Weight Loss Wednesday: Did Skin Removal Surgery Live Up to My Expectations?

Yesterday (well, Tuesday, since I'm posting this a day late!) marked the six-year anniversary of my lower body lift (excess skin removal after weight loss). If you're not familiar, and want to read more, here is a page with all the info and posts where I documented the process. In June, I posted an update with new photos and all that, so I won't get into that again now (here is the link to that post).

Instead, I thought I would share about the things that changed as well as the things that didn't change after having the surgery. Before going into something this huge, we obviously have expectations. So, did the surgery live up to mine?

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Cosmetic Expectations     

I would like to say that the main reason I wanted the surgery was entirely because of the problems that come along with loose skin (rashes, inconveniently having to "tuck" your skin into your clothes, etc.). But honestly, my main motivation for the surgery was to feel better about how my skin looked.

Being overweight my whole life, I had never had a flat stomach; and even after I was in really good shape, I had a large drape of skin covering my tight-under-there-somewhere abdomen. I hated the way it looked; and even though I knew I'd have a scar, and my stretch marks were still going to be visible, I just wanted to get rid of the skin.

After the surgery, my abdomen looks pretty flat (when my weight is at goal). The skin is still slightly loose, but the only way to correct that would have been to have a vertical incision down my midline, and I knew I didn't want that.

The lower body lift doesn't do anything to fix the inner thighs, which is why I have so much loose skin there (it's worse than it looks in the photo). But I knew going into the surgery that my thighs wouldn't change, so I won't even get into that here.

One other thing that hadn't crossed my mind before surgery was that I might look asymmetrical after the surgery. I had a lower body lift, but I didn't have an upper body lift. So, I still have lots of loose skin up there--my arms, of course, but also underneath my armpits and across my back. My upper body looks a little bigger than my lower body now. And the sizes might be a little off, too. I wear size 4 jeans, but typically a size 6 on top.

Overall, though, I am thrilled with the results! I don't feel comfortable enough to bare my belly in public (I still have stretch marks and loose skin in other areas). One of the expectations that I had hoped for was to be able to wear a bikini in public. I actually did do this when we went to Punta Cana. I wasn't even at my goal weight at the time! But I adjusted and I felt proud. But my body hasn't seen a bikini since--maybe I'll do it again one day, when I'm feeling brave. Or in a whole other country where I know no one. (Here is the post about my bikini wearing experience).

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Comfort Expectations     

The secondary reason I wanted the surgery was because the excess skin was very uncomfortable. I had to tuck it into my pants, and then it made my pants look weird in front. And running? Ugh. Running with excess skin on my abdomen can only be described like running without a bra--can you imagine running with boobs just flapping everywhere? (Haha! That visual...)

Because of this, I had to wear very tight spandex bottoms--either capris or running tights. The spandex held everything tight against me, so it wouldn't bounce (kind of like a sports bra, only for my abdomen). The spandex wasn't very attractive with my skin crammed in there, so a lot of times, I would wear something else over it. And that was hot in the summer!

You can see in this picture all of the skin in front that I had to squeeze in there, from hip to hip.

Speaking of summer, getting sweaty when loose skin compacted in spandex is basically a rash waiting to happen. I did get rashes both under the "apron" of skin as well as in my belly button. I actually used Destin (baby rash cream!) to make it feel better. The surgery resolved this entire problem. I can wear whatever I'd like to run in, except for shorts--see the "Clothing Expectations" below.

My expectations were high as far as comfort goes. I just wanted to stop getting rashes, stop feeling the skin bounce around when running, and stop having to tuck my skin into my clothes. The only reason I give this 4.5 out of 5 starts is the minor downside to the comfort factor: I still have areas of numbness, particularly on my hips. My abdomen feels fine, back and butt feel good. It's just the outer part of my hips that feel mildly numb. A small trade-off, though, in comparison.

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Clothing Expectations     

The lower body lift is just to remove the excess skin from the abdomen and backside. Because I wasn't having the excess skin on my legs removed, my expectations were only for that of my hips, butt, and thighs.

(If you picture the surgeon cutting an incision all the way around your mid-abdomen, and another circumferential incision on your very low abdomen, you would be left with a belt of skin in the middle. The surgeon removes that belt, and then pulls the top skin down and the bottom skin up until they meet together, and that's where the incisions are glued together.)

Side Note: I knew I still wouldn't be able to wear shorts after this surgery. My expectations were solely for the abdomen. Shorts have always been a problem for me. When I was obese, my thighs rubbed together so much that I would chafe very easily. When I lost the weight, I was left with lots of loose skin on my legs, particularly on my upper inner thighs.

Even if the cosmetic part of my loose thigh skin didn't bother me, running (or even walking) in shorts is extremely uncomfortable! My thigh skin bounces all over the place (again, think of running without a bra). So, shorts are not an option for me. I can wear longer shorts (about knee length) or capris, but nothing much shorter than that. (I chose not to have the thigh surgery for a few reasons, but who knows?--possibly in the future)

After my lower body lift surgery, when getting dressed I still have to do a little adjusting in the thigh area. Usually, when jeans fit my thighs, they are too big in the waist. And when they fit my waist, they are too small in the thighs. I've found that when I wear low-rise pants, I am constantly tugging at them to stay up, even though the hips and waist are fine. So, now I prefer mid-rise pants.

