Your Questions
Your Questions
Q: Dr. Eppley, I am interested in fat injections (Lipodissolve) for my lower abdomen. I am done having children and have gained an excessive amount of weight during my pregnancies. I have lost the weight, but the aftermath is stretch marks, loose skin and a “pudge.” My upper abdomen has no stretch marks and is ok. I am trying to find an affordable procedure, that I can handle with minimal downtime, as I have 2 small children.
A: What you need, without even seeing a picture of you and based purely on your rather classic description, is not going to be achieved by an injectable fat reduction technique. Lipodissolve is intended for very small fat collections (like the neck) in which the overlying skin is of good quality. It is completely ineffective for the post pregnancy belly that you are describing. What you need is some form of a tummy tuck which can more effectively deal with the excess/loose skin and fat. With this type of abdominal problem, you either hold out for a tummy tuck one day or do nothing…as nothing will offer any acceptable level of improvement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 29 years old and I have 3 kids. They are all good size and I’m small build so therefore my skin has stretched out bad!!! Also as a result in having kids I have an umbilical hernia. Can that be taken care of as well at the same time as the tummy tuck?
A: It would be very common in tummy tucks and abdominal panniculectomies for a woman to have a concurrent umbilical hernia. The hernia can be repaired at the same time as the tummy tuck procedure and is an ideal time to do given the very open exposure. In some cases there is a risk of loss of the umbilical stalk with the hernia repair dependent on the size of the umbilical hernia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently had a tummy tuck and have noticed something unusual (at least for me) afterwards. I am experiencing intense increased sexual desire. This is far beyond what I would normally feel this way. Since it is very early in my recovery ( five weeks) I can’t attribute to the fact that my body has changed and I am experiencing increased libido because of my new body shape. Is it possible that loss of weight or the removal of fat has caused some hormonal change that would account for my increased sex drive?
A: This is not the first time that I have heard from a tummy tuck patient of an increased libido after surgery. I would agree with you that it is not simply caused by a change in your appearance or hormonal levels. The most likely explanation is the coincidental pubic lift effect that results from many tummy tuck surgeries. To close the large open wound from tissue excision in a tummy tuck, the upper abdominal skin flap and the lower pubic region are moved to close over it. This lifts and tightens the pubic region and may change the exposure or angulation of the clitoris. It may also be that that the tissue shift and increased clitoral exposure may allow its increased exposure to be more directly stimulated by the rubbing on clothes. The occasional increased sex drive in a postoperative tummy tuck patient, therefore, may be a simple mechanical effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had three babies in just under four years. Each time, I was all belly, which was ok while I was pregnant, but it’s left my stomach impossible to flatten again! I’m interested in a tummy tuck and possible liposuction on my sides. I also have an umbilical hernia. Could that also be repaired at the same time?
A: Pregnancy, if repeated often enough and at close enough frequencies, makes numerous permanent changes to the abdomen. Stretched out skin, stretch marks and umbiilical hernias are common sequelae of pregnancy. While losing baby fat and weight can help make some difference, there is no amount of exercise and dieting that can help remove extra skin, reapproximate a rectus diastasis or fix an umbilical hernia. Because of the wide open exposure of a tummy tuck, both the umbilical hernia and the rectus diastasis can be repaired. The removal of extra abdominal skin completes the tummy tuck and can, in many cases, make a woman’s abdomen completely flat again. The amount of loose skin and fat, condition of the rectus muscles and whether a hernia exists or not makes for numerous types of tummy tucks.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just wanted a consult to see if a tummy tuck or laser skin tightening would be an option for me. I had a child almost two years ago and lost over 60lbs.
A: The decision between a tummy tuck and another abdominal contouring option is often debated. However, you have said two things that helped define your tummy options, even without seeing pictures of it. (although that would also be helpful) The combination of having a child and losing over 60lbs had made the use of laser skin tightening an impossibility. Even at best, laser skin tightening may be able to tighten about 1 cm. (1/2 inch of skin) I suspect that the amount of loose abdominal skin that you have exceeds that by a considerable amount. Being between stretched by pregnancy and then losing that amount of weight, the elasticity of skin has been broken and its ability to tighten removed. A tummy tuck is undoubtably what you will really need to get the improvement in abdominal tightening that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have wanted to have a tummy tuck for the last five years. I have had two children who were both born at over nine pounds. I am 5’ 7” and weigh 135 lbs. I have worked out a lot and got my stomach as toned as it can be. However I still have hanging skin if i lay on my side or bend over. I have no confidence when I have no clothes on.
