skin we would have after we began this journey. I also agree that when we are faced with this excess, we are not necessarily looking at the vanity point of view but the completion of this journey that has brought us into a healthier life for the duration of our years. I also agree with the radio hostess when she was making comment on your compassion for any bariatric patient, you can hear it in your voice the determination you have to help us! Thank you! That is one of the important criteria on my list in the search for any plastic surgeon I plan contacting in the future! Thank you again!

[BeckyinTexas 3]

Dr. Schulman.....I just received my letter from Southwestern Medical Center in Dallas and I've been choosen to take part in their Resident Cosmetic Surgery program! I'm so excited I can hardly stand myself! Thank you, thank you, thank you for offering me this suggestion! I'm waiting for them to call me this afternoon so I can set up my new patient appointment where they will take photos and discuss when and what surgery I have been selected for. Dr. Schulman, I'm so grateful to you for giving me the idea to apply for this program. I'm honestly so giddy I can hardly contain myself! Thanks again!!!!!!!!

[luluc 6]

becky that is FANTASTIC news - congrats to ya!!

[kareyquilts 1]

Becky: Congratulations! So happy for you! Now, you must start a new thread so we can give you lots and lots of support! Way to go!

[Dr. Schulman 2]

Dr. Schulman.....I just received my letter from Southwestern Medical Center in Dallas and I've been choosen to take part in their Resident Cosmetic Surgery program! I'm so excited I can hardly stand myself! Thank you, thank you, thank you for offering me this suggestion! I'm waiting for them to call me this afternoon so I can set up my new patient appointment where they will take photos and discuss when and what surgery I have been selected for. Dr. Schulman, I'm so grateful to you for giving me the idea to apply for this program. I'm honestly so giddy I can hardly contain myself! Thanks again!!!!!!!!

That is great news! I am glad things are looking better for you. They have a very competent group of residents and you will be in good hands. There may be a several month wait from this point to get an OR date, so keep being patient. Keep us posted.

[Dr. Schulman 2]

Dr. S: It was great to hear your voice on the radio link! I have seen LED lights for sale in various catalogs are they worthwhile or just not powerful enough to get the job done?

There are several models available. They are not as powerful as "professional" models, but I am not sure that means that they don't work. No studies have been done on these lower energy models. They are not very expensive (usually around 100-200) so there is not that much to lose....but I am not sure. The professional models work, but are very expensive (usually around 1500 and up) and they are still not as good as ones in the Dr's office.

You don't need to do the LEDs that often - usually every 4 weeks, so it makes more sense to find an aestetician that does it, get yourself a nice microdermabrasion and facial, followed by LEDs every 4-6 weeks. You should be able to get this for about 200 per treatment session, and you save money if you buy packages of 4 or so. The cost is more than buying the LED machine yourself, but it is great for your skin and you get pampered.

[hungry4help 0]

hi dr. schulman... i know that insurance companies rarely cover plastic surgeries. but which, if any, have a better history of paying for panniculectomies? also, besides recording instances of rashes, etc., is there anything i can do now to help my case more compelling to an insurance company?

thanks in advance for your help.

[Dr. Schulman 2]

hi dr. schulman... i know that insurance companies rarely cover plastic surgeries. but which, if any, have a better history of paying for panniculectomies? also, besides recording instances of rashes, etc., is there anything i can do now to help my case more compelling to an insurance company?

thanks in advance for your help.

I can't really tell you which companies have a better history of paying, because it is always changing and often not consistent within companies. Also, it is very likely to change again before you are at a point for plastic surgery.

The best thing to do is have your primary doc (not a plastic surgeon) document rashes. Also, make sure you get (and fill) a prescription for an anti-fungal cream or powder. Insurance companies will look for these prescription records because they know how easy it is to "document" rashes that are not always there. It is common to have hernias that can be fixed at the same time - it is not a bad idea to get a CT scan and if a hernia shows up, the insurance company usually recognizes that a panni needs to be done in order to fix the hernia. Lastly, it comes down to picutres. Most companies require that the pannus hangs at or below the level of the pubic bone - if it is not there, they usually will not pay, even despite all the other things mentioned above.

[KD8888 0]

Dr. Schulman,

Could you give your opinion as to the pros/cons of upper eyelid surgery by a PS vs. eye doctor. The plan was to have it done by the PS, but when the tape test (not sure of proper terminology) was requested of the eye doctor, he started talking about submitting the info to the insurance company and that he could do the surgery.

Thanks.

[Dr. Schulman 2]

Dr. Schulman,

Could you give your opinion as to the pros/cons of upper eyelid surgery by a PS vs. eye doctor. The plan was to have it done by the PS, but when the tape test (not sure of proper terminology) was requested of the eye doctor, he started talking about submitting the info to the insurance company and that he could do the surgery.

Thanks.

First, just because your PS does not "participate with insurance", does not mean that he can't submit the paperwork for you, and then you will receive reimbursement from the insurance company directly. You may meet criteria for reimbursement because your doctor suggested you get a "tape test" - or visual fields.

Second, if it was your PS who sent you to the eye doctor to get the test, it is highly unethical for your eye doctor to try to solicit you. It breaks many "unwritten rules." In order to provide the best possible patient care, we refer patients to specialists. If doctors become fearful that the consultant will try to "steal" patiets, then docotrs will stop referring, and this is not always best for patient care.

