Procedure groupings

[Boombalatty 94]

I have a question for those of you who have had plastic surgeries. I have reached my goal and have lost 370+ lbs from my heaviest ever recorded (300+ from when I started the effort that led me to a sleeve gastrectomy). That said, I am a man with extra skin everywhere.

I have started meeting with plastic surgeons and have it narrowed down to two. I still have some questions pending with both, but thought I would seek advice on this board before I choose one and have him start the insurance paperwork for whatever I can get covered (likely only pannus, if they will even cover that based on what some doctors said - my skin is all over so the pannus itself may not meet requirements).

Both doctors are experienced and I like their attitudes. Their prices for everything I need done are very close, so that's not a factor.

The biggest differentiator between the two is how they want to break the procedures into surgeries. The first surgeon wants to do my trunk first - stomach and upper body lift (chest and back) - and then come back in a second surgery and do thighs and arms. The second surgeon wants to do a lower body lift and thighs together then do upper body and arms in a second surgery.

Now comes the question. For those who have had multiple procedures, which do you think is better from a recovery standpoint? Trunk, then extremities or lower then upper body? I would think that the upper, then lower might be an easier recovery, but I don't know - they'll both be pretty brutal, I'd bet. I think the first surgeon might be grouping them together like that (trunk, then extremities) because that is the order that they bother me the most and it might give me 'the most bang for my buck' with regards to quantity of skin removed. So, does anyone have any advice?

Oh another thing, neither one of these do much of a hospital stay after the surgery. The first said it would be outpatient, but I can't imagine not having at least one day to make sure things are okay before coming home. (One of my follow-up questions for this surgeon - can it be added.) The second mentioned a 23hr hospital stay. Have any of you had such major procedures and not stayed in a hospital afterwards? This would only be my 2nd (& 3rd) surgery ever. My first was the sleeve and I was in the hospital for a day after.

Thanks!

[JamieLogical 8,727]

It really depends. If I had to do it over again, I think lower body first, because it's so major and it might be better to get out of the way first. But on the other hand, it might be so bad that you hesitate to ever go back and do upper body. I don't think there's any "right" answer there. I guess you should go with whichever is highest priority to you just in case you don't ever go back for a second round for whatever reason.

As for the short hospital stay, it all sounds insane to me! When I had my extended Tummy Tuck, breast lift with implants, and all over Lipo in Mexico, I stayed in a recovery house with 24/7 nursing care for two full weeks after! Certainly for the first 4 days or so, I really couldn't do anything for myself. The idea of being sent home and fending for myself 23 hours after surgery seems crazy! Plus I saw my surgeon every day post-op not just like a week later for a check-up.

[Daisee68 2,493]

I don't have any advice as I am not at that stage yet, but I just wanted to say UNBELIEVABLE JOB!! Congrats to you for such an amazing loss! I know you have worked so hard and this part is just the icing on the cake! I have thought so often about surgery lately (though not an option I think until I am at goal for a while). Right now, I would want done what bothers me the most - which is arms and breasts - but I may have a different opinion when I get there.

As far as the hospital stay part, I find it so odd that drs don't keep us more now, but I have had a LOT of surgeries (4 shoulder surgeries, hysterectomy, RNY, 4 kidney stone lithotripsies - all which required major anesthesia) and I had no hospital stay except for 24 hours for the hysterectomy and 24 hours for the RNY. 2 of my shoulder surgeries were major where I had no use of my arm and was tied up in a sling where movement COULD NOT be made (i.e. could have torn the damage that was just repaired) and I was sent home each time. One of those was a 3 hour surgery which I was sure they would keep me overnight but did not. Anyway, I know the plastics might be different because of the drains, but I live alone and my mom stayed in the first night at home with me and then I was on my own - and I was fine. Of course I didn't have to care for anyone else which I know makes a difference. Still I understand your concern and I am very curious what your doctor will say if you ask for the night in the hospital. I like the idea of a recovery house as @@JamieLogical mentioned, and I am surprised they don't really have that option here in the US but I don't think I am interested in doing the Mexico thing (although I know what a great experience @@JamieLogical has had, I am too much of a momma's baby to go there by myself and go through a surgery by myself! )

I hope you get some great advice here to help you reach comfort level with it all!! Best wishes!

