What ?'s should I ask when going to Plastic Surgeon

To all of you who have gone to a plastic surgeon - what ?'s should I be asking?  I have my first consultation on Thursday.  I plan on getting a tummy tuck and a breast reconstruction.  Hopefully I can get this done in January of next year and then 6 months later get my arms done (it looks like I have bat wings!!) 

Any advice, suggestions, or ?s that I should ask. 
Thanks!

 

 

http://www.obesityhelp.com/forums/plasticsurgery/
http://health.groups.yahoo.com/group/GastricBypass-PlasticSurgery/
http://groups.yahoo.com/group/ossgplasticsurgery2/
http://groups.yahoo.com/group/WLSandPlasticSurgery/
http://health.groups.yahoo.com/group/OSSG_Reconstructive_Plastic_Surgery/
Some other sites to look at:
http://www.plasticsurgery.org/
http://www.abplsurg.org/index.htm
http://www.surgery.org/public/index.php
http://www.tuckthattummy.com/

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Hello: I know you already had a consult but knowledge is power here is all the info I have articles,links etc! I feel it was imperative to know what I wanted and seek out the best PS for me, it my take several visits to same or different to get the right fit! Be well.



Some groups to ask ? and look at pics etc!

 

Questions to ask your plastic surgeon
http://www.amylhwilliams.com/questionsforplasticsurgeon.html
 

Original page:
http://www.webmd.com/content/Article/128/117102.htm

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The Facts About Body-Contouring Surgery

When you lose 100 pounds or more, what happens to the extra skin? For many, the answer lies in body-contouring surgery.

By Colette  Bouchez
WebMD Weight Loss Clinic

When author Frances Kuffel reached her goal weight -- after losing more than 200 pounds -- she didn't even realize how far she'd come.

"I kept thinking 'I'm still fat; I still look awful.' Someone else had to point out that my problem was no longer fat -- it was skin, all this excess skin from losing so much weight," says Kuffel, author of Passing for Thin.

As weight loss surgery becomes more popular, weight losses of 100 pounds or more are becoming common. But, experts say, the result can be at once rewarding and cruel, as layers of excess skin replace lost layers of fat.

"People who lose 100 pounds or more feel healthier, they know they are healthier, they can do things they could not do before. But when they look at their body, it's a constant reminder of where they were – and it can sometimes make it difficult to move on with their life," says J. Peter Rubin, MD, director of the Life After Weight Loss Surgery Center at the University of Pittsburgh School of Medicine.

A relatively new medical subspecialty, body-contouring plastic surgery was developed to address the aesthetic concerns of those who have lost large amounts of weight -- whether through dieting alone or with the help of weight loss (bariatric) surgery.

"Very often, it's that final step in achieving the body that many people envisioned they would have when they signed on for weight loss surgery," says Stephen Colon, MD, chief of plastic surgery at Hackensack University Medical Center in New Jersey.

According to the American Society of Plastic Surgeons, in 2005 more than 68,000 people opted for body-contouring surgery following weight loss – an increase of 22% over 2004.

Types of Body-Contouring Surgery

While operations like the tummy tuck and breast lift have been around for decades, what makes body-contouring surgery different is both the amount of skin that is removed and the fact that procedures usually cover more than one area of the body.

"The most popular [procedure] in our center is the lower body lift, whi*****ludes the tummy, outer thighs, and the area around the midsection," says Rubin.

Other choices include an upper body lift, which focuses on the breasts and back, as well as lifts for the arms, inner thighs, and the face and neck.

Because some of these operations can be lengthy, one of the newest approaches is to use two or more surgeons working simultaneously on a single patient, Colon says. This helps reduce the amount of time spent under anesthesia, and that, in turn, may speed recovery, he says.

But even with a surgical team, Rubin says, a multiprocedure involving the abdomen, a lower body lift, breast lift and arms -- a common combination -- could last eight or more hours.

