Nip, Tuck…or Not
Date:
8/27/2009 | 12:00 pm
Every year millions of people choose to have some part of their body changed through plastic and cosmetic surgery. There are many reasons people think about getting plastic or reconstructive surgery and it’s not just cosmetic. That's why it’s important that you weigh the pros and cons before you decide on plastic surgery. Send your questions for Dr. Martha S. Matthews to help make an informed decision about surgical or non-surgical techniques.
Martha S. Matthews, M.D., is head of the Division of Plastic and Reconstructive Surgery at Cooper, and an Associate Professor of Surgery at UMDNJ-Robert Wood Johnson Medical School at Camden. She has been honored as a “Top Doc” by Philadelphia magazine, New Jersey Monthly and South Jersey Magazine. Dr. Matthews is a graduate of Jefferson Medical School and completed her internship at Thomas Jefferson University Hospital in Philadelphia. Her residency in plastic surgery was completed at Eastern Virginia Medical School. Dr. Matthews is certified by the American Board of Plastic Surgery.
Her special interests are cosmetic surgery and pediatric plastic surgery. She sees patients at offices in Voorhees and Camden.
Martha S. Matthews, M.D.: Welcome to our eTalk today about plastic surgery. I have been at Cooper University Hospital for 20 years and have seen hundreds of patients benefit from their surgery – from the very young child with cleft palate to the older person who finally chose to have cosmetic surgery to look as young as she feels. There are many healthy outcomes for those patients who have thought long and hard about correcting a physical feature that has plagued them for years. Both physical and psychological discomfort can be healed through the many options of plastic surgery. If you are considering surgery or have had surgery and have questions regarding your experience, please send me your questions. I’m looking forward to “talking” with you.
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My daughter is 15 years old and has develope one breast larger then the other which very obvious. At what age can she get surgery to even out her breast? How common is this? Maria from Pennsauken |
8/27/2009 12:01:43 PM |
Martha S. Matthews, M.D.:
This is a very common problem. Most women do have differences in the size or shape of the breasts. Since most women don't see a lot of other women naked (like in the gym locker room), we don't have the perspective of knowing the range of "normal".
Breast asymmetry can be corrected at any age, but of course if there is breast growth, or change with age, pregnancy, etc, there might not be a match later.
Generally, I recommend that the girl have no change in breast size for at least 6months before considering surgery. Ideally, it would be good to wait until early 20's , when most people are done growing. But sometimes, the difference is just too great, and it is making the girl's life difficult. In that case, we need to weigh the benefit with the possibility that more surgery will be needed later.
Options include making the big breast smaller, making the small breast bigger, or both. The right answer depends on the individual.
Insurance sometimes covers this, but frequently does not.
Breast asymmetry can be corrected at any age, but of course if there is breast growth, or change with age, pregnancy, etc, there might not be a match later.
Generally, I recommend that the girl have no change in breast size for at least 6months before considering surgery. Ideally, it would be good to wait until early 20's , when most people are done growing. But sometimes, the difference is just too great, and it is making the girl's life difficult. In that case, we need to weigh the benefit with the possibility that more surgery will be needed later.
Options include making the big breast smaller, making the small breast bigger, or both. The right answer depends on the individual.
Insurance sometimes covers this, but frequently does not.
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I am suffering from gynecomastia (not pseudogynecomastia), I am 25 years old and I am planning to have surgery for treating my condition. Are there any tests I need to attend to get my condition fully diagnosed? Will there be any side effects that might cause more damage that my existing condition. Can you please give me some advice? I appreciate your help. Divakar from Farmington, MI |
8/27/2009 12:04:57 PM |
Martha S. Matthews, M.D.:
Gynecomastia (enlargement of the male breast) is a very common problem. More than half of all teenage males have this to some extent. In most people, it resolves on its own by age 20. This type is due to the hormonal fluctuations of adolescence.