A: A tummy tuck is often the only solution for loose skin on one’s stomach. Diet and exercise help with loosing fat but can not get rid of loose skin or tighten it up. Stretch out or loose abdominal skin is an irreversible problem short of surgery. Even women who are relatively thin and work out regularly find out that they simply can’t make this skin go away. Such a realization often drives them to seek out tummy tuck surgery. Whether one needs a full or partial tummy tuck depends on how much loose skin exists.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having breast implants. I am currently a 34B and am interested in a full C or a small D cup. Also, I was previously 190 lbs and am now 135 lbs. I have a flabby area above my belly button which I would love to have tightened. I work out regularly, yet it just doesn’t seem to help. This area would be optional though, as my primary interest would be having breast implants. I saw the general fees for each procedure, and was curious if combining procedures offer any cost reduction.
A: In answering your breast implants and tummy tightening questions:
1) When it comes to size of breast implants, I do not use the concept of cup size. While women understandably have that as a breast reference, implants come in volume (ccs) not cup size. And regardless of cups size or ccs, in the end all you really care about it how the breast looks…the number attached to it in that regard is not important as long as it looks the way you want. In choosing breast implant size in volume for any patient, I use a Volumetric Implant Sizing System. You can try on the various volumes and see how they look and then choose. I find this to be incredibly accurate which less to a very rare problem of patient dissatisfaction withe the outcome of their breast augmentation procedure.
2) Having lost 55 lbs, this raises the question of whether you have any loose breast skin or sagging. This is an important preoperative consideration since breast implants do not create a ‘breast lift’ effect and can make make a saggy breast look worse even though it is bigger. Seeing some pictures of your breast would help answer that question.
3) Your weight loss is also the source of the flabby area around your belly button. Since the belly button is the only fixed point on the stomach, weight loss causes the skin around it to sag resulting in flabbiness and sometimes an actual upper belly button overhang. The only method to truly tighten loose abdominal skin is some form of a tummy tuck.
4) Your assumption is correct in that there is some cost savings when procedures are combined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am not sure if I need Lipodissolve or a tummy tuck. I have gained 15 pounds or more since I have turned 40 and now can not seem to lose it. I am not sure what I need to get my clothes to fit right again. Does the lipodissolve work? How much is the cost between them? What is the diffenence? How much time will be needed off work for a tummy tuck? Will the weight come back right away? The weight is around my middle, love handles and my thighs and butt.
A: Choosing between liposuction and a tummy tuck is a common dilemma for many women, although many times it is a more hopeful wish that liposuction alone will create the result they want. While I don’t know what you look like, I am absolutely certain based on your description that lipodissolve injections are not the answer. They are for very discrete small areas of fat which is not what you have. The question is only then whether it is liposuction alone or liposuction combined with a tummy tuck. Seeing a picture of your stomach would be helpful in answering that question. There is no doubt you need liposuction, it is just whether there is enough loose skin across the stomach to justify a tummy tuck as well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get a tummy tuck and belly button reconstruction. I’m not sure what type I need. I workout approximately 5 days a week. I have a lot of scar tissue near my c-section scar that is bothersome. Would a procedure also help with the scars? What type do you recommend?
A: You are correct in your assessment that you would benefit by a tummy tuck. When it comes to tummy tucks there are really only two fundamental types; a mini- or limited and a full tummy tuck. The difference between the two is in the the location and amount of abdominal tissues removed. With uncommon exception, most women are better off with a full tummy tuck because it produces a better result, remakes the belly button and provides the best exposure for complete rectus muscle plication. As part of the tummy tuck, all scar tissue from the previous c-section(s) would be removed regardless of whether one gets a mini- or full version.
