Someone emailed me today asking where my plastic surgery pictures were located. I realized, I had never reposted them when doing the new format!  It would not have mattered how much more weight I lost.  The hanging panni made me feel obese!  It was not fat, however.  Instead, it was heavy, drooping hanging skin that needed to be surgically removed.  My insurance company considered it medically necessary and covered the abdominoplasty.

FRONT VIEW

WEEKS 1 & 9 POST-OP

Oh my heavens!  For the first time in years, I could look down and see myself.  I didn’t have to lift up any stomach or skin!  But at 9 weeks, the swelling was %&$#!  Size 4 in the left, size 10 on the right!

SIDE VIEW

Many people are concerned about the scars left by their weight loss surgery.  Luckily, I found out about this recipe prior to my weight loss surgery and used it.  Now, if you plan on having plastic surgery, it is possible that with the upper body lift or tummy tuck that your scars will be taken away, especially if getting a midline incision.  But, for those who cannot afford plastic surgery or want to look great prior to the many months before plastics, this is a great recipe.  I used it (as well as another weight loss friend) on old scars and it diminished their look drastically!  Have an old gallbladder incision?  Breast reduction or other scars?  Try this cream!

Scar Cream Recipe
This recipe was given to me by a business contact. Her mother-in-law works at Vanderbilt and a plastic surgeon there recommends this to his patients. It’s a very simple recipe. However, the Pure Lanolin is difficult to find.

Use equal parts of:
(1) extra virgin olive oil
(2) Ponds Cold Cream (I would use Ponds, not a cheaper version)
(3) Pure Lanolin (it’s sold on Iherb.com for less than $5 for a 7 oz jar. The jar is better and makes it easier to apply. The oil makes it messy and runny.

Mix all ingredients together in a plastic container. It’s very hard to stir as the Lanolin is almost like wax. I just filled up the jar which the Lanolin came in and use that to dip my cream from each application. The rest can remain in the plastic container until you are ready for a refill.

NOTE:

I have read on the MakeMeHeal forums and also recently another friend of mine posted this…it’s been suggested that the actual cream used does not matter.  Whether this is true or not, I still love THIS RECIPE!!  It makes my skin feel so soft and smooth.  But, supposedly it’s the pressure which is applied to the scarred area that promotes healing to scars.

My plastic surgeon had instructed me to massage the cream of my choice into the scar but I didn’t think too much about it. I started seeing results even on old scars and thought it was my choice of scar cream (see recipe above). Now, it’s said that the actual massaging or pressure helps blood flow to the area, which helps healing.

In the beginning, I faithfully applied the scar cream twice a day. But due to the numbness and tingling sensation, I could not massage it properly. I just sort of rubbed lotion on and spread it out. If/when you have plastic surgery, you will see what I mean because the tummy/abdomenal region is sensitive yet tingly yet numb. It is a weird sensation. But now, I actually massage the cream into the scar and work my way across the stomach area and then back again. Now I have feeling and it’s not uncomfortable.

Many who come to the end of their weight loss journeys often ask “How do I get my insurance company to pay for plastic surgery such as a tummy tuck?” This is a very valid question. Recently I shared with a group of weight loss surgery support patients that my insurance covered a portion of my plastic surgery. Another weight loss surgery patient who works at the same place I do and is ready for her plastic work was shocked. She had no idea our insurance would possibly approve the procedure of having an abdominplasty/panniculectomy done. I see the same types of questions on message boards as well.

Here are some suggestions:

• If you have any type of rash or breakdown of skin, visit your PCP (Primary Care Physician) immediately to have it documented in your file. Do not wait too long or else the rash or area will heal up quickly. Visit the doctor each time these breakouts occur as they will help your case with the insurance company. You may also want to request the doctor’s office keep a picture on file, or to document that a picture was taken and you keep the pictures, along with dates taken. (Note: insurance companies frown upon having a plastic surgeon documenting these types of issues because the surgeon has something to gain from it: your and the insurance companies’ money. Therefore, I would not see a plastic surgeon until after you have documentation.)

• The PCP may prescribe some type of ointment, lotion or other topical cream which usually helps to heal the open or chaffed wound, but does not prevent more from occurring. Most insurance companies require patients to have taken some type of medication to ensure all means of treatment have been exhausted before approving reconstructive procedures as medically necessary.

• It is no longer true that a wls patient must wait 18 months post-op to have any type of plastic surgery done. Some surgeons require that you be at a stable weight for 6 months, and others want you to be within 10 – 15% of your goal bodyweight. For example, if you weigh 130 lbs and have a goal of 120, a surgeon would more than likely go ahead with the procedure as a 10% decrease in body weight would not hinder the surgical result. However, I’ve wondered whether the results would have been different if I had waited longer for plastics. My body seems to have shifted in where it carries weight. If you can wait, it might be worth it and provide better results (unlike me as I grew impatient!)

