Ask Dr. Schulman...

[DivaStyleCoach 89]

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.

Thank you for your wonderful reply, Dr. Schulman...I will be sure to let you know when I'm ready to talk surgery. I have signed up for your newsletter and will be following this thread as well.

You mentioned in another response that some people are not necessarily able to wait a year after reaching their goal weight to have the surgery - I have had that thought as well...what has been the experience with your patients? Do most of them wait 3 - 6 months, 6 - 9 months, or 9 - 12 months before having surgery?

I'm planning (thinking positively here) to be at my goal by the fall of this year, and planning for surgery in the spring of 2010. I want to have this done before I turn 50 - I think it'll be my 47th birthday present to myself!

With the timetable I'm planning, I would be at goal for 6 months before planning the surgery. My understanding is that I will need approx 2 months for all the pre-op work - does that sound right?

Thanks again for sharing your experience, wisdom and kind spirit with us here on LBT!:thumbdown:

[Sue Magoo 71]

Hi Dr. Schulman:

Thanks so much for answering all of our questions. There's no doubt that if I was in NY I would have had a consult & Tummy Tuck with you. But I'm a Red Sox fan living 20 minutes from Boston.

Are there any restrictions for sleeping after tummy tuck surgery? I am a side sleeper and am wondering if that's going to be okay during my recovery period.

Please let me know.

Thank you.

Sue

[Dr. Schulman 2]

Hi Dr. Schulman :glare:

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. :eek: 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

In my experience, mild excess skin in the inner thighs can be corrected with a groin incision only. If the skin is more significant, than a vertical component is needed. The problem is that if you try to do this with onlya groin incision, it looks good for about 6 months, then gravity pulls the scar fromt he groin crease and down. The scar then becomes visible and the labia can be distorted. The weight pulling down can be reduced by adding a vertical incision. As I have said in the past, the more you are willing to accept in terms of scarring, the better the shape will be. Like anything, it is a cost/benefit equation. Your PS should be able to show you exactly what the difference will be in shape between the two.

It would be very odd to not have a belly button. Your PS should be able to reduce the depth of the belly button and make one that looks 100x better than what you have now. I always make the belly button a priority, because it is the only scar that is visible. If it is not done correctly (or if it is removed completely) people are very unhappy. In fact, I have many patients who have come to me (after surgery with other PS) to fix their belly buttons.

[Dr. Schulman 2]

Hi Dr. Schulman:

Thanks so much for answering all of our questions. There's no doubt that if I was in NY I would have had a consult & Tummy Tuck with you. But I'm a Red Sox fan living 20 minutes from Boston.

Are there any restrictions for sleeping after tummy tuck surgery? I am a side sleeper and am wondering if that's going to be okay during my recovery period.

Please let me know.

Thank you.

Sue

the best thing is for you to sleep in a flexed position, like you are in a chair (head raised and knees bent), so sleeping on your side in a fetal position should be fine.

I still think you should make the trip to NYC - I have nothing against Red Sox fans (I am a Mets guy, not a Yankees guy).

[pennreporter 12]

Dr. Schulman, my daughter who is almost 18 months post-lapband surgery, is having her first PS (lower body lift, breast reduction, fat injections in butt) next month. She lives in NYC but is going to Dr. LoMonaco down in Houston (Big Medicine TV doc). She's planning on being there until right after her 10-day checkup with the doctor. But she's allowed three weeks before she goes back to work. She's a haircolorist in the city and is on her feet all day. I know she's going to try to go back on a reduced scheduled at first.

What is the realisitc time before someone goes back to work? She uses her arms a lot, so will this be an issue for the breast reduction?

I noticed on your website it says that there are dains inserted (which she didn't mention to me). How long do the drains stay in? The doctor is also sending her home with a morphone pump. How many days of meds will she get from the pump?

i appreciate any answers you provide. I can't accompany her down to Texas as I'm having my band surgery two days before she leaves.

I wish she was doing it in NYC, but I think the cost is considerably less down south and banks aren't doing many medical loans these days. (plus one of her clients works on the set of Big Medicine and I think she was hoping to maybe have an "in" for the show but I don't think it got picked up again, which wouldn't have made it free but greatly discounted.)