How Safe Is It?

Among problems that have been cited are wound infection, reopening of wounds needing surgical drainage, and excess bleeding requiring a second surgery, Rubin says. Blood transfusions are also needed about 15% of the time. In rare instances, patients have developed fatal blood clots.

While some of these problems still occur (notably the need for transfusions), experts say it's on a much smaller scale in the last few years. In a study presented in 2003 at an American Society of Plastic Surgeons conference in San Diego, researchers found that many such complications could be avoided if patients allowed more time to elapse between weight loss surgery and plastic surgery.

The research reported that patients who underwent bariatric surgery (weight loss surgery on the stomach and/or intestines) who waited about a year before undergoing body-contouring surgery saw a reduction in the complication rate -- and ended up with shorter hospital stays. The researchers also reported that waiting allowed the death rate to drop dramatically, from 14% for those who had body-contouring surgery soon after losing the weight, to 0% for those who waited.

Today, Colon says, most patients are advised to wait at least one year after bariatric surgery.

But even when patients do wait, problems can still occur -- including a dramatic loosening of the newly tightened skin that sometimes requires a second round of surgery, Rubin says.

"We can't predict who will be affected and we don't know why it happens, but it does. Some people actually need more surgery," says Rubin.

Body Contouring: Is It For You?

Not everyone who loses a lot of weight needs body-contouring surgery. Moreover, experts say, not everyone needs it for the entire body.

"A lot depends on your age, your genetics, level of sun exposure, how evenly the weight was distributed, and, more importantly, how you feel when you look in the mirror," says Colon. "If you're not unhappy about the way you look, you shouldn't be made to feel you need body- contouring surgery."

Those least likely to want or need the procedure, he says, are usually under age 40. "The majority of the patients I see for this surgery are over 40. It's pretty hard to avoid the slackening effect of the skin after that age," says Colon.

What can also make a difference, however, is where you lose the weight. While a loss of 50 pounds that was concentrated in your midsection might leave you with a lot of loose skin in that area, a 100-pound loss that was more evenly distributed on your body may have less of an effect on skin.

If you do end up with droopy, sagging skin and think there's some other way around it, experts say, forget it.

"Short of surgery, there is really nothing that can help. Exercise won't tighten it, and skin creams and lotions won't do a thing to help," says Nolan Karp, MD, associate professor of plastic surgery at New York University Medical Center.

But body contouring doesn't come cheap. The average price of a full-body lift is around $30,000. Arm surgery runs in the range of $8,000, while inner thighs cost about $10,000 a pair. A breast lift and upper back surgery will set you back about $15,000, and a neck and face lift would add another $15,000 to the bill. (As you probably already guessed, insurance rarely covers any of it.)

When you add to this the need for four to six weeks of at-home recovery, for many, spandex can seem like the only viable option.

In an attempt to make things easier, many doctors use finance companies to help patients work out a kind of "plastic surgery mortgage" -- a payment plan that allows you to reduce the size of your midsection without paying an arm and a leg up front.

Doctors say they also help patients rationalize the expenditure, frequently comparing it to the purchase of a new car.

"Many people wouldn't hesitate to spend $30,000 for a new car. So I ask them, after all that hard work losing the weight, aren't you worth the same $30,000 to look the way you want to look?" says Karp.

7 Things to Do Before Having Surgery

If you are considering body-contouring surgery, here's what experts we talked to said you should do first:

1. Stabilize your weight -- at your goal -- for at least three months, and be sure to correct all nutritional deficiencies (which are common after weight loss surgery).
2. Establish a reliable support network of family and friends to help you during recovery.
3. Make sure you can get enough time off from work to recover. It will take 4-6 weeks depending on the procedure.
4. Understand that everything is a trade-off between removing skin, getting a contour, and having a scar. Scars are permanent. They do get lighter, but don't disappear over time.
5. Prioritize your body according to the area that bothers you the most, and concentrate your surgery there first. You may find you don't need additional procedures.
6. Prior to surgery, stop smoking (to reduce complications) and increase your protein intake to 50 to 70 grams per day to speed healing.
7. Choose a surgeon who is board-certified in plastic and reconstructive surgery -- not just a board-certified doctor.

