Help! Plastic Surgery Consult Today

I saw Dr. Wiener today for my PS consult. He comes very highly recommended by other wls patients and I've seen his work. It's really impressive. He's rated as one of the top plastic surgeons in the area and even in the country. I've got some mixed feelings about this whole deal. The very first thing that the front desk did when I checked in was hand me a paper that essentially said that it might take as much as 8 weeks for an insurance decision and not to bug them before the 8 weeks was up. They handed me that before they handed me the HIPAA forms or my paperwork to fill out. I'm getting the impression that they don't want to deal with insurance. The Dr. was fine until I said that I wanted to go through insurance. There was a sudden change in attitude after that. He agreed to submit the pannulectomy for insurance approval, but steadfastly refused to even submit the brachioplasty. He said that they are never approved and there was no point in wasting anyone's time. I explained that I have letters of support from my pcp, chiropractor and physical therapist for the arm surgery along with MRIs because of the physical problems I'm having, but he still refused to submit for insurance approval on the arms. I asked him if he wanted to check my ab muscles to see if I needed to have any muscle tightening done. He said no because he was only submitting for the panni and if I needed muscle tightening, he would go ahead and do it when he got in there for no charge. As for the type of TT, he thought that I would only need the horizontal cut for satisfactory results. I asked about doing the anchor cut and he did say that my tummy would be much smoother if I did the anchor with no excess left at all, but I will have a scar (of course). It's up to me to decide what I want. Either way, he'll remove 8 to 10 pounds of skin from the belly. The arms will have an elbow to armpit scar, but he says that all the excess will be gone and they will be perfectly firm. There will probably be at least 2 pounds removed from each arm. Right now I'm in the low 160's. I want to lose at least another 10 or 15 pounds before surgery. He says that right now, without losing another ounce, he can make my tummy flat as a board. The TT is 7500.00 and the arms are 3400.00 So here's my conundrum: The doctor is very highly regarded and I'm impressed with what I've seen him do with other wls patients. I'm not impressed with the attitude towards insurance. I can understand it because he certainly doesn't need the insurance business. This is a Scottsdale plastic surgeon for Pete's sake. For those of you not familiar with Scottsdale, it's referred to as Snottsdale because lots of rich, snooty people who routinely have plastic surgery live there. He's certainly got enough cash paying patients. I could look for another DR who will do the insurance submissions for everything, but there is no gaurantee that anything will be approved. I can go with the panni being approved and pay for the arms myself. I'm not enthused by this guy, but I am enthused by his work. I don't know whether to stick with him or to look for someone else. Do I go with the horizontal cut or the anchor cut? I'll have a better result with the anchor, but a scar. My bikini days are over, but I can't decide which will look better or feel better. Luckily, I don't keloid scar, but there will still be a scar. Hmmmmm... Slightly flabby or a scar? So what do you guys think? What would you do? I'm really looking for some input here. Hugs, Connie

the ins issue bothers me-the attitude you rec'd-- my first instinct is go for the quality work--but he also sounds ****y in saying taht he wouldn't even look at your abs dunno-sorry-no help!

Margo, Your reply does help. I'm also inclined to go with the quality work. I guess I don't have to love the guy to benefit from his surgical skills. Thanks for your feedback. Connie

Connie, I'm getting much the same attitude from the PS surgeon I'm pursuing; my consult with him is on 4/25, the soonest I could get after booking it 2 months ago. His office "help" went into a litany of reasons why my insurance probably won't approve any of the surgeries. Based on your post, now I get why. They don't need the hassle. Period. They got plenty of "cash cow" business. Why don't you do this -- keep moving forward with this surgeon but get a consult with another. Call your surgeon's office (the one who performed your WLS) and get their recommendations for one or two other PSurgeons. As for which type of cut, I don't know what the anchor cut is, can you explain? Otherwise, I am trying to treat this the same way I buy a used car: I don't have to marry the saleman, I just have to drive his car off the lot and then I never have to see the bum again! Do whatever it is you need to do to get the very best result with as little out-of-pocket cost to you as possible. By the way, are you getting the boobs done too? Take care, good luck with this and keep us posted! Reenie

