Plastics

Hi Everyone, After a very long time off the boards, I'm back   I had my surgery Jan. 06 and have lost almost 115 lbs. (I'm short -- so this is a lot for me).  I'm thinking 'time for plastics'.  My support group is having a plastic surgeon guest speaker tonight.  Any words of wisdom out there?  What should I be looking for?  Any red flags I should see that he's the 'wrong guy' to do surgery?  I had MANY complicatioins from my original surgery (and emergency surgery that followed), so I'm hoping this will be easier.  I'm doing great now, and feel better than I have in years.  I've started college (at 40 something, this is a first for me), and am keeping very busy. Thanks for any help you can give me. Dana from Michigan

Dear Dana, I just had my arms done and a breast reduction.  There aren't many options when it comes to plastic surgeons here, so I had to pretty much go with who was available.  I did consult with two different surgeons because the first one didn't "sit well."   To me one of the most important things is trying to get a sense of a realistic expectation.  My arms were very heavy--lots of skin--so I didn't wind up with suddenly skinny arms.  But they are contoured to match the lower part of my arm, so it looks natural.  Also, listen for the "why" behind what the ps says.  Mine doesn't do really tight arms as that tends to create more pulling during healing and bigger scars.   Th first doctor I went to didn't seem very confident about the surgery.  I don't want someone who doesn't think he can do it.  Even if he believes it will be difficult, I want him to be challenged to solve the problem rather than just wimp out! If they have pictures, be sure to look at them, especially the ones that are most similar to you.   Ask about possible complications, and what they do if one happens. Ask about length of surgery, especially if you are having more than one procedure done at a time. Ask about how your previous problems will or won't be red flags for plastics.   And good luck at college! Sally

Dear Sally, Thank you for all your help !!  I am looking to have a tummy tuck and hernia repair done first.  My arms aren't bad, so I doubt I'll do anything about them.  I carried most of my weight in my hips and legs, so that may be in my future too. The confidence issue is a really good idea.  I think your ideas about 'not too tight' are good too, as I'm a little concerned about having a 'skinny' waist and 'bigger' hips. Thanks a bunch for all your help !! Dana

Hi Dana, I had to do a double take at your location, because I, too, am going to a support group tonight that is featuring my hopefully future plastic surgeon.  This is the guy that my regular surgeon normally works with, and I have to have a hernia repair, too.  I am wondering if I *have* to chose someone that he works with?  This guy comes highly recommended but if I don't like him, I have tons of options in NYC.  I just don't understand who will repair my hernia if I chose a different plastic guy.

Anyway, good luck and thanks for posing the question.

xosm

you could go to a ps who is double board certified in general surgery as well as plastic surgery - then he could do both with one surgeon - one surgeon bill... You can choose whoever  YOU like.  I have a long list of questions I will post.  HUGS

Here is some info I have compiled over time - lots more on my profile!