Be aware that many tummy tucks also incorporate liposuction as part of it to get a better overall result.. That could be liposuction of the flanks beyond the zone of the tissue excision or above the zone of tissue excision in the upper abdominal area.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting tummy tuck. At about this time three years ago, I had a miscarriage at five months. Unfortunately, my body never really recovered from all the changes it went through. In the last three years I managed to lose about half of the weight I put on. It seems that no matter how much I try I can’t get back to normal. I’m about to graduate college and start this wonderful new chapter of my life, but I’m afraid that being stuck with my pregnancy figure will keep me from fully enjoying it. I’ve attached a couple pictures of myself for you.
A: Based on your pictures, you have an ideal stomach issue for a tummy tuck and flank liposuction. With your body now, your stomach could end up completely flat and your waistline would have an hourglass shape from the liposuction. The trade-off for this abdominal and waistline change is the low horizontal scar that accompanies every full tummy tuck. This is an issue for every woman to consider that has not yet had children and may likely do so in the future. But besides the aesthetics of the scar, it does not prevent future pregnancies nor does it affect the ability to carry a child to full term.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in body contouring after weight loss. I have 2 very large, deep atrophy dents, one on each hip from kenalog injections. I have arthritis and fibromyalgia in my hips. The pain is unbearable, and has left me disfigured. I also have lost 100 pounds over the past 3 years and have bags of fat instead of breasts. And I have a giant stomach that is all skin and fat that hangs dramatically.
A: Body contouring after weight loss, also known as bariatric plastic surgery, is commonly done today. When one loses 100lbs or more, as often happens with successful bariatric surgery or great personal diet and exercise efforts, many expected body changes occur. The large stomach deflates and become an apron that hangs over the waist line, the breasts lose their volume and hand down onto the stomach like two empty bags of skin, and the once larger arms and thighs sag. These common extreme weight loss concerns are treated with extended tummy tucks or abdominal panniculectomies and sagging breasts are changed with full anchor scar pattern breast lifts with implants in most cases. By getting rid of these tissue overhangs, combined with the weight loss, back and hip pain is often lessened. At the same time the large hip dents, which have occurred as a result of subcutaneous tissue atrophy from the steroid injections, can be treated by fat injections or even dermal-fat grafts depending on its depth and degree of skin tethering.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting a combined tummy tuck and buttock implants operation. I won’t have the money for my surgery until April 2014. Is it a good option to have a consultation a couple months ahead or within a certain time frame prior to the surgery. Also how much approximately would it be to have both procedures at the same time? Is there a discount for that or some type of deal for booking both at the same time?
A: I think it is always good to get accurate surgery and cost information way in advance of when any patient wants to do their surgery so they can plan accordingly. Doing it two or three months in advance is a good idea. I will have my assistant pass along some general cost information for a tummy tuck and buttock implants to you by tomorrow, although be aware that these are general numbers since I have no idea as to your exact tummy tuck needs.
Like all cosmetic surgery, bundling procedures together can result in a cost savings due to saving operating room and anesthesia charges. However, the combination of a tummy tuck and buttock implants done together would make for a really difficult recovery and this is not a recommended combination procedure. A tummy tuck and fat injections to the buttocks can be done at the same time but two muscular operations on opposing sides of the torso is not a good combination.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, How much for liposuction, specifically smart lipo, of the abdomen? Here is a picture of my abdomen. I am not interested in a tummy tuck scar and the recovery time. Thanks.
A: While I can understand why you would want to pursue some form of liposuction, it is neither the appropriate or effective contouring procedure for your abdominal problem. You have as much excess skin as fat as part of the loose abdominal overhang. Removing fat will only cause more loose skin and will not get rid of the overhang. It may likely leave your abdominal problem with no substantative improvement. While no one understandably wants a tummy tuck scar or the recovery from it, this is the only procedure that will be effective for your concerns. Do not waste money or effort on a liposuction procedure that will not work for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Do I qualify for a tummy tuck based on my weight of 155 lbs at 5’ 6”? Also I would like to down size my 650cc saline implants to something considerably smaller.
