A Candid Discussion of Excess Skin (post weight loss)

When I had my lower body lift in 2011, I was thrilled with the results of my surgery.

The excess skin was very uncomfortable and I felt so discouraged that I would have to live that way for the rest of my life. I hated the fact that I "ruined" my body with so many years of overeating.

When Caitlin was here recently, we had a conversation about our excess skin (something that many people who have lost a lot of weight tend to have in common). We both said we wished more than anything that we could go back in time and take care of ourselves.

When we were overeating, we never thought about the long term consequences. One you've been overweight as long as we were, some of the damage is permanent. (Of course, there are people whose skin snaps back with no problems, but from my experience, that is not the norm.)

A lot of it depends on factors like how long one was overweight, just how much excess weight that person carried, how quickly the weight was gained, how quickly the weight was lost, etc.

I remember being very young (probably junior high school?) when I first noticed stretch marks. They were light red streaks on my upper arms, and I had no idea what they were. I was hanging out with a friend, and she noticed them. I told her I had no clue what it was, and she said that it was no big deal--she had them on her inner thighs.

I came to the conclusion that everybody had those "things', and I didn't think much of it. Within the next couple of years, I learned that they were stretch marks, and that they were undesirable. I immediately became embarrassed that my body betrayed me like that. Why did I get stretch marks, when none of my other friends had them (well, other than the one who showed me the ones on her thighs)?

When I was 16, I went on a trip to Washington D.C. with several people from my junior class. I met a boy there who I really liked, and after a fun day exploring the city, he kissed me when we got back to the hotel. We were sitting on some steps, talking, when he noticed my arm.

He asked what had happened, and I quickly thought up a lie--I told him that I had gotten boiling water spilled on me years ago. He accepted that answer, and I felt embarrassed. I knew that one day, he'd figure out what stretch marks are, and he'd know that the girl he kissed in Washington D.C. had them on her upper arms.

I became self-conscious of my arms after that, and I covered my them whenever possible. I started getting them on my inner thighs, too. At the time, I still didn't know that they were being caused from weight gain. I was so worried that they'd just keep "growing" everywhere.

They became really bad in college. I started getting them on my hips, sides, and abdomen. These ones were bright red, and thicker than the ones on my arms and thighs. I had gained quite a bit of weight my freshman year of college--from what I recall, I think I went from about 180 to 205 pounds.

When I got pregnant, I gained weight very quickly, and my stretch marks became even worse. With Eli, I gained 90 pounds! The stretch marks on my abdomen went all the way up to my rib cage.

A few years later, when I finally got my act together and started losing the weight, the stretch marks got smaller and more faded, but they were still very noticeable. When gaining weight like I did, the skin literally stretches until it can't anymore, and it pulls too far--causing the skin to thin out in just that stretch mark line.

The best analogy I can think of is one of those nylon hair ties. They have elastic in them, and they are covered with a stretchy fabric. For those of you that wear them, you know that when they get stretched too far, the elastic inside can break, leaving a small spot that is thinner than the rest of it and has lost it's elasticity.

That's what stretch marks are like--the skin gets to the point of stretching until there is no elasticity left. That's what I meant when I said I'd "ruined" my body--no amount of weight loss, exercising, expensive creams, etc, will remove the marks, because that skin has been damaged.

Anyway, on to my point of excess skin. Skin is very elastic, when you think about it. It can accommodate people up to 1,000 pounds or more. But, not without causing permanent damage.

When you blow up a balloon really big, and then let it deflate, it doesn't return to its original size or tight shape. If you blow up a balloon and leave it like that for several days, and then deflate it, it looks even worse. That's the best way I can describe excess skin. It used to be full, and then when it "deflates", the skin is still the same size it was when it was stretched--but since the inside of your body is much smaller, the skin hangs there, looking kind of "baggy".

This can cause all sorts of problems, and not just cosmetic ones. The "apron" of skin over someone's abdomen, for example, can cause rashes and yeast infections in that fold. Running was difficult before my skin removal surgery on my abdomen--my skin would bounce up and down, which was painful. (Think about running without a bra--that's what it felt like on my abdomen.)

My solution was to wear very tight spandex bottoms to hold my skin in place. That certainly helped with the bouncing; but then, by having my skin pressed together in a fold, and sweating from the run, I got chafing and rashes. By running, I was trying to do something good for my body, but I just couldn't win. (Again, I felt terrible that I "ruined" my body, and there was no going back.)

