Dr. Schulman

Never heard of it!

You are right to be concerned about saggy skin remaining after inner thigh liposuction. This is a very common result if liposuction is done in someone who needs a thigh lift to remove the excess skin. Yes, age does matter, so the younger you are, the better chance you skin has of recovering and tightening. But, in my experience, even the young patient who has had significant weight loss has skin that lacks elasticity and will not tighten up fully. I have been very happy with laser liposuction in this area in particular which helps the skin tighten up a bit more than traditional lipo.

Sorry Suzanne for the delay - I must have missed your post! Massive weight loss is the first criteria for insurance coverage. Usually this means 100 pounds, but it also depends on your height and original weight (100 pound weight loss in someone who is 5'10" is not as much as 75 pounds in someone who is 5'0"). You should get documentation of the rash, even if it is small. See your GP first and usually this is sufficient. There should be precriptions that can help you. Also, if you call your insurance carrier, they should be able to give you a detailed list of requirements to prove medical necessity for a panniculectomy.

Congratulations on your weight loss. Make sure you check out the "Ask Dr. Schulman" thread - you will probably find good information that will help you in your process. If you are interested in coming to NYC, you are more than welcome to come see me. Regardless of who you choose, make sure you select someone experienced in body contouring after massive weight loss - this really is a very specialized area of plastic surgery.

It is true that there can be a moderate blood loss during a LBL and being anemic can affect your healing. Iron deficiency anemia is very common, and even with iron supplementation, it can take several weeks to get your count up. This is because it takes your body that long to produce blood cells. If you have not seen a hematologist, make sure you do. He/She may have other recommendations that may help you. make sure they have checked your b12 and folate levels as well. One other thing to consider if your count still remains at a safe, but low level is that you can always split the LBL into 2 operations - a front and a back. This will greatly reduce operative time and blood loss.

Congratulations on your weight loss. Regarding the consultation, as I have said in the past, it is never too early. If you are considering surgery around Christmas, then you should certainly come see me in October so we can work out a surgical plan for you. Without seeing you, it is impossible to say what you may need, but a LBL is among the most common needs of someone who has lost weight like you have. I am unclear from your post if that extra roll under your bra line is in the front or the back. If it is in the back, you may need this removed from the upper back with an incision that remains in the bra line. Also, you mentioned that your breasts have gotten smaller, so you may be interested in a breast lift with implant. A three week recovery should work well for you. You will need to stay in the area for a little while afterwards, and my office can help you in arranging a nearby hotel. Obviously, after I see you, we can come up with a very specific plan that meets your needs. I look foward to seeing you.

A dog ear excision is a relatively small procedure that can be done in office with local anesthesia. Most plastic surgeons will remove this without charging the patient because it is really a "touch up" from the abdominoplasty. They may or may not submit it to insurance, but will likely not get any reimbursement from this "cosmetic" procedure. I do not think that weight gain contributed to this dog ear.

There is no reason to avoid flys - unless yo notice that the implants move when the muscle contracts. Most people do not have a need to do chest exercises after breast implants because as most of you know, women tend to do chest exercises to make the breasts look bigger - which is no longer an issue for you.

Obviously, I am very late on this answer (so hopefully you did not have any problems). Most complications happen within 2 weeks, but keep in mind that things can happen later, especially when people begin to be more active and may tend to "overdue" things!

depends what type of work you do. If you usually sit at work and do not have to lift anything, then you may be ok in 2 weeks. It also depends on how well you heal. It is true the the TL is the toughest to recover from, but I have many patients who are back to work in 2 weeks - I also have many that need longer!

There is no way to predict whether or not you will need plastic surgery (incidentally, "need" ir really "want"). It depends on the quality of your skin, your genetics, the amount of weight you lost, the time it took you to lose the weight, and many other "unkowns". The best you can do is prepare for the possibility and see how it goes.

You left out the most important detail - are you still losing weight? If your weight has stabilized (even if you are short of your "goal") then you are ready for surgery. I suspect you have at least 15-20 pounds of extra skin, so you may be essentially at goal. It can never hurt to see a plastic surgeon early.

Weakening the muscles of the forehead without removing excess skin (brow lift) is usually not a good idea. You can see why. The muscle can no longer suppot the forehead and the skin will get even more droopy. I sounds like you needed a browlift with either a fhairline excision to remove the excess skin or endoscopically to pull the hairline back an inch or tow. There is no medical reason why this was not done but it sounds like this was not completely discussed between you two before. I cannot stress enough how important clear communication is between surgeon and patient - this may have nothing to do with a language barrier. This can be fixed but will require a surgical procedure after 6 months to allow the tissue to heal. Obvioulsy, you should discuss your disappointment with your surgeon on your followup visits.

Congratulations on your weight loss. I think that it is possible to return to a sit down job at 3 weeks after a LBL - barring any complications.