There can be many causes of gynecomastia in adult men. If there is a specific lump, particularly in one breast, this should be examined by a doctor to rule out breast cancer -- yes, men can get breast cancer! One common cause of enlarged breasts is obesity -- so called "pseudogynecomastia." The actual breast tissue isn't enlarged, but there is fat in the area. Weight loss is the best option for this, but liposuction can also be done. Hormonal imbalances can cause gynecomastia, as can testicular tumors that produce hormones. Your primary care doctor should be able to do a testicular exam, and to order blood work to check if your hormone levels are normal. Some drugs can cause gynecomastia; the most common is marijuana, however, some prescription drugs can cause it as well. If this is the case, stopping the drug usually resolves the problem. In some cases, where the person has had enlargement since puberty that is symmetric and feels normal, no additional testing is needed.
In most cases, there is not an identifiable medical problem -- the individual just has more breast tissue than normal. Surgery to remove the tissue is possible. In some cases, the scars are very small around the nipple. In other cases in which there is a lot of enlargement, skin may have to be tightened as well, leaving more noticeable scars. This is a very individual issue -- you would need to be examined to tell what the likely level of scarring would be.
Insurance usually does not cover this surgery, unless it is due to a tumor or other disease.
There can be many causes of gynecomastia in adult men. If there is a specific lump, particularly in one breast, this should be examined by a doctor to rule out breast cancer -- yes, men can get breast cancer! One common cause of enlarged breasts is obesity -- so called "pseudogynecomastia." The actual breast tissue isn't enlarged, but there is fat in the area. Weight loss is the best option for this, but liposuction can also be done. Hormonal imbalances can cause gynecomastia, as can testicular tumors that produce hormones. Your primary care doctor should be able to do a testicular exam, and to order blood work to check if your hormone levels are normal. Some drugs can cause gynecomastia; the most common is marijuana, however, some prescription drugs can cause it as well. If this is the case, stopping the drug usually resolves the problem. In some cases, where the person has had enlargement since puberty that is symmetric and feels normal, no additional testing is needed.
In most cases, there is not an identifiable medical problem -- the individual just has more breast tissue than normal. Surgery to remove the tissue is possible. In some cases, the scars are very small around the nipple. In other cases in which there is a lot of enlargement, skin may have to be tightened as well, leaving more noticeable scars. This is a very individual issue -- you would need to be examined to tell what the likely level of scarring would be.
Insurance usually does not cover this surgery, unless it is due to a tumor or other disease.
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Hello, I had lipo done 20 years ago, but the fat was not removed from the stomach due to location,viceral fat. Are there any new procedures with lasers or anything that destroys fat surounding organs? Thank you. Jimmy from Moorestown |
8/27/2009 12:06:28 PM |
Martha S. Matthews, M.D.:
Unfortunately, no. We all have fat on the inside as well as the outside. Liposuction can remove fat on the outside, but there is nothing other than good old fashioned diet and exercise to deal with the fat on the inside.
When you have liposuction, some fat cells are permanently removed. The rest of your fat cells are happy to take up the slack, however, and will get bigger if you gain weight. The fat won't go to the areas you've had suctioned- it goes somewhere else. Internal fat is one place it can go. So it is not rare to see someone who had liposuction in the past, who has gained some weight, and now has a problem in a new place.
Men tend to have more inside fat around the intestines, etc than women. This can cause the so-called "beer belly." Sometimes people come to me asking for liposuction of the abdomen, but I have to turn them away because the fat is on the inside, not the outside.
When you have liposuction, some fat cells are permanently removed. The rest of your fat cells are happy to take up the slack, however, and will get bigger if you gain weight. The fat won't go to the areas you've had suctioned- it goes somewhere else. Internal fat is one place it can go. So it is not rare to see someone who had liposuction in the past, who has gained some weight, and now has a problem in a new place.
Men tend to have more inside fat around the intestines, etc than women. This can cause the so-called "beer belly." Sometimes people come to me asking for liposuction of the abdomen, but I have to turn them away because the fat is on the inside, not the outside.