##### INTERVIEWING YOUR SURGEON / PLASTIC SURGEON##### First and foremost, do your homework before you see a plastic surgeon. Be sure you are at a stable weight that you can maintain comfortably. It will not be good for your results if you are gaining and/or losing much weight post plastics. Here is some suggested reading material. The Smart Woman's Guide to Plastic Surgery : Essential Information from a Female Plastic Surgeon by Jean Loftus, MD all the pros , cons etc and descriptions of about any surgery you can think of Science on Trial by Marcia Angell about the silicone breast implant controversy The Best Breast: The Ultimate, Discriminating Woman's Guide to Breast Augmentation by John Tebbits Lots of info about breast surgery. also the website www.implantinfo.com has everything you ever needed to know before getting implants, and hundreds of photos in the photo gallery. I have compiled a list of questions of what I think is important to ask a plastic surgeon. Many of the questions could equally apply to any surgeon/doctor. It can be very intimidating to really interview a doctor and ask tough questions about their qualifications, experience. With each Dr. I have consulted, I checked out their credentials prior to the initial appointment. www.abms.org has their certifications. In Illinois, where I live you can look on the web site for the Department of Professional Regulation and find out if the doctor has had any disciplinary action against his license. This will only report disciplinary action. If there was a complaint that did not have enough evidence and there was no disciplinary action it is not reported. It is a fairly difficult process for the consumer to go thru the reporting process, and I think many people are intimidated out of it, or don't have the knowledge/resources to deal with it. It will not tell you whether or not he/she has been sued. That info is very difficult to find out. If you have access to a legal search engine such as Lexis-Nexus you "might" be able to get info if there was a court judgment. Most seem to be settled out of court. Also there are many good Drs. who are sued *****ally did nothing wrong, and it is difficult to filter that out from the ones who are really incompetent. Go on your gut instincts. Interview several doctors. If ANYTHING you are being told makes you uncomfortable, do yourself a favor and don't proceed until you are comfortable. There are a lot of really good, really caring docs out there and you deserve the very best. This is your body and you will be living in it for the rest of your life, long after the doctor has forgotten your name. I saw a program "Plastic Surgery Nightmares" and one of the Drs. who was fixing badly botched plastic surgeries made the statement that the bad doctors don't even know they are bad. They think they are just fine. That really struck me that a doctor might have all the right answers but not the skill to go with it. Having a board certification in plastics tells you he has been thru an appropriate training. Be sure the certification is from the ASPS. Unfortunately any Dr. can call himself a plastic surgeon. A dermatologist can take some weekend seminars and do plastics. You need a person who was trained as a surgeon. Here is my list of questions. What are your certifications? ( My minimum standard , board certified in general surgery *and* Plastic surgery, & recognized by the ABMS, the only really credible certifications are recognized, If they have the certifications they are happy to brag about it. anyone who is an MD can call legally themselves a plastic surgeon whether they have the right training or not, also verify their certifications thru www.abms.org) Where are your surgeries performed? If it is in an outpatient surgery center, Is it an accredited facility? Is he on staff at a hospital? If the Dr. Is NOT on staff at a hospital this is a major red flag. Out patient? (I prefer to go home the same day!) What do you think you are best at? Specialty Who assists you in surgery? another MD , surgery tech, resident? Experience with procedures I need? - How many, how often? Bariatric patients - How many do you / have you done? Pictures before & afters of procedures I want Do you have a previous bariatric pt I can talk to about their experience? Pros & Cons of this surgery. what can I realistically expect? Can I get a better result with a different procedures? Preop procedure? Testing? When? where? How long does this surgery take / anesthesia time who does anesthesia? MD or CRNA? (I'd be happy with either to be honest, just like to know) Follow up care- how soon, how often, how long? Compression garment/ ace wraps? Pain control? OnQ? Return to exercise? Cost of surgery? Including anesthesia and OR charges? Payment plans? Revision policy? How do you close incisions? Stitches under skin vs. staples (if they say staples just leave, don't go back) Scar Care, treatment & prevention? Any other suggestions? Anything I should have asked and didn't? ************************************************************

Willow, THANK YOU for your help.  After reading your list of questions, I already don't like the first surgeon I've met.  I did get a referral from another support group member for a surgeon she really likes.  She showed me her scars, and the work he did was wonderful, so I'm going to make an appointment with him. Thanks again for all your help !!   Dana

Thank you, Willow.

I don't have the luxury of much time in my search, as my surgeon has said he'd like the hernia repaired within a month because of it's size and potential for problems.  Personally, I would like to lose at least another 10 pounds, which is entirely possible in the one to three months before the surgery [I'm realistic, I don't think this will happen in a month, I am hoping for May].  I wish I had time to get down to that weight and stay there a while, but I also wish I had more time so I save more money towards a boob lift, as I don't know how that could get covered.  I believe my goal weight [the very high end of normal BMI] is more than realistic and maintainable, but it would be nice to have time to prove it!

I really liked the plastics guy I met Thursday, I have an appointment to see him in his office on April 3rd.  His speciality is actually reconstructing bodies of folks who have loss a large amount of weight.  He said that with the increase of WLS, this branch of surgery is becoming a speciality of it's own.  He showed a lot of pictures of what to expect as far as looks and scars [the scars don't bother me, I already have a ton from my c-section, lap to open RnY and past gallbladder removal, the fat apron DOES].  He will combine procedures [ideally, I'd like to have tummy and boobs, but we shall see what I can afford] but not so that he is operating for longer than 4 hours.  He showed pics of the compression garments, and some breakdowns of how much one can expect to be covered by insurance, if at all.

I printed out your list and will ask the more detailed questions at my visit.  He is waiving the large consultation fee for me, which is a big relief [and gives me more options on seeking a second opinion because I will have that money].  I will also be checking up on him with the links you provided as well as asking if there are past patients I can actually speak with [he does the majority of my WLS docs patients who seek plastics].

Again, thanks so very much for taking the time to share your thoughts and information.

Personally.... I would go to several surgeons for various opinions. If you have the time to "shop around". I would stick with someone that has a background in body contouring and weight loss. Not all surgeons do have experience in this area. Also stick with someone who is ASPS certified. Those are just my tips. Go with someone you are most comfortable with and you feel will give you the best results.

Who was the plastic surgeon?  Just curious. Take care, Carey