These jeans were the first I wanted to wear after surgery. I LOVED them, but it was hard to tuck my skin in there, so I had a big muffin top. Same with the shirt--I couldn't wear it without my loose skin showing. I was thrilled when I could wear these!

(I actually just learned a technique for taking in the waist of jeans just slightly, so I'm going to practice on a few pairs and hopefully that will help solve it as well.)

I mention this so that others are aware that their clothes may fit differently afterward, even if it's not directly related to the part that is operated on (like my thighs). My thighs are now what give me problems picking out pants, especially low-rise jeans.

Still, though, every time I put on a pair of jeans, feel kind of amazed that I don't have to tuck my abdomen in, or have problems with it spilling out. Even when I was 253 pounds, I was always trying to move things around in my clothes to be more comfortable. My jeans button and zip nicely now! I am grateful for the surgery every time I put on a pair of jeans.

A lot of people ask me if my clothing sized changed. Interestingly (or not), my size was the same. I just didn't have to squeeze the loose skin in there ;)

Clothing expectations were met, except for the one thing that I hadn't thought of, which I explained above. I didn't realize the loose skin in my thighs would make it difficult to find jeans that fit well once I got rid of the loose abdomen skin. So, 4 out of 5 stars.

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Sexy Time Expectations     

(Mom, skip this part, if you're reading--haha). This aspect of surgery was never even on my radar for expectations. Jerry has always thought I look beautiful and hot and I wasn't concerned about anything in this department. But things changed!

Before surgery, I never ever ever felt sexy in lingerie. I either had fat everywhere or loose skin everywhere, and I resented it. Even though Jerry would have loved for me to wear cute lingerie, I just didn't want to because I felt uncomfortable with all of the abdominal skin.

After surgery, I went out and bought something sexy from Victoria's Secret, and I felt amazing in it! I wasn't self conscious at all. I bought probably 6-8 more outfits over the years, and I love how they can change my mood and make me feel confident and, well, sexy.

The best I ever felt was when I did my boudoir photo shoot. I can't even describe how boosting that was for myself self-confidence! I didn't want my pictures photoshopped to make me looking thinner or remove my stretch marks, or anything like that; so the photographer just posed me in very flattering ways. And I was amazed at how good they turned out! (I wasn't even at my goal weight--I think I weighed 140 on this day). Here is one of my favorites:

Photo by the amazing Catherine Kellie in Birmingham, MI

If I hadn't had the surgery, I never would have considered getting a boudoir shoot. BUT, having had one, I still highly recommend that most women get a boudoir shoot, no matter their size, shape, age, scars, stretch marks, etc. The photographers use little tricks to pose us in ways that are most flattering for us as individuals. If you look closely, you can see the stretch marks on my abdomen, but the color of the photo keeps them from being very prominent. This pose would not have made me feel nearly as good if I had done this prior to my surgery.

Now I'm straying from the point, like I tend to do!

I think the biggest thing that the surgery helped out as far as a sexual way is that I just feel a million times more confident. I know there are women who rock sexy outfits when they are overweight, but I just didn't have the confidence for that.

And Jerry's "sexy time" rating?     Hahaha! Of course.

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And the big question.... would I have had the surgery again if I could go back in time. YES. A thousand times, YES.

So there you have it! I am overall a very, very happy girl with the results of my surgery. I think I had pretty realistic expectations going into it. I had maintained my 100+ pound weight loss for a year, and my surgeon knew I'd have fantastic results.

She said a lot of women go in when they are still overweight, hoping that the surgery will make them thin. It doesn't work that way. Being at a goal/target weight for a year is ideal for the best results. (I have several posts dedicated to discussing the whole lower body lift surgery process, start to finish, so you can check it out if you are thinking about having the surgery.)

Anyone else have the surgery, and want to share how it went? Or other skin removal procedures? Did everything go according to your expectations?

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ETA: Oops, I forgot to post my Wednesday Weigh-in!

Still maintaining :)

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Skin Removal Surgery Questions and Answers (2 years post-op)

I get a lot of emails with questions about my lower body lift, and recently, a woman named Andrea sent me a list of questions that she asked me to post about. I had nothing to write about today (it was a very nice rest day!), so I figured I'd answer those questions. Hopefully other people will find this helpful, too!

(For further reference, I have a TON of details on my Skin Removal Surgery page)

Q. How long was it until the swelling was completely gone from your abdomen? Did you  "know" when the swelling was completely gone?

