Ok so I had my first PS consult today. I went to Dr Peter Fisher in San Antonio (thanks to several folks on here who highly recommended him). He said good things - I was a good candidate, at a good weight (in fact wouldn't lose anymore than 5 or 10 more pounds IF that), had good muscle tone, had a good figure already, etc. All good things to hear.

He wants to do everything in 2 procedures:

First procedure - Lower Body Lift (which includes tummy, butt, lipo of thighs and some thigh lift) and brachioplasty - procedure last 8 to 12 hours!

Second procedure (no less than 3 months later) - Thigh lift and Breast Lift / Augmentation - 4 to 6 hour procedure

I am not necessarily worried about the pain and in fact, his theory in doing so many procedures together is less recovery time and less anesthesia long term (i.e. only 2 times instead of multiple). I was watching something about PS recently and the advise was to steer clear of drs who want to do lots of procedures at once. Now I don't think that necessarily applied to this type of surgery since we have to have so much work done but it still is stuck in my head. How does a dr actually perform surgery for that long? Don't they get fatigued? And is there more long term hazards of being under anesthesia so long?

Ok - and lastly, my NUT says no surgery until at least 18 months post-op RNY. I am just going to be 1 year on June 4. Dr. Fisher wasn't at all concerned about that (all labs are good and in good health, exercise, etc.). He questioned me about nutrition, counseling, past weight struggles, etc. and didn't seem concerned at all. My therapist (who I have been seeing for 16 months and no end in sight) seems to think it is not too early. (She specializes in bariatric patients and is actually an RN so she has seen others go through this.) I haven't talked to my bariatric surgeon yet though I will at my 1 year follow up in a couple of weeks. Thoughts? IS it really too soon (given my weight is right and has pretty well stabilized the last couple of months)? I really want to get it all done this year if I can because I currently work from home and it will be much easier to recover without missing work since I don't have to drive / sit at a desk AND I have the potential (hope) of getting another job I have wanted but they are looking at hiring at year end.

As always, appreciate all the advice.

did the NUT say why?

I think if it comes down to it, I'd expect the PS expert to know about PS, and the NUT to know about nutrition.

@@Christinamo7 - Well I have often heard many doctors (plastics and bariatrics) said you had to be at a stable weight for at least 1 year before they would do plastics. My NUT says you will typically be your smallest at 18 to 24 months post-op and then will experience (most likely) a weight gain (albeit hopefully very little). Even the plastic surgeon said I would need to make sure to be stable after surgery because a significant gain or significant lose after plastics could affect the results. I think my NUT is concerned about potential gain. I'm kind of thinking my therapist really knows me best since I have seen her the most so I will definitely spend a lot of time talking to her about it before I make an decisions.

It is my understanding that the recommendation to wait is twofold but both are related to better results from plastic surgery. First to ensure your weight is stable, I continued to lose weight for about 15 months post op. Second to allow your skin to tighten naturally on its own prior to having the procedures to address loose or sagging skin (tummy tuck, thighs etc). My skin continued to tightened up on its own for at least 18 months or so out.

I'm 21 months post-op. As someone who's probably not going to have plastic surgery on my body, I have a surprisingly strong opinion about your upcoming decision. Here goes ....

In your shoes I would take the next year to focus on weight maintenance and postpone plastics until I had conquered for at least one full year all the things that can "attack" us after reaching goal.

Yes, the weight loss phases have challenges and are exciting. But (for me, at least) the many maintenance phases (it's not the same all the time) summon old obesity beasts that need careful attention and consistent management with multiple tools.

Regardless of whether maintenance goes easily for you or is full of bumps, it's a pretty big damn deal.

So that's my two cents' worth.

@VSGAnn2014- Thanks and I appreciate and understand your advice and actually not sure I disagree. A lot of what is running through my head is about how to best work it in with work timing-wise but not sure that is the best reason to have surgery (and I had the same thought last year when I had the bypass at the busiest time of my work which still went fine - and then despite my efforts to work from home after surgery - I got laid off in December...) I promise I will take your advice under sincere consideration.

Let me ask you this though - do you think there is any chance that having the excess skin removed earlier and feeling like I am more "normal" will perhaps give me more incentive to maintain? (I have actually lost 160 pounds from my highest weight so skin is pretty significant - especially in the rear / thighs and pants are VERY difficult to get on. Additionally, I am only 48...)

Duplicate response.

@VSGAnn2014- Thanks and I appreciate and understand your advice and actually not sure I disagree. A lot of what is running through my head is about how to best work it in with work timing-wise but not sure that is the best reason to have surgery (and I had the same thought last year when I had the bypass at the busiest time of my work which still went fine - and then despite my efforts to work from home after surgery - I got laid off in December...) I promise I will take your advice under sincere consideration.