A: Based on your pictures which show a double abdominal roll, you would definitely benefit by a tummy tuck which would eliminate that problem. You can also certainly downsize your implants and I will assume for now that you want to stay with saline implants. The one issue with downsizing is what will happen to the overlying breast tissue. You already have some breast tissue bottoming out and that will get more substantial with downsizing. I see the scars around the areolas which I presume is from a periareolar mastopexy with your original augmentation. To deal with these issues I would do an inframammary fold excision/tuck with your implant downsizing as well as possible a periareolar scar revision.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I believe I suffer from diastasis recti. I have had 2 pregnancies, and both were c-section deliveries. My first was emergency and my second was scheduled. I have all of the symptoms of diastasis recti, and have been to numerous doctors complaining of these symptoms over the last 5 years. None ever even mentioned diastasis. Have you done many surgeries to correct this? Are they successful? Thank you for your time!
A: Diastasis recti are a very common abdominal wall deformity after multiple pregnancies. It is important, however, to not confuse this with a hernia which is an actual hole in the abdominal wall. Diastasis recti is the vertical separation of the muscular union across the midline of the abdominal wall but has an intact wall unlike a hernia. In thin women a diastasis recti can be seen as a deep wide groove from the lower end of the sternum down to or past the belly button. Reapproximating or repairing the diastasis recti is a common part of an abdominoplasty or tummy tuck procedure, mainly because there is wide open access to do it and it helps produce some additional abdominal flattening. It is repaired by sewing it together with permanent sutures, hence the term ‘sewing the muscles together’ when a tummy tuck procedure is described. It is very rarely, if ever, done as an isolated procedure outside of a tummy tuck as there is no medical reason to do so since it is not an actual hernia. Unlike a hernia, women do not usually complain of symptoms from it other than the aesthetic look of it if they are thin enough to see it. It is also a procedure that is not covered by insurance whether it is done as part of the tummy tuck or even as a stand alone procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what is the true recovery time from a tummy tuck? In my consultation, the plastic surgeon said around two weeks. But I have read online that it can be as long as six to eight weeks. What is the truth? I am a nurse in a hospital and work in an Oncology unit. I don’t lift patients but I am up and down all the time and constantly running around.
A: The concept of recovery can mean different things to different people and understanding what that is is of great importance in a tummy tuck…where the recovery should never be underestimated and often is. The concept of a two week recovery from a tummy tuck is not a realistic one. While you may be up and around the house and doing many normal activities, that is too early to feel comfortable doing strenuous activities. Work for many people is strenuous even though it may not seem so until one is less than 100%. Short of lifting, constantly having to be up and down is a very strenuous activity to be doing just a few weeks from a tummy tuck. A more realistic approach would be to consider going back half-time, if possible, the third week after surgery and then going back full-time by a month after the tummy tuck. This will allow you to ease your way back into work. While some people will not have this luxury for recovery time and simply have to go back after two weeks (and suffer through it), a three to four week approach as described is going to be a lot better.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have never been terribly overweight, however, I can’t lose the belly fat. I would also like to take a few years off my face. Most people tell me I look to be about 45, I’m actually 56. My looks probably matter more to me than most people as I currently work in a very visible public position so I feel I need to look my best so I can stay in this business until I retire. I would like to know what I can get done and not have to be off work any long periods of time. I am very interested in liposuction of my stomach/butt/thighs/ and arms, possible facial work later.
A: Since body contouring in your primary focus for now, I will keep my comments to that area. The most important question based on your inquiry is what is the best treatment for your body fat concerns. The abdominal area is always the one body area where the debate is between liposuction and a tummy tuck. It has been my experience that most people assume that liposuction can do too much, that it can magically remove a lot of fat and tighten up a lot of loose skin. While liposuction is a very good fat remover, it can do little for excess skin. Thus whether it is an appropriate surgical method for your abdomen, arm, thighs and buttocks issues will require a physical examination to answer. My concern for you is that the desire for great body contour changes and little time of work often do not go together very well.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 42 year old female who is 5’ 3” and weighs 122lbs. I had liposuction done several years ago to remove some fat but now I have loose skin. I would love to have a very flat and tight stomach with a six-pack look. I think I need a tummy tuck to get there but the scar and the shapes of the bellybuttons I have seen scare me. I don’t know if my tummy is bad enough for a full tummy tuck, maybe just a mini-tummy tuck will do. I want a very low and thin beautiful scar and a small almond-shaped belly buttons. I would like to be able to bend over and not grab a handful of stomach skin.