A. Before my surgery, I read a lot about the swelling, and I was expecting the worst. I thought I would going to look like a giant water balloon. But I actually didn't notice it much on a day-to-day basis. I could definitely see that I looked swollen when I compared pictures from one day to the next, but I really just felt a little puffy in my abdomen. There was never a day where I woke up and thought, "Ahhh, relief! The swelling is gone!" I noticed in pictures of my stomach that I looked less puffy. I think the worst of the swelling was on Day 12, and looking at it now, I don't think it was all that bad!

Q. Was it difficult to maintain eating healthy/not gaining weight without the exercise (in that burning calories from running allows one to add calories back into his/her diet)?

A. I actually dropped about 10 pounds after the surgery, which I think is due to the fact that I took my doctor's dietary instructions very seriously. She told me to eat a TON of protein to help my body heal, so I focused on nothing but protein after surgery. I wasn't counting calories or Points, or anything; I just tried to eat as much protein as possible. I didn't limit my carbs at all, but because I was eating so much protein, I probably didn't eat as many carbs as I was used to.

From my experience, I believe that weight loss comes mainly from diet, and very little from exercise. I can train for a marathon and gain 20 pounds (as evidenced while training for my first 26.2!). I wasn't worried about gaining weight due to lack of exercise after surgery, and I focused my diet on healing my body rather than losing weight, so it worked out well :)

Q. Was it easier to notice weight loss (i.e. the last 15 lbs or so you lost post-surgery) after the surgery, because of the lack of excess skin, or did it not really make a difference in that respect?

A. I think the surgery made a huge difference in the last bit of weight loss. My doctor only removed about two and a half pounds of tissue, but after surgery, I think the decrease in size around my abdomen was very noticeable. Even now, when I gain a couple of pounds, I find it very noticeable! I get love handles if my weight gets to 138-ish, but below that, they're gone. It's so weird! Before the surgery, I never would have noticed a weight gain there, because there was so much skin hiding my form.

Q. Did you wear a compression garment and a binder, or was it a single item?

A. It was just a single item, like a huge (very tight) pair of granny panties. There were hooks along the side (like the hooks on a bra) as well as the crotch, so it didn't have to be removed to go to the bathroom. It was actually very comfortable, and I felt weird when I took the compression garment off to shower. Here is a link to the exact one that I had. It was the one my doctor told me to get; different doctors prefer different garments, though.

Q. Do you think that the surgery produced a visible change for people who just see you every day in regular clothes (i.e., should I expect that people who I have not told about the surgery may notice it)?

A. I don't think the change was hugely visible in my clothing, but I always tried to hide the excess skin before my surgery. I didn't wear tight jeans and form-fitting shirts; I could wear tight jeans and a loose sweatshirt, or jeans that would hide my skin and a more form-fitting shirt. After the surgery, I didn't want ANY baggy clothing! I wore tight jeans and fitted shirts, and I still do a lot of the time. But I don't think that people who I saw from time to time would've noticed that I had skin removal surgery. Here is a photo from before surgery and after surgery in the same clothes:

You can see a difference if you're looking for it, but I don't think anyone would have noticed if they hadn't known about my surgery. Without clothes, however, is a completely different story! ;)

Q. How long after the surgery did you start training for your marathon? Did you have any time after you started running when you were just running "for fun," or did you go right into it? 

A. I had the surgery on November 14, 2011, and I "officially" started training for my first marathon on January 16, 2012. I started running again just shy of four weeks after surgery, and I took it very easy for a couple of weeks while I continued to heal from surgery. My doctor actually cleared me to run on Day 8 post-op! But I wasn't much in the mood to run, which I'm sure she expected ;)  By the time I started marathon training, I felt 100% back to my normal self. I still continued to wear my compression garment when I ran, just because I felt more secure, but it wasn't necessary.

Q. About how many post-op appointments did you have in total?

A. I spent one night in the hospital, and my doctor came to see me before I left. Then there was the embarrassing trip to the emergency room about five days post-op. My first "real" post-op appointment was on Day 8, when I had three of my drains removed. My second post-op appointment was on Day 17, when I had the last drain removed (my doctor told me to come in when my drain was producing less than 30 cc's a day).

I had one more post-op visit after six weeks. There was a tiny spot on my incision that needed a minor revision (the skin had folded over slightly as it healed). I went in for an appointment where my doctor fixed that in the office, which only took about 10-15 minutes. I made another appointment for her to check out that spot later, but it healed really well, so I just called her and she said there was no need to come in. That was the last appointment.

Q. Do you remember about how long it was until you stopped feeling any real ab pain, and only felt some soreness, or felt nothing at all?

A. The ab pain was terrible for the first couple of days, but it got much better as the days went on. I can't remember exactly when there was NO muscular soreness, because it continued to get better and better each day, but I think I was pretty much pain-free after a couple of weeks. The worst of it was over after a couple of days post-op, though.