• Have the Plastic Surgeon take pictures and submit a letter to your insurance company EVEN IF YOU THINK IT WILL NOT BE APPROVED! You may be surprised at the findings. My insurance company had a requirement for medical necessity that the pannula hang AT or BELOW the symphsis pubis (pubic bone) region. I did not think I met this requirement. After all, it is very difficult to see yourself as you really are. Even looking straight on in a mirror, I did not know that my pannula hung down so far. The pictures is where the proof was.

• It is not your responsibility to write the letter to your insurance company. The Plastic Surgeon should write a letter, and he has done this enough to know what is necessary, and should include history, diagnosis codes, any problems that is documented in your PCP’s files such as the repeat rashes and breakdown of the skin and open wounds due to rubbing and chaffing.

• I would not suggest going ahead with surgery in hopes of obtaining insurance approval after the fact. Nowadays, most insurance companies mandate that procedures be PRE-authorized. Failure to do so will result in a denial. If your chosen surgeon does not accept insurance and/or will not write a letter to help you get it covered, find someone else (unless you can afford to pay for it yourself).

• Your insurance company may not approve all of the procedures you need or want. My insurance company, Blue Cross Blue Shield of Tennessee, did cover the panniculectomy. They did not cover the muscle repair as they consider it to be cosmetic. I paid my co-payment for the covered portion, plus the non-covered procedure. I had to choose whether I wanted the muscle repair (which I did!). Be prepared to finance or pay for some of the procedures if your insurance will not, though you can always opt to get it done at a later time.

• Make sure your chosen surgeon has done procedures on weight loss surgery patients. Our skin issues are much different and more complex than working on a normal person. If not, it could prove detrimental not only in your results, but in your health as well. Ask your surgeon to provide pictures of his or her work on bariatric patients. If he/she cannot provide pictures, act hesitant to do this, or if they do not have very many to show you, LOOK somewhere else! Bariatric surgery is a hot commodity today, and plastic surgeons want a piece of the pie! It is a sad fact that some physicians just need a few cases to add to their “reportoire” of gastric bypass patients (somewhat like a trophy or line on their resume). This will make them known in the community IF they are successful and produce good results. BUT, I would not want to be a guinea pig for a surgeon who wants to make a name for himself among the gastric community.

Remember, this is YOUR journey, YOUR body, and YOUR health. Plastic surgery is not to be taken lightly. It is a more difficult surgery than the gastric bypass procedure, and often plastic surgery is glossed over or regarded as an easy, elective procedure. Though elective, the recovery time is not a walk in the park.

Today I had a plastic surgery consult with Dr. Donald Griffin. It was regarding breast implants. Of course, I don’t keep much from my gastric bypass friends! This subject is no different. I had a breast reduction in 2005 (thank goodness) and now after losing 130+ lbs, I have nothing left! It looks like the air has been let out of my two tires.

That’s not the reason for this blog, however. While I was there, I asked him about the trouble pocket on my left middle tummy area. If you look at my pre-tummy tuck pics, you will see on my left side, under my breast, a puffy fat area. Well now, this has been pulled down to my mid tummy. I wanted to know… is it fat? Loose skin? Can it be lipo’d? Should I have gotten cut up and down my tummy when I got the abdominoplasty procedure?

He basically said that because of my obesity, the skin was stretched out. Nothing can make it spring back. I knew that. You knew that. Heck we ALL knew that! He said that its not worth cutting and redoing the tummy tuck, or the long vertical scar on my tummy. He could go in to a loose skin area on my hip where the scar stops and go up and remove some “stuff” but it will still look and feel “jiggly” as he put it.

So this is it. I know what it is now. Its not fat. There is nothing that will cure it. No amount of working out. No surgery. He said basically there is no perfect fix. I’m stuck with paying the price to my stupidity and unwillingness to take care of myself. I want to shout it from the mountaintop, from the rooftop, from any top I can reach… “Don’t let your children become obese! Don’t let yourself become obese!” It’s not worth it. There are too many repercussions that we must live with… yes you can always lose weight, but that doesn’t mean your body will physically rebound back to its original shape.

Now as for the breast implants… no decision on this yet. I have some things to consider… finances, and the possibility that there will be future surgeries involved. When you lose weight, and have had a reduction, sometimes you must go back for revisions either because the nipple skin needs corrected, or some stitching needs to be done to hold the implants in place. I might just buy bigger padded bras!