Ask Dr. Schulman...

Dr. Schulman · January 19, 2009

What an informative thread! I am slowly coming to accept that PS is in my future - the weight really is gone (well, going) and it isn't a dream!
I apologize if my questions are too..rudimentary. But I truly don't know the answers, so any direction would be helpful.

How do I find a GOOD plastic surgeon? Just because one says he/she has done 'hundreds' doesn't mean that they have. Nor does it mean they were successful. I don't know anyone who has had PS, and sure as hell don't want people to know that I am considering it. How do you know that patient 'before and after' pics are of their patients? How do you know the photo's weren't retouched? How do you find out a surgeon's complication rate if the work is done in an office rather than a hospital? I know you can research through the different medical associations licensure and actions, but if technically there was nothing done 'wrong', doesn't mean that the work was good.

Do I sound cynical/paranoid? I don't mean to, but really, if I am going to have elective surgery, I'd like to make every reasonable effort to ensure I am in the capable hands of a good surgeon, not someone who can make people feel better but is truly a hack in the OR.

Your questions are not rudimetary at all! Most people ask abotu specific procedures, but choosing the right surgeon is even more important. First, make sure your PS is trained appropriately (look at where they went to medical school, and where they did there residency and fellowship). Next, make sure they are board certified (IN PLASTIC SURGERY). Don't be fooled by doctors that say "board certified in cosmeticd surgery" - this means nothing. In fact, anyone can get a certificate stating that they are board certified in cosmetic surgery simply by applying. Make sure your PS is a member of ASPS (American Society of Plastic Surgeons). These are the basics.

Next, the best way to chose your surgeon is through referrals from otehr doctors and patients. Ask around. Ask your bariatric surgeon who they like, ask the other people in your support groups. Don't be embarrassed to ask others - I am sure you are realizing by now how common plastic surgery is, so no one will judge you for asking about it. Other bariatric patients will be much less judgemental.

You should plan on getting several consultations to see who you "click" with. Don't skimp on consultations because of the money. It is well worth it. Also, you should look for a good price for the surgery, but remember you often get what you pay for. Many surgeons will raise their prices as they get more experience. Don't overpay, but sometimes there is a reason for such low prices.

Ask to see pictures, ask about how often these procedures are done (not just how many you have done, because it is more accurate if they say they do this 5 times a months rather than say "I've done hundreds"). Regarding pics on websites - there are rules for PS who are members of ASPS that include the understanding that all pictures msut be un-retouched, and be the doctor's actual patients...unless specifically marked otherwise. This relates to the ASPS code of ethics and truth in advertising. A PS who is not an ASPS member does not have to abide by these standards! Lastly, if requested, your PS should be able to provide you with a name and number of a patient who had a similare procedures so that you can speak with them about their experience. As I said before, make sure your PS specializes in bariatric patients....it is truly a specialized area of PS.

I hope this helps.

tapshoes · January 19, 2009

Thank you so much for your response.

Let the hunt begin......

kareyquilts · January 19, 2009

Dr. Schulman: I was surprised to see in your newsletter this month that your practice is highlighting lipo-lite. Is that different than "smart Lipo? " I thought that you didn't like smart lipo? With the lipo lite, is the fat suctioned? Thanks in advance.

Dr. Schulman · January 20, 2009

Dr. Schulman: I was surprised to see in your newsletter this month that your practice is highlighting lipo-lite. Is that different than "smart Lipo? " I thought that you didn't like smart lipo? With the lipo lite, is the fat suctioned? Thanks in advance.

LipoLite is similar to smartlipo, from a different company, and using more advanced technology (my experience is that is is better than smartlipo). You are partly correct about how I feel about smart lipo (or any of the laser lipo technologies). It is a good procedure in very select individuals. I do not think it is good in the post weight loss population because the improvement will be limited and most people will be disappointed (especially given that it can be more expensive than traditional lipo). This is why it was not mentioned in my bariatric newsletter.

Body contouring after weight loss is so specialized - many of the techniques and procedures that I do in my regular cosmetic patients do not always apply. This is why I have 2 separate newsletters and each features different information. The LipoLite was featured in the cosmetic newsletter, but not in the post bariatric newsletter.

minidriver · January 20, 2009

Hi Dr. Schulman. I have a couple of short questions.

