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,

First, thanks for taking time to answer all our questions! This thread is very informative.

I had my lapband in August, 2006. I've lost a little over 100 pounds and seem to have stabalized at 210. Over the last year I've stayed pretty consistent at that weight, gaining and losing the same 5 pounds. I have a rather large apron and a bulge in my upper abdomen that will not go away, no matter what exercises I do! So my first question is, how common is it to do a full tt on someone over 200lbs? Will it cause any further complications? I'm very healthy, low blood pressure, exercise, no diabetes, and a non-smoker.

I had a consult with a ps this week and he recommended a full tummy tuck using an anchor incision to take care of the bulge in the center and remove the apron. He also recommended doing a breast lift at the same time. Is it safe to do the lift and tt at the same time, as he recomended? And what kind of recovery can I expect? I sit at a desk reading books all day for work, and he said it should only be a week or two before I can go back. Will the drains be out before then?

Also, do you know where I can find pictures of tt with the anchor incision? I've found a couple on the web, but not many! It's hard to find info on tt for heavier people, which is frustrating. I really want to have this done, as the results he thinks I can expect sound promising!

Thanks for your help.

There is no problem doing this surgery on someone over 200 lbs - as long as your health is good and there is no contraindication for anesthesia. A TT (anchor) can be done at the same time as a breast lift as long as you are motivated and your surgeon is experienced in this. I think that "one or two weeks" is a bit optimistic. You may have drains for anywhere from 1-3 weeks, depending ont he output. I have some patients go back to work at 2 weeks, but they are still going to be tired - it takes your body a long time to heal itself on the inside. Also, you may lose a decent amount of blood, so your blood count will be low and this will take a few weeks to get back to a normal level. I think it will take you longer to recover.

Here are some links to picutres of anchor TT that I have done:

"Tummy Tuck" or Abdominoplasty after weight loss | Madison Avenue Plastic Surgery

"Lower Body Lift" | Madison Avenue Plastic Surgery

Here's a good one from a woman posted on makemeheal.com. The password is "plastics".

Plastic Surgery Pictures, Videos, Photos, Pics, Before, After, Cosmetic Surgery

Dr. Schulman: What is your opinion on the length of time that someone should wear a compression garment? Does it make a difference if they have had lipo? My doctor recommended 1 month the with my tummy tuck and now, with the thigh, butt, revised tt and arm lift, he wants me to keep them on for 3 months. I've read different websites that recommend up to 6 months. Why so much variation? Do they really make that much difference so far out from surgery?

Dr. Schulman: What is your opinion on the length of time that someone should wear a compression garment? Does it make a difference if they have had lipo? My doctor recommended 1 month the with my tummy tuck and now, with the thigh, butt, revised tt and arm lift, he wants me to keep them on for 3 months. I've read different websites that recommend up to 6 months. Why so much variation? Do they really make that much difference so far out from surgery?

I usually recommend 6 weeks non-stop, then another 4 weeks part-time (about 12hr per day). There is a lot of variation with patients. Some can't stand it and don't wear it, others can leave home without it. I think the longer the better but probably no benefit after 3 months. It will keep the swelling done and make the swelling last shorter, but won't really affect overall result.

Thanks for the info, you're awesome!

Dr. Schulman,

What do you do for saddlebags under your eyes.

After losing weight before I had saddlebags. Even when I had weight I had them.

What can be done.

Thank you

nmydash

Dr. Schulman,

What do you do for saddlebags under your eyes.

After losing weight before I had saddlebags. Even when I had weight I had them.

What can be done.

Thank you

nmydash

A lower blepharoplasty will remove the excess skin and puffiness from under your eyes. It takes about 1 - 1 1/2 hours and is a relatively easy recovery - aside from swelling and bruising that last 5 days to 2 weeks.

Dr. Schulman, thank you for providing this wonderful service. I have definitely learned alot in the last few hours surfing some of the previous posts. I do, however, have a few questions of my own. I'm probably about 50 lbs. from my "goal" - a number that I'm sure I will revise considerably in the months to come. I will need an arm lift, breast lift, and TT sometime in the future. My biggest interest right now is the removal of my pannis. It has reduced slightly with my 70lb. weight loss but it is still considerable. Although I have never gone to a doctor for rashes, I could have if I had realized this was an option. (I figured he would just tell me to use some powder and diaper rash ointment!) You have commented that a PS who works with obese patients is best. Do you need that type of surgeon for this type of surgery as it does not seem cosmetic in nature? Also could you give me an estimate of the costs for this type of surgery? Thanks for your time and expertise.

[*]affiliated with a major teachng hospital

I'm curious as to why this is important...

Dr. Schulman, thank you for providing this wonderful service. I have definitely learned alot in the last few hours surfing some of the previous posts. I do, however, have a few questions of my own. I'm probably about 50 lbs. from my "goal" - a number that I'm sure I will revise considerably in the months to come. I will need an arm lift, breast lift, and TT sometime in the future. My biggest interest right now is the removal of my pannis. It has reduced slightly with my 70lb. weight loss but it is still considerable. Although I have never gone to a doctor for rashes, I could have if I had realized this was an option. (I figured he would just tell me to use some powder and diaper rash ointment!) You have commented that a PS who works with obese patients is best. Do you need that type of surgeon for this type of surgery as it does not seem cosmetic in nature? Also could you give me an estimate of the costs for this type of surgery? Thanks for your time and expertise.

