Ask Dr. Schulman...

[Dr. Schulman 2]

Dr. Schulman,

I am getting nearer my goal weight and knew going in I would need a Tummy Tuck. Due to back pain my lap band doctor felt I may qualify for my insurance to cover part of the procedure (assuming he meant the panus removal) the practice I go to has their own plastic surgeon who I have heard wonderful things about and who they assume I will use for my weight loss plastics. Part of my problem below is financial, the other is logisitcal, the obviouse only one recovery period.

This surgeon performs Lipo after the tummy tuck has healed. I'm not sure how flexible he is but I feel I need to have both done at one time. I have 4 small children and my husband is an extremely busy Veterinarian. We would fly my mom to us for my recovery period-but only one recovery-that's all she can do. I had always assumed that both could be done together?

I am also interested in a breast reduction/lift at the same time, but this is really more of a wish. Then I worry that the reason this surgeon has this policy is to keep me alive. I would love to get your opinion on multiple procedures and lipo during a tummy tuck vs. after.

Another 20 pounds lost and I'm going to start going for consults and would like to be prepared. Thanks!

Combining surgeries is ok. I routinely perform breast surgery at the same time as the tummy tuck. Regarding liposuction - extensive lipo at the same time as a TT can injure the blood supply of the tissue and increase your risk for complications. Most surgeons do a moderate amount of lipo on the flanks at the same time as TT, but do not do lipo of the upper abdomen because of what I said above.

[Dr. Schulman 2]

Hi Dr Schulman, I had a diagnosis some years ago of mild lupus though I have had no symtoms for years apart from low white blood cells. in this case would you consider it to be risky for me to have a combination of srm lift any thigh lift? Are there any additional risks for me? Would there often be a need for blood transfusions with these surgeries? How about each of them individually?

Many thanks for your advice.

Ellen

Blood loss is minimal with both of these surgeries. As long as your primary doc and hematologist thinkyou are ok for surgery, then it should be fine. However, Lupus or not, I think arm lift and thigh lift is a really tough combination in terms of recovery - it can be done, but as I have said on this forum before, it will be difficult for you.

[Desdemona 48]

Dr Schulman --

I'm back again! I followed through w/your advise and had a consult in Albany yesterday. The surgeon thinks that even though I'm still currently 30-35 lbs over goal weight that this would be the right time to go ahead with a breast reduction. I'm about 4' ll" 1/2 tall and wear a 38 D bra. 57 years old. Even when I was 18 and 116lbs my breasts were very dense and about a 34C. I drew too much attention. Now I hurt a lot with spinal degeneration (C4-7) w/stenosis, bursitis in left shoulder. The surgeon says he thinks he shouldn't take anymore than 300 grams per breast. I'm afraid he needs to take more than that. I think I'd like to get down to a C cup now with the thought that if I lose another 20 lbs after surgery they go down to a B cup. Is there any way of figuring out what my bra size will be if he removes about 300 per? Also --- does a lollipop incision with an anchor (??) seem like a good choice? He doesn't feel I'll need implants. He thinks they'll lift up well without them.

Thanks.

[Dr. Schulman 2]

Dr Schulman --

I'm back again! I followed through w/your advise and had a consult in Albany yesterday. The surgeon thinks that even though I'm still currently 30-35 lbs over goal weight that this would be the right time to go ahead with a breast reduction. I'm about 4' ll" 1/2 tall and wear a 38 D bra. 57 years old. Even when I was 18 and 116lbs my breasts were very dense and about a 34C. I drew too much attention. Now I hurt a lot with spinal degeneration (C4-7) w/stenosis, bursitis in left shoulder. The surgeon says he thinks he shouldn't take anymore than 300 grams per breast. I'm afraid he needs to take more than that. I think I'd like to get down to a C cup now with the thought that if I lose another 20 lbs after surgery they go down to a B cup. Is there any way of figuring out what my bra size will be if he removes about 300 per? Also --- does a lollipop incision with an anchor (??) seem like a good choice? He doesn't feel I'll need implants. He thinks they'll lift up well without them.

Thanks.

A reductin always includes a lift...so it would make no sense to get a reduction + implants for a lift. It is hard to determine the exact weight of your reduction ahead of time. It depends on the amoutn of fat or breast tissue in the removed specimen. I have done many many reductions and still find it difficult to guess the exact weight - I give ranges ahead of time, like 300-500g, 500-700g, 800-1000g, etc. I agree that if you are a D, than anything smaller than a C cup will probably make you feel "too small." I ahve many patients who tell me then want to be a "b" but are suprised when I show them how small a B would be on them. Everything needs to be in proportion.