Published October 13, 2006.

 

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What To Expect From Your Plastic Surgery Consultation

Questions to ask your plastic surgeon

After losing a considerable amount of weight, many bariatric patients will turn to a plastic surgeon to contour their bodies and remove the excess, sagging skin. This article describes what to expect from the initial consultation and how to best prepare for this experience. The more information you have beforehand, the more you will be able to absorb during the consultation without being overwhelmed. With a list of questions prepared prior to your visit, you can make sure you don’t forget to ask any of the essential questions.

Choosing a plastic surgeon is a very important decision that should be made very carefully. Consider at least 3 board certified plastic surgeons before making your decision. Some surgeons may have more experience than others with some of the surgical procedures you may be interested in, while other surgeons may have more recent and possibly more extensive training in the latest surgical techniques for body contouring after massive weight loss. Ask your bariatric surgeon and other bariatric patients for their recommendations, and make sure the surgeon you are considering is board certified by The American Board of Plastic Surgery and is a member of The American Society of Plastic Surgeons (www.plasticsurgery.org), the largest plastic surgery organization that also requires board certification for membership.

It may also be helpful to have someone accompany you to your consultation because the opinion of a trusted friend, relative or significant other may be extremely valuable. It is also a good idea for the person who is going to care for you during your recovery period to be the person you choose to accompany you on your consultations.

The Surgeon's Office

Upon arrival to the physician's office, typically you will be greeted by a receptionist and asked to fill out a new patient information form detailing your specific information and health history. When completing this form, be completely honest and thorough, as the information you provide helps to prevent complications during your care. When asked about medications, be sure to include any vitamin or herbal preparations, as these can affect your blood pressure and clotting ability. Honesty regarding your use of tobacco and alcohol also is very important, as this may have a profound impact on your recovery period and incision healing.

The receptionist may give you a practice brochure or resume detailing the surgeon's background, training, experience, and board certification status. Confirm that the information is consistent with the background data you gathered. Ask the surgeon to explain any discrepancies you discover. If attempts are made to deceive you, you should find another physician.

While waiting, take note of the following:

• Did you receive prompt, pleasant, and professional service upon arrival?
• Does the receptionist appear organized, helpful, friendly, and attentive?
• Does the decor appeal to you? This decor reflects the surgeon's aesthetic sense and taste.
• Does the office make you feel comfortable or nervous?
• Are you bombarded with advertisements to sell you products, or are you allowed to wait quietly in a tastefully decorated, well kept, and professional room?
• When invited from the waiting area into the office, take note of the following:
• How long was your wait in the reception area?
• Were you invited into the office at the time of, before, or after the scheduled time for your appointment?
• The staff, office decor, and scheduling procedures are an extension of the surgeon's personality. Your satisfaction with these elements is very important.

Before Meeting the Surgeon Nurse

Initially, you may meet with a nurse or a patient coordinator. This staff member is familiar with the surgeon's style and aesthetic sense and usually can competently assess a patient and answer many questions. This staff member also may become your liaison with the physician when the physician is not immediately available. You will come to know the nurse or patient coordinator quite well over the course of your surgery and recovery period, so it is wise to befriend this important staff member. In addition, you can quickly get a sense of whether or not a pleasant work environment and job satisfaction exist in this office setting.

Tour

You may be provided with a tour of the facility, particularly if the physician performs surgery in the office. Take note of the cleanliness of the facility. Would you feel comfortable having surgery performed in the office?

Chaperone

A chaperone (the nurse or patient coordinator) should be present when the surgeon is in the room with you. The chaperone acts as a witness to corroborate or deny any claims of untoward behavior between physician and patient. The door should be left ajar if the chaperone has to leave the room.