A: To get the flattest and tightest result you need a full tummy tuck. A mini-tummy tuck will make some improvement but will not meet the muster of the flattest and tightest abdominal result. Keeping the scar low as one would like depends on how much loose skin one has. Scars from tummy tucks are influenced largely by how the patient heals not necessarily by the plastic surgeon who makes them. A full tummy tuck will not get you a six-pack, only a flat tight stomach. The shape of the belly button, like the scars, is highly influenced by how you heal and your natural belly button shape. A tummy tuck does something that no amount of diet and exercising can do but getting one involves trade-offs and realistic expectations. Bending over and expecting there will be no skin to grab is one of those not realistic expectations
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can someone who is overweight have a tummy tuck with liposuction? I’m 36 years old and am 5’4” and 195lbs. I have very bad back pain due to my large stomach. I have not been very successful with any efforts at weight loss and my doctor feels it is due to the medications that I am on. Would a tummy tuck with liposuction help me? I think it would be very beneficial for my back not to mention my self-esteem.
A: The question is not whether you can have a tummy tuck at your weight but whether you should. It would take a physical examination to feel your abdominal area and see how much of the tissue can be removed. In some overweight stomachs the skin is very tight and the yield on a tummy tuck is not as much as one would think. For these patients, weight loss is key so that they create the necessary loose tissue to make the surgical effort most beneficial. In other patients, particularly those with an abdominal overhang (pannus), the results of a tummy tuck are more significant and even back pain may be improved as the strain from the weight of the overhang is removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I need to know if I need liposuction, a mini-tummy tuck or a full tummy tuck? I am 28 years old and have had two children. I had breast augmentation done three years ago and go pregnant right afterwards. I have a big hard stomach and can’t seem to lose it even though I work out and try to eat right. I am 5’ 8” and weigh 190 lbs. I think surgery is only thing I can think of to help but I am not sure what I need, liposuction or some type of a tummy tuck. Please help!
A: With a relatively high BMI (body mass index) and a ‘hard and big’ stomach, I have concerns that any form of plastic surgery is appropriate for you at this time. You need to lose some weight by some method before considering any tummy reducing plastic surgery procedure. A hard stomach indicates that the skin is tight and a tummy tuck, while it can be done, would not produce a result that may be worth the effort. (the tight skin would not allow that much to be removed) A better yield on a tummy tuck would occur if you dropped 20lbs to 30 lbs, creating greater looseness of skin. Similarly liposuction would produce less of a result that expected as some of your fat is intraperitoneal (located behind the abdominal muscles) where it is inaccessible to a liposuction cannula.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am finished having children and my body is a wreck. I have tried to get back close to my pre-pregancy body, but it is not happening. I want to have a Mommy Makeover procedure but my husband says I am just not working at it hard enough. When is a good age to have it done?
A: The effects that pregancy has on a woman’s body are largely irreversible by natural efforts for many women. Loose or separated abdominal muscles (rectus diastasis) can not be made to fuse back together by any amount of abdominal situps. Abdominal skin that has been stretched out and partially torn (stretch marks) can not have elasticity restored by situps, creams or weight loss. Breasts that have lost volume and sag can not be lifted up by chest exercises or alleged skin tightening creams. The onething a women can do is lose her pregnancy weight but all other changes require outside help
A so-called Mommy Makeover procedure, which combines breast augmentation with or without a lift and some form of a tummy tuck with or without liposuction, can be done at almost any age. But, by far, the majority of these procedures are done between the ages of 35 to 50. This is an age range where women are done having children and have proven to themselves that diet and exercise just can’t get the body improvement they desire. But age alone is not the only criteria. As long as one is finished breastfeeding, a Mommy Makeover can be done as soon as three to six months after one’s last pregancy.
