This may help you in understanding the restrictive mechanism of a Lap-Band.

The ALLERGAN protocol for Lap-Band fills calls for a six-week delay after surgery, prior to any fills. The purpose for the six-week delay is for the patient’s stomach to heal from the surgery, as well as allowing time for the Lap-Band to “Seat” or “Nestle” into the fat pad between the stomach wall and the interior wall of the Lap-Band.

Prior to receiving an EFFECTIVE fill, it is VERY uncommon to have any restriction from a Lap-Band. Some patients will NOT lose weight, or may even GAIN weight until they have received an effective fill in their Lap-Band.

Normal weight loss with a properly restricted Lap-Band is between 1 and 2 pounds per week.

The normal cycle of fills, restriction and weight loss is as follows:

1. The patient's Lap-Band constricts when the patient receives a fill. Swelling for a few days after receiving a fill is very common. Many doctors require a patient to go on a liquid diet for a day or two after receiving a fill. A fill may have a “Delayed Action” of up to 4 weeks. A “Delayed-Action” means that the fill may not become effective for up to 4 weeks after the fill. That is why the ALLERGAN protocol states that fills should not be performed on patients who will not have access to medical care for at least two weeks after a fill.

2. The patient's stomach capacity is lessened as a result of the restriction caused by the Lap-Band.

3. The patient loses weight because they cannot eat as much food.

4. The residual fat-pad between the inside of the Lap-Band and the outside of the patient's stomach reduces in size because of the overall weight loss in the patient.

5. The reduction of the residual fat-pad causes the Lap-Band to become loose again.

6. At that point, the patient needs another fill, because the Lap-Band is loose, and the patient has a loss of restriction, which allows the patient to eat larger amounts of food.

7. The patient receives another fill and the process starts all over again.

Most Lap-Band patients receive several fills to adjust the Lap-Band as their weight loss progresses, and there is less and less residual fat-pad between the inside of the Lap-Band and the exterior of the stomach wall. Once a patient has lost all of their residual fat-pad, fills become less common. As the Lap-Band patient progresses in their weight loss, the effect of very tiny fills (Less than .2ccs) becomes greater and greater.

It is not uncommon for a late-stage Lap-Band patient to experience a significant difference in restriction with as little as .05cc of fill.

Weight loss is a major metabolic change where your body is using stored fat as a primary energy source. The hair follicles hate this.

Hair thinning is very common during massive weight loss and tends to grow back to its original state at goal weight. At goal your body uses food as a primary fuel source instead of stored fat and the hair follicles are happy again. Protein is important but most band patients are not protein malnourished like the malabsorptive operations (gastric bypass, biliopancreatic diversion).

So called "hair vitamins" do not tend to have much of an affect on hair thinning because the problem isn't a Vitamin deficiency.

I tell patients to expect more hair in the shower drain and on the brush during weight loss but not to freak or panic because it will restore itself to its original grandeur at goal and then you should go and buy yourself a nice present because you deserve it.

All that hair on the bathroom floor is a sign that your are making positive changes in your life and it therefore is to be celebrated and not feared.

Thank you so much Dr. Watkins!!! This hair thing shows up in so many threads and none of us know why it happens. We've been worried that we were harming our bodies with lack of protein or vitamin deficiency. Now I know and can pass the word along to others. Is it OK if I quote you and use your name of course??????

I've had 12 fills over 11 months, none with a flouroscope...don't even know what one would look like. The clinic nurses do all the fills (thousands...) and are very skilled. I've not seen my Dr. since the surgery last Feb. and am doing fine. My daughter also goes to the same Dr./clinic and neither of us has had any problems with them finding the port. Good luck.

Hi everyone, I had my band done in MX and have since had 2 fills done there. I can't go to MX again because of finances. So my concern is having a fill without a flouroscope. How can they possibly position the needle correctly without being able to see the port? At my first fill the Dr. had problems even with the flouroscope as the port was sideways.

The second fill went a little faster but he still relied on the flouroscope to find the port hole. Any information anyone?

You need to find someone who has done a lot of fills. My surgeon in MX ( I fly there to get fills) has been doing the surgery and fills for many years. I've had two fills with him and each time, without flouroscope hit the right point (felt like a little prick) and had me sit up while he put the fill in. I'd drink Water while he filled and pulled some out until I was just right. He will be teaching some doctors and nurses this month in the USA. And they will need a lot of fills behind them so it becomes instinctive............that's just my opinion. I relate it to my own learning curve......at first it's difficult and seems like I will never learn, then it becomes second nature.

Aloha peaches9,

Thanks for all your posts. I was discouraged and after reading that you have had 7 fills, I feel better. I hope you find your sweet spot!

Aloha Dr. Watkins,

Mahalo for all your support and excellent information sharing.

