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.

Thank you so much for your response.

Let the hunt begin......

Dr. Schulman: I was surprised to see in your newsletter this month that your practice is highlighting lipo-lite. Is that different than "smart lipo?" I thought that you didn't like smart lipo? With the lipo lite, is the fat suctioned? Thanks in advance.

Dr. Schulman: I was surprised to see in your newsletter this month that your practice is highlighting lipo-lite. Is that different than "smart lipo?" I thought that you didn't like smart lipo? With the lipo lite, is the fat suctioned? Thanks in advance.

LipoLite is similar to smartlipo, from a different company, and using more advanced technology (my experience is that is is better than smartlipo). You are partly correct about how I feel about smart lipo (or any of the laser lipo technologies). It is a good procedure in very select individuals. I do not think it is good in the post weight loss population because the improvement will be limited and most people will be disappointed (especially given that it can be more expensive than traditional lipo). This is why it was not mentioned in my bariatric newsletter.

Body contouring after weight loss is so specialized - many of the techniques and procedures that I do in my regular cosmetic patients do not always apply. This is why I have 2 separate newsletters and each features different information. The LipoLite was featured in the cosmetic newsletter, but not in the post bariatric newsletter.

Hi Dr. Schulman. I have a couple of short questions.

I have always had a double chin, regardless of my weight, and now have loose skin and some "pleating" under my chin. I would like to have this fixed after I finish losing weight but really don't want to have a full lower face lift. I have a real aversion to/fear of looking like I've had a face lift. Is there anything less drastic that can be done with necks?

My second question has to do with my breasts. I have what I believe is called "pseudoptosis". My nipples are still above the crease line of my breast, but all of the breast tissue seems to have settled in the lower part of my breasts. I know I'll need a breast lift but am reluctant to have implants. Can my sort of breast problem usually be corrected with a lift without augmentation? Or is it impossible to have any fullness on the top with implants? I hope that made sense.

Thanks in advance for your time. You're very generous to deal with all these questions!

Dr. Schulman: Do you feel that lipo lite isn't appropriate for post-bariatric patients, even if they are at goal weight, have had traditional lipo and weight loss surgeries and just want a few problem areas touched up (like bra fat under the arms, for instance). Or is the skin of bariatric patients too stretched for this application?

Hi Dr. Schulman. I have a couple of short questions.

I have always had a double chin, regardless of my weight, and now have loose skin and some "pleating" under my chin. I would like to have this fixed after I finish losing weight but really don't want to have a full lower face lift. I have a real aversion to/fear of looking like I've had a face lift. Is there anything less drastic that can be done with necks?

My second question has to do with my breasts. I have what I believe is called "pseudoptosis". My nipples are still above the crease line of my breast, but all of the breast tissue seems to have settled in the lower part of my breasts. I know I'll need a breast lift but am reluctant to have implants. Can my sort of breast problem usually be corrected with a lift without augmentation? Or is it impossible to have any fullness on the top with implants? I hope that made sense.

Thanks in advance for your time. You're very generous to deal with all these questions!

Regarding your neck, there are several options aside from a necklift and lower facelift (which, when done correctly by a skilled surgeon, should NEVER look overdone). The double chin may be due to a combination of weak chin, excess fat, and loose skin. Sometimes liposuction of the neck and placement of a chin implant can really improve the appearance of your neck, without a full necklift. Lower face jowling can be helped wtih fillers and skin tightening lasers. There are many many options for you.

Pseudoptosis can be corrected by removing a wedge of tissue from the lower breast. This will help the shape of the breast, but will not do anything for upper pole fullness. For that, you will need placement of a small implant.

Dr. Schulman: Do you feel that lipo lite isn't appropriate for post-bariatric patients, even if they are at goal weight, have had traditional lipo and weight loss surgeries and just want a few problem areas touched up (like bra fat under the arms, for instance). Or is the skin of bariatric patients too stretched for this application?

I think in this situation, lipolite may be a good option. While it is not the best option for primary liposuction in post bariatric patients, it works pretty well in secondary (revision) cases (it is really good at breaking up the scar tissue that develops after regular liposuction), and also for those small "problem" areas. The skin may not respond as well as in non-bariatric people, but you should see some improvement. It is all about realistic goals -which I know you have!

Hi Dr. Schulman

I had a breast and arm lift done 3 weeks ago. For the most part I am healing wonderfully but one of my arms is still quite swollen. I seen my PS doc on tuesday and he didnt seem to concerned about it. Do you know of anything that might help the swelling go down quicker?

Thank you

Pam

Hi Dr. Schulman

I had a breast and arm lift done 3 weeks ago. For the most part I am healing wonderfully but one of my arms is still quite swollen. I seen my PS doc on tuesday and he didnt seem to concerned about it. Do you know of anything that might help the swelling go down quicker?

Thank you

Pam

Arm swelling after a brachioplasty is common. Watch your salt intake - too much can make the welling worse. Avoid cold cuts, Soups, sauces with salt (barbeque), etc. Also, sometimes wrapping your arm with an ace bandage fromt he fingers to the shulder will help - but make sure to check with your PS before doing this. Generally the swelling takes several weeks to go away, but some people may see swelling that lasts for months.

I am not sure you are at liberty answer this, Dr. Shulman, but I am trying to get some answers so I can deal with my finances. I am interested in brachioplasty and a breast lift/aug.

1-Can these surgeries be done at the same time? (or is the recovery too much!)

2-Can you give me a "ballpark figure" of the price? I live in FL, if that figures in. I would like to know what is considered reasonable.