This photo was before I had the skin removal on my abdomen. You can see how I had to tuck in the skin to fit into very tight spandex to hold it in place.

I've gotten several comments and emails about how I don't look like I have loose skin. Well, flattering camera angles and clothing can hide that. But catch me from the right angle, or God forbid, naked, you will avert your eyes and not mention it again. Hahaha!

You may notice that I never run in shorts. The photo below was the only time I tried, and I asked Jerry to take a video, because I was curious if the skin on my thighs looked as bad as it felt. This is to show that there are certain angles that are more flattering than others, which is why people who read my blog may think I don't have loose skin. Of course I'm going to show the more flattering pictures on my blog!

So, to keep the blog honest and real, I'm showing you a comparison of an unflattering pic versus a more flattering one. (These are poor quality because they are screen shots of a video.)

(By the way, I never photoshop pictures of myself to make myself look better. I do use it sometimes to make goofy photos like the header of this post, though! But I want to be "real", so what you see is what you get.)

After I lost 125 pounds, people were naturally very curious about my weight loss. I was asked questions all the time--by friends, family, acquaintances, and even total strangers. When I was losing weight, I never imagined that talking about loose skin would be as painful as it was.

The first question I was asked was, "How did you lose the weight?" and the second was, "Do you have lots of loose (saggy/baggy/deflated/you name it) skin now?" I hate this question with a passion. Unfortunately, people asked me this ALL the time.

I spent the majority of my life (about 25 years) feeling incredibly self-conscious about my body. I was teased in school for being fat. I hated having people look at me, and I always assumed people were thinking about how fat I was. I hated myself; I hated my looks.

Fast forward to age 28, when I had lost 125 pounds. I felt amazing and I loved the way I looked--until I started getting e-mail after e-mail asking me if I have loose skin.

YES, I have loose skin. NO, it's not pretty. Do I need reminding of how grotesque it is day after day? No. (I've had people tell me that they don't want to lose weight because excess skin is gross. Gee, thanks!)

I know that when people ask me this question, they aren't calling me ugly, or saying I look gross--they are just asking out of curiosity. I get it. I was curious before I lost the weight, too.

But please keep in mind that it's a very sensitive question for someone like me who spent the majority of my life being self-conscious. That's why it irritates me so much when a complete stranger asks me about saggy skin when we've never even had a conversation before. If a friend asks, I have no problem talking about my loose skin--because that person cares more about me than about my weight loss and all the flaws on my body.

When the first thing someone asks me after learning of my weight loss is if I have loose skin, it's like saying that all the hard work I did doesn't matter; that losing 125 pounds means nothing if I have loose skin; that I might as well not have lost the weight since my skin is saggy now.

I so badly want to put to rest all of the bad thoughts I have about my body and learn to truly love my body--but it's hard to do so when people remind me that I have "gross saggy skin".

This photo is after I'd lost 118 pounds. You can see how loose the skin is on my upper arms--"bat wings", as people like to refer to this problem area. (Stephanie was setting up her camera to get a photo of the two of us together, and she told me to "look like you're putting your arm around me". Hahaha! I like to tell people it's my imaginary friend ;) )

I hate that when I wave to someone, my loose skin is about half a second behind my arm, hahaha.

All of that said, YES--I have saggy upper arms, saggy inner thighs, deflated boobs (which were never big to begin with), a saggy butt, and a stomach that looked like a deflated balloon (I had the abdominal skin removed in 2011, which I'll share about below).

This is a picture of the skin on my inner thigh. I was lying on my right side (hip on left, knee to the right, so the skin was sagging down). I took this picture to "prove it" (that I had loose skin) a few years ago, but now I realize how stupid that is--I have nothing to prove to anyone! Still, here it is. The picture is a little disorienting, because I was lying on my side in bed, with my other leg tucked underneath, so that you could see the saggy skin.

I was terrified at the thought of having surgery. However, when I broke my jaw in 2010, and surgery was inevitable to fix my jaw, I wasn't afraid of it anymore. (I'm sure the IV of dilaudid helped! hahaha.) I decided to schedule a consult with a plastic surgeon. I'd had no idea at the time, but she told me that my insurance would likely cover a large portion of the surgery. I was shocked.

After some stuff to work out with the insurance company, I scheduled my appointment for pre-op; and then for surgery on November 14, 2011. My surgeon said I would have fantastic results--1) Because I was at a "normal" weight and I wasn't doing the surgery to try to be smaller or lose weight; 2) Because I'd kept the weight off for over a year; and 3) I was running a lot, and in good shape underneath the skin.

