Ask Dr. Schulman...

[SkinnyKathy 99]

Dr. Schulman,

I have more than 200 pounds to lose and I am just getting started but I have a plastic surgery question that I hope will become a real dilemma for me in the future. I was wondering if you have ever done plastic surgery on a patient who has a *lot* to lose somewhere mid-way through the weight loss period? The reason I ask is because I have always had a very significant "apron", and after two pregnancies it has only gotten worse. I am constantly battling yeast infections down there, and it makes it challenging to exercise because no matter what kind of undergarments I wear (and choices are slim at my weight), I bounce all over the place.

Now I was banded only a month ago and I haven't lost that much weight yet. I know this is only going to get worse as I lose more weight. I imagine that by the time I lose weight down to my goal weight, my apron will be down to my knees! (gross thought). So I was wondering if it be possible or advisable to get a Tummy Tuck or pannenectomy (whatever it is called when they cut off the apron) sooner, and then go for a full body lift when I get to my final goal weight.

I know this seems like I am getting way ahead of myself, but I am a planner and setting goals and milestones for myself helps keep me motivated...

[Dr. Schulman 2]

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.

The added weight is absolutely just fluid! I always tell my patients not to even look at a scale, let alone get on one. Even when I remove 10-15 pounds of skin, it is common for the person to be 10 pounds heavier because of swelling and Fluid. It is important to keep drinking liquids and limit your salt intake (avoid Soups that have a lot of sodium). As your swelling goes down, you will see your weight drop also. This might also make you have to urinate alot as your body gets rid of the fluids.

[Dr. Schulman 2]

Dr. Schulman,

I have more than 200 pounds to lose and I am just getting started but I have a plastic surgery question that I hope will become a real dilemma for me in the future. I was wondering if you have ever done plastic surgery on a patient who has a *lot* to lose somewhere mid-way through the weight loss period? The reason I ask is because I have always had a very significant "apron", and after two pregnancies it has only gotten worse. I am constantly battling yeast infections down there, and it makes it challenging to exercise because no matter what kind of undergarments I wear (and choices are slim at my weight), I bounce all over the place.

Now I was banded only a month ago and I haven't lost that much weight yet. I know this is only going to get worse as I lose more weight. I imagine that by the time I lose weight down to my goal weight, my apron will be down to my knees! (gross thought). So I was wondering if it be possible or advisable to get a Tummy Tuck or pannenectomy (whatever it is called when they cut off the apron) sooner, and then go for a full body lift when I get to my final goal weight.

I know this seems like I am getting way ahead of myself, but I am a planner and setting goals and milestones for myself helps keep me motivated...

Some people have an apron of skin that causes lots of problems and require its removal before much of the weight loss. This is a panniculectomy and will help eliminate symptoms of rashes, infections, etc. It will also help you move around an exercise - all things necessary for successful weight loss. Int his case, a panniculectomy can be done, knowing that you will liely need a full TT (or LBL) after the weight loss. This staged approach is not uncommon.

[SkinnyKathy 99]

Some people have an apron of skin that causes lots of problems and require its removal before much of the weight loss. This is a panniculectomy and will help eliminate symptoms of rashes, infections, etc. It will also help you move around an exercise - all things necessary for successful weight loss. Int his case, a panniculectomy can be done, knowing that you will liely need a full TT (or LBL) after the weight loss. This staged approach is not uncommon.

Thank you , Dr. Schulman, for this prompt response. I think this is definitely what I want to do. Can you tell me, given how much I have to lose, but also the fact that I have a pronouced apron even now, approximately when in my weight loss journey would be a good time to get the panniculectomy done?

[gingerbug 3]

Dr. Schulman,

Thanks for sharing your time with us. I have a question for you, if you dont mind. I am 16 pounds from my goal of 190 pounds on my 5'11" frame. My body shape is much thinner on top than I am on bottom. My shoulders are not much more narrow than my hips but the shape of my bottom half is much more 'curvy' than my upper half. As it stands, I feel I am thin enough on top yet I still have the same problems that I did before i had gained my weight in the first place, the hips and thighs. I feel that my skin has recovered nicely from losing weight so quickly. With the exception of what having two kids has done to my lower abdomen, which really does not look too bad in itself, I dont have any loose skin. Is it possible that I could have good results with just getting liposuction? I am a full size larger 'on the bottom' than I am 'on the top'. My goal is to look balanced. If I lose too much weight, I run a big risk of being really 'bony' on top since I have a large frame. I want to stop my weight loss at 190, spend some time at the gym toning my muscles, and then have Lipo on my lower half. I am hoping this goal is not entirely impossible. Oh, i dont know if this is relevant, but I had only been obese for about 6 years. I dont know it that plays a part in skin elasticity. Thanks for your time, V