I learned more tonight, reading all your posts, than I have since my first information session. There is much more to know about all this than what I had access to before you.

I was banded Nov. 14, 2007 and I will be having my third fill Jan. 17, 2008.

My band was empty until my first fill. I was given 3cc at each fill so I now have 6cc in a 10cc band. I am feeling just a little restiction now.

I have lost and gained and lost and my weight is where I was a week after my surgery.

I thought I was a problem patient, because of it. Now I understand more of how the process works for the others.

I hope my next fill does the trick for me.

What I appreciate most is your expertice and the clearity of your responses. It helps me sooo much!

it was probably just 1 cc. I would give it some time. It usually takes 3-4 fills to get it to the sweet spot

I've had 2 fills done and neither one was with the fluoroscope. I have not had problems with this and actually do feel more restriction with each fill.

Sue Stenzel

When talking of fills and the number we all need to find our sweet spot ... its important to POST what size band you are talking about.

A person that has a 4 cc band may only need 2-3 fills, while others with the larger 10 cc band may take 5-6-7 or 8 to get to restriction...

Our stomachs are all different thicknesses too... ie a patient with a 50 BMI stomach will need fewer fills to find restriction, while us lower BMI folks whose stomachs might have less fat around them may take more fills to get us to this restriction.

Then as you lose more weight and are closer to your ideal wgt the band will loosen again and need tiny fills.

When talking of fills and the number we all need to find our sweet spot ... its important to POST what size band you are talking about.

A person that has a 4 cc band may only need 2-3 fills, while others with the larger 10 cc band may take 5-6-7 or 8 to get to restriction...

Our stomachs are all different thicknesses too... ie a patient with a 50 BMI stomach will need fewer fills to find restriction, while us lower BMI folks whose stomachs might have less fat around them may take more fills to get us to this restriction.

Then as you lose more weight and are closer to your ideal wgt the band will loosen again and need tiny fills.

Conversely, a person with a smaller band may need multiple fills, while a person with a larger band size, but larger anatomy, may require fewer fills.

That is why comparing the amount of fill in any two person's bands is essentially futile.

Everyone is different. :smile:

When talking of fills and the number we all need to find our sweet spot ... its important to POST what size band you are talking about.

A person that has a 4 cc band may only need 2-3 fills, while others with the larger 10 cc band may take 5-6-7 or 8 to get to restriction...

Our stomachs are all different thicknesses too... ie a patient with a 50 BMI stomach will need fewer fills to find restriction, while us lower BMI folks whose stomachs might have less fat around them may take more fills to get us to this restriction.

Then as you lose more weight and are closer to your ideal wgt the band will loosen again and need tiny fills.

You are right. I have a 10cc band and required 2 fills to reach the sweet spot. The first fill was 6cc and the second 2.5cc

Conversely, a person with a smaller band may need multiple fills, while a person with a larger band size, but larger anatomy, may require fewer fills.

That is why comparing the amount of fill in any two person's bands is essentially futile.

Everyone is different. :smile:

My anatomy would be on the smaller size, I think. But, DrWatson explained that the band is permeable and the body will soak up some of the fill. Everyone is different there. So comparision doesn't work. I think we do it because we are so focused on numbers..........you know those numbers on the scale

Dr. Watson,

I was banded on May 5th, 2006. I have lost 52 lbs. I was wondering if this makes sense. I have not lost any weight other than a lb or so here & there in about 6 mos. My dr said that I am as full as he can make me and the rest is up to me. I struggle with exersize but my concern is that i can still eat quite a bit. Sometime I can not eat but other times I eat what a "typical" 120 lb woman would eat. Does the band ever get as full as it can be without a lot of restriction to the patient? Thanks for all of the great info.

Robyn

I was just talking to my Dr.s office and found out that I have a 14CC band. AND that they should have been giving me larger fills. I had 2cc the first time and 1.5 the second time making 3.5 No wonder I didn't have restriction. This is the first time I have heard of a 14cc band. Has anyone else?? :smile:

I was just talking to my Dr.s office and found out that I have a 14CC band. AND that they should have been giving me larger fills. I had 2cc the first time and 1.5 the second time making 3.5 No wonder I didn't have restriction. This is the first time I have heard of a 14cc band. Has anyone else?? :smile:

ALLERGAN introduced a larger band called the APL last year, It appears that you have that band. You're right, it may take larger fills to obtain restriction in that band.

Wendell do you know why they gave me a larger one? I was wondering if it was because I had previous WL surgery in 1972?

Wendell do you know why they gave me a larger one? I was wondering if it was because I had previous WL surgery in 1972?

Surgeons choose band size based on the patient's unique anatomy. The criteria is the closest fit to the patient's stomach, with the least dissection of the fat above the stomach. ALLERGAN specifically warns surgeons about over-dissection of that fat, as stomach perforations could occur when doing so.