Ask Dr. Schulman...

[kareyquilts 1]

What do you use for pain and about how much to do these areas costs (I realize it depends on the amount of product used, just approximately) and would you be doing the injections or a nurse? And lastly, would I just call your office for an appointment? If I use the arnica, go off NSAIDS, stop fish oil, etc, how much bruising could I expect (especially concerned about under the eyes). My son is graduating from medical school (reason for trip to NY) and then we are going to Hawaii for a business meeting. I don't want to be bruised for pictures and social events. Hope I can finally meet you!

Edited May 13, 2009 by kareyquilts
typos

[Dr. Schulman 2]

What do you use for pain and about how much to do these areas costs (I realize it depends on the amount of product used, just approximately) and would you be doing the injections or a nurse? And lastly, would I just call your office for an appointment? If I use the arnica, go off NSAIDS, stop fish oil, etc, how much bruising could I expect (especially concerned about under the eyes). My son is graduating from medical school (reason for trip to NY) and then we are going to Hawaii for a business meeting. I don't want to be bruised for pictures and social events. Hope I can finally meet you!

I use use topical lidocaine jelly inside the mouth and also add local anesthetic to the Radiesse itself. It is not painful at all. I do all my injections myself - I never have a nurse or PA do it. The cost is 1000 for first syringe and 800 for each additional. Most people need 2, but cannot tell you until I evaluate you. I hoep the bruising should be non-existent....

You can call my office to make an appointment.

[karenlynn79 0]

Hi Dr. Schulman,

I am wondering what the specific purpose of a Stage 2 compression garment is for a TT and/or thigh Lipo? I am 5 weeks out from both and have really not swelled at all. I have been wearing my garment only about 6 hours in the daytime and that's it and not had any issues or swelling the past couple days. Are the garments only for swelling? Or other purposes?

Thnx

Karen

[Dr. Schulman 2]

Hi Dr. Schulman,

I am wondering what the specific purpose of a Stage 2 compression garment is for a TT and/or thigh Lipo? I am 5 weeks out from both and have really not swelled at all. I have been wearing my garment only about 6 hours in the daytime and that's it and not had any issues or swelling the past couple days. Are the garments only for swelling? Or other purposes?

Thnx

Karen

The garments arfor swelling. Even though you do not feel swollen at 5 weeks, you still are! It can take 6-9 months for the swelling to go away. This means that if you look good now, you will look even better in a few months. The garments help to speed up the disappearance of the swelling. You should wear it during the day for at least another few weeks.

[canadagirl33 0]

Dr, Schulman,

I have been saving cash and planning for a LBL because after losing over 100lbs I know that both the front and back are in need of some help !!!

This August I have 3-4 weeks that I am completely off work and had planned to use that time for my surgery, however financially I am not able to do the full LBL. If I don't take advantage of this time-frame it will probably be a full year before I can get this kind of time off again, so I am now thinking that I should go for the TT this summer and then keep saving for the buttock/thigh for next summer.

So my questions is....is there any big disadvantage to having this done as 2 surgeries rather than a full LBL when I know that is what I ultimately want/need?

Patricia

[Desdemona 48]

Hello Dr. Schulman--

I have a few questions regarding breast density, decisions around timing of surg. for reduction and likely outcomes. I have lost over 60lbs and am still 35-40lbs overweight. At 57 yrs. I'm 4"11 and 160lbs. I have always had very amble breasts even when I was 18 yrs and 118lbs. I do feel that this was one important reason for poor body image, and perhaps an unconscious "desire" to be fat (to hide my breasts). As I'm losing -- I'm becoming very conscious again of the size of my breast. They have gotten smaller but they are still big and now they are sagging more than ever. During mamos, it has frequently been mentioned that my breasts are very dense. My guess is they are less dense now than when I was younger. When I was 18 I bought 34C but now I'm buying 38D. These are cheap bras and I have no idea what my TRUE size is. I'm apple shape and continue holding the fat in my mid-section and at the front of my body (belly fat) and that is mainly where I need to lose those 30lbs but I have lost a significant amount even there. I do have good skin which, so far, seems to be coming back pretty well considering my age (except for a bit of loose skin around my neck). I have left shoulder pain, numbness down my arms, neck pain, spinal degeneration between C4-7 with natural of fusion C5-6 due to the degeneration . There is no evidence of trapped nerves. Rest of spine is in good shape but feeling discomfort in mid and lower back with tingling in legs. Have seen a neurologist and had blood tests to rule out most likely causes. Here's my questions. Even though I'm still 40-35lbs overweight -- does it make sense for me to go ahead and have a breast reduction because of the density of my breasts? Although I'm very hopeful about losing the rest of my weight -- I have been (unfortunately) stabilized at this darn weight for about 10 mos. I'm hoping to become more active and take more off but I have no guarantee that I will get down another 40-30lbs. I'm wondering if a breast reduction will help me feel more motivated to exercise. I'm wondering if, because of the density of my breasts, if I do lose 30lbs after a breast reduction, I would tend to not lose much fat in the breasts anyway (so I wouldn't need to worry so much about how more weight loss would change/deflate my breasts). I'm also wondering how much weight I'd lose just from the surg. if I wanted to go to a B cup. Wouldn't I lose atleast 10lbs between the surg and the recoop experience? I'm also wondering, given my spine and pain problems if it just makes good sense to go ahead and do it now vs waiting to see if I can lose more weight in the next year. Finally, given the relationship between density and cancer wouldn't sooner be better than later? Wouldn't surg lower my chances of cancer? Even if my breasts didn't maintain the complete "perkiness" of the post-op after more weight loss---at my age -- I can't say it would break my heart. I'm not looking for 20 year old sex appeal -- but something that looks like a healthy, reasonably attractive middle age look. If you really think I should just bite the bullet and try to exercise another year -- I'll do that and try. Thanks for listening.

