Your Questions
Your Questions
Q: Dr. Eppley, I had gastric bypass six years ago and lost over 100 lbs. My weight went down from 324 lbs to 205 lbs and has remained stable for the last three years. While I am not small by any means, I am comfortable with my body where it is now. I will never be less than a size 14 but that is okay. It is just that I need to get rid of this inner tube around my waistline as it is heavy and interferes with a lot of activities and the wearing of clothes. My question is what type of tummy tuck do I need? Would a body lift be better than a tummy tuck? I have attached some pictures that show my unholy inner tube.
A: Losing a lot of weight always create a frontal pannus and skin excess that extends around the waistline and into the back. The fundamental difference and question to consider between an extended tummy tuck and body lift is your concern about the buttock area and any sagging that it may have developed. A body lift involves a 360 degree excision of tissue around the waistline and its effect is essentially like ‘pulling up one’s pants’. Based on your pictures, I would say that I see little benefit to the addition of an excisional area completely around your back. When it comes to incisional length and location, the more relevant issue is whether your extended tummy tuck should include a vertical component in the front, known as the fleur-de-lis type tummy tuck. This adds the extra dimension of pulling in your sides more by a vertical tightening down the middle. This would produce for you more benefit in my opinion than anything done in your back/buttock area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a body lift. I have had bariatric surgery two years ago and I need to get rid of excess skin. This excess skin around my waistline is causing severe chafing. My insurance won’t cover ‘cosmetic’ surgery. My question is this: can we get insurance to cover it if it is a medical necessity?
A: Insurance in some cases will cover an abdominal panniculectomy but it depends if the abdominal pannus meets several criteria established by the insurance industry. for such coverage. The abdominal pannus must of a certain size as seen in multiple view pictures (hangs down onto the upper thighs), have a medically documented history by a physician of skin rashes/infections that failed to be resolved by topical therapies and one must be of appropriate weight based on their height. (within 20% of their ideal body weight) Fulfilling these criteria is what constitutes ‘medically necessary’ and such information must be submitted to the insurance company for them to pass judgment on whether it is covered or not.
Even if determined medically necessary, insurance will only cover the front half of the trunk (abdominal panniculectomy) and to the back half or the full body lift.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wondering if you do tummy tucks scheduled and coordinated with a hysterectomy. What the cost would be and how much of a cost savings would it be. I am not only looking into having them done at the same time for cost savings (insurance will pay for the hysterectomy but NOT the tummy tuck) but for combining recovery time as well. Can a lower body lift (instead of a tummy tuck) be combined with the hysterectomy? A little info on me. I am a 40 year old female, about 20 months post op from bariatric surgery. I have lost about 160 to 165 lbs and now weigh about 167 and weight has pretty much stabilized the last 4 to 6 months. I am 5’3″ and happy at the weight I am at now, but the hanging excess skin is really bothering me, in the way, clothes don’t fit right, it gets sweaty under the fold, and it is very uncomfortable. Thank you for you any information you can provide me and for your time.
A: Congratulations on your successful weight loss! Either a tummy tuck or a circumferential body lift can be performed at the same time as a hysterectomy. This is an historically common combined abdominal procedure. Besides the obvious benefit of one single combined recovery, the only key question is how do the economics work out. Since you will be paying out of your pocket for either a tummy tuck or a body lift, the question is what is the OR and anesthesia cost if done in a hospital with the hysterectomy compared to it being done separately in an independent surgery center? (the plastic surgeon’s fee would be the same at either location) Many patients would assume they are similar but that is often mistaken. Either location of the surgery should be priced out so you can see the difference between your fees. If the difference is small, then one should have the body contouring procedure done at the same time as the hysterectomy. But if the difference in significant (thousands of dollars) that may give one pause as to whether it should be done separately. You may ponder as to why there would ever be a difference between the two locations (hospital vs surgery center), the answer is simple….overhead and efficiency.