[GeorgiaSuperMom 0]

Dr Schulman -

I am a year post LB and have lost over 65lbs. I am 5'8 and still weigh 190 - want to lose another 40lbs. Recently, I went to be measured for new bras and measured a 38C BUT when trying them on had to finally get a 40DD to get the support and coverage needed. Now, I am having issues with back pain, the bra straps cutting me and not being able to further my excercise to running and aerobics due to the pain they cause.

I am looking for a PS who will handle this through my insurance. I believe that I need a breast reduction - would like to be an actual 38C but in discussing this with other Drs, they are thinking that I need a breast lift which wouldn't be covered. What is you opinion on this? Also, I hope to have a Tummy Tuck at the same time. Do you feel this is a good option and at any time is this also covered through insurance? I have BCBS - HMO...I look forward to hearing from you soon! Thanks!

[Great2BThin 5]

Hi Dr Schulman,

I had lap band surgery one year ago in June '08, I am down 126 lbs. I have some loose skin but not too bad, however what bothers me the most is my legs. I can learn to live with the thighs but my calves bug me the most. They are still like 17". Is there anything that can be done for the calves? I had heard not. Thanks.

OH I should add I am only 9 lbs from goal which for me is a normal BMI

[Dr. Schulman 2]

Hi Dr Schulman,

I had lap band surgery one year ago in June '08, I am down 126 lbs. I have some loose skin but not too bad, however what bothers me the most is my legs. I can learn to live with the thighs but my calves bug me the most. They are still like 17". Is there anything that can be done for the calves? I had heard not. Thanks.

OH I should add I am only 9 lbs from goal which for me is a normal BMI

There is very little that can be surgically done to improve the calves - there are too many important vessels and nerves, and incisions in the lower leg can cause severe and prolonged swelling. Excision of some of this skin may help, but you will be left with a visible scar and the improvement may not be as good as you want.

[Great2BThin 5]

There is very little that can be surgically done to improve the calves - there are too many important vessels and nerves, and incisions in the lower leg can cause severe and prolonged swelling. Excision of some of this skin may help, but you will be left with a visible scar and the improvement may not be as good as you want.

That's what I was afraid of. Thanks so much for your quick response. Without being able to do my calves, I'm not sure I want to do the thighs then my legs will look out of proportion.

[Desdemona 48]

Dr Schulman--

Thank you for giving us so much information. It appears that I will scheduled for a breast reduction in about a month. I will still be about 30lbs from goal after the surg. The surgeon mentioned that they will have a Lipo machine close by to remove fat from my side rib cage near the breasts so I don't have that buldging fat there. Would it be a lot of extra trouble (pain, expense) to ask them to also lipo under my arms at the same time to help with the "bat wings?" Even though I have lost 65lbs so far -- my skins seems to be pretty elastic so I'm wondering if I just do lipo in the arms and exercise if it might work well enough without a having an arm lift?

Thanks again.

Edited July 5, 2009 by Desdemona

[Cinzano2 0]

Dr Schulman,

I have been at a stable weight now for 4 months after losing 135lbs, banded Jan 08.

I have read nearly all of this thread, yet still have a few questions of my own.

I think what I am aiming for is to have a lower body lift then inner thigh lift and maybe a breast lift (combined at a later date).

Would I be able to go back to my office sit down job within 2-3 weeks after the LBL.

I am fit and healthy, 49yr old and work out 2-3 times a week. (non smoker)

I understand every case is different and sometimes complications cannot be un-ruled.

The reason I ask is that I cannot get time off work for this I have to use my holidays or if they agree it will be unpaid.

I am seeing a PS in 10days to discuss this, but I am trying to do as much research as possible.

thank you for sharing your knowledge.

Suzanne

[Dr. Schulman 2]

Dr Schulman,

I have been at a stable weight now for 4 months after losing 135lbs, banded Jan 08.

I have read nearly all of this thread, yet still have a few questions of my own.

I think what I am aiming for is to have a lower body lift then inner thigh lift and maybe a breast lift (combined at a later date).

Would I be able to go back to my office sit down job within 2-3 weeks after the LBL.

I am fit and healthy, 49yr old and work out 2-3 times a week. (non smoker)

I understand every case is different and sometimes complications cannot be un-ruled.

The reason I ask is that I cannot get time off work for this I have to use my holidays or if they agree it will be unpaid.

I am seeing a PS in 10days to discuss this, but I am trying to do as much research as possible.

thank you for sharing your knowledge.

Suzanne

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.

