Ask Dr. Schulman...

[Esmeralda 2]

Thank you doctor for you response. The swelling in my legs is finally gone but I still have some bruising on the sides of my legs and on the lower part close to my knees. As for the itching it seems like its finally going away also but I have my days. I am 2 weeks out today and I still have a pulling burning feeling in the middle of my belly I think it may be because he had to redo my belly button because with the Tummy Tuck it didnt come out right so he fixed it and its still healing.

[Southern Missy 1]

Well, I guess Dr. S finally got tired of us -- he's MIA!! :smile:

[jbflorida 1]

I just scheduled my plastic surgery for May 13---exactly one year to the day of my lapband! I thought that was an auspicious sign. 5 lbs to go--

[kareyquilts 1]

Dr. S: Hi, it's been a while since I've posted on here. I'm going to pm you soon about an idea I have, but right now I'm trying to get my health up to speed. My lap band has prolapsed and I've recently been diaganosed with lymphedema. My orthopediac doctor sent me to a specialist (had knee surgery in December). When I went to see the occupational therapist she said that I probably developed the problem because of the liposuction and thigh and butt lift that I had in October. With that background in mind, I'm wondering how common this complication is? I'm not trying to place blame and it doesn't matter which procedure caused the problem, but I'm wondering why my ps didn't recognize it. How do you know when you have swelling from the procedure and when it becomes abnormal swelling? The therapist said that this will be a life long issue for me with compression stockings, special exercises etc. Do you know if that is true? My husband thought that the lymph tissue could repair itself in time? I'm not looking forward to a hot summer wearing nylons all the time. If there is no cure, why bother with it? I wanted to get my inner thighs done and the lymph specialist said that it would only complicate my lymphedema. What is your opinion on all of this? Is lymphedema a common complication of liposuction and plastic surgery? Should I seek help from my plastic surgeon or would he only refer to a specialist in this area?

[Dr. Schulman 2]

Hi Dr. Schulman,

Thanks for all the advice you have dispensed... it is priceless! :thumbup:

I have read through this entire thread and always check for updates. I haven't seen the one I have, though! So, here is my question: I am in the process of interviewing surgeons as I would like to have a panniculectomy/tummy tuck and breast reduction done the end of August/first of September. So far, I have visited 2 surgeons and have plans to visit 4 more before the end of the month. Both of those physicians submitted paperwork to my insurance for benefit determination, which was approved in both cases. However, is it really necessary for each surgeon I see to submit this paperwork if I am, in effect, interviewing them to see if I want them to do my surgery? If not, how do I tell them not to seek approval until I decide?

Thanks!

Melissa

Pre-authorization is specific to the operating surgeon, so technically, yes, each doc needs to do it. You can tell the office that you have had the procedure pre-authorized with another doc and you are not sure which surgeon you will choose. You can just suggest that they not bother getting it done until you notify them that you have selected them (in reality, it is sometimes nothing more than jsut a phone call to insurance that they wil probably do anyway).

[Dr. Schulman 2]

Well, I guess Dr. S finally got tired of us -- he's MIA!! :thumbup:

I apologize for letting the questions pile up... I am catching up now, promise.

[Dr. Schulman 2]

Dr. S: Hi, it's been a while since I've posted on here. I'm going to pm you soon about an idea I have, but right now I'm trying to get my health up to speed. My lap band has prolapsed and I've recently been diaganosed with lymphedema. My orthopediac doctor sent me to a specialist (had knee surgery in December). When I went to see the occupational therapist she said that I probably developed the problem because of the liposuction and thigh and butt lift that I had in October. With that background in mind, I'm wondering how common this complication is? I'm not trying to place blame and it doesn't matter which procedure caused the problem, but I'm wondering why my ps didn't recognize it. How do you know when you have swelling from the procedure and when it becomes abnormal swelling? The therapist said that this will be a life long issue for me with compression stockings, special exercises etc. Do you know if that is true? My husband thought that the lymph tissue could repair itself in time? I'm not looking forward to a hot summer wearing nylons all the time. If there is no cure, why bother with it? I wanted to get my inner thighs done and the lymph specialist said that it would only complicate my lymphedema. What is your opinion on all of this? Is lymphedema a common complication of liposuction and plastic surgery? Should I seek help from my plastic surgeon or would he only refer to a specialist in this area?

