Ask Dr. Schulman...

[Dr. Schulman 2]

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.

Redness is common and often occurs a few months after the surgery - this is because the scar is "maturing". A scar gel may help. Usually those products help withe raised and thickened scars, and do nothing to help reduce redness - but it is not too late to try it. The redness usually fades. One thing that does make the redness worse (and last longer) is sunshine. So make sure to keep sunscreen on the scars while they are healing - even in the cold, because the UV rays can penetrate some clothing. After about a year, if there is still redness, you might consider a laser treatment (YAG laser) to help get the red out.

[lilith 6]

After about a year, if there is still redness, you might consider a laser treatment (YAG laser) to help get the red out.

Hi Dr. Schulman,

Does laser treatment help with stretch marks? Either red or white?

Thank you!

[Dr. Schulman 2]

Hi Dr. Schulman,

Does laser treatment help with stretch marks? Either red or white?

Thank you!

There has been some success with lasers for stretch marks. Fraxel works by resurfacing the skin and blending in the stretch marks. It works fairly well, but requires multiple treatments. It costs anywhere from about $500 to $1500 per treament, depending on the amount of area.

There are some UV Light machines that claim to help white stretch marks by giving them color - beware of this technology because it uses concentrated UV light to "tan" the skin - like a very concentrated tanning booth.The concern for future skin cancer is a legitimate one!

[lilith 6]

There has been some success with lasers for stretch marks. Fraxel works by resurfacing the skin and blending in the stretch marks. It works fairly well, but requires multiple treatments. It costs anywhere from about $500 to $1500 per treament, depending on the amount of area.

There are some UV Light machines that claim to help white stretch marks by giving them color - beware of this technology because it uses concentrated UV light to "tan" the skin - like a very concentrated tanning booth.The concern for future skin cancer is a legitimate one!

Thank you for the information! I had laser treatment for hair removal in the past and blistered quit badly, (it got better with each treatment but the hair grew back anyway... ) is that the same type of laser?

[Lap_dancer 8]

Hello Doctor Schulman:

I wrote to you several months ago. I have found a plateau of weight los. To clarify, I began a peak weight of 389 pounds, at surgery weighed 352+/- and currently weigh 298. My weight has flexed from 300 - 307 flexed around this for about four months.

You spoke to me about a partial stomach reduction. I bare most of my weight in my stomach.

I had a consultation where a Plastic surgeon recommended another loss of 50 pounds but also stated he had only done 30 WLS patients and had complications with all.

Followup to this: I had an MRI of my lower spine done. I have a compressed vertabrae, slight bulge in disc, scoliosis and mild arthritis all in the Lumbar and S region. The PT believes that the shift in body weight from losing so much from my stomach created a weight bearing area higher on my body where my spinal problems are. Trying to excercise more has brought out the increased experience of pain.

Pain is exhaserbated by excercise and walking.

I now wear a TENS unit each day and night tacked to my back.

I have completed three months of PT with 5-10% improvement that returns once I begin my work routine which requires much walking.

I am physically and mentally tapped. My weekends are flat on my back.

My insurance company has given me names of "plastic surgeons" who "treat WLS patients". Such is the one that I went to who suggested I lose more to get into the % range he is comfortble working with.

I am at a loss for a direction to go in at this stage. I have an appt. with my MD who knows I have more resources in WLS contacts. He will ask "what do you want to do", I feel it in my bones.

Any suggestions for us?

I live in the Tampa bay area. I have BCBSFL. Approval for doesn't even appear to be a problem as they are authorizing plastic surgeon visits for pre-surgical evals. After losing close to 100 and seeing I am off diabetes meds, off sleep apnea equipment, I am getting good response from my insurance.

Again. Any assistance you could offer would be appreciate.

[KD8888 0]

Redness is common and often occurs a few months after the surgery - this is because the scar is "maturing". A scar gel may help. Usually those products help withe raised and thickened scars, and do nothing to help reduce redness - but it is not too late to try it. The redness usually fades. One thing that does make the redness worse (and last longer) is sunshine. So make sure to keep sunscreen on the scars while they are healing - even in the cold, because the UV rays can penetrate some clothing. After about a year, if there is still redness, you might consider a laser treatment (YAG laser) to help get the red out.