I have always had a double chin, regardless of my weight, and now have loose skin and some "pleating" under my chin. I would like to have this fixed after I finish losing weight but really don't want to have a full lower face lift. I have a real aversion to/fear of looking like I've had a face lift. Is there anything less drastic that can be done with necks?

My second question has to do with my breasts. I have what I believe is called "pseudoptosis". My nipples are still above the crease line of my breast, but all of the breast tissue seems to have settled in the lower part of my breasts. I know I'll need a breast lift but am reluctant to have implants. Can my sort of breast problem usually be corrected with a lift without augmentation? Or is it impossible to have any fullness on the top with implants? I hope that made sense.

Thanks in advance for your time. You're very generous to deal with all these questions!

kareyquilts · January 20, 2009

Dr. Schulman: Do you feel that Lipo lite isn't appropriate for post-bariatric patients, even if they are at goal weight, have had traditional lipo and weight loss surgeries and just want a few problem areas touched up (like bra fat under the arms, for instance). Or is the skin of bariatric patients too stretched for this application?

Dr. Schulman · January 23, 2009

Hi Dr. Schulman. I have a couple of short questions.
I have always had a double chin, regardless of my weight, and now have loose skin and some "pleating" under my chin. I would like to have this fixed after I finish losing weight but really don't want to have a full lower face lift. I have a real aversion to/fear of looking like I've had a face lift. Is there anything less drastic that can be done with necks?

My second question has to do with my breasts. I have what I believe is called "pseudoptosis". My nipples are still above the crease line of my breast, but all of the breast tissue seems to have settled in the lower part of my breasts. I know I'll need a breast lift but am reluctant to have implants. Can my sort of breast problem usually be corrected with a lift without augmentation? Or is it impossible to have any fullness on the top with implants? I hope that made sense.

Thanks in advance for your time. You're very generous to deal with all these questions!

Regarding your neck, there are several options aside from a necklift and lower facelift (which, when done correctly by a skilled surgeon, should NEVER look overdone). The double chin may be due to a combination of weak chin, excess fat, and loose skin. Sometimes liposuction of the neck and placement of a chin implant can really improve the appearance of your neck, without a full necklift. Lower face jowling can be helped wtih fillers and skin tightening lasers. There are many many options for you.

Pseudoptosis can be corrected by removing a wedge of tissue from the lower breast. This will help the shape of the breast, but will not do anything for upper pole fullness. For that, you will need placement of a small implant.

Dr. Schulman · January 23, 2009

Dr. Schulman: Do you feel that Lipo lite isn't appropriate for post-bariatric patients, even if they are at goal weight, have had traditional lipo and weight loss surgeries and just want a few problem areas touched up (like bra fat under the arms, for instance). Or is the skin of bariatric patients too stretched for this application?

I think in this situation, lipolite may be a good option. While it is not the best option for primary liposuction in post bariatric patients, it works pretty well in secondary (revision) cases (it is really good at breaking up the scar tissue that develops after regular liposuction), and also for those small "problem" areas. The skin may not respond as well as in non-bariatric people, but you should see some improvement. It is all about realistic goals -which I know you have!

pammycakes · February 7, 2009

Hi Dr. Schulman

I had a breast and arm lift done 3 weeks ago. For the most part I am healing wonderfully but one of my arms is still quite swollen. I seen my PS doc on tuesday and he didnt seem to concerned about it. Do you know of anything that might help the swelling go down quicker?

Thank you

Pam

Dr. Schulman · February 7, 2009

Hi Dr. Schulman
I had a breast and arm lift done 3 weeks ago. For the most part I am healing wonderfully but one of my arms is still quite swollen. I seen my PS doc on tuesday and he didnt seem to concerned about it. Do you know of anything that might help the swelling go down quicker?

Thank you

Pam

Arm swelling after a brachioplasty is common. Watch your salt intake - too much can make the welling worse. Avoid cold cuts, Soups, sauces with salt (barbeque), etc. Also, sometimes wrapping your arm with an ace bandage fromt he fingers to the shulder will help - but make sure to check with your PS before doing this. Generally the swelling takes several weeks to go away, but some people may see swelling that lasts for months.

jbflorida · February 9, 2009

I am not sure you are at liberty answer this, Dr. Shulman, but I am trying to get some answers so I can deal with my finances. I am interested in brachioplasty and a breast lift/aug.