Needless to say, I am THRILLED with the results of the surgery, even five years later (I wrote an update of the surgery with current pictures here).

Believe it or not, I could button and zip those jeans before surgery. It just took a lot of stuffing my skin into them. It felt different than trying to wear jeans that were too small.

Over the last several years, I've noticed more and more the toll that the excess skin has taken on my upper arms and my inner thighs. I really don't want surgery for these. But they are hindering things that I'm afraid will only get worse over time.

I will write more about this later, because this post is already long enough. Recently, though, I contacted my plastic surgeon to ask about having a consult. I have in no way made a decision to have more surgery (and I'm thinking that I probably will decide not to--the recovery for legs is terrible, from what a few of my friends who have had the surgery told me).

The consult will only be to see my doctor thinks it's a good option for me, based on the issues I'm having.

If I do choose to go through with surgery, I would likely plan for next winter (maybe November or December) so that my healing time won't be so miserable. We don't tend to do much in the winter months.

I want to make sure my weight stays pretty stable this year, too. I'd like to stay under 144, which is at the top of a normal BMI range for me. (Also, our debt will be paid off and we will be able to save up for the surgery.) Jerry is super supportive of me getting it--he's been mentioning it for a few years now, when he hears me complain about the skin for various reasons.)

Anyway, this turned into a very long-winded post! If anyone has questions about loose skin, I'd be happy to open up and answer them here. (If they are too personal, I will say so, but for the most part, I'm pretty candid about it now. So, ask away!)

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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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Less than 24 hours until surgery!

I’m so irritated right now because my internet has been down since just after I wrote yesterday’s blog. I can’t stand not being able to check my e-mail and blog comments and all that! Oh, and yesterday morning, Jerry was driving to work when the van overheated, so he came right back home and had to use a vacation day (there wasn’t enough time for him to get the Jeep and make it to work on time). I just came to my mom's for a minute to post this with her internet.

My surgery is less than 24 hours away as I write this—I’m SO excited!  Yesterday, I had Jerry take a whole bunch of “before” pictures of me and my saggy belly. I’m not at all sad to see it go, but I just want to make sure I get all the pictures I want before it’s gone. I can’t wait to compare photos a few weeks and months from now.

Here, you can see why I don't wear form-fitting clothes! I had to tuck my skin into my capris, and it bulges out).

Last night, Renee, Jessica, and I went out to dinner at La Pita. It’s an AMAZING Middle Eastern restaurant that I love, and Renee and Jessica had never been there.  I ordered my usual chicken kabob, which comes with hummus, warm pita bread, salad, rice pilaf, and my favorite—garlic sauce. It’s a pure white dip that has the texture of mayonnaise, and tastes like pure garlic heaven. LOVE that stuff! My kids asked me to bring some of it home, so I bought a 12 oz container of it for home.

Renee and Jessica really liked the food, which made me happy—since it was my idea to go there, and because it was kind of far to drive (40 minutes). I wish we had taken a picture of us there! Totally forgot about it. We were too busy inhaling garlic and hummus and pita bread!

Today I’ve been trying to get my house ready for when I come home on Tuesday. I want to have everything clean and ready for me to just relax for the next 10 days. I still have to get a few groceries, but I have no car today (Jerry had to take the Jeep to work, and my dad is going to fix the van later today). I have to pack overnight bags for the kids, because they are going to stay at my parents’ house for 3-4 days.

The kids were invited to a birthday party this afternoon. I feel so rushed to get everything done, but I already told them I’d take them to the party. After the party, they’ll go to my parents’ house for the night, and I’m going to bed at about 8 PM tonight. I have to leave at about 3:45 in the morning! My surgery starts at 6:30, and it’s supposed to take about six hours. I showed Jerry how to write updates on my blog. I apologize in advance if he updates a little too frequently! I am going to have him take lots of pictures and a video or two and I’ll post them as soon as I can. Maybe Wednesday?  I’ll be home on Tuesday evening, but I don’t know how I’ll be feeling.

Don’t forget to watch my Dr. Oz episode on Friday!! As soon as it airs, I’m going to publish the posts I wrote about the whole 24 hours I was in NYC for the taping.

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Pre-Op Excitement

Thanks for the advice on Phoebe!  Who would've thunk that one of my readers was a veterinarian?! If only one of my readers was a plastic surgeon looking for a pro bono case, I'd be all set ;)  I put a warm compress on Phoebe's wound a couple of times today and it no longer has any pus coming out--so I think that's good. It's still super red and there is still a hole in her skin though.  She's been sleeping all day, even sleeping on my lap for a while (which she never does).

