Ask Dr. Schulman...

[Dr. Schulman 2]

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?

You should wait until your weight loss stabilizes - this may or may not be at your "goal". I am guessing that you will have about 10-20 pounds of skin, so your weight loss may stop a bit short of your goal of 143.

It is possible to have the apron removed while you are still losing weight. This is only in extreme situations where the pannus causes too many problems that you just can't deal with. The downside of having the apron removed early is that it will onlybe a panniculectomy (no muscle repair) and cosmetically, the result is not as good as a Tummy Tuck. Also, because you are still losing weight, you may have some small healing/wound issues because of poor nutrition. You should also be warned that you will likely need a revision to a formal tummy tuck after the weight loss stops.

So the bottom line is to wait until the weight loss stops and stabilizes. It should be only under extreme circumstances that you have something done sooner.

[lellow 1,713]

Thanks for that info, Dr Schulman. I guess if I manage to lose 40lbs+, waiting to lose that last bit and stablise won't be too hard to do.

[Coco 0]

Hi Dr Schulman,

I'm writing to you from Dublin in Ireland, I have been reading your thread for sometime now and have learned so much from your replies to others. My question to you is this, would you do a preliminary consultation via a email with an estimate of costs before doing a face to face consultation. My dilemma is this, in Ireland we have few PS who are as qualified - particularly in surgery required after significant weight loss - as you and your colleagues seem to be. There are options with surgeons in Europe but again I have heard mixed results with these. I would go to NY at the drop of a hat as I love that city, but obviously with having surgery in mind and at tickets costing 600 Euro return it would be good to get an initial consultation via email. I am looking at a breast lift, Tummy Tuck and upper arm lift. Could those procedures be done at the same time and how long would I have to wait before flying back to Ireland. I have a brother in NY so accommodation is not an issue for me. Thanking you in advance. :smile:

[Dr. Schulman 2]

Hi Dr Schulman,

I'm writing to you from Dublin in Ireland, I have been reading your thread for sometime now and have learned so much from your replies to others. My question to you is this, would you do a preliminary consultation via a email with an estimate of costs before doing a face to face consultation. My dilemma is this, in Ireland we have few PS who are as qualified - particularly in surgery required after significant weight loss - as you and your colleagues seem to be. There are options with surgeons in Europe but again I have heard mixed results with these. I would go to NY at the drop of a hat as I love that city, but obviously with having surgery in mind and at tickets costing 600 Euro return it would be good to get an initial consultation via email. I am looking at a breast lift, Tummy Tuck and upper arm lift. Could those procedures be done at the same time and how long would I have to wait before flying back to Ireland. I have a brother in NY so accommodation is not an issue for me. Thanking you in advance. :smile:

It is not a problem to a preliminary consultation via email - keeping in mind that there is no substitute for seeing you in person and getting an idea of the quality of your skin and how I think it will heal after surgery. I will be able to give you an estimate for the cost and also the amount of recovery time you will need in NY. I would still have to see you face to face in a "real" consultation, but this "virtual" consultation is a reasonable first step.

Given the power of the Euro compared to the dollar, I sure you will find that there is a real financial benefit in traveling to the US for surgery.

Combining all three operations would be very ambitious. It does not mean that it can't be done, but it might be a difficult recovery, especially given the fact that you will be returning to Ireland after the initial healing process. I think that picking 2 of the 3 is a better option for a combined procedure.

Without knowing exactly what the surgical plan is, I cannot tell you for sure how long you would need to stay here, but it will be in the neighborhood of 2-4 weeks.

I will PM you my email and you can send me more specific information.

[migbt 0]

Dr. Schulman,

Thank you for lending yourself to us... that is awesome!

I am 50 years old, had WLS in 2006 and have lost 60 lbs. No, not goal, but I still work at it. I am having a hysterectomy and pannilectomy on Monday. I have opted to keep my ovaries even though my doctor has recommened that because of my age, she remove them. I have no cysts or cancer in my family.

MY QUESTION: She said that if she has to go in and remove them later, it will mess up my pannilectomy? I was thinking about this and believe she is thinking I am getting a Tummy Tuck?

Is she correct? and if it "messes" it up ... what does that mean.

Thank you again and you can be sure I will discuss with both GYN and PS on Monday at 6 am before we have surgery..

Donna

[Dr. Schulman 2]

Dr. Schulman,

Thank you for lending yourself to us... that is awesome!

I am 50 years old, had WLS in 2006 and have lost 60 lbs. No, not goal, but I still work at it. I am having a hysterectomy and pannilectomy on Monday. I have opted to keep my ovaries even though my doctor has recommened that because of my age, she remove them. I have no cysts or cancer in my family.

MY QUESTION: She said that if she has to go in and remove them later, it will mess up my pannilectomy? I was thinking about this and believe she is thinking I am getting a Tummy Tuck?

Is she correct? and if it "messes" it up ... what does that mean.

Thank you again and you can be sure I will discuss with both GYN and PS on Monday at 6 am before we have surgery..

Donna

Having your ovaries out later will not "mess up" anything. I suppose that your gyn means that you will have a scar in the middle of your abdomen if you need a surgery later (because that is how they normally do it). This is probably because he/she will be uncomfortable doing the surgery through your panniculectomy incision (which is lower, and horizontal). Basically, if you need something done later, just make sure that your gyn asks a PS to help them expose the necessary areas through this panniculectomy incision so you don't have any new scars. I routinely am asked to "make the incision and get exposure" in patients who have had previous abdominoplasty or panniculectomy, and now needs some other abdominal surgery.

