Ask Dr. Schulman...

[Shalee04 7]

Dr Schulman, I have started my plastic surgery consults a few weeks ago. I am amazed at the whole process and how 3 different Dr's come up with 3 different options for me. and the price differences are astounding. I have learned alot of info from reading your answers to all our our questions here on the boards.

I always go into my consults with alot of questions for the Dr's. I wish there were more PS's that specialized in patients with weight loss. Have you heard anything about a Dr. J. Timothy Katzen??

He is one of the Dr's I am considering, He seemed top me to know the most about weight loss patients needs and gave me realistinc goals, was very patient with me and answered all my husbands and my questions. He didn't beat around the bush or tell me he could make me look like a movie star, which I had one tell me, I ran real fast out of his office.

Also HOW long is too long to be under for surgery?? I was quoated about 8-9 hours for a Extended TT and also a breast lift with implants by one Dr. And then a few days later another Dr. said the time in surgery for those same procedures would be 2 1/2-3 hours BIG time difference. and that scares me that they are so different.

Thanks for your input,

Kelly

[Dr. Schulman 2]

Dr Schulman, I have started my plastic surgery consults a few weeks ago. I am amazed at the whole process and how 3 different Dr's come up with 3 different options for me. and the price differences are astounding. I have learned alot of info from reading your answers to all our our questions here on the boards.

I always go into my consults with alot of questions for the Dr's. I wish there were more PS's that specialized in patients with weight loss. Have you heard anything about a Dr. J. Timothy Katzen??

He is one of the Dr's I am considering, He seemed top me to know the most about weight loss patients needs and gave me realistinc goals, was very patient with me and answered all my husbands and my questions. He didn't beat around the bush or tell me he could make me look like a movie star, which I had one tell me, I ran real fast out of his office.

Also HOW long is too long to be under for surgery?? I was quoated about 8-9 hours for a Extended TT and also a breast lift with implants by one Dr. And then a few days later another Dr. said the time in surgery for those same procedures would be 2 1/2-3 hours BIG time difference. and that scares me that they are so different.

Thanks for your input,

Kelly

I know of Dr. Katzen. He has a good reputation and the majority of his practice is related to weight loss surgery. He has a strong following of patients. He tends to be a bit on the aggressive side - long surgeries, and massive liposuction, etc. It is common for him to suction 10 L of fat from the legs before he does the LBL a few months later. I personally think that this leads to long OR times (8-9 hrs) and up to 1 week in the hospital, with increased complication risks. The data clearly shows that OR times exceeding 6 hours and liposuction exceeding 5 liters significantly increases the risks of surgery.

While this very aggressive approach is not my particular style, Katzen gets good results and his patients tend to be happy, so I guess it works for him. I know the prices can be signficant as well given the extensive surgery, hourly rate for the OR, and overnight hospital stays.

Regarding the time in the OR, every doc is different. Some work fast, and some have people helping them which enables them to cut down the OR time. Personally, I think 2-3 hours for an extended TT and breast lift with implants is way too short - I would be concerned that one person is working on the breasts while another is working on the abdomen.

You should be sure of who the person is helping! I always do this surgery with a plastic surgery fellow (or two) and sometimes another board certified surgeon with me - I never have a technician or a nurse doing the surgery with me. I get paid for my skill and training, and it is not fair to the patient to have someone else perform a major portion of the operation. I consider myself fast, but it would take me about 2-3 hours for the TT and then another 2 hours for the breasts - for a total of 5-6 hours.

Hope this helps.

[loridee11 519]

Thank you SO much Dr.! I feel 1000X better about the vertical incision. I've always had an hour glass figure (although as I've lost weight it's gone away due to the extra skin just around the middle) and I really want that back.

~Lori

[Dr. Schulman 2]

Thank you SO much Dr.! I feel 1000X better about the vertical incision. I've always had an hour glass figure (although as I've lost weight it's gone away due to the extra skin just around the middle) and I really want that back.

~Lori

I am glad I helped. A good rule of thumb is "the more you are willing to accept in terms of scarring, the better result you will get in terms of shape!"