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My surgery is a week from Monday! Can you believe it came this fast? I went to Sam's Club today to buy a bunch of high-protein snacks at the recommendation of my surgeon. I got cashews and pistachios, sliced turkey, Havarti cheese, eggs (to hard-boil), chocolate protein powder (whey--I haven't broken out since I started using it again, so maybe it wasn't the dairy that was causing me to break out after all). 

The hospital where I'm having my surgery called me today to ask me a million health questions and give me pre-op instructions. I made the full payment yesterday for the surgery (borrowed money, of course).  They are sending me a waiver in the mail to sign and return--it's to allow the surgery to be filmed. I'm still glad with the decision to do that, because now I know my surgeon will do her best work ;)  I made sure that my name and any identifying information will not be anywhere on the video.

I got my other compression garment in the mail today, and I opened it to try it on--I wanted to make sure it wasn't waaay too small. I'm surprised that it's not nearly as tight as I pictured (especially since I haven't had the surgery yet, so my skin is all still there and in the way). I wonder if I should have ordered a small instead of a medium?  I followed the guidelines for measurements, and it said medium. But I've lost 10 or so pounds since I ordered it. I would rather it be too tight than not tight enough. I'll ask my surgeon.

Jerry used my being layed up and not able to do much other than watch TV for 10 days as an excuse to order Showtime today. Normally, I'd be pissed to spend $15 a month on it--but I want to watch Dexter soooo badly that I am going to "allow" it ;)  at least until I'm not restricted in my movement. Occasionally, we get free Showtime for 6 months, and that's how we got hooked on Dexter. I'm dying to watch this season! I also want to watch this season of The Big C, because I got hooked on that too.

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 I went for a short three-mile run today. It feels weird to not have a schedule, especially since I can only run for another week before I have to stop for six weeks. I've also gotten so used to running five or more miles at a time, so three just seems like a waste of time. Which is stupid thinking, I know. Three miles equals about 300 calories, which equals a yummy dessert! Of COURSE it's not a waste of time!

Speaking of food, it's been 19 days since my last binge! AND that includes spending a night by myself in NYC. I've been doing awesome with this non-dieting/non-intuitive eating/non-bingeing approach :)  Eli gave me all of his Tootsie Rolls yesterday, because they happen to be the one candy he doesn't like. I love them! I ate one last night and one after dinner today, and I don't even feel the impulse to go eat the rest. This is such a strange feeling, but I hope it lasts! 

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I've been going crazy with wanting to know when my Dr. Oz episode will air! I'm so scared to see it! I almost don't want to watch, because I'm afraid I'll be too critical of myself, and only see the flaws. I was trembling so badly while I was on the stage, and I'm afraid my lipstick was too red, and I'm afraid my arms are going to look ginormous.

A lot of you asked me if I was going to mention my blog--and no, I didn't. I wasn't allowed to mention my blog or Sparkpeople :(  I asked over and over about Spark, because I feel so passionately about Spark, but the producer said it didn't "fit in". I didn't get to CHOOSE what I talked about.

Basically, a producer interviews you for a looong time and picks out the stuff they want to use--it's all the truth, but it isn't the whole story. I didn't even get to mention RUNNING. I just hope that what they chose to use was actually helpful and/or motivating to people. But enough about that. I'll write more after it airs!

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I didn't have much time to e-mail last week because I was very busy getting stuff together for the show--I'm still catching up. Sorry if you're waiting for a response!

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Twilight nerd

True to my word, I did not run today. I spent the day catching up on housework instead. That's even less fun than running!

My surgery is three weeks from tomorrow--I cannot even describe how excited I am! Sometimes I feel extremely nervous, but at the moment, I'm about 99% excited and 1% nervous. We'll see how that changes as it gets closer to the surgery date.

Speaking of the surgery date, I'm SO BUMMED that I have to miss out on a much anticipated event on November 19th. My friend Rachael has a Twilight premier party every time one of the new Twilight movies comes out. It's a really big deal among my friends, and I love to go.

First we go to the movie together and then we go to the party afterward. Rachael keeps the theme with the movie--last time it was a "graduation party" where she set up a tent in the yard and had a graduation cake, and all that. You may remember the outfit I wore:

Very festive, no? ;)  And the atmosphere:

Notice the 'forks' in the cake! :)

Anyways, Rachael hand-delivered the invitations for the Breaking Dawn party recently, and I had already made my surgery appointment. Check this out!