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: 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: Dr. Eppley, I am a two time kidney transplant recipient, both from cadaver donors.
Due to both surgeries, my abdomen healed fine, it’s just that it healed in the shape of the letter V so to speak, and I have this big pouch that looks like a giant lip at my lower abdomen, no matter how much exercise I do, it is not going anywhere. I have considered cosmetic surgery for years, but was not aware that I could have it due to my transplants. I did gain weight, but I managed to lose 45 lbs. but I still have problem areas, that I feel I need to have corrected to help my appearance more. I am comfortable with myself, I just want to look as good as I feel.
A: Thank you for your inquiry and glad to hear that you are doing so well. A kidney transplant patient can have an operation like a tummy tuck safely and effectively. This would require that you have clearance from your nephrologist, have good blood counts (e.g., normal white blood cell count as an indicator of immunocompetence) and that the tummy tuck be modified to eliminate muscle plication and simply remove the skin and fat overhang. I would be happy to review any pictures that you may care to send to see if this would be a good option for you. It would also be helpful to know the location of the cadaveric kidney which usually in a subcutaneous abdominal location.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am interested in a non-invasive procedure for fat reduction basically at thigh and abdomen. I would like to know what you recommend and what do you think about CoolSculpting. I have had 3 c-sections, no other medical conditions. Thanks.
A: Let me make some general comments about the differences between non-invasive vs. surgical treatments for body contouring. (fat reduction and skin tightening) First, when it comes to considering non-invasives (e.g., CoolSculpting, Exilis etc) the patient never has anything to lose…other than money. There are no medical risks or downtime. The only risk is in how well it will work. Thus if someone is dead set against surgery then go ahead and do the non-invasive approach. It will either produce a satisfying result or it will not. Second, understand that no non-invasive therapy will ever produce a surgical looking result. I don’t care what is said about it or how good some before and after pictures look. The role of noninvasive treatments for many patients is a bridging therapy…I don’t want surgery but I want some improvement. ..and I will accept that it will likely do less than I ideally want. Lastly, no patient wants to waste their money and effort on a treatment that never had a good chance to work for them. Thus it is important to get a qualified answer beforehand as to what your chances are for success with any non-invasive treatment.
While I have no idea what you look like, the fact that you have had three pregnancies/c-sections give me cause for concern about the success of any non-invasive treatment approach for your abdomen. Your abdominal skin is stretched out and probably has poor elasticity…that would be inevitable after three pregnancies. If you have any stretch marks at all, there is next to no elasticity. That skin has a very limited ability to shrink back down on its own no matter what energy treatment is applied to it. So even if you can shrink some fat what will happen to the skin? Without skin shrinkage with fat reduction the change in the abdominal contour will likely not be an aesthetically significant improvement. On your abdomen after three c-sections the real question is whether anything will really work short of a tummy tuck.
The thigh area is always different because the skin always has better quality. The issue here is the debate of something like CoolSculpting vs liposuction. I think that answer lies in how much reduction is needed and what does your abdomen really need. If a tummy tuck is the only answer to your abdominal concerns, then you might as well have liposuction done on the thighs at the same time.
I would be happy to review of any pictures of your abdomen and thighs to give you a more definitive answer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I believe I need a pubic lift. I have lost 100 lbs and am still over weight by a lot. But I had an abscess removed from one side of the upper pubic area and I’m also uneven on both sides. If you type in pubic lift blog on yahoo and under images there is pictures I believe of one you did that is quite large like mine little different I presume. My question is cost and what would be the steps and healing?
A: When
one has lost 100lbs, I would have no doubt that a pubic lift is needed. But I am suspicious that you may need much more than that. Usually such weight loss causes a lot of abdominal tissue overhang which is most commonly called a pannus or apron. This is a hip to hip removal of the abdominal overhang that would include a pubic lift. It is possible that an isolated pubic lift may suffice, or be partially helpful, but I would have to see pictures of your abdominal area to make a visual evaluation. There is a big difference in the cost and recovery of a pubic lift vs. abdominal panniculectomy so knowing what you look like is essential to answer your questions with any accuracy.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I have an “apron” that hangs below my pelvic bone due to 3 c-sections. I have had this for 20 years. It is my dream to wear a wedding dress and not see the hang over through the dress. Would I have time to heal before wedding date of late October 2013?