Meeting the Surgeon

Finally, you will meet the surgeon. The length of initial consultation may be as brief as 15 minutes or longer than an hour, depending on the complexity of issues involved. Initial impressions are extremely important. Is the surgeon dressed and groomed in accordance with your idea of professionalism? This may indicate to you immediately whether or not the surgeon is someone in whom you wish to place your trust.

The surgeon will introduce himself or herself and offer a few introductory remarks. The surgeon should clearly explain his or her credentials, education, training, and experience. Feel free to ask about the surgeon's background. A well-trained surgeon is proud of his or her accomplishments and will gladly share them with you. You also have a right to know the status of malpractice claims and awards. It should not be considered an insult to inquire about these issues. Avoid a surgeon who has multiple malpractice claims or awards. Also make sure that the surgeon carries malpractice insurance; not all states require physicians to do so.

The Consultation

Several factors regarding surgery should be discussed with the physician during initial consultation, including procedure, location, anesthesia, recovery, and cost. A clear understanding of these factors will help you to make a more informed decision.

The surgeon should inquire about your concerns, priorities, and motivations for pursuing surgery, as well as your fears. The surgeon also should try to insure that you have reasonable expectations for the outcome, and, therefore, should explain what is possible and what is not possible.

Questions You Should Ask About the Procedure

• What is the simplest and safest surgery to help me achieve my goals?
• How is the surgery performed?
• What is the expected length of operation?
• Are other options available?
• What results can I expect, and how long do the typical results last?
• Where will scars be located, and how noticeable will they be?
• Will scars fade over time, and how long will this take?

Avoid the surgeon who does things only one way. The beauty of cosmetic surgery as a practitioner is that there are many ways of accomplishing the desired result. Your surgeon should be able to discuss options with you, fully explaining the advantages and disadvantages of each and why one may be recommended over another.

Questions You Should Ask About the Surgeon's Experience With the Procedure

• How many times has the surgeon performed this procedure?
• How long has the surgeon been performing this procedure?
• How many times per year does the surgeon perform the procedure?
• How many patients have required reoperation or touchups?
• What complications may occur?
• How frequently do these complications occur?

Avoid the surgeon who is not appropriately trained in the type of surgery you desire. You may want to ask to speak with other patients who have had the procedure. Most surgeons maintain a list of patients willing to speak with potential new patients. To protect privacy, the surgeon most likely will have the established patient call you rather than give you the patient's phone number.

Another key aspect is to review photos of actual bariatric patients who have had the same procedure(s) you are interested in. If the surgeon cannot show you any pre- and postoperative photos, it is likely that he or she is inexperienced in the procedure(s). Conversely, if the surgeon can show you numerous examples of his or her work with bariatric patients, you can rest assured that this surgeon probably has a thorough knowledge of and experience with bariatric patients and their special needs surrounding surgery.

Questions You Should Ask About Logistical Matters

• What preparation is required the day before and morning of surgery?
• Should my regular medications be taken on the morning of surgery?
• What time should I arrive at the surgery location?
• Should someone drive me?
• Should someone wait at the surgery location or come back later?

Smoking

The surgeon also will discuss smoking with you. Smoking may lead to severe complications and wound healing problems. Your surgeon may not perform certain procedures if you are unwilling to quit smoking for a certain period of time preoperatively and postoperatively. You should view elective cosmetic surgery as a chance to change your life. You can improve your appearance through surgery and improve your health through smoking cessation and improving diet and exercise habits. You should end up looking better, feeling better, and living longer.

Where Your Surgery Will Be Performed

Sometimes you have a choice in the location of your surgery, whether in a hospital, ambulatory surgery center, or office surgery setting. Some surgeons prefer to perform the majority of their procedures in their own office surgery suites as a convenience to themselves and to save money. Others prefer to do only minor procedures in the office while performing more major operations in a local hospital or ambulatory surgery center. The factors to be considered when choosing between office and hospital surgery are discussed below.