Not sure if you can read it, but it's a WEDDING INVITATION for Bella and Edward!!! How fun is that?!! I so badly want to change my surgery date, but you know how much of a pain in the ass it was to get the date that I have, so I can't. And there is no way I'll be able to go anywhere just 5 days out from surgery.

Renee tried to make me feel better by saying that there is no drinking in the church hall, so there won't be wine involved... lol. But I'm still super sad to miss out.

I've been trying to come up with a list of things I'm going to need in the couple of weeks after surgery. I bought my compression garments that the doctor had me order, and I bought a mattress protector for my bed (I don't want to get blood and yucky stuff on my mattress). My mom has a walker that my dad used after his knee surgery, so I'm sure that will come in very handy. I really need to read the message boards and make a list.

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Pre-Op Appointment for Lower Body Lift Surgery

So I went back to the plastic surgeon today, to finalize details for the surgery. After asking her a bunch of questions, I decided that I am going to go ahead with the lower body lift (rather than just the tummy tuck). There was good news and bad news--apparently my insurance is going to cover a panniculectomy only, which is removal of the abdominal skin.

This does NOT include the tightening of the abdominal muscles or the replacement of the belly button (which, the surgeon told me, would mean my belly button would be down near my pubic area afterward!)

So if I wanted her to do those things, it would not be covered by insurance--it would cost roughly $2,000 out of pocket to add that. Of course, I told her that the belly button replacement is a MUST, so adding that and the muscle repair wasn't even optional for me.

We also talked about my hips and butt, and she said that if we did the lower body lift, the cost out of pocket would be $4,300. She showed me the results I can expect, and even though the hips and butt are a cosmetic procedure and not medical (like my abdomen), I decided that I really want to just do it all. I don't think I'll have a problem financing it--but I'll definitely need to consider getting a job next year to help pay for it. (This is when I wish I had a big enough blog to make money for blogging!)

Anyway, my mom went with me to the appointment this time, and asked a few questions too. She liked the surgeon and she thinks I made the right decision about the procedure. She kept saying, "You've EARNED this!"  And I guess that's true. But my body wouldn't look like this right now if I had taken care of it from the beginning.

All of the pre-op paperwork was filled out, and the doctor gave me prescriptions for antibiotics and pain meds to get filled before surgery. She gave me two bars of soap that she wants me to use--one the night before surgery, and one the morning of surgery.

And then, for the big surprise... She actually asked me if I would be willing to let a film crew record a video of the surgery itself. At first, I just laughed, like, "Um, NO". But she said my face would not be in it, and it's would be used for medical students. I decided to say yes. Because when I think about it, she is probably going to make damn sure to do her best job possible if she is being filmed. Also, I will know that everyone in the surgery room will be on their best behavior as well, and there will be less of a chance for something to go wrong ;)

I asked why she chose ME to film, and the reason was because she said I have a "tiny little body under there" and that I'm going to have great results from this. Most of the weight loss patients she works on are post-bariatric surgery, and they are still overweight; they also don't do much exercise (particularly not strenuous exercise like running). My body is very fit underneath my saggy skin, so she knows I will have good results worth using in a video, apparently. The film crew is actually working on a series of videos of different procedures.

The doctor stressed how important it is for me to eat a lot of protein post-op. This is going to be very difficult for me, but I'm going to follow all instructions right to the tee to make sure I heal as fast as possible. Losing weight, I felt best on a lower-protein, higher-carb, higher-fat diet.

I always feel kind of crappy when I eat a lot of protein or especially when I limit carbs. I think I'll get some non-dairy protein powders and I'll make shakes for breakfast and lunch, and then I'll try to have meat with dinner every day. She wants me to get upwards of 100 grams of protein per day, which is going to be challenging. And she wants me to start doing this soon.

My recovery is going to suck for about 10 days. I will not be able to sit up at all--I can only lie down on my side or stand (this is to avoid stretching the incision on my back). This means I won't be able to even go anywhere, because I'd have to sit in the car. I'm hoping that my friends will come visit me and keep me company! I was hoping to be able to blog often, but I don't know how I'll do that, unless I'm standing. Or maybe I'll do video blogs ;)

So from now until the surgery, all I have to do is prepare for my recovery; get financing for the surgery; buy 2 compression garments; and fill my prescriptions. The doctor wants me to stay overnight in the hospital, so I will be having the surgery on a Monday instead of Friday the 11th, like I thought. Right now, it looks like November 14th--but they are waiting to get confirmation that the the team will be available overnight (or something like that). I'll let you know when the date is for-sure, but it looks like it'll be the 14th!