Also...hate to rattle on..other than a physician's CV and reading their own site about their accomplishments, are there any watchdog websites to really check on your prospective physican? I'm somewhat nervous with her going to a "TV doc," although his credentials look great.

Trisha

Edited May 9, 2009 by pennreporter
typo

[Dr. Schulman 2]

Dr. Schulman, my daughter who is almost 18 months post-lapband surgery, is having her first PS (lower body lift, breast reduction, fat injections in butt) next month. She lives in NYC but is going to Dr. LoMonaco down in Houston (Big Medicine TV doc). She's planning on being there until right after her 10-day checkup with the doctor. But she's allowed three weeks before she goes back to work. She's a haircolorist in the city and is on her feet all day. I know she's going to try to go back on a reduced scheduled at first.

What is the realisitc time before someone goes back to work? She uses her arms a lot, so will this be an issue for the breast reduction?

I noticed on your website it says that there are dains inserted (which she didn't mention to me). How long do the drains stay in? The doctor is also sending her home with a morphone pump. How many days of meds will she get from the pump?

i appreciate any answers you provide. I can't accompany her down to Texas as I'm having my band surgery two days before she leaves.

I wish she was doing it in NYC, but I think the cost is considerably less down south and banks aren't doing many medical loans these days. (plus one of her clients works on the set of Big Medicine and I think she was hoping to maybe have an "in" for the show but I don't think it got picked up again, which wouldn't have made it free but greatly discounted.)

Also...hate to rattle on..other than a physician's CV and reading their own site about their accomplishments, are there any watchdog websites to really check on your prospective physican? I'm somewhat nervous with her going to a "TV doc," although his credentials look great.

Trisha

A LBL is one of the largest surgeries after weight loss and most patients (especially ones that work on their feet) require at least 3 weeks. You are also right to assume that reducing arm movement is important. She needs to check with her surgeon about his specific restrictions on activity, because it varies from doc to doc. I do not think it is a morphine pump - more likely it is a pain pump that gives local (non-narcotic) medicine called marcaine and lasts about 3 days.

Be assured that Dr.LoMonaco is an excellent surgeon and well respected among his peers. You should always check to make sure your surgeon is a member of ASPS and can check for complaints against them with the state medical board.

She should know that having surgery such a long distance away has certain issues. I also operate on many out-of-town or out-of-country patients, and require that they stay for a substantial amount of time after the surgery, because complications often do not arise within a 10 day period. Also, sometimes the drains remain for 1-3 weeks and I do not allow my patients to return home until the drains are out. She should also be prepared to travel back to Houston for frequent follow-up visits. Again, I am sure her surgeon has specific requirements that she must adhere to. Also, if there is a problem down the road, she must be prepared to travel back to see her operating surgeon.

So, it is possible that surgery in Tx is initially cheaper than in NYC (although, I would disagree with that generalization), staying the appropriate time, traveling back and forth for follow-up visits every few weeks than every few months can add significantly to the cost and ultimately make it substantially more expensive.

[pennreporter 12]

Thank you so much for your response, Doctor, although I don't know that it has alleviated any of my nervousness for her. I will convey all of this to her, so that at least she has questions to ask. I know that she would have conveyed the fact that she lives in NYC. So let me ask you another question...she's paying 27k for all three procedures in Houston. She had several consultations in Houston and they were all within that ballpark. Would that be that much difference than if she got her surgery in NYC? Her best friend lives in Houston, so she does travel there somewhat frequently but it sounds like she may not be aware of the follow-up that she will need.

Thank you again so much

Trisha

[Dr. Schulman 2]

Thank you so much for your response, Doctor, although I don't know that it has alleviated any of my nervousness for her. I will convey all of this to her, so that at least she has questions to ask. I know that she would have conveyed the fact that she lives in NYC. So let me ask you another question...she's paying 27k for all three procedures in Houston. She had several consultations in Houston and they were all within that ballpark. Would that be that much difference than if she got her surgery in NYC? Her best friend lives in Houston, so she does travel there somewhat frequently but it sounds like she may not be aware of the follow-up that she will need.

