Your Questions

Q: Dr. Eppley, I am interested in numerous body contouring procedures since I have lost 130 lbs. But I did not achieve this weight by bariatric surgery so would it be possible for me to have multiple procedures in one day? I have a lot of loose skin from my arms to my thighs so I need a lot of work done and the quicker I can get it off the better.

A: The origin of one’s weight loss has little impact on how any number of body contouring procedures are done in a single operative event. Actually extreme amounts of weight loss achieved by non-bariatric means, diet and exercise, are ‘safer’ since there are no metabolic issues to consider. (unlike a gastric bypass) There really are few differences between body contouring after weight loss and bariatric plastic surgery considerations when it comes to the type of body reshaping procedures considered and how they are put together. The key issues in doing multiple  body contouring procedures is the length of time to do the surgery and what period of recovery time does the patient have. As all body contouring involves considerable trauma to the body if you just consider the size of the body surface areas being treated.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in multiple bariatric plastic surgery procedures. I had a gastric bypass done two years ago and have lost 140lbs. I now weigh 170 lbs, down from 310. I need a lot of work and want an arm lift, back lift, tummy tuck, thigh lift and liposuction with fat transfer to my buttocks and hips. Can this be done all in one surgery> It is safe to do all of these at once? Also, how long should I stop smoking prior to major body contouring surgery like this so I can heal properly?

A: While all of these bariatric plastic surgery body contouring procedures can be done in one surgery, that is not advised nor would any plastic surgeon do it. This is why too much trauma to your body and it increases the risk of major affter surgery complications llike DVT, infection and wound separations. As I counsel every extreme weight loss patient, you simply can not fix all of your body concerns in one surgery.

Every extreme weight loss patient needs to draft a complete list of their body concerns and then prioritize them. This will then allow you to create a series of two or three separate surgeries, spaced three to six months apart to get every body area addressed, It is more reasonable and common to do in the first stage the tummy tuck and arm lift and then do the back and thigh lifts in a second stage.  It would be uncommon in a severe weight loss patient to have enough fat to harvest by liposuction to be able to do buttock or hip augmentation. It may be possible but not usually likely.

Regardless of how you sort and stage your body contouring procedures you must have stopped smoking months before. You need to stop once and for all at least 6 to 12 weeks before these surgeries. Otherwise, you are at high risk for major wound healing problems even if you ‘cheat’ on your smoking before and during the healing process.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have had a lap band for about 5 years and I have lost about 90 pounds and basically kept it off give or take an occasional 5 to 8 pounds. I would very much like to get rid of the remaining skin and fat in my stomach and upper torso area. I am searching for a surgeon who has quite a bit of experience with these procedures. I was planning on a local plastic surgeon do it but he is moving out of state and is booked solid. I only know of one other Dr. in this area who has extensive experience in this procedure on drastic weight loss, however, I do not choose to have him do this for me. I have consulted and been examined by my initial plastic surgeon about one year ago and he approved me for the surgery. I just was not quite ready at the time. I am now.  I am 66 years old. I am very active and always have been and am in very good health.
I would like to know if you are accepting patients from central Illinois, and if this is something that we can talk about the possibilities and the possible concerns of my not living in your area. I will likely have to self-pay, since my insurance company was approached as to if I would be covered for this procedure, and I was denied. They feel that it is cosmetic and not a necessity. Therefore I would also like to be informed of the cost involved. I would also like to have my breasts lifted and was wondering if it is possible to do both surgeries at the same time and the cost of that procedure as well. I think you in advance for your time and consideration.

A: Congratulations are your weight loss and, equally importantly, the ability to have maintained it. With a near 100 lb weight, you undoubtably have many of the typical findings that one would expect with  a resultant abdominal pannus and significant breast sagging. While I would ultimately need to see some pictures  of you to confirm your exact surgical needs, having done a lot of extreme weight loss patients (bariatric plastic surgery) over the years I can envision with some certainty as to your needs… an extended tummy tuck and full (type 4) breast lifts. It is very common to do both of those procedures together and it is safe to do so.

I have patients that come from all over the world for a variety of procedures so we are very familiar with how to handle patients from afar and can accurately foresee their needs and how they must be accomodated from afar. Doing a tummy tuck and a breast lift in a 66 year-old from afar would need to be done as an overnight procedure in our facility. The extent of the procedure (it is surprisingly not that painful) and your age mandates overnight observation for your medical safety. Whether you would then go directly home the next morning or stay just one more night in a local hotel is an issue to be discussed and also based on how you feel. You would go home with abdominal drains (you would have breast drains but those would be removed the next day) and those would need to stay in for 10 days at which time you would come back to have them removed. We follow all of our patients carefully using e-mail, photographs and texting, available 24/7, to handle any questions or needs. Thus you may be far away but are electronically just a click of a button close. All incision are taped so you have to provide no care to them and can shower with 48 hours, getting all tapes wet without any concerns about doing so.

Dr. Barry Eppley

Indianapolis,Indiana

Q: Hello! I had gastric bypass surgery in August 2008. Since that procedure, I have lost over 135 pounds. Here is the my problem. I have worked much of my life trying to gain control of my weight and now that I have done that I have excess and sagging skin that is a constant reminder of the overweight, unhealthy person I used to be. Furthermore, I am at a dead end financially as I had to pay out of pocket the expenses for by bypass surgery which was almost $50K. I am exhausted financially between the surgery and my four kids. Are you aware of any programs, grants or clinics that are available to assist bariatric patients with the skin removal they need after their weight loss?

A: Congratulations on your weight loss success. That is a big accomplishment. While such extreme amount of weight loss is a big first step, most patients with this much weight loss will have large amounts of deflated skin that just hangs. This is managed by a range of procedures known as bariatric plastic surgery. With the exception of an abdominal panniculectomy, these procedures are cosmetic from a financial perspective. I know of no doctors or clinics that perform these extensive procedures at low to no cost. They require a large amount of surgical effort and operating room expense which is why there are no limited cost facilities or programs that perform them.

I wish you continued success in maintaining your current weight and one day being able to complete phase 2 of your body metamorphosis.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I had bariatic surgery four years ago. This has left me a lot of loose hanging skin as well as a prominent and painful bulge around my belly button. I have been told that it is a hernia and it certainly feels like it is. Are you qualified to fix a hernia and do tummy tuck? What is the normal price for this type of procedure as I currently have no insurance?

A: Thank you for your inquiry. It is extremely common to have to do a hernia repair with any type of abdominal contouring procedure for the bariatric patient, whether it is a simple abdominal panniculectomy, a fleur-de-lis abdominoplasty, or a circumferential body lift. Hernias are now less frequently found with the newer laparoscopic bypass surgeries than with the older open approaches but they are still relatively common. As a plastic surgeon, we routinuely fix hernias using a muscle repair technique rather than the placement of any type of synthetic mesh. This is easy to do with the wide open exposure that occurs with the tummy tuck procedure.

The cost of a ‘bariatric’ tummy tuck can be quite variable based on what type of abdominal procedure is really needed. There are three basic options for the extreme weight loss patient, whether they have lost the weight by bariatric surgery or not. There are two types of frontal cutouts (panniculectomy, fleur-de-lis tummy tuck) and the circumferential body lift. (360 degree tummy tuck or tummy tuck combined with a hip and buttock lift) To get an accurate quote, one has to know exactly what is going to be done. This being said, as an outpatient procedure done under general anesthesia, the total costs can range from $ 6,500 to $ 9,500.

Dr. Barry Eppley

Indianapolis, Indiana