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I have a hernia from a bowel resection. Can I have this repaired during a tummy tuck? Kathleen from Gloucester Township |
8/27/2009 12:08:10 PM |
Martha S. Matthews, M.D.:
Usually this is possible.
I frequently do tummy tucks at the same a patient is having another abdominal surgery. The most common are with hysterectomy or with hernia repair. We coordinate the tummy tuck ( also known as an abdominoplasty) with the doctor who is doing the other surgery. If the person wants me to do the abdominoplasty, but they do not have a Cooper doctor for the other problem, my office can help to facilitate a consultation with the other specialist.
It makes sense to combine the recovery period of the other surgery with the recovery from the abdominoplasty. Usually, there is not any additional pain, and you only have to have anesthesia once.
Most abdominoplasties are not covered by insurance. There is some cost savings to having a cosmetic procedure done at the same time as a procedure covered by insurance.
I frequently do tummy tucks at the same a patient is having another abdominal surgery. The most common are with hysterectomy or with hernia repair. We coordinate the tummy tuck ( also known as an abdominoplasty) with the doctor who is doing the other surgery. If the person wants me to do the abdominoplasty, but they do not have a Cooper doctor for the other problem, my office can help to facilitate a consultation with the other specialist.
It makes sense to combine the recovery period of the other surgery with the recovery from the abdominoplasty. Usually, there is not any additional pain, and you only have to have anesthesia once.
Most abdominoplasties are not covered by insurance. There is some cost savings to having a cosmetic procedure done at the same time as a procedure covered by insurance.
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What would be the best procedures to have age spots and spider veins removed? Carol from Lumberton |
8/27/2009 12:10:14 PM |
Martha S. Matthews, M.D.:
Spider veins on the face are best treated with laser. This is an office procedure. Usually, one treatment is needed. This is not covered by insurance. I do not perform this procedure, but Cooper's dermatologists are able to do so.
Spider veins on the legs can be treated with injections. The material injected causes the veins to clot off, and the body absorbs them. This is an office procedure. It sometimes requires more than one treatment, depending on how bad they are.
Age spots can be treated in several ways. If you are willing to be patient, topical bleaching cremes can be effective. They use a drug called hydroquinone. The prescription strength is more effective quicker. Bleaching agents take 6-8 weeks to work. If you are in more of a hurry, there are lasers that treat age spots, and chemical peels are very effective as well. Our dermatologists offer laser treatment. I do chemical peels for age spots in the office. There is some down time for recovery, but the end result is worth it. It is possible to peel the backs of the hands and the chest as well (two areas that really give away age)
Spider veins on the legs can be treated with injections. The material injected causes the veins to clot off, and the body absorbs them. This is an office procedure. It sometimes requires more than one treatment, depending on how bad they are.
Age spots can be treated in several ways. If you are willing to be patient, topical bleaching cremes can be effective. They use a drug called hydroquinone. The prescription strength is more effective quicker. Bleaching agents take 6-8 weeks to work. If you are in more of a hurry, there are lasers that treat age spots, and chemical peels are very effective as well. Our dermatologists offer laser treatment. I do chemical peels for age spots in the office. There is some down time for recovery, but the end result is worth it. It is possible to peel the backs of the hands and the chest as well (two areas that really give away age)
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Can I get a tummy tuck even though I've had 6 surgeries on my abdomen? I've had three vertical C-Sections, two hernia surgeries, and an abdominal hysterectomy. Would that create too much scar tissue to remove? Thank you! Kelly from Camden |
8/27/2009 12:13:11 PM |
Martha S. Matthews, M.D.:
Maybe. It depends on exactly where your scars are. A tummy tuck removes all the skin below the navel, so it is a great way to get rid of vertical C-Section scars. Of course, you trade it for a horizontal scar, but that is placed where it is covered by panties.
A plastic surgeon would need to examine you to tell if you are a good candidate or not.
A plastic surgeon would need to examine you to tell if you are a good candidate or not.