Let me ask you this though - do you think there is any chance that having the excess skin removed earlier and feeling like I am more "normal" will perhaps give me more incentive to maintain? (I have actually lost 160 pounds from my highest weight so skin is pretty significant - especially in the rear / thighs and pants are VERY difficult to get on. Additionally, I am only 48...)

Great questions!

But I'm not the best one to answer them, given the differences in our ages, starting weights, and the fact that I've had zero body plastics so far.

@@CowgirlJane and @@MichiganChic and others who've had significant (and successful) body plastics could give you better answers, I bet.

People repeat advice given them, but for people with LOTS of excess skin they often do it in phases even before they get to goal. My stock advice js to get several consultations and listen to the recommendation and why. In my case, I did my first consult within a month of hitting goal and no surgeon ever advised I wait. After losing 150 (more like 180 or more from lifetime hugh) that skin wasn't going to recover enough on its own to make waiting a year advisable. I had plastics 8 months after hitting goal and it's been great!

@@CowgirlJane - Thanks. That makes me feel a little better

I lost 135lbs and got to goal in almost exactly a year. I had my plastics at 18 months. My skin did tighten a significant amount in those six months and I think my results were better for it.

I had everything done in one big surgery but I had a by less than you have planned. I had breast lift/augment, arm lift and tummy tuck. My surgeon limits himself to 8 hour surgeries and he felt he could accomplish those in that time because I needed no liposuction (I had run and yoga'd my way to 17% body fat). I had some interest in a thigh lift as well but he couldn't do all four and his goal was to have me so happy with those three I didn't want to do the 4th. He succeeded. He says in his experience people aren't as satisfied with the thigh results as they are with the others.

After burn, yes! I got much hungrier. Protein helped. I added extra shakes for healing.

@JaimeLogical - I know you had your first surgery back when you lost the first time. You say your results stayed great even though you regained. What are your thoughts on waiting or going forward now?

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So I emailed the dr that I had the consult with and he said he can break up the procedures in to 3 separate surgeries but that it is not cost effective. He said he does 8 to 12 hour surgeries once or twice a week. He can bring in an assistant surgeon if needed at extra cost (which I may request be done just to cut down on time). He is booked until mid-August, so I still have a little time for my weight to stabilize. (Wasn't sure I wanted to do it during the summer anyway.) Also, they have referred patients to an after care nursing company who will come to the hotel once a day (or however long you pay them for I suppose) to help with the drains, wound care, transport to follow up appts, etc. They are sending me that info so I can check in to pricing. (That will help tremendously so I can send my family home after a few days.) The hotel they refer out-of-town patients to are very used to working with him and make arrangements to get recliners or lift-chairs delivered to your room for duration of the stay. BTW, I was super impressed that I emailed the dr my questions on late Sunday night and got a personal response from him within about 30 minutes. I also emailed the surgery scheduler and she responded by 9 am. this morning. Really like the way these people work!

My local WLS support meeting was having a plastic surgeon speak tonight. I was gonna go (but didn't). I looked up that drs website and his results are nowhere NEAR as good as Dr Fisher's results! Made me even more resolved to make Dr. Fisher my choice.

Don't know how I missed this one, but I'm a little late to the party! I had all the procedures you are talking about, broken down as your doc suggests. I had my first procedure, a lower body lift with auto-augmentation and a brachioplasty in the first surgery (20 months post VSG), and breast lift/aug and vertical thigh lift in the second, four months later. She breaks them up that way to keep the anesthesia time to 6 hours or less, and also to get as much done as she can. For me, I couldn't have tolerated any more at one time. Its a lot of surgery, incision lines, and post operative pain. (all worth it). I didn't want to break it out any more, because each surgery (with anesthesia) carries risk.

Having said all that, I personally would work this around the timing that works for your life. Plastics take time and patience, and often require more recovery than you think. All these procedures and healing take time, may require tweaks, and if you can have with minimal work time lost, I would do it. Every procedure I had required time away from work. I took 2 weeks, then worked a week remotely, then went back, In reality, I should have probably been off closer to six. I was 52 at the time, working at a demanding desk job, just for reference.

One last note - I do think having had plastics is a big motivator for me to stay on track. At 3.5 years after surgery, it would be very easy to gain a little and just accept it in all that skin. With tight skin, I am much more conscious of a small gain, and for ME, it does make me think twice. I had read that people who have plastics tend to do better in maintenance long term, and it's been true for me.

Thanks so much @@MichiganChic! Very helpful!

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