I thought that this might be a good place to post questions to me, so that other people can see your questions and my answers. I will continue to answer questions from those of you that private message me, but this is a nice way to share the information with others - since many of your questions are relevant to other people.

I will try to answer the questions as quickly as possible, and include links and pictures when appropriate.

I am obligated to add this disclosure.....any information provided by me is my opinion and cannot substitute for an actual consultation with your qualified physician.

Dr. Schulman,

I have read alot of post where people were able to get up and go only after a day or 2 after lap band surgery. Even going back to work the day after surgery. I had my surgery on Monday the 15th of Sept and today is the 20th of Sept. I am 5 days out. I am starting to wonder if I am o.k. I am still SUPER sore and it hurts when I strain to get up out of a chair or roll over in bed, I cannot hardly lay on either side. I am still not feeling up to anything! I am bad diabetic and usually heal slower, but am I healing too slow?

Memommie: I'm not Dr. Schulman, but I can tell you that I was sore for a few weeks. The port area can be very tender. The port itself is fairly large and your body needs to adjust to it and it will be fairly painless after awhile. I wouldn't worry about how other peple heal, everyone is different. At this point, I think your reaction is within the realm of normal. Take it easy and let your discomfort be your guide. If you not feeling better in another week, then I would talk with your band doc. Good luck and welcome to band land!

Thank you Karley, That helped alot. Did you also have trouble laying on your sides for awhile?

Yes, it can be painful to sleep on your side for a while, but you will be able to again before you know it! Good luck!

Dr. Schulman: Once again I come to the answer man with a question. In less than a month I am having lipo of my inner and outer thighs and knees, outer thigh lift, butt lift, arms and possible anchor revision of my tummy tuck. I have a lot of significant people in my life telling me that I don't need the anchor revision. I don't like the little roll of skin on my upper abs when I sit down, but for some reason, I'm a little nervous about that particular scar. I don't know why since I am going to have so many scars! Would you please look at the attached pictures and give me your professional opinion on whether you think I could benefit from the anchor revision (sorry to put you on the spot!). I would really appreciate it! Thanks!

Dr. Schulman: Once again I come to the answer man with a question. In less than a month I am having lipo of my inner and outer thighs and knees, outer thigh lift, butt lift, arms and possible anchor revision of my tummy tuck. I have a lot of significant people in my life telling me that I don't need the anchor revision. I don't like the little roll of skin on my upper abs when I sit down, but for some reason, I'm a little nervous about that particular scar. I don't know why since I am going to have so many scars! Would you please look at the attached pictures and give me your professional opinion on whether you think I could benefit from the anchor revision (sorry to put you on the spot!). I would really appreciate it! Thanks![ATTACH]15047[/ATTACH]

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Karey,

The roll of skin on the upper abdomen will always be there when you sit.....even the skinniest of skinny will have this. More important is how it looks to you when you stand. I think you could benefit from a fleur-de-lis incision......it will give you better shape because it will narrow you at the waist, which you cannot do with just the horizontal TT incision. But, do you need it? Probably not, but it will improve your shape and tighten the upper part of your abdomen.

The answer is really about what you are willing to accept in terms of scars. The up and down scar will run from the bottom of the breast bone to the lower horizontal incision. It is a long scar and cannot be easily concealed.

You really could go either way with this one! If I thought you would not benefit from the additional scar, I would tell you. It is a constant balance between shape and scar.....

Dr. Schulman: Once again, thank you. I appreciate your candor. I will probably go ahead with it. What is the pain like for this procedure? Will I not notice it that much with everything else that is going on? A friend was telling me about a procedure called a "corset stitch?" Is this done often with a fleur-di-lis incision? My ps never mentioned it so I'm confident that I'm not having that done, but I would still get the smaller waistline?

Dr. Schulman: Once again, thank you. I appreciate your candor. I will probably go ahead with it. What is the pain like for this procedure? Will I not notice it that much with everything else that is going on? A friend was telling me about a procedure called a "corset stitch?" Is this done often with a fleur-di-lis incision? My ps never mentioned it so I'm confident that I'm not having that done, but I would still get the smaller waistline?