Thank you for the information. I would never have thought of sunscreen at this stage or in cold weather.

[Dr. Schulman 2]

Hello Doctor Schulman:

I wrote to you several months ago. I have found a plateau of weight los. To clarify, I began a peak weight of 389 pounds, at surgery weighed 352+/- and currently weigh 298. My weight has flexed from 300 - 307 flexed around this for about four months.

You spoke to me about a partial stomach reduction. I bare most of my weight in my stomach.

I had a consultation where a Plastic surgeon recommended another loss of 50 pounds but also stated he had only done 30 WLS patients and had complications with all.

Followup to this: I had an MRI of my lower spine done. I have a compressed vertabrae, slight bulge in disc, scoliosis and mild arthritis all in the Lumbar and S region. The PT believes that the shift in body weight from losing so much from my stomach created a weight bearing area higher on my body where my spinal problems are. Trying to excercise more has brought out the increased experience of pain.

Pain is exhaserbated by excercise and walking.

I now wear a TENS unit each day and night tacked to my back.

I have completed three months of PT with 5-10% improvement that returns once I begin my work routine which requires much walking.

I am physically and mentally tapped. My weekends are flat on my back.

My insurance company has given me names of "plastic surgeons" who "treat WLS patients". Such is the one that I went to who suggested I lose more to get into the % range he is comfortble working with.

I am at a loss for a direction to go in at this stage. I have an appt. with my MD who knows I have more resources in WLS contacts. He will ask "what do you want to do", I feel it in my bones.

Any suggestions for us?

I live in the Tampa bay area. I have BCBSFL. Approval for doesn't even appear to be a problem as they are authorizing plastic surgeon visits for pre-surgical evals. After losing close to 100 and seeing I am off diabetes meds, off sleep apnea equipment, I am getting good response from my insurance.

Again. Any assistance you could offer would be appreciate.

Patty,

I am not entirely clear about waht you are asking. I think that you have lost a significant amount of weight - even though you are still well shot of your goal. The fact that you are experiencing back problems is likely due to your pannus - or at least exacerbated by it. There may be some truth that the weight loss re-districuted the weight and now you have back issues. Either way, I think that removal of this pannus is indicated and will probably help your back symptoms. You should look into a panniculectomy, knowing that you will need a formal TT when you are at goal. You should find a PS experienced in this. The fact that your PS has said that he has done 30 patients and ALL had problems is very hard to believe - this is a 100% morbidity rate, and probably exagerated because he wants to disuade you from having it done. If this complication rate is true, than you don't want him to operate on you anyway!

Hope this helps. Again, I was not sure of what you were specifically asking, because I think we both know that a panniculectomy is what you need to help your back pain.

[Lap_dancer 8]

Patty,

I am not entirely clear about waht you are asking. I think that you have lost a significant amount of weight - even though you are still well shot of your goal. The fact that you are experiencing back problems is likely due to your pannus - or at least exacerbated by it. There may be some truth that the weight loss re-districuted the weight and now you have back issues. Either way, I think that removal of this pannus is indicated and will probably help your back symptoms. You should look into a panniculectomy, knowing that you will need a formal TT when you are at goal. You should find a PS experienced in this. The fact that your PS has said that he has done 30 patients and ALL had problems is very hard to believe - this is a 100% morbidity rate, and probably exagerated because he wants to disuade you from having it done. If this complication rate is true, than you don't want him to operate on you anyway!

Hope this helps. Again, I was not sure of what you were specifically asking, because I think we both know that a panniculectomy is what you need to help your back pain.

Thank you so much doctor. I felt this was what I needed to do. I appreciate your assistance at this time and will send an update on my progress.

[Lap_dancer 8]

Update: Spoke with a plastic surgeon's office (one of many). They were open about insurance not covering many requests for the penni.