[Snowgator 3]

Dr. S.,

I'm concerned that many people say weight loss makes their face look older. If after weight loss my crows feet and crepey skin under the eyes gets worse, does laser treatment such as the Fraxel work?

[Dr. Schulman 2]

Dr. S.,

I'm concerned that many people say weight loss makes their face look older. If after weight loss my crows feet and crepey skin under the eyes gets worse, does laser treatment such as the Fraxel work?

Fraxel works for fine lines, wrinkles, acnes scars, and pigmentation. It takes several treatments sessions (3-5, with a month between each). Chemical peels, and microdermabrasion can work well also. There is also surgical excision of the skin (blepharoplasty).

With weight loss, the face loses fat as well. So much of the time, the treatment is to add volume - this will "inflate" the face and smooth out the lines and crepey skin. Here is an analogy - If you add Water to a raisen, you get a grape. This is why PS talk about putting volume (fillers, fat, implant) into the face - when you just spent so much time, effort, and money to lose the weight.

[MissyL 0]

Hi Doctor Schulman,

This is a huge thread, sorry if this has been asked but im really curious!

I'm 23 and I have 110 pounds to go before i hit my goal weight (lost already 121 pounds) and i was wondering is it better to do Tummy Tuck once i hit my goal weight? because i was hoping to do the operation once i am ALMOST at my goal weight by about 22 pounds (would be 176 pounds at the time) as i know you loose more weight after the surgery... do you think that's ok??

Also i plan to do an arm lift and im abit concerned about the mark after surgery... does the mark ever go away??

Thanks for your time

Edited August 22, 2008 by MissyL

[Dr. Schulman 2]

Hi Doctor Schulman,

This is a huge thread, sorry if this has been asked but im really curious!

I'm 23 and I have 110 pounds to go before i hit my goal weight (lost already 121 pounds) and i was wondering is it better to do Tummy Tuck once i hit my goal weight? because i was hoping to do the operation once i am ALMOST at my goal weight by about 22 pounds (would be 176 pounds at the time) as i know you loose more weight after the surgery... do you think that's ok??

Also i plan to do an arm lift and im abit concerned about the mark after surgery... does the mark ever go away??

Thanks for your time

Congratulations on your weight loss. I think the best plan is to do the TT (or circumferential body lift) when you are close to goal - or at least when your weight loss stabilizes. It is true that you can loose more weight after the surgery. Also, with your 200+ pounds lost, I am sure you will have about 20+ pounds of skin...so you may never actually get to your goal because you should factor in the weight of the skin.

The scar froman armlift will fade, but it may never disappear completely. The scar quality really depends on your body andhw you heal. When done correctly, it should not be visible from the front, back, or side with your arms down at your sides. If you develop large hanging skin, I am guessing that you will accept some scarring.

[pammycakes 1]

Hi Dr. Shulman

I have a couple questions. The first one I believe you have answered once or twice for other people. I am wondering when the best time to start looking into PS would be for me? I am at 275 right now and my goal weight is 220. The last 6 months I have been losing an average of 5 lbs a month. I have lost 110 lbs. I am hoping to have my arms, breasts and stomach taken care of. Also because of the fact my goal weight isnt as low as many people looking into PS would that have any affect on the doctors decision to do my surgeries or on how they would be done?

Thank you for your time

Pam

[Dr. Schulman 2]

Hi Dr. Shulman

I have a couple questions. The first one I believe you have answered once or twice for other people. I am wondering when the best time to start looking into PS would be for me? I am at 275 right now and my goal weight is 220. The last 6 months I have been losing an average of 5 lbs a month. I have lost 110 lbs. I am hoping to have my arms, breasts and stomach taken care of. Also because of the fact my goal weight isnt as low as many people looking into PS would that have any affect on the doctors decision to do my surgeries or on how they would be done?

Thank you for your time

Pam

My recommendation is to see a plastic surgeon when you are within 30 lbs of goal, or if your weight loss has stopped (regardless of where you are in relation to your goal). Keep in mind that about 10+ pounds will be skin, so you may not get to your goal weight. It may take a while to get an appointment and it may take several months to be scheduled, paperwork, etc., so best to start early.

