Question:
Some Answers about Plastic Surgery from a Plastic Surgeon

I have had the pleasure of corresponding with Dr. Steve Fallek and wanted to share his answers with the AMOS community.<br><br><b>How long to wait to have plastic surgery following wls?</b><br><b><i>I wouldn't operate in any case prior to one year after surgery. In addition, if there were any complications I might hold off longer. Two to three years seems to be the average waiting time for most patients but you can certainly wait as long as you want. The more important issue is oncerning goal weight. As long as weight loss was ongoing, I would hold off on surgery. If your weight has stabilized over a few months to a year, I would consider surgery. Hopefully, that would be closer to 75-80% of intended weight loss with 90% being optimal. Many if not all plastic surgery procedures may be repeated as necessary. The drawbacks include increased risk, cost, and further surgery.</b></i><br><b>What questions should a patient ask of a potential surgeon?</b><br>It's most important that the surgeon who performs any cosmetic reconstructive surgery is a board certified plastic surgeon. This means they are board certified by the American Board of Plastic Surgery. There are a variety of other boards and many unscrupulous physicians will claim they are board certified by other boards or even unaccredited organizations. If you have any questions, you can call the ABPS to check on certification. The reason this is important is that ABPS certified plastic surgeons are the most qualified, capable, and experienced physicians in body contouring. Plastic surgery should never be taken lightly for it is still surgery and post weight loss plastic surgery is more extensive still. In this patient population the skin resection, blood loss, fluid shifts, and anesthesia risks are all greater. Plastic surgery performed by skilled physicians lowers the risk. Many plastic surgeons are also board certified by the American Board of Surgery and are fully trained in the field of general surgery. This means they have performed many weight reduction surgeries during their training and are intimately familiar with bariatric surgery. In my opinion and I am one of those, I do not believe this is critical in choosing a plastic surgeon although it is an advantage.<br>What else should you look for in a surgeon? They should feel comfortable performing all types of body contouring. It would be silly to go to one surgeon for a breast lift, another for an abdominoplasty, and a third for a facelift. Although I hate this question, do they have one area of expertise overall? Be wary of the liposuction expert who has never done a breast lift. Ask them how many procedures ey have done recently and what types of procedures that they perform. The field of bariatric surgery is growing exponentially and with it the amount of plastic surgery. Do you need to see pictures? I'm not so sure. Obviously, the surgeons show their best results. Some surgeons won't show pictures since it may be construed as a guarantee that all their patients will look that way. You should also ask them where they perform their surgeries and which hospitals they are affiliated with. Many surgeons operate in surgicenters or in their offices. The advantage to this is time for the surgeon and usually a slightly reduced fee for the patient versus the hospital. The disadvantage is it's not a hospital and if there is a problem, then what? If you feel comfortable with this situation as least ask the surgeon what happens if there is a problem. Most surgeons have admitting privileges at one of the local hospitals where you can be transferred in case of an emergency. Again, don't believe plastic surgery isn't real surgery. There are always risks. If your surgeon doesn't explain them to you, find another surgeon. Most important to the doctor-patient relationship is trust. You need to feel as comfortable with your plastic surgeon as your general surgeon. If not, go elsewhere.</b></i><br></b>What is the difference between an abdominoplasty and a panniculectomy?</b><br><b><i>An abdominoplasty (tummy tuck) is an operation where classically the loose abdominal skin, fat, and soft tissue are pulled down like a drape and excised. Then the abdominal musculature is tightened and the umbilicus is reconstructed. The incision and scar is usually hidden in the bikini or underwear line. It is most commonly performed in post pregnant women with a "pouchy" abdomen, stretch marks, and loose muscles from pregnancy. Insurance companies consider it cosmetic surgery. A panniculectomy is an excision of a pannus, or the overhang of skin, fat, and tissue. The overhang is simply excised without tightening of the muscles. In adition, the excess tissue is usually below the umbilicus which is not involved. However, umbilical reconstruction may depend on the presence of an umbilical hernia. A panniculectomy is considered more "reconstructive". Insurance companies are more likely to reimburse for this procedure especially if it is to improve hygiene, ambulation, and recurrent infection.<br><br>I appreciate Dr. Fallek providing us with this important information. He may be contacted via email at [email protected] or via telephone at 212-535-9080.    — [Deactivated Member] (posted on October 25, 2000)

October 25, 2000
Denise, THANK YOU very much for posting this information. Although I am pre-op, the long term issues such as body reconstruction are something I think about. Knowing the questions to ask and the difference in terminology is extremely helpful!!
   — Laura B.