Some of you have asked me if I'm going to show pictures from before and after. I haven't decided yet. If you had asked me this before the weight loss, I would have said sure, of course I'd want to show it off! However, I get so many questions about excess skin that I have become extremely self-conscious of it; and the last thing I want to do is draw attention to it and feel like a freak show. I was thinking that maybe I'll make a private photo album for my "loyal" readers, people that I feel comfortable sharing the pics with.

I'm so excited to just do this already!!

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GOOD NEWS!!

I'M GETTING A TUMMY TUCK!!! 

I spoke with the plastic surgeon's secretary today, and she said that my insurance said it's medical, not cosmetic (per the doctor's notes) and that it will be covered.  If I should choose to do the lower body lift, I'll have to pay extra for it--and I have to admit, I'm kind of leaning toward doing that, assuming I can finance it--but at the very least, I'll be getting a tummy tuck!!

Tentative date is Nov. 11th. 11-11-11... hopefully that's good luck! ;)  The secretary has to speak with the doctor tomorrow and make sure the OR is available for about 4 hours on that date, and if so, then that's when I'll be getting the surgery.  That happens to fall on the same Friday as the Friday I fell and broke my jaw last year (Nov 12). And I'll be staying in the same hospital.

I'm SO EXCITED and so nervous at the same time. I can't believe it's actually happening. But like I promised, you're the first to know :)

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The Kroger cashier

I don't know if I talked about this before, but after I lost the weight, I still had the same driver's license picture from when I was 253 pounds.  Whenever I would get carded for buying alcohol, it was not an issue--nobody ever commented. Until this one cashier at Kroger. She looked at the license, looked at me, looked back at the license, back at me... over and over. She said, "Is this YOU?" And I explained that I'd lost over 100 pounds. She was in awe.

Every time I went through her lane, she would comment on it. Then, in January, I told her that I was (finally) getting a new license photo. When I got the new license, I showed her the photo, and she said it was "Much better!"

Driver's License comparison

So I went grocery shopping yesterday and went through her lane to check out. As soon as she saw me, she said, "Guess what! I just have to tell you... I've lost 26 pounds!"  I was so happy for her and I congratulated her (she probably needs to lose about 100 pounds). She said, "I was inspired by you--every time you came in, you were skinnier and skinnier, so I finally decided to lose weight."

Hearing that made me feel so good! People online tell me all the time that I am inspiring, and I love to hear that, but it was so great to SEE someone who was inspired enough to lose 26 pounds.

Another thing that made me feel good (and I can't believe I forgot to write this in my tummy tuck consult entry!) was a comment the doctor made. She had me stand in front of a mirror and she was showing me what the results of the surgery would give me. She said (quote): "You have SUCH a tiny frame..."  Wait, WHAT?! ME? I have a tiny frame??

It's so weird because when I was fat, I always assumed I was a "large" frame. You know those magazines, or websites or whatever that tell you what your goal weight should be, based on your frame size, and you have to choose small, medium, or large? Well, I never even took time to think about it. Duh, I was a large frame. It wasn't until I lost almost 100 pounds that I realized I might have a small frame after all. My sister's friend made a comment about my "tiny hips" and numerous people told me that I was "petite".

Hearing those words being spoken about ME was mind boggling. I always WANTED to be small--I have no desire to be very muscular, or curvy or anything like that (hello barely-B cups!). I just want to be a cute and fits-in-your-back-pocket kind of small :)  When I look in the mirror, I don't see it, but looking at some pictures I do... there is one pic in particular that makes me feel petite (it's a dark pic, sorry):

I was 141 pounds in that picture, and I am pretty happy with how I look. I think I look well-proportioned.

So anyway, the doctor said that I have a tiny frame and that the excess skin and tissue around my belly is the only thing that is not proportioned to my body. I'm trying so hard not to get my hopes up about the surgery, but I just can't help it. I wish they'd tell me NOW. The kids start school this week, so hopefully that will be a good distraction for me until I hear from the insurance company.

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Do you think you have a small, medium, or large frame? If you are overweight, would you be shocked to lose weight and find out you have a "tiny" frame underneath?

Do you get carded when you buy alcohol? If not, at what age did they stop carding you? I rarely get carded anymore  :(  When I have my kids with me, I NEVER get carded--but when I'm alone, I do sometimes.

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