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Dr. Matthews, I have been dieting and exercising and have lost 30 lbs., about half the weight I feel I need to to be fit and healthy. I am seriously considering a tummy tuck and would like to know your thoughts. Should I be at goal weight before the surgery? Does it enhance the outcome of the procedure to be at my slimmest or will I be able to continue with my weight loss post recovery?I want to maximize the surgery's benefits. I am 51, weigh 171 and am 5'5". Thank you. Lisa from West Chester |
8/27/2009 12:15:42 PM |
Martha S. Matthews, M.D.:
Congratulations on your healthy efforts.
It is possible to do the tummy tuck either way, but remember, I can only operate on the body that shows up that day. If you have a tummy tuck, and then lose more weight, it is possible that you would not be as tight as you would have been if you had waited. All things being equal, I'd like a patient to be close to her goal weight.
However, sometimes someone needs the boost that the surgery will give them to get the motivation to keep going. In some cases, depending on how loose the skin is, and how big the "fat roll", it won't make much difference when it is done, so the person might choose to do the surgery now, and continue with weight loss.
I often see people for consultation who are in your circumstances. I use my judgment to tell them what the likely result will be now or later, and advise them on which I think is best, and give them the pros and the cons so they can decide what is best for them. If you'd like to make an appointment to see me, just click the appointment button on this page.
It is possible to do the tummy tuck either way, but remember, I can only operate on the body that shows up that day. If you have a tummy tuck, and then lose more weight, it is possible that you would not be as tight as you would have been if you had waited. All things being equal, I'd like a patient to be close to her goal weight.
However, sometimes someone needs the boost that the surgery will give them to get the motivation to keep going. In some cases, depending on how loose the skin is, and how big the "fat roll", it won't make much difference when it is done, so the person might choose to do the surgery now, and continue with weight loss.
I often see people for consultation who are in your circumstances. I use my judgment to tell them what the likely result will be now or later, and advise them on which I think is best, and give them the pros and the cons so they can decide what is best for them. If you'd like to make an appointment to see me, just click the appointment button on this page.
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What are the weight requirements for liposuction? How over-weight do you have to be to qualify to get liposuction? Susan from Blackwood |
8/27/2009 12:18:36 PM |
Martha S. Matthews, M.D.:
Liposuction is a procedure to change the contour of the body. It is not a procedure to cause weight loss. Generally, good candidates for liposuction are people who are at or close to normal weight, but have bulges they don't like -- such as saddlebags, love handles, etc. People who are mildly overweight can have liposuction to improve their contour, but it doesn't make them skinny. Generally, people who are obese are not good candidates.
Liposuction is not a substitute for healthy diet and exercise. In fact, if a person has liposuction but then does not eat a balanced diet and exercise, they will gain weight and it will come back in new places. Liposuction is only a tool to get the body you want -- unfortunately, it still takes your effort to maintain it.
Insurance almost never covers liposuction. It is considered cosmetic surgery.
Liposuction is not a substitute for healthy diet and exercise. In fact, if a person has liposuction but then does not eat a balanced diet and exercise, they will gain weight and it will come back in new places. Liposuction is only a tool to get the body you want -- unfortunately, it still takes your effort to maintain it.
Insurance almost never covers liposuction. It is considered cosmetic surgery.
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For how long can a person expect tightness in the face and neck after facelift surgery? Gloria from Wynnewood |
8/27/2009 12:20:02 PM |
Martha S. Matthews, M.D.:
Uncomfortable tightness after a facelift is common for the first month or two. No matter how tight the face is pulled during the facelift, the skin does relax a bit. Almost everyone will get a little loosening over time, with a final result about 6 months after surgery. After that, the facelift will last at the same rate the individual ages. This depends on the elasticity of the person's skin, whether they smoke (BAD), heredity, good diet, sun damage, etc.
So if loosening happens to everyone, why do we see some celebrities with that "too tight" look? Some people are unrealistic about what they want. If you pull too tight, and pull over and over again, you will get a result that is very unnatural looking. It is best to be realistic, and to stay on the side of natural. No plastic surgery can make a 60-year-old look 25 -- it just doesn't look real.