Edited May 31, 2009 by Desdemona

[Dr. Schulman 2]

Dr, Schulman,

I have been saving cash and planning for a LBL because after losing over 100lbs I know that both the front and back are in need of some help !!!

This August I have 3-4 weeks that I am completely off work and had planned to use that time for my surgery, however financially I am not able to do the full LBL. If I don't take advantage of this time-frame it will probably be a full year before I can get this kind of time off again, so I am now thinking that I should go for the TT this summer and then keep saving for the buttock/thigh for next summer.

So my questions is....is there any big disadvantage to having this done as 2 surgeries rather than a full LBL when I know that is what I ultimately want/need?

Patricia

There is no disadvantage to splitting a LBL into 2 surgeries - in fact, I have many patients that choose this route.

[Dr. Schulman 2]

Hello Dr. Schulman--

I have a few questions regarding breast density, decisions around timing of surg. for reduction and likely outcomes. I have lost over 60lbs and am still 35-40lbs overweight. At 57 yrs. I'm 4"11 and 160lbs. I have always had very amble breasts even when I was 18 yrs and 118lbs. I do feel that this was one important reason for poor body image, and perhaps an unconscious "desire" to be fat (to hide my breasts). As I'm losing -- I'm becoming very conscious again of the size of my breast. They have gotten smaller but they are still big and now they are sagging more than ever. During mamos, it has frequently been mentioned that my breasts are very dense. My guess is they are less dense now than when I was younger. When I was 18 I bought 34C but now I'm buying 38D. These are cheap bras and I have no idea what my TRUE size is. I'm apple shape and continue holding the fat in my mid-section and at the front of my body (belly fat) and that is mainly where I need to lose those 30lbs but I have lost a significant amount even there. I do have good skin which, so far, seems to be coming back pretty well considering my age (except for a bit of loose skin around my neck). I have left shoulder pain, numbness down my arms, neck pain, spinal degeneration between C4-7 with natural of fusion C5-6 due to the degeneration . There is no evidence of trapped nerves. Rest of spine is in good shape but feeling discomfort in mid and lower back with tingling in legs. Have seen a neurologist and had blood tests to rule out most likely causes. Here's my questions. Even though I'm still 40-35lbs overweight -- does it make sense for me to go ahead and have a breast reduction because of the density of my breasts? Although I'm very hopeful about losing the rest of my weight -- I have been (unfortunately) stabilized at this darn weight for about 10 mos. I'm hoping to become more active and take more off but I have no guarantee that I will get down another 40-30lbs. I'm wondering if a breast reduction will help me feel more motivated to exercise. I'm wondering if, because of the density of my breasts, if I do lose 30lbs after a breast reduction, I would tend to not lose much fat in the breasts anyway (so I wouldn't need to worry so much about how more weight loss would change/deflate my breasts). I'm also wondering how much weight I'd lose just from the surg. if I wanted to go to a B cup. Wouldn't I lose atleast 10lbs between the surg and the recoop experience? I'm also wondering, given my spine and pain problems if it just makes good sense to go ahead and do it now vs waiting to see if I can lose more weight in the next year. Finally, given the relationship between density and cancer wouldn't sooner be better than later? Wouldn't surg lower my chances of cancer? Even if my breasts didn't maintain the complete "perkiness" of the post-op after more weight loss---at my age -- I can't say it would break my heart. I'm not looking for 20 year old sex appeal -- but something that looks like a healthy, reasonably attractive middle age look. If you really think I should just bite the bullet and try to exercise another year -- I'll do that and try. Thanks for listening.

It is common to havee breast reduction done before you have reached your goal weight - especially if you are symptomatic from the breasts (which you clearly are). Future weight loss after your reduction may make your breast sag a bit, but it is unlikely to bother you (if it happens at all). It is impossible to say how much weight you will lose without seeing you, but it may be around 5 pounds. Incidentally, make sure to speak with your surgeon about size - most people that want a reduction ask to be a "b" but change their mind when they see how small a "b" really is in comparison to what they start with. There is some data that shows that the incidence of breast cancer is reduced after a breast reduction. It may also make detection of early cancers easier because of there being less tissue to visualize on mammogram.

So, if you want this, there is no reason to wait. It will likely make your weight loss begin again because you will be more mobile, have an easier time exercising, and be more motivated to lose weight.

