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. S

after reading a copy of questions/responses, would I have to wait to have a TT. I am at 240 right now and would like to lose 40 more.

I have a large hanging belly that I would like to have removed. Do I have to wait or can I successfully have it removed at this stage or weight loss?

Does insurance cover this procedure?

removing this problem area would really help with my self esteem

thank you in advance

Dear Dr S - thank you for answering all of these questions!

I'm close to 40 and was morbidly obese for > 10 years so have lots of extra skin and will need multiple procedures. Do you ever combine an inner thigh lift with a lower body lift? I can't decide what bothers me more- my pannus, my lumpy heiny or my inner thighs :redface:

thanks!

many procedures are combined, but a LBL is best when done alone. It is the largest of the operations and requires the most recovery. There are blood supplu issues when adding an inner thigh lift to a LBL or TT and will increase the complication rate significantly.

Dr. S

after reading a copy of questions/responses, would I have to wait to have a TT. I am at 240 right now and would like to lose 40 more.

I have a large hanging belly that I would like to have removed. Do I have to wait or can I successfully have it removed at this stage or weight loss?

Does insurance cover this procedure?

removing this problem area would really help with my self esteem

thank you in advance

You should wait on a TT until you are at goal. You may consider a panniculectomy at this stage, which will remove the hanging skin, without tightening the muscle or removing excess skin that is above the belly button. Insurance may pay for a panniculectomy and you should check with your insurance carrier about the specific requirements. Keep in mind, if you have a panniculectomy now, you will likely require a revision at a later date to convert it to a TT.

While I just had my lap band surgery I do have a few questions for down the road when I cross that 'lose skin path' I know I will cross.

1) I had a breast reduction back in 94, I went from a 32 III to a 32 C/D (I am now a 36 D/DD (kids and weight gain). Would I be able to get a lift after the initial reduction 14 years ago? (will be 15 by the time I get to that point)

2) I carry 90% of my weight on my bottom half, I know my insurance (at this time) will cover a full/partial body lift if I need it but my concern is how successful are thigh (inner/outer) lifts. I have been researching things and have read more then once that thigh lifts are harder then upper body lifts at being successful. Why is this? It has me concerned that I would be making a mistake.

While I just had my lap band surgery I do have a few questions for down the road when I cross that 'lose skin path' I know I will cross.

1) I had a breast reduction back in 94, I went from a 32 III to a 32 C/D (I am now a 36 D/DD (kids and weight gain). Would I be able to get a lift after the initial reduction 14 years ago? (will be 15 by the time I get to that point)

2) I carry 90% of my weight on my bottom half, I know my insurance (at this time) will cover a full/partial body lift if I need it but my concern is how successful are thigh (inner/outer) lifts. I have been researching things and have read more then once that thigh lifts are harder then upper body lifts at being successful. Why is this? It has me concerned that I would be making a mistake.

1. You can have a brest lift after a reduction. Your lift will use the same incisions as when you had the reduction in the past. I suspect you may have some "reduction" and not just a lift. Remember, a breast reduction includes a lift.....a lift will only raise everything up, but will keep volume the same.

2. There is no true 'outer thigh lift." This is part of a lower body lift in which the buttocks, lower back, abdomen, and outer thighs are improved. An "upper body lift" is completely different and will nto do anything to improve your outer thighs. Which is more difficult? That is hard to say. A LBL is much more complicated, so I guess it is true that it is harder...but it is "apples" and "oranges." To a surgeon experienced in this kind of procedures, you should get a good result with either.

Here are some pictures:

1. Lower Body Lift

2. Upper Body Lift

3. Breast Lift

4. Breast Reduction

many procedures are combined, but a LBL is best when done alone. It is the largest of the operations and requires the most recovery. There are blood supplu issues when adding an inner thigh lift to a LBL or TT and will increase the complication rate significantly.

thank you! I had wondered if compromising the blood flow/tissue to much of the thigh at one time would be a bad idea. Makes sense even if I don't like the answer. thanks!

:redface:

Earlier I had discussed an "upper body lift" that will help with the back rolls and underarm rolls....."banana rolls".

Here is a link to a picture of a recent patient who had this procedure.

Thank you! I plan to start consultations for PS soon and I've been researching the upper body lift. I hope to meet with you, Dr Schulman. (I'm on Long Island)

Would you commonly do an upper body lift and a breast lift at the same time?

Thank you! I plan to start consultations for PS soon and I've been researching the upper body lift. I hope to meet with you, Dr Schulman. (I'm on Long Island)

Would you commonly do an upper body lift and a breast lift at the same time?

Breast lift/reduction and an upper body lift is a perfect combination. They are commonly done together.

Would having a ventral hernia be one of the medical reasons of course along with other reasons to having the lap band or would having this cause you not to be able to have the lap band?:ohmy:

Would having a ventral hernia be one of the medical reasons of course along with other reasons to having the lap band or would having this cause you not to be able to have the lap band?:ohmy:

The 2 things are totally unrelated. A hernia should be fixed, and you should discuss with your surgeon having a lap band and the hernia repaired at the same operation. Depending on the size, the hernia can be repaired laparoscopically. Another alternative is to wait to have the hernia repaired after you lose weight and during your plastic surgery (assuming of course that the hernia is not at risk for strangulation or incarceration....speak to your surgeon about this issue).

