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.

Question.....I did not think to as my Doc this, but will at next visit, but was thinking maybe you could answer it for me...

My Doc said that I would only have internal stitches. So what will be on the out side? I have heard of them using something like superglue, is this true, or do they use some kind of special stich?

Thanks

Laura

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"internal stitches" means that they are hidden under the skin and will dissolve. They are placed so that the skin is completley together and no glue is needed (but some people put it anyway).

Dr. Schulman...I haven't been on the site in several months but I'm back now with questions, of course. I had the panniculectomy done December 5, 2008. They found that I had 2 large hernias when they did the procedure so the doctor repaired them. It was not quite the walk in the park I was hoping for. I had to wear drain tubes for 2 1/2 months because of a huge seroma. Finally, the tubes came out and now, it's looking great! Even with all the set-backs with my surgery, I'd do it over again! Basically, it was the hernias that caused the most problems after surgery. Is it my imagination or have my thighs actually gotten larger since the surgery or is it now I don't have the fat apron hanging down covering most of the top part? It's gotten so bad, skin is sagging below my knees now. I've lost 317 pounds so the sagging skin is to be expected and I actually am thrilled that I no longer carry around 469 pounds but the excess skin is horrible and disgusting. Now to my question, just because I had problems after my panniculectomy, would you think that a thigh lift would be as bad? I'm hoping and praying to have an arm and thigh lift done. My insurance finally covered my panniculectomy but it doesn't cover the other surgeries at all even though I get rashes and infections in the folds of skin both on my thighs and arms. I hate sounding like a whinner because I'm so blessed to have lost so much weight and to have had the panniculectomy, but now my thighs look even worse than before. After my surgery, I had to go to a place in Dallas to get fitting for a special binder to wear and the woman that was going to fit me asked what type of disease I had to make my legs look like they did. I tried to laugh it off but it just made me feel worse. I now avoid full lenght mirrors at all costs. For anyone that might need a TT or panniculectomy, go for it because the results from that are fantastic! Someday I hope to be brave enough to post pictures so everyone can see. To sum up this LONG question. Could my skin be sagging more now after the panniculectomy? Also, can an arm lift and thigh lift be done at the same time to save on expenses? My first surgery was done on an out patient basis so I didn't have the expense of a hospital stay but if they could combine the two, would it probably require a stay? Thanks once again, Dr. Schulman, for all your help!

Most likely your thighs appear bigger becuase your stomach is smaller...it is very very common to feel this way. IT is possible they did get bigger though with swelling or more weight loss. Either way, the fact that you had such a serious seroma after places you at higher risk for a seroma after the thigh or arm lift (does nto meanit will definitely happen). I think that a thigh lift in you would be best with an overnight stay. This will give you 24 hours of bedrest and lower your chance of complications. doing the arms at the same time may be a very tough combination for you and would recommend against it,b ut talk toyour doc.

Dr. Schulman:

Thanks for all the great advise that you give us all. I am just starting my weight lose journey and still have 60 more pounds to go, I had breast cancer and a lumpectomy 6 years ago that removed 1/4 of my right breast. Am actually very happy with the reduction and outcome of my right breast, but would like my left breast to match. My BCBS insurance does not cover any plastic surgery needed from weight loss, but it would cover surgery to make my breast the same size from the cancer. Do you feel this surgery would still be covered by insurance since I waited until after the lap band surgery to have done. Being uneven when I was so over weight previously didn't matter to me and after 8 surgeries that were cancer related an elective surgery didn't fit into my schedule. But I am now ready to do things for myself. Do you think that I would need to wait until I am at my ideal weight before having the surgery?

Thanks you!

You probably do not have to wait until your ideal weight, but I would like to see you get closer...maybe to within 30 pounds. I do not think that insurance will be an issue because as long as your diagnosis is breast cancer and acquired asymmetry of breast, you will be fine.

Dr. Schulman, my daughter went ahead with her surgery with LoMonaco and so far everything seems to be going per plan. Surgery was Thursday. She was able to remove breast drains today, possibly one of the lower drains tomorrow and able to shower tomorrow.

But my question is actually for myself. I've seen where there's a procedure for the arms where instead of the long incision, they do the incision under the armpit. Assuming you do both kinds, what determines who can have the one just under the armpit?

Also, back to my daughter, LoMonaco doesn't want her sitting up at a straight angle right away. How long does that usually continue? She was able to see her stitches finally and feeling a little Frankenzilla-like right about now.