Edited October 9, 2008 by gingerbug

[AliceJ 0]

Dr Schulman, I am about 10 pounds from my goal weight and am considering having the smas facelift ( cosmo facelift) I do not want to have a major lift. Also a little Lipo in neck. Any thoughts? Thank you

[Dr. Schulman 2]

Thank you , Dr. Schulman, for this prompt response. I think this is definitely what I want to do. Can you tell me, given how much I have to lose, but also the fact that I have a pronouced apron even now, approximately when in my weight loss journey would be a good time to get the panniculectomy done?

It is really impossible to answer that question. My suggestion is to lose as much as you can, until the apron is just too much for you to handle. You should try to get almost 1/2 way - but it totally depends on how bad and how fast your apron gets.

[Dr. Schulman 2]

Dr. Schulman,

Thanks for sharing your time with us. I have a question for you, if you dont mind. I am 16 pounds from my goal of 190 pounds on my 5'11" frame. My body shape is much thinner on top than I am on bottom. My shoulders are not much more narrow than my hips but the shape of my bottom half is much more 'curvy' than my upper half. As it stands, I feel I am thin enough on top yet I still have the same problems that I did before i had gained my weight in the first place, the hips and thighs. I feel that my skin has recovered nicely from losing weight so quickly. With the exception of what having two kids has done to my lower abdomen, which really does not look too bad in itself, I dont have any loose skin. Is it possible that I could have good results with just getting liposuction? I am a full size larger 'on the bottom' than I am 'on the top'. My goal is to look balanced. If I lose too much weight, I run a big risk of being really 'bony' on top since I have a large frame. I want to stop my weight loss at 190, spend some time at the gym toning my muscles, and then have Lipo on my lower half. I am hoping this goal is not entirely impossible. Oh, i dont know if this is relevant, but I had only been obese for about 6 years. I dont know it that plays a part in skin elasticity. Thanks for your time, V

Without seeing you and the quality of your skin, it is impossible to to know if liposuction alone is enough for you. From what you are describing, liposuction may improve your lower half enough for you to be happy. The issue is whether your skin will tighten enough after liposuction. It might, given the fact that it sounds like it tightened fairly well from the weight loss. It is certainly a reasonable plan for some people.

[Dr. Schulman 2]

Dr Schulman, I am about 10 pounds from my goal weight and am considering having the smas facelift ( cosmo facelift) I do not want to have a major lift. Also a little Lipo in neck. Any thoughts? Thank you

I have never heard of the cosmo facelift, but there are many names used for facelifts (usually made up by the surgeon or his publicist). Using the term "major" or "mini" is misleading because it usually only refers to the actual skin incision. The problem is that the work on the SMAS that is needed to provide a natural looking facelift (not like the tight pulled looks of the 1980s) requires a longer incision. The mini-lifts have a smaller incision and ironically eliminate the part of the incision that is hidden behind the hairline. liposuction under the chin and neck is commonly performed with most facelifts.

[AliceJ 0]

Thank you for your quick response....I will continue my search. This procedure (cosmofacelift) I believe was started by Dr Assassa in California. Thanks again

[Dr. Schulman 2]

Thank you for your quick response....I will continue my search. This procedure (cosmofacelift) I believe was started by Dr Assassa in California. Thanks again

I did some quick research - A cosmo facelift is a non-surgical facelift using contour threads. While "cosmo facelift" is trademarked by Assassa, similar techniques have been described by several surgeons going back many years. I personally have my issues with these "threadlifts" as I have had to operate on several people who have had these threadlifts by other doctors - most were unhappy with the results, and some had complications from the threads. A threadlift may give some improvement, but the improvements are temporary (the data shows that the improvement lasts only a few years, at most), and the costs are not as low as people think. I have yet to see a person who has lost significant weight in which a threadlift will give much improvement.

While I say this, keep in mind that there are many satisfied patients out there who have had a thread lift. Please do your research. Make sure you go to a qualified doctor (a board certified plastic surgeon and member of the ASPS) because many docs doing this are not even surgeons and do not have the knowledge about the underlying structures of the face. There are many potential complications with this - just like with any procedure.

