Ask Dr. Schulman...

[Dr. Schulman 2]

Dr Shulman, this is unrelated but part of my new me along with the lapband, and future tt and breast reduction. My vagina is so stretched after 2-10lb babies and kegal and ben-wa hasnt helped. It is rare to reach a orgasim due to lack of tightness i guess. Any suggestions if ps can help?

The exercises may help, but often do not help enough is there is significant laxity. There are some procedures available for vaginal tightening. I do not perform these in my practice (I do labial reduction, but not vaginal tightening). The procedure is a vaginaplasty and is most commonly done by gynecologists (there may be a few PS who do this, but it is uncommon).

[renewedhope 4]

Dr, I have a question in regards to the vertical vs horizontal incision. My excess skin is primarily below the belly button. I have a waist now and do not look boxy. Without doing the vertical incision will I maintain my shape. I am not looking for more curves. I jsut don't want to lose the ones I have. I am having the muscle repaired, but really I just have a lot of skin that needs to be removed, but maintaining my curves is important to me.

[Dr. Schulman 2]

Dr, I have a question in regards to the vertical vs horizontal incision. My excess skin is primarily below the belly button. I have a waist now and do not look boxy. Without doing the vertical incision will I maintain my shape. I am not looking for more curves. I jsut don't want to lose the ones I have. I am having the muscle repaired, but really I just have a lot of skin that needs to be removed, but maintaining my curves is important to me.

Obviously, I cannot tell you for sure without seeing what you look like, but it sounds like you may not need a vertical incision - not everyone does. When done correctly (especially when combined with some liposuction), a TT can give a great shape. It seems to be that people who have lost massive weight tend to get a better shape when a vertical incision is added. But like I said earlier, this is still only about 1/3 of my patients. To be honest, I do much fewer fleur-de-lis in band patients, as compared to gastric bypass or duodenal switch patients - I think because band patients tend to lose less weight and over a longer period of time - 2 things that help the skin tighten after weight loss.

[renewedhope 4]

Thank you so much.

[andreerichards1 4]

I was wondering how long should someone wait to get a tt after you reach your gold weight? someone told me two years.

[emc1985 0]

Hi Dr. Schulman,

I'm scheduled to have surgery in about two weeks. I hoping to lose over 100 pounds, but I'm worried about having loose skin afterwards. I'm not opposed to the idea of plastic surgery, but I'd like to avoid the pain, inconvenience and cost if possible. I've heard that there are a number of things I could do to improve my skin's elasticity as I'm losing, including:

-Using Vitamin E oil

-Using cocoa butter

-Taking silica supplements (through bamboo extract?)

-Building lean muscle

-Getting massages

To your knowledge, are any of these effective? I'm not looking for a miracle, but it would be great if I could at least minimize the surgery that I'll need.

Thanks so much!

[Dr. Schulman 2]

I was wondering how long should someone wait to get a tt after you reach your gold weight? someone told me two years.

Your weight should be stable for a minimum of 6 months - even if it is short of your goal. (2 years is a very long time to wait).

[Dr. Schulman 2]

Hi Dr. Schulman,

I'm scheduled to have surgery in about two weeks. I hoping to lose over 100 pounds, but I'm worried about having loose skin afterwards. I'm not opposed to the idea of plastic surgery, but I'd like to avoid the pain, inconvenience and cost if possible. I've heard that there are a number of things I could do to improve my skin's elasticity as I'm losing, including:

-Using Vitamin E oil

-Using cocoa butter

-Taking silica supplements (through bamboo extract?)

-Building lean muscle

-Getting massages

To your knowledge, are any of these effective? I'm not looking for a miracle, but it would be great if I could at least minimize the surgery that I'll need.

Thanks so much!

None of those things will improve your skin's elasticity. The most important factors are younger age, less overall weight loss, longer time losing weight, good nutrition during weight loss (protein), and GENETICS. All those things you list may make you feel better, and make your skin smoother/shinier/etc. but won't affect elasticity.

[Dr. Schulman 2]

This thread got quiet all of a sudden....you mean to tell me that I have answered everyones questions already?

[TracyinKS 7]

Dr., last week I had a ps consult for a TT and Breast lift. Was told that I would need an extended TT, but when I called around some other places had never heard of an extended TT! This scared me and I ended the call pretty quickly. What is the marker that denotes mini/regular/extended?

Also after a cool little roll/tuck and lift I was shown where my breasts swere supposed to be! (although I tried it at home to show dh and it didn't work so well!) but it really made me want my breasts done as well.

[Dr. Schulman 2]

Dr., last week I had a ps consult for a TT and Breast lift. Was told that I would need an extended TT, but when I called around some other places had never heard of an extended TT! This scared me and I ended the call pretty quickly. What is the marker that denotes mini/regular/extended?

Also after a cool little roll/tuck and lift I was shown where my breasts swere supposed to be! (although I tried it at home to show dh and it didn't work so well!) but it really made me want my breasts done as well.

The term "extended TT" is kind of a misnomer. Technically, there is a TT, a circumferential TT/belt lipectomy (if it goes all the way around), and a LBL (if it includes a outer thigh lift and buttock lift - although some consider a circumferential TT and a LBL to be the same).

If the TT incision goes to the side of the hips (longer than a regular TT) but does not go all the way around, than it can be called an "extended TT." In my experience, anyone who has lost significant weight ends up with what you would consider an extended TT. The problem is that these terms are not universal (and I am not sure it matters). If you call a plastic surgeon's office, the person answering the phone may not understand what an extended TT is. The main thing to ask is if he/she has experience with people who have lost significant weight through bariatric surgery.

[kareyquilts 1]

Any suggestions for pre-surgery jitters? Is it alright to take a sleeping aid, ie. Lunesta?

[Dr. Schulman 2]

Any suggestions for pre-surgery jitters? Is it alright to take a sleeping aid, ie. Lunesta?

It is ok to take a sleeping pill, if it is something that you have taken on other occassions. I don't think that you should take anything that you are not used to - it is never good to try something new, the night before surgery, and on an empty stomach. You would hate to have a reaction to something and then have to reschedule the surgery.

Try to relax (easier said than done) and have confidence in the decision that you have made. Try any relaxation method that you think will work (deep breathing, meditation, tea, etc.) You will get medicine before the surgery that will make you very very relaxed.

Good luck.

[kareyquilts 1]

Looking forward to feeling very relaxed! Just suffering from insomnia and anxiety about 3-4:00 am every night (with 8 more days to go)! Lunesta works fairly well to get me to that point, sometimes longer. I guess I'll work on deep breathing and positive imaging. I do remember that even though I was in pain after the surgery, the anxiety was gone and that was wonderful. This too shall pass. Thanks for the advice!

[shortgal 5]

Good Morning Dr.

I am interested in several procedures but the first one I am interested in is a neck lift. This seems to be one of the lesser common ps procedures so how do I know how to choose a competent surgeon for this particular procedure?

What questions should I ask of the Dr.?

I have a very crepe like area hanging and I believe I need the neck muscle tightening as well.

Will a neck lift improve my jowls?

How much scarring is there for this type procedure and is it well hidden?

Is there a surgeon in Ct you can recommend I consult with?

I am also interested in a panni and thigh lift ( but will not consider a thigh lift unless the scar can be hidden in the groin).

I am not at goal but I am ready for the neck lift. I had my lapband only eight months and it was removed (long story) so I never lost all the weight I was hoping to. I have been at the same weight now for five months and would like the neck lift done in January.

What type of recovery time can I expect for a neck lift?

Thanks for any info you can provide.