Q. How long was your longest drain in for?

A. I had four drains, two in front (left and right) and two over each hip. I had three of the drains removed on Day 8 post-op, but the last one was in for 17 days! My doctor didn't want to remove it until it was producing less than 30 cc's of drainage per day. I couldn't wait to get that thing out! Even though my body was feeling much better, and I was wanting to try on new clothes and all that, the stupid drain was in the way. I felt much more like myself after the last drain was pulled. And I could sleep on my stomach again! :)

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I'm now a little over two years post-op, and I am still SO SO SO glad that I had the surgery! My scar isn't nearly as bad as I imagined it would be, and across my butt, it's practically invisible. Clothing is much more comfortable, without having to push and poke my skin around to fit into my pants.

Running is more comfortable, because I don't have to worry about the skin bouncing (that used to hurt!). And even though the outward change, while I'm wearing clothing, isn't drastically huge, I feel a million times more confident in how I look. I used to be so self-conscious of my saggy skin, and I hated always trying to hide it. I would do the surgery again in a heartbeat!

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All About My Skin Removal Surgery, Part 2: The good, the bad, and the ugly

Click here to read Part 1 first.

Having a lower body lift after losing well over a hundred pounds was one of the best decisions I've ever made. It's been over seven weeks since surgery, and I'm SO HAPPY that I did it! It wasn't all sunshine and roses, however. Here, I will share the good, the bad, and the ugly parts of the skin removal surgery...

The Good

I'll start with the obvious: My mid-section looks a million times better than it did before surgery! Even from the first day post-op, I was thrilled with the results.

The surgery wasn't nearly as painful as I thought it was going to be. The first few days were rough, which I'll talk about in "The Bad" section, but the rest of recovery was pretty easy. My stomach and incision were completely numb, so it didn't hurt. I switched from Vicodin to Motrin after about a week, and I'm sure I could have done that even sooner.

Before surgery, I was very worried about the incision across my back (which is at the top of each butt cheek, very low). It really scared me to have an incision that went all the way around. But after the surgery, I actually paid very little attention to that part of the incision, because I kind of forgot about it. The back lift part of the lower body lift was the easiest part of the surgery.

The compression garment wasn't nearly as annoying as I'd read about online. Actually, I kind of liked wearing it. It's a secure feeling. It's very tight, but I wasn't uncomfortable wearing it at all.

I was able to move easily on my own after about five days.

I was cleared to start running again (or any exercise except ab work) after just eight days post-op (but I chose to wait until 4 weeks).

I feel SO MUCH MORE CONFIDENT in my body now. I don't feel like I have to "hide" my figure, and I feel confident to wear cute clothes and tight jeans. It has done wonders for my self-esteem!

I recovered very quickly. I thought I would be layed up in bed for six weeks, but I was moving around easily by two weeks post-op.

I didn't have a single complication. This might have been luck, or maybe the fact that I followed my surgeon's instructions right to the tee, but I was very happy not to have any complications.

The Bad

I was extremely nauseous after surgery for about 15 hours. I even dry-heaved a few times in the hospital, and it hurt very badly because my abs were sore. I've never experienced nausea like that! It was so bad that I cried (which made it hurt more).

My mouth was extremely dry after surgery for about 24 hours. I was told that part of the anesthesia causes you to stop producing saliva for about 24 hours. It was extremely difficult to chew and swallow food because I had no saliva in my mouth. I drank a ton of water just to be able to eat.

It's hard to get comfortable while lying down, and it hurt my abs very badly to turn over. I slept on each side and my back, turning every couple of hours so I didn't get too stiff, but turning over was very painful in my abs.

I was extremely weak. I cannot believe how tired I got from everything I did. For about the first week post-op, I became exhausted from something as simple as taking a shower or walking to the bathroom. I would have to do my shower quickly enough so that I could lie back down. I was out of breath from just walking to the bathroom. It was a weird feeling, because I was in great shape prior to surgery, running 3-5 times a week. I can't imagine doing this surgery if I was OUT of shape to start with. The weakness was probably THE hardest part about the surgery.

The drains are a pain in the ass to carry around. I had four of them, and it was impossible to tuck them into my pants, so I had to come up with other creative ways of wearing them. While at home, I just hooked them to my shirt or waist band, not caring that they were visible.

I had a weird burning pain on my thighs for a few weeks. It was a surface pain that felt like I had been burned (like a sunburn). I don't know what it was from--the skin looked totally normal there--but it resolved after a few weeks.

After taking four weeks off from running, I wasn't able to just pick up where I left off. It was painful in my abs, but mostly, my lungs felt like they were on fire from being out of shape. I was very winded, even going at a slow, easy pace.

My hip bones felt very strange for a few weeks post-op. They weren't really painful, but I couldn't stand to press on them or have any pressure on them. I couldn't wear tight jeans for a few weeks because they pressed against my hip bones and it was a very weird, extremely uncomfortable feeling.

My abdominal muscle repair was the most painful part of the surgery. Like I said, my incision didn't hurt, but my ab muscles were sooo sore for about ten days. I walked hunched over for about a week. Sneezing, coughing, and laughing were pretty painful for a couple of weeks.