I will have my assistant calculate those specific costs between the two locations for just one of the procedures (tummy tuck) so we can see how different or similar those costs would be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had gastric bypass surgery 2 years ago and am now bothered by a lot of belly skin that hangs down onto my legs. Besides giving me problems with the fitting of pants, I have trouble keeping it clean and it takes a lot of powder to keep the area underneath dry. Occasionally the area under this flop of belly skin will get really red and sore and my doctor puts me on a fungus powder to get rid of it. I know that plastic surgery can cut off this skin but what will happen to the extra skin that will still be there that wraps around the hips and across the back? Is there anything that can be done to get rid of this skin also or do I just have to live with it?
A: With a lot of weight loss, the skin on the trunk of the body falls like wax melting off a candle. This usually occurs in a 360 degree circumferential manner, but it is always worse in the front. This is particularly so in women due to their already existing loose skin and muscle of the abdominal area due to pregnancies.
What type of plastic surgery contouring procedure that is optimal depends on how much loose skin exists across the back. While an abdominoplasty or tummy tuck (also called an abdominal panniculectomy in the bariatric patient) is a good frontal procedure, it can be extended to go the whole around the back as well if needed. This is called a body lift or circumferental belt lipectomy. This may be a better reshaping for you based on the amount and location of excess skin around your waistline.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 50 years old and my average weight hovers around 108 lbs. I have had four pregnancies. I have already had a mini tummy tuck but now have belly fat above my belly button and at the rib cage. There is also fat around the hip area as well. I have a surgery scheduled for liposuction but was told I would have to later have a “full body lift” to get the loose skin off. There is maybe two inches at the sides. I am in good shape. I use to go to the gym. Is it possible to do the liposuction with the other procedure or will it “kill the skin” as I am told and would not a tummy tuck be preferred to a “full body lift”?
A: At your age, regardless of how good your skin quality may be, liposuction will not tighten up the skin to any significant degree. While I can’t see what you look like, your statement that you have extra skin now is a certainty that you will have more extra skin after liposuction.
It makes sense, therefore, to consider some type of skin removal when you are doing the liposuction procedure. It would be unusual for someone like you to need a full body lift. Body lifts are exclusively done on patients who have lost a lot of weight, whether by bariatric surgery or on their own. You more likely need an extension of your previous tummy tuck out to the hip areas or maybe a little beyond to get the excess skin. The 360 degree or circumferential scar that results from a body lift is not likely needed in your case.
Liposuction can be safely done at the same time as the skin excision. While devascularizing the undermined skin is possible (‘killing the skin’ as you have indicated), an experienced plastic surgeon will know how to blend those two together to minimize that risk.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am interested in a full body lift. How much does that cost?
A: The term ‘full body lift’ is a rather vague term from a plastic surgery standpoint. Even though it is a widely used term for a plastic surgery procedure, I have learned that what it means to a patient can be very different from what it means to a plastic surgeon.
A body lift is a specific procedure that is almost exclusively used in the extreme weight loss patient, usually after bariatric surgery. It is essentially a 360 degree or a circumferential tummy tuck. It is best perceived as a combined tummy tuck (front) and buttock lift (back) done together through a single incision that rums around the waistline. It is done to deal with the extreme skin excess that develops after a lot of weight loss with an abdominal overhang, sagging thigh skin, and a deflated and droopy buttocks. By removing a large amount of circumferential skin, the lower half of the body is lifted, like pulling up your pants so to speak.
From a patient’s perspective, however, a body lift can often imply that things are lifted from the arms done to the thighs in a single procedure. Much like the confusion from a facelift, where people almost always believe it lifts the face from the forehead down to the neck when it does not (only lifts the neck and jowls), a body lift is a waistline procedure. While it has a dramatic and often life-changing effect, it does not lift the ‘entire body’.
When patients ask about price for the body lift procedure, it is important to know exactly what they are really talking about and what a body lift means to them. To get a meaningful price for such a procedure, one really needs to come into the office and be seen and evaluated. It is a little like calling the auto shop and just asking how much it is to overhaul your car…one has to know exactly what it needs before an accurate quote can be given.
Dr. Barry Eppley
Indianapolis, Indiana