So if loosening happens to everyone, why do we see some celebrities with that "too tight" look? Some people are unrealistic about what they want. If you pull too tight, and pull over and over again, you will get a result that is very unnatural looking. It is best to be realistic, and to stay on the side of natural. No plastic surgery can make a 60-year-old look 25 -- it just doesn't look real.
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I previously had a surgery where my bowels shut down due to a reaction to the anesthesia. I became extremely distended, and ever since this has happened, my abdomen has dropped and hangs low and always seems distended. Why has this occurred over time? Rosalind from Philadelphia |
8/27/2009 12:22:20 PM |
Martha S. Matthews, M.D.:
There are a lot of possibilities, some serious and some not so serious. If you are distended or bloated a lot, then you should discuss this with your primary care physician. You should also make sure you are up to date with your GYN exam -- distension and bloating can be an early sign of ovarian cancer. Your doctor may recommend you see a gastroenterologist (specialist in the bowels and intestines) or a urologist (specialist in bladder/kidney).
If there is nothing wrong inside you, then work on your muscle tone. Pilates exercises are great for the abdominal muscles. If that doesn't help, consider seeing a plastic surgeon to see if a tummy tuck will help.
If there is nothing wrong inside you, then work on your muscle tone. Pilates exercises are great for the abdominal muscles. If that doesn't help, consider seeing a plastic surgeon to see if a tummy tuck will help.
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Is there a down side to a tummy tuck? Sharon from Pennsauken |
8/27/2009 12:24:04 PM |
Martha S. Matthews, M.D.:
All surgeries have risks. The most common risks for a tummy tuck is infection, and collections of fluid under the skin that must be removed (this is called a seroma). There is a very long scar that goes from hipbone to hipbone. The scar is usually good, and is hidden beneath the panty line, but it is still there.
When you go to a doctor for a consultation, he or she should discuss both the most common risks, and also any rare but serious risks. The doctor should also discuss any factors that are special to you and your circumstances that might increase risk or perhaps lead to a less than perfect result.
When you go to a doctor for a consultation, he or she should discuss both the most common risks, and also any rare but serious risks. The doctor should also discuss any factors that are special to you and your circumstances that might increase risk or perhaps lead to a less than perfect result.
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Dr. Matthews, a few years ago you performed a gynecomastia procedure on me. This was submitted and covered by my insurance. Is there ever a situation where liposuction would be covered? I have at least 15 pounds around my waist that I cannot get rid of. My weight always bounces back to 210. I'm taking medicine for high cholesterol and a statin for potential heart problems. I feel that removing this weight would improve my overall health. Would this be covered by insurance and would lipo be a benefit? Steve from Mount Laurel |
8/27/2009 12:27:50 PM |
Martha S. Matthews, M.D.:
Hi, it is always nice to hear from a former patient.
While it would seem to make sense that removing fat would help your health, this has never actually been proven for liposuction. Because there is no scientific evidence that it is a health benefit, Liposuction is not considered to be a medically necessary procedure.
Liposuction is a good option to change contour of the body, but in most cases it doesn't cause a significant weight loss, or a change in cholesterol or other bloodwork. Also, it is definately not a substitute for diet and exercise. In fact, if someone is slightly overweight, or having their weight creep up yearly, this will continue and perhaps even get worse after liposuction unless that person also makes lifestyle changes.
While it would seem to make sense that removing fat would help your health, this has never actually been proven for liposuction. Because there is no scientific evidence that it is a health benefit, Liposuction is not considered to be a medically necessary procedure.
Liposuction is a good option to change contour of the body, but in most cases it doesn't cause a significant weight loss, or a change in cholesterol or other bloodwork. Also, it is definately not a substitute for diet and exercise. In fact, if someone is slightly overweight, or having their weight creep up yearly, this will continue and perhaps even get worse after liposuction unless that person also makes lifestyle changes.
