Were you informed about PS before you were banded?

Dr. Schulman · 05-13-2008, 06:59 AM

As many of you know, I often speak at bariatric support groups in New York and New Jersey. One thing that never fails to amaze me, is how many people are surprised at the body changes after bariatric surgery. Many people had no idea that the skin may remain after weight loss and that needing (wanting) plastic surgery is extremely common.

Patients are much more educated now about PS after weight loss - through support groups that sponsor plastic surgeons, through websites like this one, and in speaking with their bariatric surgeons.

There is always room for improvement - especially on the "pre-op" side, so that you know that the weight loss may not always be the end of your journey.

I am interested to hear your thoughts about the way in which you were educated about plastic surgery (or not educated), and whether this occurred before or after your band procedure. This will help me be able to better educate people about this subject.

**Jack** · 05-13-2008, 07:05 AM

Yes, it was mentioned briefly in passing during my initial consult now nearly 4 years ago. I actually had went for PS consult a few months back, and was told something I've never heard before: "You're not fat ENOUGH to merits the potential risks of this procedure." Talk about a mixed blessing....

I've got plenty I'm sure will never go away.

Southern Missy · 05-13-2008, 07:25 AM

I went to 3 different seminars. In 2 of them, it was briefly touched upon as a possible need but in the 3rd, they actually had a PS who came in and did a Power Point. It was very enlightening. I thought it was also very motivational.

luluc · 05-13-2008, 07:27 AM

I was told I "might" need plastic surgery to get to my goal weight of 125; my Dr's goal was 140. Coming up on that number, I know I will not require any surgery due to weightloss.
I wont' rule out any work that comes with the normal aging process

jet · 05-13-2008, 07:31 AM

i was told not to even consider it until 2 years post banding and that it maynotbe necessary. some people are lucky and skin moudls to new shape, ifound that quite unbelievable. though i wonder if excercise on those areas might help

Apples2 · 05-13-2008, 07:58 AM

Our surgeon brought the PS subject up in our lap band informational seminar. He stated that we should not even consider it for one year after goal.

I know that I will want PS. I have lost 50lbs with 50lbs to go. My lower stomach is already hanging more than it did and I am having trouble with rashes even though I shower 2x daily. Guess I should start documenting that with my reg. dr.

Frangipani · 05-13-2008, 08:21 AM

I have been a yo-yo dieter for some time now and have fluctuated from a size 6 to my highest weight last year, size 26. I have consulted with plastic surgeons during my previous downward cycles, so I definitely knew that there would be work to be done at some point.

However, I was not ready to focus in on plastic surgery until I was closer to goal because I simply did not know what was going to "bounce back" and what wasn't. I am very pleasantly surprised that the skin in my upper abdomen and body has fallen back into place very nicely and I have smooth skin, no fat and a slim waist. However, I am quite surprised (extremely appalled actually) at how poorly the breasts, buttocks, and pannus made it through the battle.

I honestly figured that it would be a waste of time to focus in on this issue earlier in the banding surgery/weight loss process, and looking back, I was right. The "wait and see" approach worked very well for me. In fact, if you had told me early on in the process that I might need to have my breasts and buttocks lifted after I lost 100 pounds, I might have gotten very discouraged about the whole thing, as these were issues that had never been a problem for me in the past.

Now I'm okay with it though, because I have worked very hard to get this weight off, and I feel that this plastic surgery is a thank-you gift to myself.

Hope this helps a little

! I very much appreciate your highly educational posts and your sincere efforts to advise us, Dr. Schulman.

Cherlita · 05-13-2008, 11:14 AM

My surgeon discussed it, but I don't recall if I asked the question or he volunteered the info. PS was briefly mentioned at the Info session. I would have liked to hear more PS info at the session. My surgeon said they will not consider PS for at least 1 year after reaching wgt loss goal. I also recall he mentioned they will only do panniculectomies. For other procedures such as a full body, they refer to a PS in Denver.

Cherlita

juliegeraci · 05-13-2008, 11:37 AM

I knew with over 100 lbs to lose I most likely would need a tummy tuck. That being said I had one 20 lbs from goal. I am now 10 lbs from goal and my stomach looks really good. It is definitely an added expense but worth it.