Dr. Schulman thank you for fielding our questions. It's very educating to read the questions and responses.

I posted a question earlier regarding my breasts and stomach. It is difficult for me to exercise without having an "exercise hangover", that is, pain that requires I take medication for back pain and upper shoulder pain. My weightloss is down to a crawl and my portion control is fine thanks to the band. I don't know where to begin in looking for a surgeon, what to tell them and frankly, because I still have over 100 pounds to lose I'm afraid I'll just be told to lose more weight (my plan anyway). Should I suck it up, quit whining and deal with the pain or should I pursue reduction at this stage?

Thank you in advance.

Dr. Schulman thank you for fielding our questions. It's very educating to read the questions and responses.

I posted a question earlier regarding my breasts and stomach. It is difficult for me to exercise without having an "exercise hangover", that is, pain that requires I take medication for back pain and upper shoulder pain. My weightloss is down to a crawl and my portion control is fine thanks to the band. I don't know where to begin in looking for a surgeon, what to tell them and frankly, because I still have over 100 pounds to lose I'm afraid I'll just be told to lose more weight (my plan anyway). Should I suck it up, quit whining and deal with the pain or should I pursue reduction at this stage?

Thank you in advance.

I remember from your last question that your abdominal pannus and breasts are causing your discomfort. Sounds like everything you describe supports that you shuld have something done soon, rather than wait for you to reach goal (which we all know won't happen without the skin beign removed...it's the old chicken or the egg question)

Your weight loss has essentially plateaued. So you have 2 options as I see it. 1) consider converting your band to a bypass 2)have the excess skin removed now so that you can exercise, feel better about yourself (don't underestimate the motivational power of this) and jump start your weight loss again.

Meet with a PS. He or she should be familiar with your situation and be sensitive to your complaints. If they tell you that you should "suck it up and come back when you lose more weight", run away...very quickly. That would be the response of a PS not experienced with working in this area. Like I said earlier, I think you would do great with a breast reduction and panniculectomy at this stage (even though you have more to go).

If your search for a PS ever leads you to NYC, make sure you look me up!

I remember from your last question that your abdominal pannus and breasts are causing your discomfort. Sounds like everything you describe supports that you shuld have something done soon, rather than wait for you to reach goal (which we all know won't happen without the skin beign removed...it's the old chicken or the egg question)

Your weight loss has essentially plateaued. So you have 2 options as I see it. 1) consider converting your band to a bypass 2)have the excess skin removed now so that you can exercise, feel better about yourself (don't underestimate the motivational power of this) and jump start your weight loss again.

Meet with a PS. He or she should be familiar with your situation and be sensitive to your complaints. If they tell you that you should "suck it up and come back when you lose more weight", run away...very quickly. That would be the response of a PS not experienced with working in this area. Like I said earlier, I think you would do great with a breast reduction and panniculectomy at this stage (even though you have more to go).

If your search for a PS ever leads you to NYC, make sure you look me up!

Dr. thank you for cutting to the point. Thanks to this response I've called my insurance, spoke to a 'Drone" who had no idea what I was talking about, switched to a supervisor who did and is calling me back later this evening when I have more details of the specifics of what I am looking for in a surgeon.

"Your plastic surgeon should understand how skin reacts to massive weight loss, and the nutritional implications of this weight loss on your ability to heal after surgery.".

I know by my intake that it isn't what I am eating or how much but more to do with what is going on with my body and lack of ability to move. I think reduction now will certainly allow me to move without the after pain I suffer. I'd also like to correct the area around my pelvis that has been "morphed" by the weight rubbing against it for so many years. Thanks again. I sure wish you were in Florida!

PR

UPDATE:

I spent the afternoon on the phone with my insurance company and eventually got a supervisor. To my surprise this person understood what I was looking for. Because we could not find a surgeon on my BCBS plan who listed bariatric/reconstruction/or something other than "plastic surgery", the supervisor informed me that my insurance company would assist me in finding a provider who provided such services if they were deemed "medically necessary". Not worried about that.

Dr. Schulman thank you for the direction. I would have spent the next year or more sucking it up, popping my X-Strength Tylenol every four hours and first thing in the morning.

Hi Dr. Schulman:

I have a few questions concerning panniculectomy versus tummy tuck.

Thank you for sharing your expertise with all of us on this website.

I've gone from 324 (April 2007) to 188 (now), and hope to get to 159 by the end of the year so that I will have normal BMI. I have alot of loose skin, especially in my lower abdominal area.

Can you please explain the difference between a panniculectomy and a tummy tuck?

My insurance will cover a panniculectomy if I can show a history of rashes, etc. If I were to get them to approve a panniculectomy and I opted to get the tummy tuck does insurance usually cover a significant part of the cost of the tummy tuck because it takes care of the pannus?

Please let me know. I'm in Massachusetts and I was told to think about $10k for a tummy tuck. I was also told that I should wait a few months after being at goal to get a tummy tuck. Do you agree with this wait?

I look forward to hearing your answers.

Thanks.

Sue