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I am a 36 year old female considering a tummy tuck and lipo after four children. How long should I weight after giving birth in Jan 2009, and how much weight should I attempt to lose before surgery ? (weight now = 216lbs.) Do you give free consultations? Amina from Camden |
8/27/2009 12:30:28 PM |
Martha S. Matthews, M.D.:
You should definitely try to get within 10 pounds or so of your goal weight. In addition, you should work on your muscle tone before surgery.
There isn't a strict weight limit, because that depends on how tall a person is, how they are built, etc. This operation can be done on people without "perfect" bodies, however you need to have realistic expectations. Part of the consultation is explaining what you can expect as a result.
New moms should realize that one of the post-op restrictions is no lifting over 15 pounds for about 1 month. You would need to think about how you can work around this with your child.
We do have a fee for consultation, but this is applied as a credit to any surgery scheduled within 1 year. During the consultation, you are seen by the doctor and have an opportunity to ask as many questions as you need.
In our practice, prospective patients can call and talk to our cosmetic surgery coordinator, Connie, or our nurse, Carlene, at any time, with no charge. Both of these ladies are very knowledgeable, and can give you lots of information and even a rough idea of costs, without any obligation to you. So if you're just "shopping" or thinking about it but not ready to commit, feel free to call and ask for them.
There isn't a strict weight limit, because that depends on how tall a person is, how they are built, etc. This operation can be done on people without "perfect" bodies, however you need to have realistic expectations. Part of the consultation is explaining what you can expect as a result.
New moms should realize that one of the post-op restrictions is no lifting over 15 pounds for about 1 month. You would need to think about how you can work around this with your child.
We do have a fee for consultation, but this is applied as a credit to any surgery scheduled within 1 year. During the consultation, you are seen by the doctor and have an opportunity to ask as many questions as you need.
In our practice, prospective patients can call and talk to our cosmetic surgery coordinator, Connie, or our nurse, Carlene, at any time, with no charge. Both of these ladies are very knowledgeable, and can give you lots of information and even a rough idea of costs, without any obligation to you. So if you're just "shopping" or thinking about it but not ready to commit, feel free to call and ask for them.
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How expensive are these procedures (tummy tuck, or liposuction)? Are there payment plans or financing available? Are they becoming any safer? What is the criteria for them? Audrey from Camden |
8/27/2009 12:33:06 PM |
Martha S. Matthews, M.D.:
We do everything possible to make these procedures as safe as they can be. Procedures are all done in accredited facilities with assistance of extremely qualified anesthesiologists and nurses.
There are three components to cost of any cosmetic procedure. One is the surgeon's fee. Our offices can give you a rough idea of these fees by phone. Of course, we would need to see you to give you a definitive answer about what you need and what it would cost.
The next component is the anesthesiologist's fee (the doctor that puts you to sleep, when needed) and the final component is the facility fee (charge for the operating room, recovery room, supplies, etc) Both of these are calculated based on the amount of time the surgery takes. We can give you an estimate of how long we think it will take.
Fees for surgery are due in advance. There are financing plans around for cosmetic surgery, but frankly, most people with good credit can do better on their own, using a line of credit, etc.
Another option for those interested in cosmetic surgery but have cost issues is our Cosmetic Surgery Resident Clinic. We are also a training program for plastic surgeons, and our residents, who are in training, do cosmetic surgery that is fully supervised by one of our faculty members. Our residents have had at least 5 years of training, so they are not beginners. Surgical fees are significantly discounted in this clinic. Not everyone is comfortable with this option, but if it interests you, you can contact Connie in our offices at 856 325-6767 and ask for information about the resident clinic.
There are three components to cost of any cosmetic procedure. One is the surgeon's fee. Our offices can give you a rough idea of these fees by phone. Of course, we would need to see you to give you a definitive answer about what you need and what it would cost.
The next component is the anesthesiologist's fee (the doctor that puts you to sleep, when needed) and the final component is the facility fee (charge for the operating room, recovery room, supplies, etc) Both of these are calculated based on the amount of time the surgery takes. We can give you an estimate of how long we think it will take.