I had to eat a ton of protein. This is under "The Bad" because I've never been a "protein person". I don't like meat very much, and it's hard to get a lot of protein without eating meat. I ate a LOT of pan-fried salmon, tuna fish, and nuts to get protein. I had a protein shake every morning, and my snacks were string cheese and nuts. My doctor wanted me to get 100+ grams per day, and I complied by getting probably about 130 grams. That is VERY hard to do!

Salmon and parsley potatoes--my lunch every single day!

I definitely needed help around the house for the first five days or so. Luckily, I have a super supportive mom and husband. They took great care of me! When Jerry was at work, my mom came over and did housework for me and helped me move around. Jerry waited on me hand and foot. My parents kept my kids for a few days. This surgery would be extremely difficult to get through if you don't have someone to help you.

The Ugly 

Initially, the incision looks kind of gross. There is a lot of dried, crusty blood, but I didn't want to peel it or pick at it for fear of opening up a wound.

My belly button still looks red and irritated, but it's just the color of the incision right now. It doesn't hurt (and never has) but it looks kind of gross for a while. When I first came home, I had gauze packed in there with tape over it.

On each side, just behind my hips, there was a spot in the incision a couple of inches long that looked puckered. I asked my surgeon about it, and she said that it was normal and after the sutures dissolved, it would smooth out. (She was right, it has smoothed out now). But the first couple of weeks, it looked gross--wrinkled and kind of gathered on the bottom half of the incision. My surgeon said it was from the bottom half being larger than the top half--which makes sense. Of course the skin isn't going to line up perfectly. So it was wrinkled while it healed. (You can see that in the below photo)

My back was very bruised (from about the middle of my back all the way to the incision line). This was from the small amount of liposuction that my surgeon did on my lower back. The bruising didn't hurt, but it sure was ugly!

The drain tubes coming out of my body didn't bother me, but I guess many people would consider it ugly ;)  There was one on my left hip, close to my butt, two just under my pubic hair line (one of the left, one on the right) and one on the front part of my right hip. The one on my left hip was pretty sore and I was relieved to have it removed.

My belly button looked off center at first, and I was worried about having to get a revision down the road to fix it. But it must have been because of swelling or something, because gradually, it centered. It's still a little off, but that's how it was before surgery. The surgeon doesn't actually MOVE your belly button--they just move the skin around it.

The swelling is pretty bad for a few weeks. Immediately after surgery, I was excited to see that I wasn't swollen at all. I thought I was just lucky. Then it hit me after about a week, and I swelled up a lot. Even now, I'm seven weeks out from surgery and my very low abdomen is still swollen--it looks like a baby bump.

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I think that pretty much sums up everything I can come up with about the surgery! Of course, I'm happy to answer questions, so feel free to e-mail me.

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All About My Skin Removal Surgery, Part 1

After losing well over a hundred pounds, I knew I was going to need some skin removal surgery--particularly from my abdomen. My skin was so deflated and saggy, and it got in the way all the time. I got rashes and infections under the "apron" of skin and in my belly button. Running for exercise was hard, because my stomach would bounce up and down, causing a lot of pain.  My clothes didn't fit right, because I had to tuck my extra skin into my pants. And no matter how big my pants, I always had a hangover of skin on my sides (love handles).

I called my insurance company, just to see if it was even possible to get the expensive surgery covered by insurance. Surprisingly, they told me that it's possible. They told me to go see a plastic surgeon, who would determine if it was medically necessary, and then submit the claim. I had no clue what the surgeon would be looking for, and more importantly, I had no clue how to pick a surgeon.

When I went for a consult (I'll explain how I picked my surgeon later), she told me I was a perfect candidate for not just a tummy tuck, like I was planning on, but a lower body lift (also called a belt lipectomy, or circumferential tummy tuck, among other names). Basically, the surgeon makes an incision ALL THE WAY AROUND your lower abdomen, and all the way around your upper abdomen, and then pulls the top down to meet the bottom, and sews it back together. It includes a muscle repair of your abdominal muscles, which pulls your muscles together and gives your stomach the very flat look--rather than a rounded, beer-belly look.

I was very anti-body lift, because I'd heard it was much riskier, and I really didn't care what my butt looked like. However, I eventually decided to get it (I'll explain that more later, too). I had the surgery and am THRILLED with the results! Here, I will write ALL the details for anyone who is considering the surgery. This is all from my own experience--remember, I'm not a doctor! ;)

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Candidates for surgery

This is NOT a weight loss surgery. I can't stress that enough. If you are overweight, you will not get skinny from this surgery. The surgery is meant for people that have lost a large amount of weight and have saggy skin around their middle.

To get an idea of the results you can expect, put your hands on your hips and holding tight, pull up all that skin--you'll notice your hips, butt, and abdomen all lift up tight. If you don't have a lot of flabby skin on your butt or hips, then maybe a tummy tuck would be the way to go. I would talk to a plastic surgeon and see what they recommend.

Insurance

There is a (very small) chance that your insurance company might pay for a part of your surgery. I almost didn't even ask, because I was SO SURE that my insurance company wouldn't cover it--but I'm glad I did, because I was pleasantly surprised to find out that they covered about 3/4 of the cost.