This may not be how things happened, but if it is, and you have a good relationship with your PS, then I would let him/her know, so that they can find another eye doctor to refer to.

In terms of who is better - obviously, I am biased. PS have a minimum of 6 years of surgical training. Opthomologists do not have any blepharoplasty training unless they do a one year occuloplastic fellowship. That being said, there are some bad PS and there are some excellent opthamologists (make sure they are an opthomologist, with occuloplastic training! - if they don't, then they are not experienced enough to do eyelid surgery)

[nursenky9 0]

Dr. Schulman: I had a TT back in 2003 along with a totl abd hysterectomy. I have gained alot wt since then, I am in the process of getting my ins approval for th band. Have u marketed your services to the surrounding bariatric clinics/surgeons?

Does ins cover PS for WLS? I have Highmark BCBS PA they mentioned to me that reconstructive surgery is covered, the policy they sent me was just on the WLS

[Fanny Adams 7]

Dr Schulman

I am still in the middle of my weight loss journey but I am looking ahead to the future. I know that I will need a breast lift when I am done, but I am not sure what type of lower body surgery would be best. I have generally carried my weight very evenly and don't have specific problem areas that stand out more than others. I do have a hanging pannis but this is receding as I lose weight. However, I do have two very specific problems that could interfere with surgery results.

Firstly, I have a large scar (>10") from fallopian tube surgery performed about 20 years ago. This runs underneath my pannis across the top of the public line and really accentuates the droop of the pannis. For this reason, I'm thinking that a pannelectomy (sp?) would be appropriate. Secondly, I have a large scar (almost 18")that starts to the right of the centre of my spine and about 2-3 inches below my bra line, and goes around the right side of my body to the front, finishing just above the hip bone. This is from a major kidney operation that I had 35 years ago. This accentuates the fold of fat on my waist line, when seen from behind, and makes me lean towards the idea of a lower body lift.

Is is possible to have these scars removed or disguised in any way as part of one of the other procedures? Which procedure would be most appropriate to incorporate this into? Or will I end up with THREE scars, no matter which way I go?

Edited July 30, 2008 by Fanny Adams

[Dr. Schulman 2]

Dr. Schulman: I had a TT back in 2003 along with a totl abd hysterectomy. I have gained alot wt since then, I am in the process of getting my ins approval for th band. Have u marketed your services to the surrounding bariatric clinics/surgeons?

Does ins cover PS for WLS? I have Highmark BCBS PA they mentioned to me that reconstructive surgery is covered, the policy they sent me was just on the WLS

I have a very good relationship with many bariatric surgeons throughout the country. I also speak at bariatric surgery support groups throughout New York and New Jersey.

Insurance will pay for reconstructive procedures or procedures that are medically necessary. Much of plastic surgery after weight loss is still considered cosmetic unless you can demonstrate a true medical need. Usually a panniculectomy is considered medically necessary - if you have chronic skin irritation, rashes, infection, etc. If you look throught this thread, you will find many posts about this topic that can tell you more specific details. You can also obtain this from your insurance company when the time is nearer.

[Dr. Schulman 2]

Dr Schulman

I am still in the middle of my weight loss journey but I am looking ahead to the future. I know that I will need a breast lift when I am done, but I am not sure what type of lower body surgery would be best. I have generally carried my weight very evenly and don't have specific problem areas that stand out more than others. I do have a hanging pannis but this is receding as I lose weight. However, I do have two very specific problems that could interfere with surgery results.

Firstly, I have a large scar (>10") from fallopian tube surgery performed about 20 years ago. This runs underneath my pannis across the top of the public line and really accentuates the droop of the pannis. For this reason, I'm thinking that a pannelectomy (sp?) would be appropriate. Secondly, I have a large scar (almost 18")that starts to the right of the centre of my spine and about 2-3 inches below my bra line, and goes around the right side of my body to the front, finishing just above the hip bone. This is from a major kidney operation that I had 35 years ago. This accentuates the fold of fat on my waist line, when seen from behind, and makes me lean towards the idea of a lower body lift.

Is is possible to have these scars removed or disguised in any way as part of one of the other procedures? Which procedure would be most appropriate to incorporate this into? Or will I end up with THREE scars, no matter which way I go?

The scar from the gyn surgery is not an issue at all. In fact, the majority of my patients have a pre-existing scar in that area (s-secction, etc.). This is removed with the PS - eith an panni, abdominoplasty, or LBL. The Scar from the kidney surgery is a little more of an issue. Because of blood supply issues, it may interfere a bit with PS - it may limit the amount of tissue removed in that area, but this really depends on exactly where the scar is (your PS will evaluate it when the time comes). Either way, this kidney scar can be revised - it can be redone by your PS and made to look nicer.

Hope this helps. Good luck with the weight loss

[mss 1]

I will add a question as well Dr Schulman

I have had one consult with a re constructive surgeon and he suggested an abdominoplasty. I have a huge scar from a left hepact..... (whatever the word is for removal of the left lobe of my liver) due to an adenoma. I had a PE following surgery - 2 years ago. This surgeon is concerned about my past PE however he said he could still do the surgery on me however it would be a very conservative procedure due to my significant scarring and the PE. He hasn't operated on a person who has had a PE before so I am wondering if I should see someone who has had more experience in operating on people who have had clots? I assume all surgeons have to start somewhere though.