PS - I see you are in Dallas. Any chance you would be willing to tell me which doctors you decided (even if in a PM?) I have really researched Dr. Peter Fisher in San Antonio but keep thinking that surely I can find a competent doctor in the DFW area so I don't have to travel as far (though Dr. Fisher's work is impeccable!)

[kealot 136]

I am located in Houston, TX. I haven't had cosmetic surgery yet, but I am scheduled for my first on on 4/21. I am having mine broken up into 3. Breast list, sides under my arms and my arms for 1st surgery. Lower 360 body lift/belt lipectomy for 2nd surgery. Thighs for 3rd surgery. My surgeon said that many people do the belt lipectomy 1st because you get more bang for your buck, but since my bat wings and breast bother me more, I'm doing that one 1st.

Edited March 21, 2016 by kealot

[Boombalatty 94]

PS - I see you are in Dallas. Any chance you would be willing to tell me which doctors you decided (even if in a PM?) I have really researched Dr. Peter Fisher in San Antonio but keep thinking that surely I can find a competent doctor in the DFW area so I don't have to travel as far (though Dr. Fisher's work is impeccable!)

Thanks for your support Daisee68.

I met with two surgeons here in Dallas, but I am going to Nashville, TN to have the surgeries, I think. I met with several surgeons in Nashville and it's going to be easier for me to have the surgery there and stay with family for the recovery. Also, the quotes from the Nashville surgeons were much less... almost on par with a quote I got Dr in Mexico (but without the aftercare)...

I just worry about going to Mexico and the surgeon I spoke with back-pedalled on things he said previously when I asked extra questions. He also wasn't too confident about how many surgeries would be needed nor some special work I need done that others were confident about fixing. (And he is one that is well regarded on this board. ) I never heard back from my inquery into the BariatricPal associated surgeon's group after an initial 'We got your email' message.

In Dallas, I met with Dr Ben Tittle and Dr Jeffrey Kenkel. They both seemed like very good doctors and we're referred by my sleeve surgeon, but Dr Tittle seemed in a hurry and I wanted someone to explain things to me better. Dr Tittle also wanted things broken into 3 surgeries - I think I prefer only going through two.

I really liked Dr Jeffrey Kenkel a lot. However, he was very expensive - like 15k-20k more expensive for everything than the two I am considering in Nashville - although he did include 2 nights of aftercare. I'm not pinching pennies at the sake of my health, but that's quite a bit when the Nashville surgeons have bariatric experience and were referred by a bariatric group there.

I did look at Dr Fisher's website and considered talking to him, but thought I'd go locally (where family could stay with me) or Nashville (where I could stay with family). I don't know about traveling to San Antonio...how long before you would want to be in a car long enough to drive (or fly) back to Dallas?

Sent from my SM-N900T using the BariatricPal App

[Daisee68 2,493]

Thank you for the info! And the drive back is what I fear. I considered renting a house for 2 weeks and having different family come stay with me that way I would be there if needed and since I work from home, I could just work from there (the second week anyway ). I will check out Dr Kenkel but $15k-20k more is a LOT! I'm glad you have family in Nashville and found doctors there. That sounds like a great plan!

Sent from my SM-T560NU using the BariatricPal App

[mBig 21]

PS - I see you are in Dallas. Any chance you would be willing to tell me which doctors you decided (even if in a PM?) I have really researched Dr. Peter Fisher in San Antonio but keep thinking that surely I can find a competent doctor in the DFW area so I don't have to travel as far (though Dr. Fisher's work is impeccable!)

Thanks for your support Daisee68.

I met with two surgeons here in Dallas, but I am going to Nashville, TN to have the surgeries, I think. I met with several surgeons in Nashville and it's going to be easier for me to have the surgery there and stay with family for the recovery. Also, the quotes from the Nashville surgeons were much less... almost on par with a quote I got Dr in Mexico (but without the aftercare)...

I just worry about going to Mexico and the surgeon I spoke with back-pedalled on things he said previously when I asked extra questions. He also wasn't too confident about how many surgeries would be needed nor some special work I need done that others were confident about fixing. (And he is one that is well regarded on this board. ) I never heard back from my inquery into the BariatricPal associated surgeon's group after an initial 'We got your email' message.