[Corliss 0]

I had face lift in Monterrey Mx on June 23. I had neck, face, upper and lower bleph and the muscle in my forhead weakened. I also had my ears trimmed. I am extremly happy with most of it, however my forehead does not match the rest of my face. The skin is quiet loose and wrinkled. My eyebrows are low as a result, basically unchanged since before the surgery. I find this disturbing as it is a contrast to the rest of my face. My understanding was that he would in doing the full face lift, elevate my brow somewhat. I told him in consult that I did not want to look unnatural and have that surprised look all the time. When I asked him afterwards if it was going to pull up on its on or if my brows would stay that way, he told me that I had said specifically that I did not want that surprised look. This was all true, and I am wondering if since this was a Mexican surgeon that the language nuances may have made a difference in his understanding what I really wanted or was there some medical reason that he could not have done this in combination with the upper and lower bleph. If you could shed some insight on this issue I would appreciate it.

Do you think I could yet have a brow lift or would too much scar tissue have developed from the incisions he made to weaken the forehead muscle?

I also wonder if it is usual for patients to not require narcotics after face lift. My doctors gave me Supradol (Mexican tordol and tylenol combo) and Ultracet (ultram and tylenol). This was quiet painful surgery on my face though the arms were not very painful. My doctor told me I was the first patient he had ever had who had such pain with a face lift. That was a bit disturbing because I don't require a lot of pain meds and following lap band was off after the second day of Supradol.

Any how I would appreciate your thoughts on these issues and any advice as to how to deal with my mismatched face lift.

Thank you,

Corliss

[Dr. Schulman 2]

I had face lift in Monterrey Mx on June 23. I had neck, face, upper and lower bleph and the muscle in my forhead weakened. I also had my ears trimmed. I am extremly happy with most of it, however my forehead does not match the rest of my face. The skin is quiet loose and wrinkled. My eyebrows are low as a result, basically unchanged since before the surgery. I find this disturbing as it is a contrast to the rest of my face. My understanding was that he would in doing the full face lift, elevate my brow somewhat. I told him in consult that I did not want to look unnatural and have that surprised look all the time. When I asked him afterwards if it was going to pull up on its on or if my brows would stay that way, he told me that I had said specifically that I did not want that surprised look. This was all true, and I am wondering if since this was a Mexican surgeon that the language nuances may have made a difference in his understanding what I really wanted or was there some medical reason that he could not have done this in combination with the upper and lower bleph. If you could shed some insight on this issue I would appreciate it.

Do you think I could yet have a brow lift or would too much scar tissue have developed from the incisions he made to weaken the forehead muscle?

I also wonder if it is usual for patients to not require narcotics after face lift. My doctors gave me Supradol (Mexican tordol and tylenol combo) and Ultracet (ultram and tylenol). This was quiet painful surgery on my face though the arms were not very painful. My doctor told me I was the first patient he had ever had who had such pain with a face lift. That was a bit disturbing because I don't require a lot of pain meds and following lap band was off after the second day of Supradol.

Any how I would appreciate your thoughts on these issues and any advice as to how to deal with my mismatched face lift.

Thank you,

Corliss

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.

[Corliss 0]

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.

Dr Schulman, Thanks for your reply. I did discuss this by email with my surgeon. He says that he did lift the tail of the brow up. He used and endoscopic approach, but I don't see how there is any difference other than my eyebrows are flatter and lower. I had a point in the middle of my eyebrows before surgury, like the "devils brow" but now it is just straight so i guess that is why if he lifted the tail of them but I cannot for the life of me understand why my brow would be lower if he lifted the tail. He said that he had not done the coronal lift because I have an ample forehead already. I have written him back asking for more information but have not heard back from him.

In your experience can a coronal browlift be done without making the hairline receed further? Can an endoscopic lift be repeated perhaps elevating the entire eyebrow area without making the full incision ?

Thanks you,

Corliss

[pam726 0]

Dr. Schulman,

I have always had my own idea of when to do PS but I have never asked a doctor their advise. I just wanted to see what you thought about my story.

I am 31 years old, a mother of two and pretty active. I am training for my first marathon in January of 2010. I have ran one half marathon and will run another one in November 2009!!

Currently I am at a weight of 145.2 (weighed this morning!!!) and pre-band I was weighing 224. I want a Tummy Tuck, a breast enlargement and something done to improve the appearance of my inner thighs and arms.

Should I wait until I hit my goal of 124 or go now for a consultation with a doctor?

Thank you in advance for your knowledge! I wish you were in Texas and I would just come see you and ask all of this!