[Apples2 19]

I have a question for Dr. Schulman (or anyone with a similar experience). I am a few days away from my LB anniversary date. I have been very successful in taking off all of my excess weight and am very happy with most areas of my post-weightloss body. Not a lot of excess skin on this 53 yr old body.

I have noticed that with the last 20lbs or so that it takes me what I consider to be "too long" to reach orgasm. I am in a 30 yr marraige and things have always been great in that dept. Just wondering if a mons lift would help????????????

[ellen 0]

Dr Schulman

I am hoping to have a revision armlift this year involving liposuction and a repositioning of the scars. I would like to have a thigh lift performed at the same time, mainly because of the difficulty of taking time off work a second time. Is this combination regularly performed or something you would recommend against?

[GREATFUL 24]

Question.....I did not think to as my Doc this, but will at next visit, but was thinking maybe you could answer it for me...

My Doc said that I would only have internal stitches. So what will be on the out side? I have heard of them using something like superglue, is this true, or do they use some kind of special stich?

Thanks

Laura

__________________

[GREATFUL 24]

Question.....I did not think to as my Doc this, but will at next visit, but was thinking maybe you could answer it for me...

My Doc said that I would only have internal stitches. So what will be on the out side? I have heard of them using something like superglue, is this true, or do they use some kind of special stich?

Sorry, should have told you what type of surgery. I will be having a full TT.

Laura

[BeckyinTexas 3]

Dr. Schulman...I haven't been on the site in several months but I'm back now with questions, of course. I had the panniculectomy done December 5, 2008. They found that I had 2 large hernias when they did the procedure so the doctor repaired them. It was not quite the walk in the park I was hoping for. I had to wear drain tubes for 2 1/2 months because of a huge seroma. Finally, the tubes came out and now, it's looking great! Even with all the set-backs with my surgery, I'd do it over again! Basically, it was the hernias that caused the most problems after surgery. Is it my imagination or have my thighs actually gotten larger since the surgery or is it now I don't have the fat apron hanging down covering most of the top part? It's gotten so bad, skin is sagging below my knees now. I've lost 317 pounds so the sagging skin is to be expected and I actually am thrilled that I no longer carry around 469 pounds but the excess skin is horrible and disgusting. Now to my question, just because I had problems after my panniculectomy, would you think that a thigh lift would be as bad? I'm hoping and praying to have an arm and thigh lift done. My insurance finally covered my panniculectomy but it doesn't cover the other surgeries at all even though I get rashes and infections in the folds of skin both on my thighs and arms. I hate sounding like a whinner because I'm so blessed to have lost so much weight and to have had the panniculectomy, but now my thighs look even worse than before. After my surgery, I had to go to a place in Dallas to get fitting for a special binder to wear and the woman that was going to fit me asked what type of disease I had to make my legs look like they did. I tried to laugh it off but it just made me feel worse. I now avoid full lenght mirrors at all costs. For anyone that might need a TT or panniculectomy, go for it because the results from that are fantastic! Someday I hope to be brave enough to post pictures so everyone can see. To sum up this LONG question. Could my skin be sagging more now after the panniculectomy? Also, can an arm lift and thigh lift be done at the same time to save on expenses? My first surgery was done on an out patient basis so I didn't have the expense of a hospital stay but if they could combine the two, would it probably require a stay? Thanks once again, Dr. Schulman, for all your help!

[NEW BEGINNINGS 0]

Dr. Schulman:

Thanks for all the great advise that you give us all. I am just starting my weight lose journey and still have 60 more pounds to go, I had breast cancer and a lumpectomy 6 years ago that removed 1/4 of my right breast. Am actually very happy with the reduction and outcome of my right breast, but would like my left breast to match. My BCBS insurance does not cover any plastic surgery needed from weight loss, but it would cover surgery to make my breast the same size from the cancer. Do you feel this surgery would still be covered by insurance since I waited until after the lap band surgery to have done. Being uneven when I was so over weight previously didn't matter to me and after 8 surgeries that were cancer related an elective surgery didn't fit into my schedule. But I am now ready to do things for myself. Do you think that I would need to wait until I am at my ideal weight before having the surgery?

Thanks you!

[pennreporter 12]

Dr. Schulman, my daughter went ahead with her surgery with LoMonaco and so far everything seems to be going per plan. Surgery was Thursday. She was able to remove breast drains today, possibly one of the lower drains tomorrow and able to shower tomorrow.

But my question is actually for myself. I've seen where there's a procedure for the arms where instead of the long incision, they do the incision under the armpit. Assuming you do both kinds, what determines who can have the one just under the armpit?

Also, back to my daughter, LoMonaco doesn't want her sitting up at a straight angle right away. How long does that usually continue? She was able to see her stitches finally and feeling a little Frankenzilla-like right about now.

Thanks for your input earlier. I had my banding on June 1 and the only thing possibly for me will be my arms...we'll see. Going to try to do as much exercise as I can but not sure if that will get all of it.

Trisha (pennreporter)