This is not very common, but when it develops can obviously be a big problem. It can happen after any surgery that interrupts the lymph flow (the flow of Fluid back into the blood stream). Ironically, there are some reports in the plastic surgery literature that use liposuction as a treatment for severe lymphedema - usually the kind people are born with and not the result of a surgical procedure or injury. Also, some plastic surgeons have been successful by performing microsurgery to repair the injured lymph vessels (they attach them directly to veins).

You husband may be correct to some extent. If it is the result of your surgery, then it may continue to get better over the course of the next several months. Using compression garments will certainly help int he meantime. I would wait it out a bit longer. I cannot promise ti will get better (it amy not), but you need to give it more time.

Also, this is so uncommon, that it is usually not specifically discussed pre-operatively. I do tell my patients that there is a small chance of prolonged swelling, but do not use the term lymphedema specifically. I am sorry you are going through this. Be patient and hopefully your body will regrow the necessary lymph vessels. If not, there are some other options to explore later. And I agree that you should not have any mroe procedures until this works itself out.

[mrgrta 0]

Dr Schulman,

I am scheduled for a circumferential tt with fleur de lis, Lipo and hernia repair next Thursday. My surgery is supposed to to last around 6 hours. I don't know why I can't get the thoughts of blood clots out of my head, but this has been my biggest concern about this procedure. I do plan to get up and move around as much as possible after surgery to avoid blood clots, but I'm still concerned. Can you tell me how common this occurs after this type of surgery? Thanks for your time.

[DivaStyleCoach 89]

Hi Dr. Schulman,

I have read through this entire thread and am very impressed with your level of knowledge and willingness to help so many of us make informed and good decisions regarding PS.

I live in CT, so you are certainly on my list to see when I'm ready for PS - which won't be for a while yet, because I'm fairly new to the band (only since Nov 08).

My first question is regarding keloids - I am African-American, and have had previous abdominal surgery (straight up the middle, around my belly button) which has a pretty well-defined keloid. I am using scar gel on it, and it's improved somewhat, but it made me think what might happen after PS. I saw a couple of pictures of AA clients on your website and am wondering if your practice has had any challenges with patients developing keloids.

Second - I am planning to lose nearly 100 pounds, and feel certain I will need a TT or at least a panni to remove excess skin. I don't have a big abdomen right now, nor do I have a lot of hanging skin, but I understand that may change. Right now "pulling in" my abs makes most of the 'hang' go away - is there any way to minimize the need for surgery by working the abs specially hard or increasing Protein content to help the skin and muscles build optimally?

I should mention that I'm 46, and have been overweight for over 30 years. The band is the best thing I've ever done for myself! I am fairly active - walking 5 - 7 days per week, and about to add weight training back into my routine.

I am thinking that I'm at least a year away from surgery, but now is the time, I think, to do as much prep work as possible. I would be considering a TT and breast lift / possible reduction at the same time. I am currently a 40H, and am not sure what size I would go "down" to, only that I want the girls to be MUCH perkier than they currently are.

Thanks in advance - I know this is a LOT to include in a single posting!

[Dr. Schulman 2]

Dr Schulman,

I am scheduled for a circumferential tt with fleur de lis, Lipo and hernia repair next Thursday. My surgery is supposed to to last around 6 hours. I don't know why I can't get the thoughts of blood clots out of my head, but this has been my biggest concern about this procedure. I do plan to get up and move around as much as possible after surgery to avoid blood clots, but I'm still concerned. Can you tell me how common this occurs after this type of surgery? Thanks for your time.

Blood clots are not very common. Your surgeon should take precautions in the OR with compression boots, and you should be up and moving as quickly as possible. With your plannerd surgery, you will likely be on 1 -2 days of bed rest, so you should "pump your calves" by moving your feet. You may also be on a blood thinner afterwards.

[Dr. Schulman 2]

Hi Dr. Schulman,

I have read through this entire thread and am very impressed with your level of knowledge and willingness to help so many of us make informed and good decisions regarding PS.

I live in CT, so you are certainly on my list to see when I'm ready for PS - which won't be for a while yet, because I'm fairly new to the band (only since Nov 08).

My first question is regarding keloids - I am African-American, and have had previous abdominal surgery (straight up the middle, around my belly button) which has a pretty well-defined keloid. I am using scar gel on it, and it's improved somewhat, but it made me think what might happen after PS. I saw a couple of pictures of AA clients on your website and am wondering if your practice has had any challenges with patients developing keloids.

Second - I am planning to lose nearly 100 pounds, and feel certain I will need a TT or at least a panni to remove excess skin. I don't have a big abdomen right now, nor do I have a lot of hanging skin, but I understand that may change. Right now "pulling in" my abs makes most of the 'hang' go away - is there any way to minimize the need for surgery by working the abs specially hard or increasing Protein content to help the skin and muscles build optimally?