I would call your insurance company ask what the requirements are to get a panniculectomy covered. A panniculectomy is the removal of the "apron" of skin on your lower abdomen. This does NOT include  muscle repair or replacing your belly button to where it should be. I learned that a panniculectomy would be covered, but everything else would be considered cosmetic, and I would have to pay out of pocket for that.

The requirements for MY insurance to cover the panniculectomy were: 1) Must have lost at least 100 pounds; 2) Must have kept the weight off for at least 6 months, and 3) Must have rashes caused from the excess skin. Since I met those three requirements, my insurance covered that part.

The rest of my surgery--muscle repair, replacing my belly button (both of which are included in a full tummy tuck, or abdominoplasty), and the hip and butt lift part were considered cosmetic, and not covered by insurance.

Choosing a plastic surgeon

My selection process was actually quite simple. I only went to one consult and decided she was the surgeon for me. But first, to select a surgeon, I decided that I wanted to pick someone in the Henry Ford Health System. I've seen great doctors in that system, and I used to work for a fantastic OB/GYN in the HFHS. My jaw surgeries were at Henry Ford Main Hospital in Detroit, and I was happy with how everything went. So I started looking online at the plastic surgeons of HFHS, and reading their bio's. All of them sounded impressive. There were a few that specified they worked with post-bariatric surgery patients--while I did not have bariatric surgery, I did lose a lot of weight, so I knew that these surgeons were probably the right choice. One really stood out to me, for some reason--Dr. Donna Tepper. I never thought I'd pick a female surgeon, but I liked her bio.

I decided to e-mail the surgeon who performed my jaw repair surgery and ask him if there was a plastic surgeon he would recommend for me. I really liked him, and trusted his input. When he wrote back, he said Dr. Tepper--without my even mentioning that I liked her bio. So it was almost like a sign that I should choose her.

I set an appointment, which took about 5 weeks to get in for a consult. When I met her, she was VERY confident, and happy that I lost the weight through diet and exercise--she made me feel very comfortable. She had a great personality, sense of humor, and wasn't too pushy. She answered my questions and didn't seem like she was in a rush to get out of there.  I felt like I was talking to a friend. I really liked her, and didn't see any reason NOT to choose her. I listen to my gut feeling when I'm making an important decision, and deep down, I knew she was the right choice.

When choosing a surgeon, it's VERY important to choose a surgeon who is board certified. Don't just take their word for it, either--you can look here to check for yourself. I would also recommend that you choose a surgeon who has hospital rights, or who only works out of a hospital. Some surgeons do the procedures in their own offices, so if something goes wrong, you can't just go to the hospital to fix it. Dr. Tepper works out of several different HFHS hospitals, which eased my fears--and also made it more convenient, because I was able to see her in different locations, depending on what was easiest for me.

Also, and this is just coming from my opinion, of course... the very very popular plastic surgeons are not necessarily the best ones. A lot of times, they are only popular because they have commercials advertised on TV, or billboards with their names on them. They are probably very busy and won't have much time for you--a lot of people don't put much thought into selecting a surgeon, so they just pick the guy who has a television commercial, because he "must" be good to have his own commercial.

I think it's very important to choose a surgeon that you can tell LOVES HIS OR HER JOB. Dr. Tepper was very excited about my weight loss and I could tell she was excited that I was going to have a good result due to my hard work. Seeing that she was excited about it, I knew she was in it because she loved her job--and because of that, I knew that she would want to do her best job during my surgery.

When I read the tummy tuck message boards, I notice that everyone asks, "Who is 'the BEST' surgeon in such-and-such state/area?" and they let that be the deciding factor. But a lot of those people don't have very good results after their surgery, and then they later find out that their surgeon doesn't have time for them to work with them and make them happy, so they are stuck with a bad surgery. 

My advice would be to do your own homework--choose a hospital that you trust, and check their website for plastic surgeons. Read the bio's and see if any stand out to you. See if they specialize in post-weight loss surgery. Then meet them and see if they seem confident, excited about their job, and tell you what to realistically expect from the surgery.

Questions for your surgeon

Once you choose a surgeon, you'll want to come up with a list of questions that you want answered before surgery. Make sure you carry a list everywhere with you so that you can add to it if a question pops into your head. Some questions I asked:

*Is it possible for this to be covered by my insurance? Do you submit a claim for me?
*How long before I can run again?
*How long can I realistically expect to need help at home?
*How long is the surgery time?
*Do you take precautions during surgery to prevent blood clots, since the surgery time is so long?
*Will I stay the night at the hospital? Can my spouse stay with me?
*What can I do after surgery to recover as quickly as possible?
*Do I need to buy a compression garment?
*Can you show me exactly where my incision scar will be? Will it be visible above my panty line?
*What positions can I sleep in after surgery?
*Will I have drain tubes? How many? Where will they be placed?
*If I have a question or problem after surgery, and I need to get a hold of you after office hours, what number should I call?