Fees for surgery are due in advance. There are financing plans around for cosmetic surgery, but frankly, most people with good credit can do better on their own, using a line of credit, etc.
Another option for those interested in cosmetic surgery but have cost issues is our Cosmetic Surgery Resident Clinic. We are also a training program for plastic surgeons, and our residents, who are in training, do cosmetic surgery that is fully supervised by one of our faculty members. Our residents have had at least 5 years of training, so they are not beginners. Surgical fees are significantly discounted in this clinic. Not everyone is comfortable with this option, but if it interests you, you can contact Connie in our offices at 856 325-6767 and ask for information about the resident clinic.
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I have lost some weight and now have an "apron" of sagging skin drooping in the abdominal area. Will health insurance cover this being removed? Katherine from Merchantville |
8/27/2009 12:35:25 PM |
Martha S. Matthews, M.D.:
Insurance will sometimes cover an operation called a panniculectomy. This operation removes the apron of overhanging skin. It does not affect the skin above the navel, and doesn't tighten the abdominal wall. A panniculectomy will improve appearance somewhat, but it is not primarily a cosmetic operation.
Indications for insurance coverage of panniculectomy vary from company to company, but in general, the apron has to hang completely over the mons area (meaning it has to cover the pubic hair and hit the tops of the thighs), and the excess skin has to cause some sort of problem such as rashes or infections under the skin, or obstruction of walking, sitting, etc. These problems have to be documented by at least one other physician other than the plastic surgeon, and have to have been present for at least 6 months, with non-surgical treatments tried.
To get the best cosmetic result, some people also benefit from an abdominoplasty (tummy tuck) or other procedures. If the patient has insurance coverage for a panniculectomy, she would then pay on her own for the cosmetic portion.
Indications for insurance coverage of panniculectomy vary from company to company, but in general, the apron has to hang completely over the mons area (meaning it has to cover the pubic hair and hit the tops of the thighs), and the excess skin has to cause some sort of problem such as rashes or infections under the skin, or obstruction of walking, sitting, etc. These problems have to be documented by at least one other physician other than the plastic surgeon, and have to have been present for at least 6 months, with non-surgical treatments tried.
To get the best cosmetic result, some people also benefit from an abdominoplasty (tummy tuck) or other procedures. If the patient has insurance coverage for a panniculectomy, she would then pay on her own for the cosmetic portion.
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I had gained 100lbs after having a c-section and then lost it all about 3 years later. (I gained it in one year, and I was able to lose all of it in one year). I now have a horrible stomach that hangs at the c-section scar. The scar it very long, from hip-hip so it is not a little problem. I also have skin now hanging from my things and my upper arms and although I do not work out vigorously I do work out but none of it seems to tighten up. Is there any hope? I also just had a PE following minor sinus surgery. Would that mean that I could have a PE again, especially after something like plastic surgery? Kellie from Vineland |
8/27/2009 12:38:50 PM |
Martha S. Matthews, M.D.:
Absolutely there are things that can be done to help. Skin that has been stretched out sometimes will never go back to normal- particularly if there are stretch marks. Working out is great, because the better toned your muscles, the better you will look after your surgery.
PE (pulmonary embolus) is a serious and potentially fatal problem. This is a risk after any major surgery, particularly abdominal surgery. Having had one pulmonary embolus, you are at increased risk of having another. There are some special things we would do to help minimize this. Patients who are obese, who are on hormones, who smoke, and who do not move around much are also at increased risk.
PE (pulmonary embolus) is a serious and potentially fatal problem. This is a risk after any major surgery, particularly abdominal surgery. Having had one pulmonary embolus, you are at increased risk of having another. There are some special things we would do to help minimize this. Patients who are obese, who are on hormones, who smoke, and who do not move around much are also at increased risk.
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I had three c-sections in the course of 21 years and wanted to tighten my flabby midsection. Do you recommend a tummy tuck, or laser lipo? Shalang from Camden |
8/27/2009 12:40:49 PM |
Martha S. Matthews, M.D.:
It depends.