Thanks for your input earlier. I had my banding on June 1 and the only thing possibly for me will be my arms...we'll see. Going to try to do as much exercise as I can but not sure if that will get all of it.

Trisha (pennreporter)

I am glad verything went well with your daughter. I had no doubt, Dr. LoMonaco is an excellent surgeon. She will need to specifically ask him what the time frame is for not sitting up straight. It is probably so she does not pull on the suture line and will likely be for a few more days.

The short scar brachioplasty is good for people with mild to moderate skin laxity of the arm. In general it is not the optimum choice for weight loss patients, but we will have to see how your arms react to the weight loss. Exercise is good for you, but remember,t he problem is a skin issue, and you can;t exercise away skin...

Good luck with your weight loss and I hope to see you whenyou get closer to goal!

Thank you Dr. Schulman. As always, you answer my questions. You're certainly one of the good guys!

"internal stitches" means that they are hidden under the skin and will dissolve. They are placed so that the skin is completley together and no glue is needed (but some people put it anyway).

THANKS for thr response and information Dr. Schulman. You know it great to have someone like you to talk too. Thank you!

Laura

I will definitely be contacting you a little further down the road on arm surgery. I'm a low BMI bander. So hopefully will be during the winter months. I'm a court reporter in the Poconos and work gets pretty slow during that time.

Daughter is doing wonderful. She actually went out for a walk today (drains and all) for a couple of blocks, which Dr. Lomonaco recommended). Last two drains will come out tomorrow and she showered today and started cutting down pain meds. She I'm thrilled for her.

Thanks so much. You've been great on your input. I will be doing as much arm exercising between now and then...can't help to at least have the underlying muscles in better shape.

Trisha (pennreporter)

Dr. Schulman, I am interested in getting lipo to my inner and outer thighs. I don't really have any hanging skin, just some localized fat deposits, despite all of the exercise that I do. Can you tell me what the recovery would be like and approximately how long I would need to be off work? I am a nurse and am up on my feet for 12 hour shifts. Also, is this something that could be combined with a breast lift or would they need to be done separately? Thanks for your time.

Dr. Schulman, I am interested in getting lipo to my inner and outer thighs. I don't really have any hanging skin, just some localized fat deposits, despite all of the exercise that I do. Can you tell me what the recovery would be like and approximately how long I would need to be off work? I am a nurse and am up on my feet for 12 hour shifts. Also, is this something that could be combined with a breast lift or would they need to be done separately? Thanks for your time.

Lipo of the this and a breast lift can be combined (and often is). Most people can go back to work in 1 week after lipo of thighs, assuming that they have a desk job. In your case, you will probably need 2 weeks off (especially if a breast lift is combined).

Hello, I hope you can answer this question. I am planning on doing lipo from the waist to the knees, a tummy tuck, and breast implants. Can these procedures be done together? If so, is recovery difficult enough to consider doing them separately? If all three should not be done together, is there a certain order or combo that would work well? One last question, I am waiting until next summer to schedule these because I want to have a steady weight for at least a year and because I want to continue to lift weights as I have been doing to be as strong and fit as possible for when I have the surgeries. Do you find that those who are physically fit have better results or have an easier time with recovery? Thank you, I appreciate your time.

Thank you for the information you are wonderful to be so very helpful to us all! I really appreciate it!

Hello, I hope you can answer this question. I am planning on doing lipo from the waist to the knees, a tummy tuck, and breast implants. Can these procedures be done together? If so, is recovery difficult enough to consider doing them separately? If all three should not be done together, is there a certain order or combo that would work well? One last question, I am waiting until next summer to schedule these because I want to have a steady weight for at least a year and because I want to continue to lift weights as I have been doing to be as strong and fit as possible for when I have the surgeries. Do you find that those who are physically fit have better results or have an easier time with recovery? Thank you, I appreciate your time.

I think that all three procedures can be combined, but keep in mind that the recovery will be much more difficult. It will be hard having the tummy tuck and lipo at the same time. Lipo of the legs is more painful than other areas and the swelling can be significant. If you were to split it up, a good combo is the TT alone, and the breasts and lipo together (in whatever order you desire). "Recovery Time" is difficult to answer, because everyone heals differently, but at least a few weeks...

It is true that the better shape you are in, the better you will recover.

Good luck to you.

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!

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

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.