I think you are right that the gyn is not familiar with the PS procedure that you are getting. Don't worry about it. Good luck Monday!

[kareyquilts 1]

Dr. Schulman: I survived my tt revision (extensive anchor with more skin taken to almost 2 inches back to my hips), brachioplasty, Lipo and thigh and butt lift. The surgery was on Wednesday the 15th (it took 7 hours). I had my first look today (shower). I know from previous experience that alot of what I am seeing is swelling, but I still have to ask. LOL! My right butt check is ALOT larger than the other one. Is that normal? It all looks too larger. Also, my thighs are so large that I can't fit into my size 6-8 size pants. Also there is still dimpling on the lower back thigh. Am I stuck with this? I have to say that this has been a very difficult set of procedures. I wasn't prepared for the lack of mobility with my arms. I didn't know that I wouldn't be able to feed myself, etc. I did know that I wouldn't be able sit up straight, but I didn't know how hard that would be. This part isn't a questions, just sharing my experience for anyone that is interested. I guess I'll weigh in on if it was all worth it in 4-6 months.

[Dr. Schulman 2]

Dr. Schulman: I survived my tt revision (extensive anchor with more skin taken to almost 2 inches back to my hips), brachioplasty, Lipo and thigh and butt lift. The surgery was on Wednesday the 15th (it took 7 hours). I had my first look today (shower). I know from previous experience that alot of what I am seeing is swelling, but I still have to ask. LOL! My right butt check is ALOT larger than the other one. Is that normal? It all looks too larger. Also, my thighs are so large that I can't fit into my size 6-8 size pants. Also there is still dimpling on the lower back thigh. Am I stuck with this? I have to say that this has been a very difficult set of procedures. I wasn't prepared for the lack of mobility with my arms. I didn't know that I wouldn't be able to feed myself, etc. I did know that I wouldn't be able sit up straight, but I didn't know how hard that would be. This part isn't a questions, just sharing my experience for anyone that is interested. I guess I'll weigh in on if it was all worth it in 4-6 months.

Glad you made it! The swelling is normal. As you can see, it can be very extensive. You have probably seen in some other posts, that I always warn people about trying to fit into their pants after liposuction - it never works! Make sure you point out the buttock difference to your PS - again, this is probably just swelling, but should make sure it is not a seroma. Seromas are more common inthe back and buttocks than in the front - this is why I always put drains in the back and buttock as well. I am sure it will be worthit in a few months.

[kareyquilts 1]

Thanks for the feedback! You know I think you're great!

[lilith 6]

None of those things will improve your skin's elasticity. The most important factors are younger age, less overall weight loss, longer time losing weight, good nutrition during weight loss (protein), and GENETICS. All those things you list may make you feel better, and make your skin smoother/shinier/etc. but won't affect elasticity.

Is there any way to tell how elastic your skin is? I know this is sort of a silly question... but I was really set on this surgery until I had an hour lecture from a friend about how I'm going to hate myself when I have hanging skin vs the curves I have now, I'm 33, I've had 3 children and most of my weight is in my bottom and legs, I'm 5'5" and 254 currently. Thanks for any advice...

[css95 0]

Dr.

I had a breast reduction, everything went very good, no pain to speak of.

I am now starting to have very bad lower back pains.

I am 61, and have had the very big breast for 30 years.

Is my back try to use different muscles, it has been two week sense I had everthing done. And my back is giving me fits.

Thanks for your help.

[Dr. Schulman 2]

Is there any way to tell how elastic your skin is? I know this is sort of a silly question... but I was really set on this surgery until I had an hour lecture from a friend about how I'm going to hate myself when I have hanging skin vs the curves I have now, I'm 33, I've had 3 children and most of my weight is in my bottom and legs, I'm 5'5" and 254 currently. Thanks for any advice...

It is basically impossible to predict how your skin will respond to weight loss. The possibility of excess skin should not determine whether or not you have bariatric surgery. The most important thing is your health, and no one can dispute the effects of obesity and obesity-related illness. I am sure that others will agree that your friend should be more supportive of your needs.

[Dr. Schulman 2]

Dr.

I had a breast reduction, everything went very good, no pain to speak of.

I am now starting to have very bad lower back pains.

I am 61, and have had the very big breast for 30 years.

Is my back try to use different muscles, it has been two week sense I had everthing done. And my back is giving me fits.

Thanks for your help.

This is very common and it is because of using different muscles of your back. Your back was used to large breasts pulling and now the weight is removed. Ask your doctor for the name of a physical therapist who can help you with stretching and strengthening exercises for your back.

[lilith 6]

It is basically impossible to predict how your skin will respond to weight loss. The possibility of excess skin should not determine whether or not you have bariatric surgery. The most important thing is your health, and no one can dispute the effects of obesity and obesity-related illness. I am sure that others will agree that your friend should be more supportive of your needs.

Thank you for your reply. I guess I'll hope for the best! I spoke to a friend yesterday who lost a good deal of weight without WLS and she still ended up with loose skin. So I guess it doesn't matter....

[KD8888 0]

Dr. Schulman,

I am about 2 1/2 months out from BL and LBL. Initially my incisions looked really good and I was surprised at how little they showed. Within the last couple weeks as the weather has cooled, my skin has become more dry generally and the incision areas have turned more red/purple, even where the drains were. I don't think the redness is necessarily unusual for me. It seemed like it took forever for my gall bladder scars to fade and my lap band scars from over a year ago are still red although they are starting to fade. Would kelocote or something else help the scars fade at this stage or have I waited too long to start using something?

Thanks for any suggestions.

Edited October 24, 2008 by KD8888