In Dallas, I met with Dr Ben Tittle and Dr Jeffrey Kenkel. They both seemed like very good doctors and we're referred by my sleeve surgeon, but Dr Tittle seemed in a hurry and I wanted someone to explain things to me better. Dr Tittle also wanted things broken into 3 surgeries - I think I prefer only going through two.

I really liked Dr Jeffrey Kenkel a lot. However, he was very expensive - like 15k-20k more expensive for everything than the two I am considering in Nashville - although he did include 2 nights of aftercare. I'm not pinching pennies at the sake of my health, but that's quite a bit when the Nashville surgeons have bariatric experience and were referred by a bariatric group there.

I did look at Dr Fisher's website and considered talking to him, but thought I'd go locally (where family could stay with me) or Nashville (where I could stay with family). I don't know about traveling to San Antonio...how long before you would want to be in a car long enough to drive (or fly) back to Dallas?

Sent from my SM-N900T using the BariatricPal App

I see you are having surgery today here in Nashville. Here's praying for your speedy recovery! When you do recover can you elaborate on which surgeons you met with and which one you chose? Costs? Recovery time? And all else that would help! Thanks!

[Boombalatty 94]

I see you are having surgery today here in Nashville. Here's praying for your speedy recovery! When you do recover can you elaborate on which surgeons you met with and which one you chose? Costs? Recovery time? And all else that would help! Thanks!

Actually, I'm not having surgery today. I did end up scheduling my upper body in Nashville on May 18th with Dr. Brian Tierney. I am waiting on the final costs, but it is approximately $13,000 for this first one. I am having a bilateral male chest reduction, correction to my xiphoid process and arm/forearm lift (I was so large even my forearms have extra skin). The plan is to have the lower body (belt lipectomy and thigh lift, estimate for Dr Tierney was ~$17,000) at the end of the year due to work commitments.

In Nashville, I met with Dr Tierney (St Thomas affiliated), Dr Chad Robbins (Centennial affiliated), Dr Bruce Shack (Vanderbilt), and Dr Michael Burgdorf (I have a relative who went to him). Here are my thoughts:

Dr Burgdorf - wouldn't try to work with my insurance (but I knew that going in). Really took time to explain things and I liked his manner. However, he wanted to break things into 3 procedures instead of 2. I prefer getting it done in 2 passes.

Dr Shack - didn't spend a lot of time talking to me. Seemed to want to rush me out. I guess he knows what he's doing, though. He wanted to do 3 procedures as well. Strangely enough, he was the (slightly) cheapest option even considering 3 procedures...especially if you didn't finance with CareCredit as he had reduced cash and credit prices.

Dr Robbins - I really liked him a lot. He spent lots of time going over the procedures. He could do what I wanted done in 2 procedures. It was a very hard choice between him and Dr Tierney, but came down to the fact that I liked Dr Tierney's approach of doing a 360 belt lipectomy with Dr Robbins only doing abdominoplasty. (Dr Robbins wanted to do 360 around my chest and only front on the lower body. Dr Tierney wanted to do mainly front on upper body and 360 on the lower body...it came down to I think I do want the butt lifted a bit, but Dr Robbins didn't think it was necessary as pulling other areas would end up lifting it a bit...but I couldn't see it by pulling skin on my own in front of a mirror. I would bet that either plan would end up giving me a great result beyond my hopes since I've been big since I was 6 years old.)

Dr Tierney - I liked him a lot, too. He didn't spend quite as much time going over the procedures as Dr Robbins, but he had an emergency surgery to get to, so I understand. (Unlike Dr Shack who just didn't seem that he cared about my questions.) He did spend enough time that I got a good feeling from him.

Both Dr Robbins and Dr Tierney were recommended by the St Thomas Bariatric surgery group when I called them to ask to whom they referred patients. I didn't bother calling the Vanderbilt bariatrics team because I assumed they would refer patients to the Vanderbilt plastic surgeons.

For those wondering about Dallas surgeons, I also met with Dr Tittle again before finally choosing to proceed with Dr Tierney. My reservations about Dr Tittle are gone. He spent a lot more time with me on the second visit and really went over things. I would have no doubts about going with either Dr Tittle or Dr Kenkel in Dallas. Dr Tittle did want to do 3 procedures, but I bet my results would be phenomenal with 3 procedures with him the way he talked about being able to go back and touch up areas from the previous surgery.