1-Can these surgeries be done at the same time? (or is the recovery too much!)

2-Can you give me a "ballpark figure" of the price? I live in FL, if that figures in. I would like to know what is considered reasonable.

Thanks---we are fortunate to have you share your knowledge!

quennee · February 9, 2009

Dr Schulman,

I had a LBL with thigh Lipo 2 weeks ago and was wondering if it is normal for the drainage to be different colors from the different sides? My left one hurts and is much darker than the right side. I also swell more on my left. I am going to my private doctor on Tuesday and I am still taking antibiotics just in case. I had the LBL in Mexico and I really dont feel like taking the 5 hour drive back to my PS. Can you also tell me the standard amount of drainage that they will let you take the drains out? THANKS

Jachut · February 9, 2009

Hi Dr Schulman,

I was wondering what your views on mini tummy tucks combined with hernia repair were.

I have 2 incisional hernias at either end of my caesar scar which my GP says are nothing to worry about. However, hernia's dont get better, and these look a bit weird, they are visible looking down my body and they can ache a bit by the end of the day (they also make a really revolting squelchy noise when pressed, lol).

So I was thinking........ I couldnt really justify a full Tummy Tuck. I ahve a bit of loose skin and probably ne4ed a bit of Lipo on the residual upper ab fat pocket, but my muscles are rock hard, absolutely flat and are not separated.

If I were to be opened up to repair these hernias rather than have them done laparascopically, would it be an unusual thing to ask to just remove a crescent of skin from the lower belly and tighten it up without moving the navel etc?

I'm thinking there's a very very tiny possiblity that in Australia, this the anaesthetics cost of the op might then be covered partly by medicare due to the hernia repair comopent. Private insurance covers the hospital stay either way.

Dr. Schulman · February 9, 2009

I am not sure you are at liberty answer this, Dr. Shulman, but I am trying to get some answers so I can deal with my finances. I am interested in brachioplasty and a breast lift/aug.
1-Can these surgeries be done at the same time? (or is the recovery too much!)

2-Can you give me a "ballpark figure" of the price? I live in FL, if that figures in. I would like to know what is considered reasonable.

Thanks---we are fortunate to have you share your knowledge!

Arms and breasts can be combined into one operation if you are willing to go through a larger recovery process. I don't think it is "too much" in terms of recovery, but combining arms with anything is difficult because you will need to use your arms to take care of your breasts (change dressings, bathe, etc.) The prices vary. In general, armlifts will run about 6,000-8,000 and breast lift (with implants will run about the same. You may have to pay an additional fee depending on whether you choose silicone or saline (silicone is about 1000 more). Combining these procedures should save you money but that is up to your individual surgeon. Good luck. Make sure you select someone qualified to do this.

Dr. Schulman · February 9, 2009

Dr Schulman,
I had a LBL with thigh Lipo 2 weeks ago and was wondering if it is normal for the drainage to be different colors from the different sides? My left one hurts and is much darker than the right side. I also swell more on my left. I am going to my private doctor on Tuesday and I am still taking antibiotics just in case. I had the LBL in Mexico and I really dont feel like taking the 5 hour drive back to my PS. Can you also tell me the standard amount of drainage that they will let you take the drains out? THANKS

Usually drains remain until there is about 30cc or less per 24 hours. After a LBL, the drains can remain up to 3 weeks. The color is usually tea-colores or clear yellow. Dark color may mean that there is blood - old bleeding or new bleeding.

I recommend discussing this with your plastic surgeon to make sure there is nothing that needs addressing. I understand the surgery was done a distance away, but you should at least be able to speak to your ps on the phone. He may ask you to come see him. I know this may be a huge inconvenience, but as has been discussed in the past, this is the major reason why people should really understand what is involved with traveling out of the country for surgery - the prices are less, and usually the surgery goes well, but sometimes you can develop small (or major) complications that need to be dealt with by your ps.