Foofy · 05-13-2008, 02:54 PM

My surgeon never mentioned it. I figured I would need a TT and BL was actually excited about the prospect. What surprised ME was all the other places that I seem to be getting loose skin - my forearms and upper arms, my thighs, and my neck. If things done start "tightening up" I'm gonna look like a Shar Pei. I've never smoked and I always ate lots of fruits and vegetables and had great looking skin. Ah well.

Did you see the episode of the Simpsons where Homer gets a band and uses clothes pins on his back to pull all the loose skin taut? Classic. All potential bariatric patients should see it (even if it does confuse the two bariatric procedures).

Dr. Schulman · 05-13-2008, 03:14 PM

Quote:

Originally Posted by Frangipani

Hope this helps a little

! I very much appreciate your highly educational posts and your sincere efforts to advise us, Dr. Schulman.

It is my pleasure. I think it important that everyone gets a good understanding about plastic surgery - the good and the bad!

It also works both ways. I learn a lot about what issues are most important to the patients, which helps me improve my practice by understanding these issues.

Keep up the good work everybody!

bandster_1007 · 05-13-2008, 04:57 PM

my doctor told us that it was a possibility, but not to consider ps until 1 year, post goal.

i have personally ALWAYS been very large bottom, real heavy thighs, etc. i will probably need a lower body lift, boob lift, etc. lol..although i'm hoping not due to the expense and recovery time (i'm a baby). but dh knows that i refuse to live with skin that reminds me of my fat life, once i am thin.

Sue Magoo · 05-13-2008, 05:35 PM

Dr. Schulman:

Have any of the bariatric surgeons ever consulted you about placement of the port to reduce scarring for those who might want to have a tummy tuck after they are at goal? What is the best place? Just curious.

Thanks for answering our questions on the forum.

Sue

Dr. Schulman · 05-13-2008, 05:51 PM

Quote:

Originally Posted by Sue Magoo

Dr. Schulman:

Have any of the bariatric surgeons ever consulted you about placement of the port to reduce scarring for those who might want to have a tummy tuck after they are at goal? What is the best place? Just curious.

Thanks for answering our questions on the forum.

Sue

Sue,

I have never had a bariatric surgeon consult me regarding the location of the port becasue the port needs to be in a location that is best for fills - and this is often not the best cosmetic location. It is more important that you have a functioning port, thatis easily accessed, and will not "flip."

When I perform a TT, I routinely have to move the port because of the amount of skin that I remove. Usually, the port is changed to a low profile port at this time as well. I can replace the port from the underside of the skin during the TT and this makes a completely scarless port site...the problem is that you will eventually have a scar if the port ever has to be changed or removed.

In general, the scars from a plastic surgeon tend to be better (thinner, less red, flatter) than ones from other surgeons. We don't do anything magical - we just have special techniques and instruments that we use. So, when I replace a port during a TT, the scar tends to be much better than it was the first time. Occassionally I am called into the OR to close the port sites during the initial banding if the patient is extremely concerned about scarring.

MollyMolly · 05-13-2008, 05:55 PM

Yes, mine did.

They also bring in a PS who specializes in fixing post-WLS patients up for support group once a year to do a slide show & talk about the various procedures, answer questions. So the bulk of the PS info we get is after banding.

Since some people might walk away from getting the WLS if they knew in advance they might have saggy skin and need PS, my center was also frank up front that even if you have a bit of loose skin after losing a lot of weight, you are still going to look WAY better than you do as a morbidly obese person (not to mention the health benefits losing the weight). So they cautioned against getting too worked up about potential loose skin.

Seriously, I'd rather get to goal and wear support garments and a size larger than normal to account for the loose skin than stay hugely fat and struggle with my co-morbidities. Batwings and saggy abdomen might not be pretty in a swimsuit, but neither is the average 299-lb woman.

That's my opinion anyway. I'm sure there are some who feel they are more beautiful with rolls of fat cascading out than a little extra skin. Different strokes.

Were you informed about PS before you were banded?

Were you informed about PS before you were banded?

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