Your surgery should be performed by a PS who is experienced in treating post-bariatric patients. You are right, that a true panniculectomy is not cosmetic - it is reconstructive. This is why insurance will usually cover a protion of the surgery. Post bariatric patients have different health isues, different skin qualities, and need multiple procedures. This is why you need a specialized PS. A general PS can do something as basic as a panniculectomy, but may not be qualified to deal with the unusual complications that often arise. The price for a panniculectomy varies greatly by region. In general the surgeon fee is about 6,000 - 8,000. If your insurance covers this, then they usually contribute somewhere between 1500 and 2500. A breast lift can be around the same, and no insurance contribution (totally cosmetic). These procedures can be done at the same time if your surgeon is experieced combining procedures. The recovery he stated seems appropriate. You can expect to have drains in the abdomen anywhere from 1-2 weeks.

I'm curious as to why this is important...

I think that this is one of the major qualifications. It means that your PS has an excellent CV and actively teaches medical students and residents. This means he has to be current in the field and regularly attends conferences for ongoing education. Major teaching hospitals constantly review qualifications and will take titles away if your PS is not adhering to the standards and requirements of the institution. It is not adequate to just have "privileges" at a hospital - it is better if your PS has an academic position like "professor". This is just another way of ensuring that your PS is qualified - because "unqualified" PS will not be able to get an academic position at a major teaching hospital.

Dr Schulman,

In your expert opinion, what do you do for patients that have experienced Necrosis, cause by blood flow compromise? I am 8 weeks out from Anchor TT took off 8lbs. from day 2 we noticed a issue with part of the incision near the pubic line. Now 8 weeks later I still have a large wound. it has been treated with Wet/dry dressing changes. Then he switched it to Dakins solution instead of saline. Now becasue of nothing happening he has me putting the SSD cream on it to promote blood flow. My wound seems to have just stalled. No worse no better???? Very frustrating to say the least.

Here's a pix of it from 12-04-2008. I would say its a little more healed then this pix. Any ballpark idea how long these types of wounds take to heal? also, IS there anything the PS could do to speed the healing up??

Thanks

Dr Schulman,

In your expert opinion, what do you do for patients that have experienced Necrosis, cause by blood flow compromise? I am 8 weeks out from Anchor TT took off 8lbs. from day 2 we noticed a issue with part of the incision near the pubic line. Now 8 weeks later I still have a large wound. it has been treated with Wet/dry dressing changes. Then he switched it to Dakins solution instead of saline. Now becasue of nothing happening he has me putting the SSD cream on it to promote blood flow. My wound seems to have just stalled. No worse no better???? Very frustrating to say the least.

Here's a pix of it from 12-04-2008. I would say its a little more healed then this pix. Any ballpark idea how long these types of wounds take to heal? also, IS there anything the PS could do to speed the healing up??

Thanks

This is a tough situation, but unfortunately it is not uncommon. It can take a long time to completely heal (months). It seems like you have seen some improvement over the past few months, but not a huge amount. It may take a few more months to heal completely. In some cases, we can speed the process up, or even "bypass" the process.

To speed things up, you should ask your PS about a negative pressure wound dresing that uses a vacuum to help speed healing. It is called a wound VAC (Vacuum-Assisted Closure). It has been a huge advance in wound healing. Also, hyperbaric oxygen therapy (just like they give to divers with the bends) is also used to help speed healing of wounds. Both these are commonly used so you should not have a problem finding a PS experienced with this.

To "bypass" the healing, sometimes a wound can be removed and then closed in one operation. If the skin around the area is mobile, your PS may be able to use that tissue to close the wound. This can be done if there is adequate tissue surrounding it and there is no infection. This can also be done in stages (2 or 3 smaller surgeries) if the wound is too big to close in one operation.

I would definitely ask your PS about these things. Topical ointments and creams (like SSD and Dakins) kill bacteria...but they can also kill the cells you need to heal. The result can be very slow healing, like in your case.

Good luck. I think you have tried the basic things, with some improvement. Fortunately there are other options for you to think about.

Thanks Dr Schulman, I will ask him about some of these types of healings when I see him on Monday. I'm 8 weeks out and don't see this healing anytime soon.

Dr. Schulman: So glad you're around to ask questions of. You really do help a lot of people! When is the article coming out in the aging magazine? I'm wondering if you could give me some advice. I have a very raised scar on one of my arms from my brachioplasty (the other scar is nice and flat). I am about 10 weeks out. I have been massaging it and using silicone strips and have seen a little improvement. There is also a lot of suture reaction (I'm assuming that is what it is) so that under the skin is very solid and rough feeling. Someone told me that after 3 months if the scar tissue isn't broken down that it will just stay about the same. I was also told by another source (none of them doctors) that cortisone shots in the suture area will help. What's the real scoop? Thanks!