Ask Dr. Schulman...

[Dr. Schulman 2]

Good Morning Dr.

I am interested in several procedures but the first one I am interested in is a neck lift. This seems to be one of the lesser common ps procedures so how do I know how to choose a competent surgeon for this particular procedure?

What questions should I ask of the Dr.?

I have a very crepe like area hanging and I believe I need the neck muscle tightening as well.

Will a neck lift improve my jowls?

How much scarring is there for this type procedure and is it well hidden?

Is there a surgeon in Ct you can recommend I consult with?

I am also interested in a panni and thigh lift ( but will not consider a thigh lift unless the scar can be hidden in the groin).

I am not at goal but I am ready for the neck lift. I had my lapband only eight months and it was removed (long story) so I never lost all the weight I was hoping to. I have been at the same weight now for five months and would like the neck lift done in January.

What type of recovery time can I expect for a neck lift?

Thanks for any info you can provide.

A neck lift will help tighten the muscle of your neck, and also the loose skin. It will not do much to improve your jowls - for that you need a facelift (which includes a necklift). The incision is around the front and the back of the ears (same as for a facelift) and probably a small incision under the chin for tightening the muscles. The recovery is much easier than body procedures. There is minimal pain, and swelling is the major issue. You should expect to be bruised and swollen for anywhere from 5 days to 2 weeks. A necklift is the same, whether it is done for aging or after weight loss. I do not have a name of anyone in CT but you should check the ASPS website (www.plasticsurgery.org)

[shortgal 5]

Thank you for the quick reply.

How many facelifts (with neck lift) do you do in an average year? If the incision is the same (with just the added chin incision) then it makes sense to do both neck and face together.

How long does the procedure take? How many postop visits are involved after the procedure?

I am in Fairfield County, so I could go to NYC for the procedure. I am more concerned with how many trips I'd have to make down there.

I will check out your web site and the ASPS site as well. Thanks.

[Dr. Schulman 2]

Thank you for the quick reply.

How many facelifts (with neck lift) do you do in an average year? If the incision is the same (with just the added chin incision) then it makes sense to do both neck and face together.

How long does the procedure take? How many postop visits are involved after the procedure?

I am in Fairfield County, so I could go to NYC for the procedure. I am more concerned with how many trips I'd have to make down there.

I will check out your web site and the ASPS site as well. Thanks.

I do about 10-15 facelifts per year. All the facelifts include a necklift. While the incisions are the same, a face + neck is a larger operation than a neck alone. I think it does make sense to have a facelift at the same time as a necklift, but only if you need it (some people do only need a necklift). It is also common to have a chin implant placed at the same time - this tends to help with neck contour in people with a small chin (you can see pictures of this on my website).

The surgery is ambulatory, and I would see you the next day. It makes sense to stay in the city for a day or two to avoid traveling, and also in the rare case that there is a complication. My office can arrange for a discount at a local hotel if you desire. You would then be seen on post-op day 5 (or 6), post-op day 12 (or 13), and then about 2 weeks after that. You will then see me about 2 months later to make sure everything has healed well. Obviously, the schedule of appointments is just a guide, but you can expect to see me about 3 times within the first 2 weeks. I routinely operate on people from out of town, so I am sensitive to your convenience (as long as it does not interfere with your safety!)

[ImaKaren4U 0]

Dr Schulman,

Do you have any comments that might help me?

Hi there! Well - one year after being banded, I got my apron removed, breasts lifted and augmented 4 weeks ago on Sept 8th. Well the doctor gave me enough strong painkillers for 2 weeks, a lesser one the 3rd week and said to take ibuprofen after that - which isn't doing the job. For the past 5 days I have been very nauseas and have vomited nearly every time I eat anything - which as you know isn't easy with the Lap Band. I am worried that it may hurt the lap band. (Vomited badly all night last night)

My question is this: is it ok to request painkillers from the doctor? How long have others been on it?

Being nauseas - has anyone else experienced this weeks after surgery?

[kareyquilts 1]

Karen: I'm sure that Dr. Schulman will respond to this, but I think that you should get your band checked. It sounds like it may have slipped. You shouldn't be nauseated that far out from surgery. Unfortunately, I had a similar experience when I had my TT. I think that when my port was replaced they may have pulled too hard on the band. I had problems similar to what you are describing and ended up having to have my band replaced. I wished that I would have checked it out much sooner. I wish you the best.

[ImaKaren4U 0]

Karen: I'm sure that Dr. Schulman will respond to this, but I think that you should get your band checked. It sounds like it may have slipped. You shouldn't be nauseated that far out from surgery. Unfortunately, I had a similar experience when I had my TT. I think that when my port was replaced they may have pulled too hard on the band. I had problems similar to what you are describing and ended up having to have my band replaced. I wished that I would have checked it out much sooner. I wish you the best.

Thank you for your information - I would think that I would have had problems before the 4th week out?

Also, I haven't had any acid reflux or heartburn - which as you know can be another sign of slippage or of a band being too tight.