I don't think that a PS experienced in this area will be affected by your weight. We understand that everyone is different, and some people can not get to a low goal wight (or don't want to). We also know that lapband patients tend to lose less weight than other bariatric surgery (like GB or DS).

[kareyquilts 1]

Dr. Schulman: Speaking of goal weight, I have been trying to lose the last 20 pounds for many many months now. It seems that my body likes me at my current weight (5'6'- 155 lbs.). I have a Tannika scale which is suppose to measure body fat and according to that scale, I am still 38% fat! Do you know how accurate these types of measurements are? I believe that I do have more weight to lose. I am excersicing 6 days a week, aerobics and then pilates or strength training. I am keeping my calories at about 1200/day, which I record faithfully. I'm not asking for diet advise, but I'm wondering how to know when you can't loose anymore? I just loose and gain the same 2-3 pounds. I am schedule for a thigh and butt lift, arms and revision of my Tummy Tuck in October and really want to loose as much as I can before, since I am not anxious to go through any more surgery after that. My ps says he will probably remove another 7 pounds. I just know that doesn't necessarily equate to that much lost weight for me. With my first round of surgery, the ps removed 4.5 pounds from the tummy and 3 pounds of fat from Lipo. When it was all said and done, I probably only lost 3 pounds. I want to be the best that I can, but it seems like I'm swimming upstream. Any ideas?

[Shalee04 7]

I know of Dr. Katzen. He has a good reputation and the majority of his practice is related to weight loss surgery. He has a strong following of patients. He tends to be a bit on the aggressive side - long surgeries, and massive liposuction, etc. It is common for him to suction 10 L of fat from the legs before he does the LBL a few months later. I personally think that this leads to long OR times (8-9 hrs) and up to 1 week in the hospital, with increased complication risks. The data clearly shows that OR times exceeding 6 hours and liposuction exceeding 5 liters significantly increases the risks of surgery.

While this very aggressive approach is not my particular style, Katzen gets good results and his patients tend to be happy, so I guess it works for him. I know the prices can be signficant as well given the extensive surgery, hourly rate for the OR, and overnight hospital stays.

Regarding the time in the OR, every doc is different. Some work fast, and some have people helping them which enables them to cut down the OR time. Personally, I think 2-3 hours for an extended TT and breast lift with implants is way too short - I would be concerned that one person is working on the breasts while another is working on the abdomen.

You should be sure of who the person is helping! I always do this surgery with a plastic surgery fellow (or two) and sometimes another board certified surgeon with me - I never have a technician or a nurse doing the surgery with me. I get paid for my skill and training, and it is not fair to the patient to have someone else perform a major portion of the operation. I consider myself fast, but it would take me about 2-3 hours for the TT and then another 2 hours for the breasts - for a total of 5-6 hours.

Hope this helps.

Thank you for your answer Dr Schulman,

I am going back to talk to Dr Katzen again this Friday, so far he has been the one both my husband and I feel the best about. I have had 2 other consults and the 1 Dr we just diodn't feel at all comfortable with and then there was Dr speedy Gonzales, hehehe So we shall see what happens after friday.

Thanks Again

[lherstine 0]

Dr. Schulman,

i am about 44 lbs away from my goal weight. I have stabilized within a pound or two up and down. I am still trying to get down and i am wonder if it is to early to start looking into ps? I am interested in a Tummy Tuck as opposed to a pannilectiomy (sp?) i have bcbs of michigan and i have went to my doctor already for an infection of the belly button. And i have low back degeneration, which my chiropractor says that the excess skin is aggrevating. Do you know what has to be supplied to get bcbs to pay for the surgery?

[bradley18 0]

Dr. Schulman,

I have been advised to have the lap band proceduer, I need to lose about 50 pds., my problem is that I have NASH, and it has turned into cirrhosis, I want to make sure this is not going to hurt my liver anymore than it already is, any information would be appreicated.

Bradley 18

[Donna113 2]

Dr. Schulman, if a person gets TT will the skin be less resilient? Example, if a person within 30 lbs of goal gets a TT and then loses more weight after the TT, will there be loose skin requiring yet another TT?