The doctor has performed recontouring and reconstructive surgery.

I have an appt. with my MD on Monday to go over the past six months, the physical therapy, etc., and to develop a plan.

The plastic surgeon's office asked me to gather as much information as I could tracing my journey to present to assist them in further developing a now and then plan as well as presenting that plan to insurance for approval.

Wish me luck all.

Dr. S. thank you very much for your guidance. I wish you were in Florida.

[ghostbuster 3]

Hello Dr. Schulman, I've mentioned before that I have an adhesion from my port scar. Is it normal that it causes pain when I twist or bend or strech? If it is causing pain do I have a chance of getting my insurance to cover the surgery to fix the adhesion. It does look like an extra belly button, but that's really not the main problem. It's hard to exercise when you feel like you are tearing you insides out everytime you jog. Any suggestions? Or how much should I expect to pay if I just had to get it done at my own cost? - Thanks!

[Dr. Schulman 2]

Hello Dr. Schulman, I've mentioned before that I have an adhesion from my port scar. Is it normal that it causes pain when I twist or bend or strech? If it is causing pain do I have a chance of getting my insurance to cover the surgery to fix the adhesion. It does look like an extra belly button, but that's really not the main problem. It's hard to exercise when you feel like you are tearing you insides out everytime you jog. Any suggestions? Or how much should I expect to pay if I just had to get it done at my own cost? - Thanks!

Scar adhesions are common and they can cause pain. Insurance will usually cover the procedure (which is relatively minor and can be done under local anesthesia in an office) if there is pain involved. I don't think that you will have a tough time getting it covered, but you never know. The prices will vary, but a ballpark fee of 1000-2500 is reasonable - just a guess, because it obviously depends on a bunch of other factors like size, etc.

[nycskinny 0]

Hi everyone (Hi Dr. S!),

I have not been on here is so so long, but wanted to check in and give an update. I had my TT and BL with Dr. S almost a year ago, and then I had my armlift done this past June with him. I am so happy that I am done with my plastic surgery (well, maybe my thighs, but I am going to wait a bit and enjoy the new bod!).

I just got back from vacation in Mexico. It was my first vacation in 5 years, and my first time being in a public pool in 10 years. I was always so self-conscious about my size and then about the extra skin. It was only a one piece suit, but it was a great experience anyway (I don't think bikinis are in my future).

I know this thread is to ask him a question and I don't mean to "hijack" it, but I just wanted to say hello to everyone who participates on this site because the information really helps all of us! I also wanted to say hi to my most favorite and talented doc in the world. Yes, that is you Dr. S! I will see you next week for my check up. Please don't be mad that I am tan, I know that it makes wrinkles, but that it what you are for, right?

[Foofy 0]

NYC skinny,

Congratulations on your success. You should post your pics.

[BeckyinTexas 3]

Dr. Schulman...I finally was approved by my insurance for my panniculectomy. It only took 6 months and 3 appeals but I finally won! I'm scheduled for surgery December 5th. I haven't met yet with my plastic surgeon, other than my initial visit with him in April, but I have questions that are making me crazy right now and hopefully you can give me a quick reply. What is the down time usually for this surgery? I've been told by his office that it should be a 2 hour surgery and if all goes well, it will be a day surgery. Are drain tubes always necessary? If so, how long do they stay in? On a scale from 1-10, how bad will the pain be? I'm pretty tough, hopefully. I had bunion surgery 3 years ago and 4 hours later, I walked out of the hospital on my own and even went to get my prescriptions filled. My surgeons nurse said if I could do that, this should be a piece of cake for me. I've read everything I can find on the internet about this surgery but I do have these questions and hopefully you can help me. Thanks again for all your support and encouragement with this. It just shows that fighting for what you want so desperately can pay off...it has for me.

[shortgal 5]

Hi Dr. I have a few more questions relating to face/neck lift.

How long should the surgery take?

Are sutures, staples, glue or a combo of all used?

I would like to come see you but I prefer not to have surgery and followup that far away, as I would have to drive myself or take the train alone.