I do not have nausea all day, usually just in the evening through part of the night until I go to sleep. Did your nausea - when you had a band slip - happen all the time or just some of the time? And how long after your TT surgery? (I have read other posts from banders with TT and nausea that was resolved and not from slippage) It isn't that I am not considering this as a possibility but I need to make sure our symptoms are similar enough.

My husband is FREAKING out because we just paid for the Tummy Tuck and boobies and he can't rationally think about the possibility of paying for a band replacement or modification too.

Thanks for your input.

[renewedhope 4]

Have you called your doctor yet to let them examine you to determine if there is a problem with your band? Being this far out from surgery, I would think a follow up and evaluation of your nausea is indicated. My doctor would want to know.

[ghostbuster 3]

Hello Dr. Schulman,

I have a few questions about TT/LBL's. Does a LBL always include a TT? I have been lucky enough to hardly have any loose belly skin, but I do have quite a bit of skin on my butt/hips/thighs that I want to get rid off and it seems like a LBL would be the way to go. I plan on having kids someday so I didn't really want to do to much of a TT since it will probably just get all stretched out again in the next 5-10 years. Also, the scar for my port incision seems to be "stuck". It looks like I'm growing an extra belly button. Have you ever seen this before? Would I have to get a TT to fix that? Also, if I were to get a LBL/TT could I get my breast done at the same time? Sorry, I have been all over the place. I'll sum up

1. Does a LBL always include a TT?
   
2. Is it worth it to get a TT if you plan on having kids in the next few years?
   
3. The scar from port is "stuck". Have you ever seen this before?
   
4. Would I have to get a TT to fix that?
   
5. Can I get my breasts done at the same time as the LBL/TT?
   

Thanks!

Edited October 8, 2008 by ghostbuster

[Dr. Schulman 2]

Dr Schulman,

Do you have any comments that might help me?

Hi there! Well - one year after being banded, I got my apron removed, breasts lifted and augmented 4 weeks ago on Sept 8th. Well the doctor gave me enough strong painkillers for 2 weeks, a lesser one the 3rd week and said to take ibuprofen after that - which isn't doing the job. For the past 5 days I have been very nauseas and have vomited nearly every time I eat anything - which as you know isn't easy with the Lap Band. I am worried that it may hurt the lap band. (Vomited badly all night last night)

My question is this: is it ok to request painkillers from the doctor? How long have others been on it?

Being nauseas - has anyone else experienced this weeks after surgery?

It concerns me that you are having so much pain 3 weeks after surgery. Most people still have soreness, but it is rare to need any strong pain medicine at this point. Also, the nausea/vomiting that you describe may be a sign of something wrong with you band (slippage?) Some people do get nausea fromt he narcotic pain medicine, but this sounds like something different. I would obviously call your PS for evaluation. I would not take more pain medicines until you have verified that there is nothing else going on. Pain can be a sign of a problem, and you don't want to "mask" the pain and possibly delay diagnosis of something. You should call your bariatric surgeon also, to have your band checked. Please keep us informed about what happens.

[Dr. Schulman 2]

Hello Dr. Schulman,

I have a few questions about TT/LBL's. Does a LBL always include a TT? I have been lucky enough to hardly have any loose belly skin, but I do have quite a bit of skin on my butt/hips/thighs that I want to get rid off and it seems like a LBL would be the way to go. I plan on having kids someday so I didn't really want to do to much of a TT since it will probably just get all stretched out again in the next 5-10 years. Also, the scar for my port incision seems to be "stuck". It looks like I'm growing an extra belly button. Have you ever seen this before? Would I have to get a TT to fix that? Also, if I were to get a LBL/TT could I get my breast done at the same time? Sorry, I have been all over the place. I'll sum up

1. Does a LBL always include a TT?
   
2. Is it worth it to get a TT if you plan on having kids in the next few years?
   
3. The scar from port is "stuck". Have you ever seen this before?
   
4. Would I have to get a TT to fix that?
   
5. Can I get my breasts done at the same time as the LBL/TT?
   

Thanks!

1. A LBL always includes a TT, buttock lift, and outer thigh lift. If you only need the back done, it is possible to just get a buttock lift and outer thigh lift, without the TT. This would technically not be a LBL, but rather a buttock/thigh lift. Basically, it would be the back part of a LBL incision. This does not prevent you from getting a TT in the future. WHile it is unusual for someone to only need the back done, and not the front, it does happen occassionally.

2. I think that if kids are in the plans within the next few years, than waiting for the TT is reasonable. You are right that the belly will stretch out a bit, and many people have a small revision after the kids.

3. Scars can be "stuck" from adhesions to deep tissue. This is very common and can be seen in any scars. There are ways to fix this without a TT. You can have a scar revision in which the adhesions are cut and it will no longer appear "stuck". Sometimes, fat or other things can be placed underneath to correct a divot.

4.see#3. No

5.Many procedures can be combined. I routinely combine TT with breast lift/augmentations - in fact, I just got out of the operating room for this very procedure. Combining procedures depends on your health, motivation, and skill of the surgeon. I prefer to not combine another procedure with a LBL because it is a big operation itself and requires a lot of recovery. It would be dangerous to add to this procedure.