Office Surgery Suites

Many physicians have surgical suites in their offices where they perform the majority of their operations. The growth in office-based surgery was influenced by escalating costs of hospital care and the ability of properly trained physicians to perform procedures safely in properly accredited office surgery settings. Due to the differences in overhead, procedures performed in an office setting often are slightly less expensive than those performed in a hospital or ambulatory surgery center. Some hospitals and ambulatory surgery centers, however, have responded to the competition by lowering their fees.

Convenience

Office surgery provides convenience for you and your family by providing for all of your needs in one facility. This approach streamlines service and healthcare delivery in a single facility and is also comfortable and convenient for the surgeon.

Safety

Office surgery is safe when performed by a properly trained physician with appropriate board certification and the necessary safety equipment present and a sound plan to implement in the event of a life-threatening emergency.

Untoward events can occur in any surgery setting, even in the hands of the most skilled and experienced surgeons. Many complications arise from cir****tances beyond the surgeon's control (eg, certain wound infections). On occasion, complications can be the result of the surgeon's lack of adequate training to perform the procedure, an improperly equipped or accredited facility, or an improperly trained staff.

Regulation

Any physician, regardless of his or her training, can open an office surgery suite and advertise as a plastic surgeon and perform plastic surgery on the unsuspecting public. Regulation of office surgery settings is currently voluntary and often substandard. New laws are being passed in an attempt to correct this potential problem. If you decide to have your surgery in an office surgery suite, choosing a physician whose surgery suite is accredited adds an additional level of quality assurance. Accreditation requires that physicians are properly credentialed and that facilities are appropriately equipped and staffed. The American Association for Accreditation of Ambulatory Surgery Facilities (AAASF) is one organization that provides accreditation for office operating rooms. The AAASF may be contacted at 847-949-6058.

Contingencies

Despite thorough training of physicians and staff and accreditation of facilities, emergencies can occur during an office procedure. Emergency plans must be in place and be able to be activated immediately. The surgeon and staff must be familiar with how to activate the emergency system and what each person's role is in the event of an emergency situation. You should inquire about the emergency plans by asking questions as follows:

• What emergency plans and equipment are in place to provide for my needs in the event of an emergency?
• Are the surgeon and staff certified in Advanced Cardiac Life Support (ACLS)?
• Does the surgeon have admitting privileges at a local hospital should problems arise during my office surgery? (Call the hospital to confirm this).
• How would I be transported to this facility?
• Has an adverse event ever occurred in the past?

Do not have surgery performed in any office where you are uncomfortable with the emergency procedures.

Hospital or Ambulatory Surgery Center / Broad Range of Services

Hospitals provide a broad range of services and specialists available close by should any serious complications arise. If you have other medical conditions that make the proposed procedure more risky than usual, your surgeon may opt to perform the procedure in a hospital setting. You should ask your surgeon whether or not your other medical conditions warrant a hospital setting for your surgery.

Physician Privileges

To obtain hospital privileges to perform a procedure, surgeons must provide proof of education, training, and experience. This provides an added level of assurance that the surgeon has been properly educated and trained.

Accreditation

Much like board certification for a physician, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) establishes a baseline standard of excellence among hospitals and is recognized nationwide. You should ask if the hospital where your surgery will be performed is accredited by JCAHO. The JCAHO may be reached at 708-916-5800 for confirmation.

Your wishes for a particular surgery location should be considered, but the ultimate decision should be based on the procedure you are having and your overall health. Avoid a surgeon who operates in his or her office but does not have hospital privileges to perform the same operation. Also avoid a surgeon who operates in his or her office without some accreditation by an ambulatory surgery accreditation association. And finally, avoid any physician claiming to be a plastic surgeon or cosmetic surgeon if they are not certified by The American Board of Plastic Surgery.