A: Prepare to have your dream come true. One of the most rewarding of all tummy tucks is the removal of the abdominal apron, also known as a pannus. Its dramatic removal creates not only an instantaneous waistline change but a near lifestyle improvement without a floppy bag of tissue getting in the way of clothes, exercise, personal hygiene and intimate relations. Given that your wedding is over six months away, you will be in good shape for your wedding as long as you have the tummy tuck at least 3 months before the big day. The other good news is that after the tummy tuck there is no chance that this abdominal apron will ever come back unless one has more children (I am assuming after 3 that you are having no more) or unless you gain a tremendous amount of weight (greater than 50 lbs) and lose it again.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had lap band 3 years ago and am looking to have excess skin removed, a breast lift and some liposuction in the arms and legs region, just wanting some prices and if my insurance would cover any of it due to being post lap band.
A: To answer your questions, the first thing I need to see is some pictures of what your body looks like. What I am particularly interested in seeing is the size of your abdominal pannus and the degree of breast sagging that you have. But in the interim, let me provide you with some reality about the bariatric surgery patient and and what insurance will or will not do wit the sagging skin that develops afterwards.
1) The only procedure that has any remote chance of being covered would be an abdominal panniculectomy, removal of the abdominal overhang or a simple amputation tummy tuck. But for this to even be considered, a pre-determination letter must be written that describes the medical symptoms the pannus is causing and pictures that show the amount of abdominal overhang. To qualify the pannus must hang over the groin creases and onto the upper thighs and there must be a documented history of treatment for intertrigo. (skin infections under the pannus) Based on this submitted information, it is up to the insurance company to make a decision about coverage.
2) Breast sagging and the breast lift with or without implants is not considered a medical necessary procedure and is not eligible for insurance coverage.
3) It would be extremely unusual for the extreme weight loss patients to benefit by liposuction. The skin quality is often too stretched out to respond well to fat removal alone.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 34 years old and am 5’ 6” tall and 165 lbs. To my own credit I have lost 54 lbs over the past year with diet and exercise; It has been tough but I have done it and I am determined to lose even more. But I appear to have hit a point now that the weight is not budging. My problem is that I now have an apron of skin and fat that hangs over that has started causing a lot of discomfort during any form of exercise. I am doing all I can from a diet and exercise standpoint. Should I go ahead with tummy tuck surgery now or wait until I lose more weight?
A: Now that you have hit the proverbial wall and have an overhanging apron (pannus), I think you would benefit by a tummy tuck right now. The psychological benefits would be enormous and would empower you to lose the additional weight afterwards. I have seen this effect many times in patients who look just like you and have the identical story. Tummy tuck surgery itself will casue some additional weight loss by what is removed, which is usually in the range of 3 to 7 lbs. (everyone thinks the apron weighs a lot more than it actually does) But an identical if not more weight loss occurs from the recovery process. (burning calories to heal) This is why many tummy tuck patients like you will be down in weight 15 to 20 lbs by 6 to 8 weeks after surgery. That provides a good surge towards your eventual weight loss goal.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have had lumbar spondylolisthesis from birth. I had gastric bypass to help with weight on my lower back. I didn’t lose the 100lbs requested to get tummy tuck but the lumbar pain is still horrible every day and night. Can insurance cover a tummy tuck as medically necessary ?
A: The only way to know whether insurance will cover any plastic surgery procedure is to send in a pre-determination letter with photos and wait to receive a written response. The size of your abdominal overhang must meet very specific physical criteria and documented medical symptoms to qualify for medical coverage. As a general rule, I would not be optimistic. Most insurances turn down every request for any form of an abdominoplasty no matter how big it is or what symptoms that it is associated with it.. Send me some pictures of your abdominal area and I’ll tell you what I think your chances are based on my experience.
Dr. Barry Eppley
Indianapolis, Indiana