Hey Reenie, The anchor cut is a verticle cut down the abdomen along with the bikini cut that goes from hip to hip. This give you a more defined waist and removes more skin, but there is the visible verticle scar. The regular tummy tuck just has the scar that runs hip to hip and the scar is usually not visible in a swimming suit (even a bikini). Mind you that at the age of 44, my bikini days are over. However, having never had a tiny waist and flat belly, I'm really wanting that now. I've worked very hard on my abs over the last year and under this flab and skin are abs of steel. My physical therapist is in awe and says that she can't even keep up with my ab routine. Even with the extra skin, you can see muscles at the top of my abdominal area. It's sheer vanity that wants to get rid of as much skin as possible so I can have cut abs. On the other hand - there will be that long scar running down the center of my gut. I feel silly and vain for having such a hard time deciding on this. As for the boobs, Dr. Personality wouldn't even discuss my boobies yesterday. He said since I want arms and tummy done first, we'll do those and then worry about the boobs later. Usually people want to do tummy, boobs, arms and then thighs. My arms have a higher priority than the boobs. Dr. P and I agree that it would be too much to throw the girls into the arm/tummy mix so they will have to wait. They're getting done later though. I'll probably see someone else for them. I met a dental hygeinist who had the most magnificent set of girls I've ever seen. She gave me the name of her doctor so I'll probably go to him for that job since I'll probably be self pay. I like your used car analogy. You're right, I don't have to go home with this guy. I just have to sport his handywork and I want the best. He's not the cheapest salesman so he'd better be damned good. Hugs, Connie

Connie, am I reading wrong or are you and the surgeon discussing doing the tummy and arms simultaneously? because I have heard that for best healing, you want to take it easy on your arms after surgery, and if your gut was just cut open, you'd be using your arms a lot. I consulted with three different surgeons/teams for my RNY so of course I'm going to say that I think you should have at least one other consult. I could have gone in-network for my RNY surgery but the surgeon who accepted my insurance, while he seemed very nice, was just kicking off a new program and had done less than ten procedures. I opted to pay $3500 myself (the difference between the surgeons' bills and my out-of-network benefits) and go with a more experienced team. In the end if you have confidence in a quality guy who costs more (but you could still afford it) I'd say go with a quality guy. As was pointed out, the good ones don't need to take insurance jobs... unfortunately, the flip side of that suggests that the ones who do need to take insurance... Hey one more thing - take your time on this decision. I'm really hoping you find someone that's just as quality but more comfortable for you. Jen

To me the prices seem kind of high. I was quoted $7500.00 but that was for the full belt lipectomy. That is the one that goes all the way around the waist. I was approved by my insurance for the abdominoplasty but I have too pay for the back. I actually just found out yesterday that it was approved. I am very excited. If your Dr. is treating you poorly then I would find a different one. Nick

So here's another thought (what's that Willie Nelson tune..."You are always on my mind...") - you already have a vertical cut from the WL surgery, right? If they do the anchor cut, which it sounds as if that will produce a better result, they will just be cutting over the scar you already have, so why not opt for that? Unless I'm not understanding something here and I'm sure the vertical incision will be much longer than the one you have now...what do you think? Reenie

Reenie, I had my RNY done laproscopically. If it had been done open, I'd be having no problem with this decision because I'd already have a scar. As it is now, my lap scars are very minimal, that's my hesitation with the vertical cut. The more I'm thinking and talking about this, the more I think I'll go with the vertical scar. I've talked to several male friends about this and they all say go with the tighter abs and vertical scar. That's not why I'm leaning towards vertical, but it's funny that the scar wouldn't be as unattractive as the leftover pudge to them. I'm leaning towards the vertical scar because that gives me the best chance at ripped abs. I've always been strong and worked my muscles. Even at my fattest, I had some hellacious ab muscles under all the flab because I've always worked out. I've never been able to see the results of all my muscle work and the thought of being able to see the results is pretty appealing. I do volunteer work with a gang prevention organization and was at a conference all morning. One of the groups there was a performance troop that does a Brazilian dance/martial arts thing. Those kids were really cut. The whole group couldn't have mustered up an ounce of fat among the whole lot of them. I'm not delusional enough to think that I will look anything like any one of them, but it made me even more determined to work on muscle definition. So I'm off to the gym again. Reenie - thanks for all your advice, support and thoughts on this. I'm so surprised that I'm in a conundrum about this, but it helps to have you think it through with me. Hugs, Connie

Yep, now it makes sense! I hadn't even considered you may have had laproscopic surgery so of course you would be concerned about adding that big ol' vertical scar. I think the advice you're getting from other folks is quite valuable, Connie, why don't you get a 2nd consult with another surgeon just so you have a basis for comparison. I'm planning to do likewise. These hernias are really bothering me and I want to get this done as soon as I can. Take care, sweeite. Reenie