You should know by now that I think safety is key. Do your research in the procedure, and the doctor.

[AliceJ 0]

Thank you so much for investigating. I appreciate what you have to say. I will continue my research.

[canadagirl33 0]

Hi Dr. Schulman

As I read about TT's I see mention now and again about 'mini-tucks'. Can you tell me what these are and how they differ from a full TT??

As well...I spoke to a lady locally that had a TT a few years ago and she commented on the muscle repair that was involved and then made a comment that since I have never had a pregnancy my muscle damage would be minimal. I hadn't thought about it at all and now I'm confused about how extensive my TT will have to be and if I will have any muscle repair done. Can you explain this to me??

Also, the Dr I am considering works out of a clinic in Vancouver and not a hospital altho he does have operating privilages at Van. General (the private clinic setting is new here in BC because of our provincial health care and if I wait to have the surgery in hospital I could literally wait ~years~) So because the surgeries are done as a day surgery for the most part (the facility can keep us overnight if necessary) they don't do LBL's and it would have to be done as 2 surgeries....a TT and then months later a back/butt/hip/thigh type lift. If I were planning on having all of this done would it actually be better to have it done somewhere as 1 major surgery or split it up? My concern is 2 surgeries, 2 recoveries... any thoughts?

Thanks in advance !!!

Patricia

11/16/06

306/202/175ish

5'11"

[Dr. Schulman 2]

Hi Dr. Schulman :crying:

As I read about TT's I see mention now and again about 'mini-tucks'. Can you tell me what these are and how they differ from a full TT??

As well...I spoke to a lady locally that had a TT a few years ago and she commented on the muscle repair that was involved and then made a comment that since I have never had a pregnancy my muscle damage would be minimal. I hadn't thought about it at all and now I'm confused about how extensive my TT will have to be and if I will have any muscle repair done. Can you explain this to me??

Also, the Dr I am considering works out of a clinic in Vancouver and not a hospital altho he does have operating privilages at Van. General (the private clinic setting is new here in BC because of our provincial health care and if I wait to have the surgery in hospital I could literally wait ~years~) So because the surgeries are done as a day surgery for the most part (the facility can keep us overnight if necessary) they don't do LBL's and it would have to be done as 2 surgeries....a TT and then months later a back/butt/hip/thigh type lift. If I were planning on having all of this done would it actually be better to have it done somewhere as 1 major surgery or split it up? My concern is 2 surgeries, 2 recoveries... any thoughts?

Thanks in advance !!!

Patricia

11/16/06

306/202/175ish

5'11"

A "mini" tuck is designed for the person with a small pooch - like the thin woman who has had a few children. It removes the skin below the belly button, and tightens the muscle below the belly button. It does very little to improve anythng above the belly button. I have never seen someone who has lost significant weight who is a candidate for a "mini TT".

It is true that if no muscle repair is done, the recovery is much easier (it is the muscle repair that hurts). I almost always do a muscle repair - even if you have never had children. This is because the muscle has been stretched from being overweight (you have extra fat inside the abdomen as well). Even if the muscle is in really good shape, it can often benefit from being tightened a little bit. This makes for a flatter abdomen and a much better result.

A LBL can be split into 2 operations - the front and the back. I do this sometimes, specifically because like you said, each can be done as an outpatient. Most people find that the "back" is a much easier recovery (because there is no muscle repair). There is no problem doing this in 2 operations and yes, it is two recoveries, but overall it is probably easier than recovering from a LBL. Given the situation you describe, this may be the way to go for you.

[lellow 1,713]

Hi Dr Schulman,

thank you for all the great responses to the questions in here. I hope you'll be able to help me with my question:

I've had an 'apron' since having my son 14 years ago. It got worse when I had another baby 2 and a half years ago and have had my lapband for 2 and a half months. I have lost 30 lbs already, and the 'apron' is getting far more pronounced, and hangs halfway to my pubic bone already.

My goal weight is 143lbs and I've still got 40lbs+ to go to get there. I've booked an appt with a PS for January, and I'm wondering, if it's feasible for me to look at a TT once I get to 165lbs? I'm not sure how long I can take this apron and the rashes and having to 'tuck' it into all my clothes. Or would I be better off waiting to lose that last 20lb+?

I also wonder how much of my excess weight is in actual 'skin', and if I get to goal then get a TT, will it mean I'll be even lighter than goal?