[ImaKaren4U 0]

It concerns me that you are having so much pain 3 weeks after surgery. Most people still have soreness, but it is rare to need any strong pain medicine at this point. Also, the nausea/vomiting that you describe may be a sign of something wrong with you band (slippage?) Some people do get nausea fromt he narcotic pain medicine, but this sounds like something different. I would obviously call your PS for evaluation. I would not take more pain medicines until you have verified that there is nothing else going on. Pain can be a sign of a problem, and you don't want to "mask" the pain and possibly delay diagnosis of something. You should call your bariatric surgeon also, to have your band checked. Please keep us informed about what happens.

Thank you for your information Dr. Schulman. Today - and even last night - the nausea is better. I spoke to my bariatric surgeon and he says I should have the Fluid drained off because of the swelling, which hadn't been done previously. He also said he doesn't think it is slippage because I would be having major heartburn, reflux, and stomach pain also. The PS doesn't know how to remove the fluid from the band so I have to travel to my bariatric surgeon's office 4 hours away and they don't take these appointments except on Mondays. Anyway...I think most of my pain might be from the vomiting and coughing (because I am also sick). I will keep you all informed.

Also - as a PS yourself, what do you recommend the time period be for wearing the support bra (ie 24/7) and the compression garment. Is the compression garment mostly to encourage the swelling to diminish or to support the new muscle structure or ??

[ghostbuster 3]

Hello Dr. Schulman,

I have a few questions about TT/LBL's. Does a LBL always include a TT? I have been lucky enough to hardly have any loose belly skin, but I do have quite a bit of skin on my butt/hips/thighs that I want to get rid off and it seems like a LBL would be the way to go. I plan on having kids someday so I didn't really want to do to much of a TT since it will probably just get all stretched out again in the next 5-10 years. Also, the scar for my port incision seems to be "stuck". It looks like I'm growing an extra belly button. Have you ever seen this before? Would I have to get a TT to fix that? Also, if I were to get a LBL/TT could I get my breast done at the same time? Sorry, I have been all over the place. I'll sum up

1. Does a LBL always include a TT?
   
2. Is it worth it to get a TT if you plan on having kids in the next few years?
   
3. The scar from port is "stuck". Have you ever seen this before?
   
4. Would I have to get a TT to fix that?
   
5. Can I get my breasts done at the same time as the LBL/TT?
   

Thanks!

Thank You, Thank You! Hopefully I'll be close to my PS goal weight in the next few months!

[Dr. Schulman 2]

Thank you for your information Dr. Schulman. Today - and even last night - the nausea is better. I spoke to my bariatric surgeon and he says I should have the Fluid drained off because of the swelling, which hadn't been done previously. He also said he doesn't think it is slippage because I would be having major heartburn, reflux, and stomach pain also. The PS doesn't know how to remove the fluid from the band so I have to travel to my bariatric surgeon's office 4 hours away and they don't take these appointments except on Mondays. Anyway...I think most of my pain might be from the vomiting and coughing (because I am also sick). I will keep you all informed.

Also - as a PS yourself, what do you recommend the time period be for wearing the support bra (ie 24/7) and the compression garment. Is the compression garment mostly to encourage the swelling to diminish or to support the new muscle structure or ??

Glad you are feeling better. I usually have my patients empty the band prior to plastic surgery specifically for this reason. Also, I think it is important to get high nutrition prior to (and after) plastic surgery.

It seems to me that your PS should be able to empty the band. It is not difficult and I am sure he can discuss how to do this with your bariatric surgeon over the phone. It does not make sense to me that you are so uncomfortable (and vomiting) until Monday. PS routinely fill and unfill similar devices such as breat implants, tissue expanders, etc. And a PS experienced with bariatric surgery should be comfortable with how the band works - just my 2 cents!

I have my patients where the support garments all the time for 4 weeks. It helps both to reduce swelling and support the muscle repair. Then I have them wear them as much as possible (about 12 hours) for weeks 4-6. After that, they can go without, but most of my patients prefer to continue wearing an abdominal garment - they say it just makes them feel better and more supported. Your PS may have different recommendations so be sure to check with him.

[ImaKaren4U 0]

It seems to me that your PS should be able to empty the band. It is not difficult and I am sure he can discuss how to do this with your bariatric surgeon over the phone. It does not make sense to me that you are so uncomfortable (and vomiting) until Monday. PS routinely fill and unfill similar devices such as breat implants, tissue expanders, etc. And a PS experienced with bariatric surgery should be comfortable with how the band works - just my 2 cents!

Thank you again for your feedback...just an update - my PS will not do it nor will my PCP! They both said basically because they didn't put it in, they wouldn't do it because of insurance reasons....so - Monday is when I get unfilled 5 more days! :eek:

[css95 0]

Dr. Schulman:

I had a breast reduction and my arms done last Friday 10/3/08

I am so happy, and have had zero pain. Just the garment is very tight, but that will get better soon. Thanks for all you help.

One week after surgery I gained 4 pounds, Is this just the way it goes?

Or am I retaining fluids? Or is it just me. I haven't eaten that much?

Just thought I would ask, you seem to know all of our questions.

Thanks Againg for all your encouragement.