Two different consults, two very different opinions...

Hi, this is my first post on the plastic surgery board! I am down now 160 pounds  from my highest weight (my weight has been stable for about 7 months), and I am looking into getting this skin suit removed. I have completed the two consultations that I had scheduled, and now I am thoroughly confused….  

The first surgeon recommended a fleur-de-lis abdominoplasty (with the anchor cut) and a medial thigh lift with the incision to the knee. He said that the fleur-de-lis would allow more skin to be removed from my abdomen and my waist to be cinched in more. I completely understand his recommendation, but I am a little unsure if I am comfortable with the additional vertical scar. These two procedures could be done together.   

The second surgeon had a completely different opinion. She not only no longer does the fleur-de-lis abdominoplasty because of the increased complications associated with the additional incision, but she said even with those problems aside, she did not feel that would be the best option for me. I carry the majority of my remaining excess weight on my thighs and butt, and cinching in my waist that tight will make my upper body even more out of proportion from my lower body. She makes a valid point, and this is something I am concerned about. However, she did stress that with the amount of skin that I will be having removed, I WILL have dog ears from the abdominoplasty. She also did not feel that I was a candidate for a thigh lift at this time. She recommended I have the abdominoplasty and an arm lift first, and try to lose an additional 50 pounds before I could have any more lower body work done. Umm trust me, if I could lose another 50 pounds, I would. She did acknowledge that this might not be possible, and then I would need large volume liposuction of the hips and thighs, wait at least six months, before I finish the lower body lift (which would take care of the dog ears) and the inner thigh lift. So, three major surgeries and about 2 years of recovery time.  

Has anyone not gone for the fleur-de-lis and wish they had? 
Did anyone have problems with dog ears after surgery? I’m just wondering if this really is more common when large amounts of skin are removed, or if it’s a matter of surgical technique.   

Both doctors are board certified plastic surgeons with a large amount of experience with post-bariatric patients, and they both come highly recommended. But after looking at the before and after pictures of their patients, I feel more confident in the first surgeons skill, but still don’t know if I want the fleur-de-lis. Oh, and to make my decision more difficult, my insurance will most likely pay for the full abdominoplasty (not just the skin removal), but only if I go to second doctor, since she is in my network. Uggghhh….  

-Angela

 I know what you mean about very different opinions.  I went to three surgeons and all three had different ideas on what to do as well as how to do it.  I'd recommend at least one more consult.
Good luck!

Looking at your pictures, I agree with doctor #2. I would not worry about losing more weight, you have obviously done an excellent job, but it does appear as though you should have some lipo on your outer thighs. For most people, the outer thighs line up with the shoulders. I don't think you'd be happy if everything else is done and they remain out of proportion.

 I would advise going to more consults. I went to 4 and they all told me something different- I took the info and chose what i wanted and the best doctor.

I had a similar body disposition as you do now. I had a LBL with lipo of the thighs (the fat pockets were resistant to exercise) and will be having a thigh lift (down to the knee) after I see the full results of the lipo. 

Good luck, it's a difficult decision to make.  

Thank you everyone for the input, I appreciate it. The first doctor was offering me the options to remove the skin from the areas that inhibit my daily life, and was very good about not offering any procedures that I did not ask about. The second doctor was just explaining all the options available to aggressively change my body size and shape. I think before I have any more consultations, I need to decide what my goals are and how far I am willing to go….

I totally understand your dilema. No matter how many surgeons you see, you will get a different opinion from each.

Don't hesitate to go back to each and ask questions, even after your consult.
I'd pose the question as such: " I understand and respect that each surgeon has his or her own approach to dealing with my situation. I would however, like to understand why you wouldn't choose to do an anchor cut.  Can you thoroughly explain this to me, since another surgeon is recommending this I want to understand more clearly where each surgeon is coming from in order to be more confident in my decision."

It is a very major procedure and I take it extremely seriously.  Trying to get the biggest bang for ones buck isn't always the best choice. Sometimes in order for these procedures to be done at their best, they need to be done individually. (ex.  lower body lift then a thigh lift).  Mainly due to time constraints under anethesia. I don't want my surgeon taking shortcuts or in order to  get everything done. Just something to keep in mind. I know we all want it now, and having to do 3 recoveries is a lot.

Anyway, your heading the the right direction. Just  be sure you are comfortable  with who you choose.

I actually think going back to the first surgeon and asking more questions is what I am going to do. I researched for months before I decided which surgeons to consult with, and the only other doctor in the city that I would see is out on maternity leave. During my second consult, I was able to do exactly as you suggested. I let her know what else had been recommended for me, and what my concerns were. For my first consult, I was just way too nervous! 

And let me tell you all, I originally wanted to mostly focus on my lower body and maybe get the arms done. But today, I had an endoscopy because of some burning abdominal pain I’ve had trouble with on and off. As I lay in the bed wearing a hospital gown and no bra, with my saggy boobs tucked into my armpits, surrounded by three young, very hot male doctors, my feelings about needing a breast lift suddenly changed lol…

I would urge you to get a few more opinions. I know that they require a lot of time and effort to go to. I hade 7 consults. Each consult you learn more and more and get a better understanding of what you want, what is most important to you and learn more and more you want to ask further surgeons. The first four surgeons I met with all gave me different recommendations. Based on those I had better questions to ask the last 3. I was able to e-mail the 4 earlier surgeons more questions based on my later consults. I ultimately opted to go with surgeon number 5 based on my research and his answers to further questions and the fact that I had concerns and has some techniques I wanted to explore and he was willing to do. I.e. I learned about the z scar on the arms and wanted that. He doesn't traditionally do the z scar but after we talked we decided it was the best solution for me. He was also willing to do a transverse scar on my upper stomach based on the fact that I'm not concerned about scars. I found that they need to be willing to not just answer your questions but ultimately discuss what you want done also and work together on the procedures.

You can also take pics from the front, side, back and other side and send to Dr Sauceda at [email protected] and he'll give you his opinion on what he can do for you and send you a quote.  You can have several procedures at once with one recovery as his wife uses an epidural and twilight sedation.  We have a group here, if you want to see some of his work.  Click on Dr Sauceda in my siggy line.  He'll also be up front if he feels you should try to lose more weight, but if you've been weight stable for 7mo, that may be it...