Thank you again so much

Trisha

Don't be nervous. It is a common procedure and safe if done correctly with appropriate follow-up care. It appears that even in NYC, the price will be in the same ballpark.

[Dr. Schulman 2]

Thank you for your wonderful reply, Dr. Schulman...I will be sure to let you know when I'm ready to talk surgery. I have signed up for your newsletter and will be following this thread as well.

You mentioned in another response that some people are not necessarily able to wait a year after reaching their goal weight to have the surgery - I have had that thought as well...what has been the experience with your patients? Do most of them wait 3 - 6 months, 6 - 9 months, or 9 - 12 months before having surgery?

I'm planning (thinking positively here) to be at my goal by the fall of this year, and planning for surgery in the spring of 2010. I want to have this done before I turn 50 - I think it'll be my 47th birthday present to myself! :biggrin:

With the timetable I'm planning, I would be at goal for 6 months before planning the surgery. My understanding is that I will need approx 2 months for all the pre-op work - does that sound right?

Thanks again for sharing your experience, wisdom and kind spirit with us here on LBT!:tt2:

Most of my patients have the first surgery around 6 months after weight loss plateau (may not be "at goal"). This means that many see me as the weight loss begins to slow to just a few pounds a month. I think you are right that it may take about 2 months for the logistics of getting insurance approval, financing approval, etc. But many do not go through insurance (or know they willnot be eligible) so surgery can be booked as soon as medical clearance is obtained.

[mrgrta 0]

Dr. Schulman, I am about 11 days post op from a circumferential tt with fleur de lis. The surgery turned out great and my results are amazing! I have noticed that the top of the vertical incision (which sits right under my bra) kind of sticks out and looks puffy, almost like a dog ear. Same situation goes for my backside where the two ends of the incision stop (they stop about an inch from eachother). Is this something that usually evens out within time, or does it stay puffy forever? I know I'm still early out, but I'm just curious.

[mrgrta 0]

I also forgot to ask if it is possible to do a breast lift (no implants) under local anesthesia with iv sedation?

[Dr. Schulman 2]

I also forgot to ask if it is possible to do a breast lift (no implants) under local anesthesia with iv sedation?

yes. But keep in mind that "IV sedation" is a vague term. It can range from just a little vlium, to more powerful sedation. If you are receiving a deep sedation, then it is still considered "general anesthesia" - just without a breathing tube.

[Dr. Schulman 2]

Dr. Schulman, I am about 11 days post op from a circumferential tt with fleur de lis. The surgery turned out great and my results are amazing! I have noticed that the top of the vertical incision (which sits right under my bra) kind of sticks out and looks puffy, almost like a dog ear. Same situation goes for my backside where the two ends of the incision stop (they stop about an inch from eachother). Is this something that usually evens out within time, or does it stay puffy forever? I know I'm still early out, but I'm just curious.

It usually gets better over time, but may never completely go away without a small revisional procedure. FYI, if your TT incision does not meet in the back, then by definition it is not a "circumferential TT" - not a big deal, just semantics I guess. I have found that if the TT does not go all the way across the midline of the back, there usually remains a puffy area right above the tail bone that can appear "tail-like" that most people are unhappy with. See if it settles down, but don't be surprised if you come to ask your PS to fix it in about a year.

[kareyquilts 1]

Dr. Schulman: I just read your May newsletter and I'm very intrigued by your intra-oral filler injections. I'm going to be in NYC in June and I'm wondering which areas of the face you can do this on. I'm a real bruiser and am very interested in this. Thanks!

[Dr. Schulman 2]

Dr. Schulman: I just read your May newsletter and I'm very intrigued by your intra-oral filler injections. I'm going to be in NYC in June and I'm wondering which areas of the face you can do this on. I'm a real bruiser and am very interested in this. Thanks!

I have been using this technique for about a year and love it! It allows me to build up the cheek bones and help with the undereye area and NL lines. I use a product (Radiesse) that lasts 12 months. Luckily for me, there are very few doctors performing injections using this technique. When you are in NYC, come at see me - I can do the injection the same day. To help minimize brusing, take arnica starting 3 days before the planned injection and continue taking it for 3 days after. Also, as I have said before, no red wine, aspirin, motrin, ibuprofen for 1 week before.