If you work, you'll want to ask about when you can go back to work, what the restrictions will be, etc. At your pre-op appointment, you'll want to ask everything. If your surgeon seems annoyed at the number of questions, I would definitely reconsider that surgeon! Dr. Tepper was very patient and answered everything I asked.

Pre-Op

I asked all my questions at my pre-op appointment (this was the appointment after my initial consult, and was more detailed), and was given the prescriptions for the medications I would need after surgery: an antibiotic to prevent infection, Vicodin for pain, and a muscle relaxer for muscle spasms.  I was also given two sterile antibacterial soap-filled sponges--one to wash with in the shower the night before surgery, and the other to use the morning of surgery.

I had about two months to wait until surgery, so I spent that time getting prepared. My husband requested some time off work to care for me, we started saving some money for those days he took off work, and I bought a few things that I figured I would need--gauze, medical tape, my compression garments that my surgeon told me to get, a Go-Girl thing so I could pee standing up after surgery (laugh now, but it was my best friend for two weeks after surgery!), and protein powder (the doctor wanted me to have a lot of protein).

About a week before surgery, I quit drinking wine :(  The instructions were not to have alcohol for 48 hours before surgery, but I figured a week would be even better. I filled my prescriptions so they were ready when I got home. I paid for the part of the surgery that my insurance wouldn't cover (see below for costs). I had to get some blood drawn for lab tests. And then I arranged with my parents for my kids to spend a few days there.

The day before surgery, I washed my bed sheets so they would be nice and clean. I cleaned my house and made sure there wasn't any clutter. That night, I washed with the special sponge they gave me, and I was told not to eat after midnight (I quit eating at 7 pm). I went to bed and set the alarm for 3:00 AM--crazy, I know. I was told to be at the hospital at 5:00 in the morning, and it was over an hour away. When I woke up, I took a shower and used the second sponge, then dressed in comfy, baggy clothes. Jerry drove us to the hospital.

Cost of surgery
The cost of the surgery I had varies ENORMOUSLY, but I'll share the costs that I incurred. The costs are broken down by anesthesia, operating room use, hospital stay, surgeon fees, etc. Keep in mind that my insurance covered a huge chunk of it...

Out-of-pocket expenses:  $134 one-time consultation fee; $200 for 4 compression garments; $4,380 for the cosmetic portion of surgery; $808.73 for co-pays to insurance after surgery. TOTAL: $5,522.73.

I'm not sure how much the surgery would cost if you paid straight cash (no insurance whatsoever) but I'll ask my surgeon next time I go in. The average cost of this particular surgery (from what I read online) is $18,800. Yes, that sounds like an insane amount of money--you could buy a car for that! But this is something that I wanted more than anything else, and if I have to make payments for a few years to pay for it, it's worth it to me.

But like I said, the cost varies enormously, so don't write off the surgery if you don't think you can afford it. I would at least go see a surgeon to find out the cost and what your options are. I was SHOCKED when I discovered that a huge chunk of the surgery was covered by insurance.

The surgery
You can read about my experience the day of surgery here.

The hospital
I have to admit, when my doctor said she wanted to do the surgery at a tiny little hospital called Cottage Hospital in Grosse Pointe, Michigan, I was nervous. I was hoping she'd want to do it in the huge Henry Ford Hospital in Detroit--it just seemed "safer" because it was bigger. But the doctor's secretary told me that Dr. Tepper really likes the staff that she works with at Cottage, and that it's in MY best interest to go where the doctor is comfortable. I could have insisted that I have the surgery in Detroit, but of course I wanted my surgeon to be happy while she's working on me! So I agreed to go to Cottage. It was the best decision I could have made, and I'm SO GLAD that I had the surgery at Cottage Hospital. (So keep in mind that it's important for your surgeon to feel comfortable).

We were the only people there at 5:00 in the morning, which was a strange feeling. The whole staff that interacted with me was SO FRIENDLY and nice and made me feel very comfortable. There wasn't a single person who I was displeased with. All the nurses, the anesthesiologist, even the security guard who had to unlock the doors for us--super nice, and helpful.

My doctor had me stay for '23-hour observation' after my surgery, and I'm very happy I did that. I was literally the ONLY overnight patient in the hospital--crazy, right?! But it was fantastic--anytime I needed something, the nurses were right there. I had a catheter in, so I didn't haven't to get up to go to the bathroom at all. The nurses took very good care of me, emptying my surgical drains, getting me water (constantly, I was so thirsty!), even setting up a bed for my husband to stay with me overnight. Dr. Tepper came to check on me after the surgery, and then again the following morning, when she said I could go home whenever I was ready.

I honestly cannot say enough good things about Cottage Hospital.

Post-Op

I have a lot of blog posts about the aftermath of the surgery, but I'll explain the gist of it here.

I had four surgical drains placed during the surgery. The drains are tubes that come out of your abdomen with a bulb on the end that collects fluid (blood, saline from irrigation during surgery, etc) so that the fluid doesn't collect inside of your abdomen.