Thanks---we are fortunate to have you share your knowledge!

Dr Schulman,

I had a LBL with thigh lipo 2 weeks ago and was wondering if it is normal for the drainage to be different colors from the different sides? My left one hurts and is much darker than the right side. I also swell more on my left. I am going to my private doctor on Tuesday and I am still taking antibiotics just in case. I had the LBL in Mexico and I really dont feel like taking the 5 hour drive back to my PS. Can you also tell me the standard amount of drainage that they will let you take the drains out? THANKS

Hi Dr Schulman,

I was wondering what your views on mini tummy tucks combined with hernia repair were.

I have 2 incisional hernias at either end of my caesar scar which my GP says are nothing to worry about. However, hernia's dont get better, and these look a bit weird, they are visible looking down my body and they can ache a bit by the end of the day (they also make a really revolting squelchy noise when pressed, lol).

So I was thinking........ I couldnt really justify a full tummy tuck. I ahve a bit of loose skin and probably ne4ed a bit of lipo on the residual upper ab fat pocket, but my muscles are rock hard, absolutely flat and are not separated.

If I were to be opened up to repair these hernias rather than have them done laparascopically, would it be an unusual thing to ask to just remove a crescent of skin from the lower belly and tighten it up without moving the navel etc?

I'm thinking there's a very very tiny possiblity that in Australia, this the anaesthetics cost of the op might then be covered partly by medicare due to the hernia repair comopent. Private insurance covers the hospital stay either way.

I am not sure you are at liberty answer this, Dr. Shulman, but I am trying to get some answers so I can deal with my finances. I am interested in brachioplasty and a breast lift/aug.

1-Can these surgeries be done at the same time? (or is the recovery too much!)

2-Can you give me a "ballpark figure" of the price? I live in FL, if that figures in. I would like to know what is considered reasonable.

Thanks---we are fortunate to have you share your knowledge!

Arms and breasts can be combined into one operation if you are willing to go through a larger recovery process. I don't think it is "too much" in terms of recovery, but combining arms with anything is difficult because you will need to use your arms to take care of your breasts (change dressings, bathe, etc.) The prices vary. In general, armlifts will run about 6,000-8,000 and breast lift (with implants will run about the same. You may have to pay an additional fee depending on whether you choose silicone or saline (silicone is about 1000 more). Combining these procedures should save you money but that is up to your individual surgeon. Good luck. Make sure you select someone qualified to do this.

Dr Schulman,

I had a LBL with thigh lipo 2 weeks ago and was wondering if it is normal for the drainage to be different colors from the different sides? My left one hurts and is much darker than the right side. I also swell more on my left. I am going to my private doctor on Tuesday and I am still taking antibiotics just in case. I had the LBL in Mexico and I really dont feel like taking the 5 hour drive back to my PS. Can you also tell me the standard amount of drainage that they will let you take the drains out? THANKS

Usually drains remain until there is about 30cc or less per 24 hours. After a LBL, the drains can remain up to 3 weeks. The color is usually tea-colores or clear yellow. Dark color may mean that there is blood - old bleeding or new bleeding.

I recommend discussing this with your plastic surgeon to make sure there is nothing that needs addressing. I understand the surgery was done a distance away, but you should at least be able to speak to your ps on the phone. He may ask you to come see him. I know this may be a huge inconvenience, but as has been discussed in the past, this is the major reason why people should really understand what is involved with traveling out of the country for surgery - the prices are less, and usually the surgery goes well, but sometimes you can develop small (or major) complications that need to be dealt with by your ps.

Hi Dr Schulman,

I was wondering what your views on mini tummy tucks combined with hernia repair were.

I have 2 incisional hernias at either end of my caesar scar which my GP says are nothing to worry about. However, hernia's dont get better, and these look a bit weird, they are visible looking down my body and they can ache a bit by the end of the day (they also make a really revolting squelchy noise when pressed, lol).

So I was thinking........ I couldnt really justify a full tummy tuck. I ahve a bit of loose skin and probably ne4ed a bit of lipo on the residual upper ab fat pocket, but my muscles are rock hard, absolutely flat and are not separated.

If I were to be opened up to repair these hernias rather than have them done laparascopically, would it be an unusual thing to ask to just remove a crescent of skin from the lower belly and tighten it up without moving the navel etc?

I'm thinking there's a very very tiny possiblity that in Australia, this the anaesthetics cost of the op might then be covered partly by medicare due to the hernia repair comopent. Private insurance covers the hospital stay either way.

I think you ahve a good understanding of this and combining a mini with an open hernia repair is a good plan. You may not "need" it, but you already have a scar there, and you do have s small amount of skin laxity. Besides, while a laparascopic hernia repair is common now, doing it open allows them to really see the hole and fix it from the inside and outside.

I am not sure who is planning on doing this - ps or the surgeon ding the hernia repair? This is a simple procedure for a ps, but a general surgeon may not be able to (or willing to) just "remove a crescent of skin" and give you as nice a result as you are expecting. There are a lot of "tricks of the trade" that we do during a mini TT, and often there is a lot of work under the skin, even though the incision is small. All these things add up (hopefully) to a discrete scar and flat lower abdomen. We want want we do to "appear" simple, when it is really not. I am sure you can find a ps willing to do this for you at the same time as your hernia repair - it is actually very common to do this. Obviously, I strongly advice against having a non-ps perform any cosmetic procedure on you. I would never remove a gallbladder (even though I was trained in general surgery first and can probabably still do it) and I would hope that a general surgeon would never do a tummy tuck (even a mini).