I should mention that I'm 46, and have been overweight for over 30 years. The band is the best thing I've ever done for myself! I am fairly active - walking 5 - 7 days per week, and about to add weight training back into my routine.

I am thinking that I'm at least a year away from surgery, but now is the time, I think, to do as much prep work as possible. I would be considering a TT and breast lift / possible reduction at the same time. I am currently a 40H, and am not sure what size I would go "down" to, only that I want the girls to be MUCH perkier than they currently are.

Thanks in advance - I know this is a LOT to include in a single posting!

Congratulations on taking the first step to better health. Unfortunately, there is no way of knowing how lax your skin will beand what surgeries you will need after your weight loss. As I have said before, peopel with bands tend to have less loose skin than people with bypasses - this is because the weight loss is more gradual. But, givent hat yuo expect to loose over 100 pounds, you should expect to have significant skin. There is nothing you can do to prevent it, but keeping healthy diet and high protein will make you better prepared to heal after surgery and make your recovery smoother.

I haev many african american patients and keloids (more correctly, hypertrophic scarring) is always a concern. I use special techniques to avoid this, but much depends on how your skin will heal. My experience is that event hough you may have had keloids from a previous procedure, it is usually much better after plastic surgery using the tecniques that I use. It is also possible to "revise" the scars at a later date if they heal thick - I have a larger number of people that come to see me specifically to revise thick scars that they have from other surgeries with other doc.

I look foward to seeing you as you approach your goal. Make sure you have signed up for my newsletter so you can take advantage of my latest special promotions and hear the latest news.

[openag 0]

Dr. Schulman, I'm planning to have a reduction and abnominoplasty. I have a few questions about recovery devices. I hear so much about compression garments. Do you have any advice about picking the right one? Also do you encourage your patients to use Bromelaine or Arnica Montana to reduce bruising? Thank you for providing this service.

[Dr. Schulman 2]

Dr. Schulman, I'm planning to have a reduction and abnominoplasty. I have a few questions about recovery devices. I hear so much about compression garments. Do you have any advice about picking the right one? Also do you encourage your patients to use Bromelaine or Arnica Montana to reduce bruising? Thank you for providing this service.

I recommend arnica, starting 3 days before the procedure and for 5 days after. It probably does not work for everyone, but it certainly is not harmful. I recommend a simple compression binder for after the TT - this will be worn for about 3-4 weeks, and then it can be changed to a surgical girdle. For reductions, I recommend a soft sports bra that has a zipper in the front - it should not be too tight and youi can get it in any sproting goods store. This will be worn for 4 weeks and then can be changed to a regular bra without underwire. You surgeon should be able to show you exactly the type of garment to purchase (if he/she does not suppy it for you).

[kareyquilts 1]

Dr. Schulman: Thanks for your reply! I really appreciate it. I hope that my lymph system will repair itself and I am willing to continue the compression therapy and exercises that I have been given and give it more time. If these efforts don't improve the situation, do I need a specialist to try to re-attach the the lymphs to my blood vessels? You know that I am a big advocate of reconstructive surgery after weight loss and I'm very sad that my journey might be over. Thanks again for all the good that you do!

[canadagirl33 0]

Hi Dr. Schulman :thumbup:

A couple of questions...

I noticed this question was asked a little while ago and in amongst all the others you missed it...and I'm curious about it as well so it bears repeating. With the thigh lift, how bad does it have to be for the decision to be made to make a vertical incision down the inside of the thigh rather than using just an incision in the groin crease. Like it was mentioned, my thighs aren't great and I would consider having them done, but I don't want to trade flabby that I have to cover up to a scar that I want to cover up as well.

Also... I am planning a TT within the next few months I hope and I have a question regarding belly buttons. I have always had what I consider to be a really deep belly button. Ove the course of adulthood I regularly (every couple of months) get a minor infection inside it with slight weeping. I know to keep it dry and clean and I do !!...but still this happens. I almost never need oral antibiotics or anything and can clear it up in a few days with an OTC antibiotic creams and a Q-tip. :tt2: My question is how odd would it be to request not having a new belly button done during my TT? And if we do go with a new bb will it still be as deep? I'm not really concerned if I have a belly button or not...the TT is to make me more confortable and get rid of the hanging skin, I don't plan on necessarily wearing anything that would show my tummy anyhow....so is it an issue?

Thanks for your time !!

Patricia