The pain will be about the same for the fleur-de-lis or a standard TT. The extra skin incision does not really hurt and will not add anything significant to your recovery - unless you have problems with healing the extra incision. The pain will be from the muscle repair. A "corset stitch" is a technique for muscle tightening. Most people do a variation of this, without calling it a "corset". Keep in mind, because this is a revision, you may not need the muscle tightened if it was tightened the first time - this will make it a much easier recovery for you if no muscle repair is done. Your waisline will be much much better, even without this "corset".

Good luck, and let us know how it goes.

Dr. Schulman

I have seen in the discussions about TT's you talking about tightening the muscle. Is this always necessary with a TT? Thank you for your time.

The pain will be about the same for the fleur-de-lis or a standard TT. The extra skin incision does not really hurt and will not add anything significant to your recovery - unless you have problems with healing the extra incision. The pain will be from the muscle repair. A "corset stitch" is a technique for muscle tightening. Most people do a variation of this, without calling it a "corset". Keep in mind, because this is a revision, you may not need the muscle tightened if it was tightened the first time - this will make it a much easier recovery for you if no muscle repair is done. Your waisline will be much much better, even without this "corset".

Good luck, and let us know how it goes.

Dr Shulman, Does having the fleur-de-lis insion really make a waist line that much smaller then say just an extended tummy tuck? Or give better results for someone both a Pani and alot of upper belly skin?? Out of the 4 PS's I consulted with 2 never ever do this type and the other 2 only occassionaly. Also whats the difference between inserting silicone implants from the nipple or under the breast? Is one way bettr then the other in your opinion??

Thanks again for all your advice to us on these boards.

Kelly

Dr. Schulman

I have seen in the discussions about TT's you talking about tightening the muscle. Is this always necessary with a TT? Thank you for your time.

The muscle tightening is almost always necessary. The muscle gets stretched after weight gain, and pregnancies. Simply removing the extra skin and fat, without tightening the muscle, does not give as good a result (ie flat belly!). Sometimes the muscle is in good condition and does not need to be tightened. This is more common in men. Standard TT should all include muscle tightening. If only the skin is removed, with no muscle tightening and no belly button moving, then it is called a panniculectomy.

Dr Shulman, Does having the fleur-de-lis insion really make a waist line that much smaller then say just an extended tummy tuck? Or give better results for someone both a Pani and alot of upper belly skin?? Out of the 4 PS's I consulted with 2 never ever do this type and the other 2 only occassionaly. Also whats the difference between inserting silicone implants from the nipple or under the breast? Is one way bettr then the other in your opinion??

Thanks again for all your advice to us on these boards.

Kelly

The fleur-de-lis absolutely gives a better shape - narrower waist and reduces the likelihood of giving a boxy look after TT. The trade-off is a long, visible scar. Many PS do not do this operation - but this doesn't mean that this operation is unnecessary. For those of us who have a lot of experience with weight loss patients, sometimes this operation is the only way to give the best result. I don't do it for everyone, because not everyone needs it. I do it about 25% of the time. Probably 33% of my patients would benefit from it, but some do not want the extra scar - and I understand that, so I let them make the decision.

Regarding implant incisions, it is really just preference. The scar around the nipple is well hidden - if it heals well. Sometimes, people make bad scars and if this happens, the bad scar will be right in the middle of the breast. By placing it underneath the breast, the scar is hidden (even if it heals badly). About 2/3 of my patients chose to have the implant placed from under the breast, but like I said, it is entirely personal choice. In theory, placing it from the nipple may slightly increase the chance of having decreased nipple sensation afterwards. If you need a lift, in addition to implants, then the incision can be placed in an area which is convenient for the lift - as to avoid 2 separate incisions.

Dr. Schulman: I did have the muscle repair with my original TT 6 months ago. I will keep you posted. I appreciate you so much. Thank you, again!

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?

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).