Anesthesia

Anesthesia is a complex and essential part of any surgical procedure and must be performed safely. Anesthesiologists and certified nurse anesthetists are specialists with experience in administration of all types of anesthesia. Surgeons also are trained in some types of anesthesia and routinely administer local anesthetics, as well as intramuscular or oral sedation to their patients in conjunction with the surgical procedure.

Several types of anesthesia exist. Your wishes should be considered, but ultimately, the decision as to which type to use is based on your health and the proposed procedure.

General Anesthesia

The deepest form of anesthesia is called general anesthesia. The person providing anesthesia takes over the responsibility of breathing for you. You are sedated and feel no pain. You are unconscious during the procedure and will not remember it.

Deep Intravenous Sedation

Deep intravenous sedation, termed by some as “twilight sleep," is a combination of local anesthetic injected at the site of surgery and intravenous sedation. You breathe for yourself, but you are in a deep sleep throughout the procedure and feel no pain. More than likely, you will not remember the procedure.

Regional Anesthesia

Regional anesthesia numbs a specific portion of the body and is administered by anesthetizing the nerves coursing to that region. This typically is combined with intravenous sedation. You will not feel the procedure, but you may be awake during all or part of the procedure.

Local Anesthesia

Local anesthetics alone may be used for certain small procedures. The operative site is numbed, but you remain wide awake and aware of the procedure being performed. To prevent anxiety, you may be given a small amount of sedation orally, intravenously, or intramuscularly.

Meeting the Anesthesia Provider

You should ask to meet your anesthesia provider prior to surgery. This gives you the opportunity to discuss with your provider the appropriate type of anesthesia for your proposed surgery and any specific concerns regarding your safety and health.

Recovering From Your Procedure

The recovery period is an important part of the recovery process. Questions you should ask regarding your recovery process include the following:

• What kind of care will I require?
• When will I be able to go home? Is an overnight stay required, or is one available if I prefer?
• Who will attend me in the case of an overnight stay?
• Will I need someone to drive me home?
• If a problem arises after I go home, who answers calls after hours and on weekends?
• If I need to be seen after hours, where will this occur?
• If I need help in my home, is a private duty nurse available? At what cost?
• Are any special garments, medications, or diets required during the recovery period?
• How much pain/swelling/bruising is to be expected? How long are these likely to last?
• How long does the entire healing process last? How many follow-up visits are necessary?
• Who performs the skin care/postoperative follow-up/suture removal? (in some offices, these functions are delegated to the staff).
• When can I wear makeup?
• When may I return to exercise/bathing/driving/normal activities/work?
• At what point will I feel comfortable in a social setting?
• What if I am dissatisfied with the results or with the degree of changes achieved?
• If touchups are necessary, when would these be performed?

Answers to these questions will help you properly prepare for the postoperative period.

Cost of Your Procedure <

During the information-gathering phase of your search, you may have obtained fee information by phone from the office staff of prospective physicians. During the consultation, you will receive a quote of the surgery fees, which should be provided in written form for you to take with you.

Consultation Fees

In competitive regions, surgeons tend to waive consultation fees. In areas with fewer surgeons, consultation fees may not be waived. Even within highly competitive markets, however, some surgeons may charge fees while others may not.

Surgical Fees

Surgical fees vary state to state and within the same city or region. Legally, surgeons cannot discuss fees with other surgeons, so fees may fall over a ver

Thank you soooooo very much!!!  I am going to take the time and go to every one of the sites you suggested.  You must be the "go to lady"!!!!  Thanks again!

I actually attached what I thought was 12 articles they didnt take? if you want them email me off list [email protected]

Hi Jamie,
what else should have been attached?  There was a lot of info should there have been more?

Thanks,
Debbi

Yes indeed this is just 2 articles I have about 8 more if you are interested I can send as word docs if you send me your email address to [email protected]