The drains were not painful to me at all--just a nuisance. You have to empty the drains and record the amount of fluid that you empty--and my doctor said she would remove them when they were draining less than 30 cc's per 24-hour period. Three drains were removed on Day 8. The last wasn't removed until Day 17. The removal did not hurt at all, it just felt very strange. It's important to leave them in long enough so that you don't have fluid accumulate and form a seroma, which can get infected.

I also had to wear a surgical compression garment. My doctor gave me a pamphlet at my first appointment and showed me the one she wanted me to order. She said to get two--one in beige and one in black. She told me to bring the black one to my surgery, and I would wake up from surgery with it on. (She said black because it would certainly get stained in the first couple of days, and the stains aren't as noticeable on the black). My garment fit like a pair of granny panties that went up to my rib cage--only very very tight. The garment is actually pretty comfortable, and I liked the secure feeling while it was on. I was told I would have to wear it 24/7 for six weeks (except while showering).

The incisions were very easy to care for. All surgeons have their own instructions, but my surgeon told me that there would be no dressings on the incisions, and I didn't have to do anything special. I didn't have external stitches--she used some sort of Dermabond to close the top layer. In the layers of skin underneath, there were absorbable stitches. There was also a strip of tape on the incision, but I didn't even know this until Day 8, when she told me I could take it off. It was stuck on there really good!

Because my incision went all the way around my body, I was told that for ten days, I would have to lie down or stand--no sitting! I could lie on my sides or my back, or even my stomach if it was comfortable (but I chose not to because of my drains). The reason for not sitting is because it would put strain on the incision across my butt.

I was given Vicodin for pain, but I learned that Vicodin doesn't help at ALL for me. I switched to plain old Motrin after about a week. The pain was the worst the first 2-3 days--it wasn't the incision that hurt, but my abdominal muscles. They were extremely sore, like I did a million sit-ups. After Day 3 or so, the pain wasn't bad at all for me. I still felt sore, but nothing unbearable.

I was allowed to shower from the day I got home from the hospital. She told me to wash gently with the regular soap I always use, and pat dry. The hardest part about showering was the drains--I had to put a chain around my neck and clip the drains to the chain. The first few days, I had my mom or Jerry reach into the shower and hold the drains while I washed quickly.

As far as exercise goes, my surgeon told me that I could exercise whenever I felt comfortable--just no ab work. I had no interest in exercising until about Day 14, but I hurt my knee, so I waited until almost 4 weeks post-op before I ran again.

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A few random questions that I've gotten...

*What happens if you become pregnant now?*
Jerry and I are done having kids--we made that decision 'permanent' after Eli was born ;)  I don't know much about this, because it wasn't relevant to me, but I would certainly recommend waiting until you're done having kids to get a surgery like this to get the best results possible. Pregnancy caused a LOT of stretch marks on me, and I'm sure that wouldn't be any different if I'd gotten pregnant after my surgery. But this is something that I would ask a plastic surgeon.

*Why didn't you wait until you were at your goal weight to have surgery?*
I never really reached my goal weight, and when I went to surgery, I was about 15 pounds higher than my goal. However, I had maintained that weight for about a year, and I was comfortable with my size--wearing a size 4/6 prior to surgery. My surgeon said I was at a healthy weight and she had no concerns about my losing weight before surgery, so I went for it.

*Did you pick November for surgery for a particular reason?*
I wanted to get the surgery as soon as possible after my consult, but I had to wait for the insurance clearance, and then I was in my friend's wedding in October, so I had to wait until after that. November was a good time because I would be all healed up by summer :)

*Did you have to wait six weeks to have sex after surgery?*
No, my surgeon told me that whenever I felt ready it was fine to have sex. But I wasn't interested for a while! I waited about 5 weeks.

*Was it embarrassing having Jerry or your mom help you in the bathroom/shower?*
They've both seen me give birth, so helping me in the shower was no big deal :)  I'm not self-conscious in front of Jerry at ALL, and while I was a little embarrassed to undress in front of my mom, it was certainly no time to be modest. I didn't need help going to the bathroom, but I needed help showering (they held the drains). And I felt extremely exhausted, so it was nice to have them there if I felt faint.

*Did you get to see the video of your surgery?*
Not yet--I'm going to ask my surgeon for a copy of it when I see her next week. My surgery was videotaped (with my permission) for educational uses. I didn't think I'd want to watch it, but I kind of do now!

*How was the drive home from the hospital? When were you allowed to drive after surgery?*
I don't remember the drive home very much, but it wasn't TOO bad. My husband was careful going over the bumps :)  I had to recline my seat back as far as it could go. I was able to drive once I was off the pain meds AND it was at least 10 days post-op--because my doctor wanted me to lie down flat for 10 days, only sitting to go to the bathroom. I was driving by day 11.

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I think this pretty much sums up all the facts about the surgery. In the next post, I list all "the good, the bad, and the ugly" parts about it!  Click here for Part 2.

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