If your skin tone is poor (one indication is a lot of stretch marks) then lipo is probably not for you.
Also, if you have a lot of loose skin already, particularly above the navel, Lipo is not the best choice.
Some people benefit from both lipo and tummy tuck.
There are many kinds of lipo- tumescent, ultrasonic, laser, etc. They are all very similar techniques, and the general feeling among most plastic surgeons is that one is not clearly better than another. Each surgeon has his or her preferences. Don't get fixated on the technique- unfortunately, a lot of that is marketing, not science. Discuss with your doctor what techniques he or she prefers, and if it makes sense to you, go for it. Any doctor should be able to explain to you why they do things the way they do.
If your skin tone is poor (one indication is a lot of stretch marks) then lipo is probably not for you.
Also, if you have a lot of loose skin already, particularly above the navel, Lipo is not the best choice.
Some people benefit from both lipo and tummy tuck.
There are many kinds of lipo- tumescent, ultrasonic, laser, etc. They are all very similar techniques, and the general feeling among most plastic surgeons is that one is not clearly better than another. Each surgeon has his or her preferences. Don't get fixated on the technique- unfortunately, a lot of that is marketing, not science. Discuss with your doctor what techniques he or she prefers, and if it makes sense to you, go for it. Any doctor should be able to explain to you why they do things the way they do.
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What are the adverse conditions in having lipo suction? What is the best type of lipo suction to have done? Recovery time? Cost? Lipo for Hip cost? Lipo cost for abdomen? Dawn from West Deptford |
8/27/2009 12:43:05 PM |
Martha S. Matthews, M.D.:
All surgeries can have complications, and all of them have their limitations.
The final result of liposuction depends on your skin's ability to shrink down after the fat is removed. Some people have more elasticity than others, and a person with good elasticity will have a better result than someone who does not. A fairly common result after liposuction is some loose skin, or areas in which the skin doesn't shrink as much as one would like. During your consultation, your doctor should be able to give you an idea if this would apply to you.
Skin tightening takes time. It takes about 6 months to see a final result.
Another potential problem with liposuction is small irregularities of the skin- either bulges or little dents. These are usually minor. Liposuction does not treat "cellulite" appearance.
Most people bruise at least some. This is not a complication, but can be a problem if you don't expect it. There is some skin numbness for a few months.
Infections are rare but can happen. There can be other rare complications.
If you gain weight after liposuction, the areas treated may not gain weight evenly, and you could end up with bulges where you don't expect.
There is no single best type of liposuction. Your doctor should be familiar with several options, and be able to explain to you what he or she recommends and why.
Cost is impossible to estimate without seeing you. It depends on exactly what you want treated, and how extensive the issue is.
The final result of liposuction depends on your skin's ability to shrink down after the fat is removed. Some people have more elasticity than others, and a person with good elasticity will have a better result than someone who does not. A fairly common result after liposuction is some loose skin, or areas in which the skin doesn't shrink as much as one would like. During your consultation, your doctor should be able to give you an idea if this would apply to you.
Skin tightening takes time. It takes about 6 months to see a final result.
Another potential problem with liposuction is small irregularities of the skin- either bulges or little dents. These are usually minor. Liposuction does not treat "cellulite" appearance.
Most people bruise at least some. This is not a complication, but can be a problem if you don't expect it. There is some skin numbness for a few months.
Infections are rare but can happen. There can be other rare complications.
If you gain weight after liposuction, the areas treated may not gain weight evenly, and you could end up with bulges where you don't expect.
There is no single best type of liposuction. Your doctor should be familiar with several options, and be able to explain to you what he or she recommends and why.
Cost is impossible to estimate without seeing you. It depends on exactly what you want treated, and how extensive the issue is.
Martha S. Matthews, M.D.
: Thank you to all of you who sent questions for our eTalk today. We certainly covered a number of topics having to do with plastic surgery. My colleagues and I would be most happy to further discuss your options, just click on the button above to reach our Physician Referral Service for available appointments. Best wishes to all for a safe and healthy Labor Day Weekend.
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