Weight Loss Surgery Forums

Ask OH February 2008

Q. What is a total body lift?

A.  A total body lift is a trademarked phrase, which is a somewhat confusing phrase.  Typically, it describes a single stage surgery which incorporates a circumferential body lift, leg lift, breast lift, breast augmentation, torsoplasty, and arm lift.  Usually, this surgery is performed in a hospital with multiple surgeons operating on different body parts.  This surgery is long and may require multiple blood transfusions.  In addition, your recovery is in a hospital and maybe quite extended.  This procedure is not covered by insurance.  Most experienced board certified bariatric plastic surgeons do not perform a single stage total body lift.


Q. Do I really need a total body lift or can I just get a tummy tuck?

A. To determine if you need a circumferential body lift or a tummy tuck, first decide what bothers you.  If just the abdomen bothers you, then you need just a tummy tuck.  If the lateral hips and buttocks also bother you, then you need a circumferential body lift.  The tummy tuck will eliminate the central abdominal skin and fat only.  The circumferential body lift will eliminate central abdomen, as well as lateral hip, upper lateral thigh, and buttock skin and fat.

Q. I want to have my arms, legs, face, and body all done at the same time. Some doctors say this ok, some say no. What do you think?

A. I, as well as most experienced bariatric plastic surgeons, stage their procedures for best results.  I think having your arms, legs, face, and body all done at the same time is very dangerous.  This has to do with the length of surgery, time under anesthesia, and the total length of all your incisions.  It takes a significant amount of time for your liver and kidneys to process all that anesthesia after surgery.  In addition, a ?long? surgery increases your chances of infection.  This has to do with increased time of open areas in the operating room.  Also, with that amount of surgical dissection, you have an increased need for blood transfusions.  Blood transfusions automatically increase your chances of complications.  Postoperatively, I would also worry about your body?s ability to heal these incisions.  Typically, after weight loss surgery, your body is nutritionally challenged and may have a difficult time healing these multiple incisions.  For safety, I believe you should have staged procedures.  Staged surgeries make recovery easier and safer.  The risk for complications and need for blood transfusions is also decreased significantly.  In addition, I believe that your surgery should be performed by an individual surgeon, as opposed to a team of surgeons.  Trying to get perfect breast or body symmetry between two or three surgeons is very difficult.

In addition, I do not perform arm and leg surgery together.  If these are done at the same time, it is very difficult to ambulate, go to the bathroom, and use the bathroom appropriately.  This leads to extended healing and an uncomfortable recovery. 

Q. What credentials should I look for when choosing a plastic surgeon?

A. No matter what people say, when choosing a plastic surgeon, the first thing you should check is whether they are truly board certified by the American Board of Plastic Surgery.  The best resource is www.plasticsurgery.org.  If your plastic surgeon is on this website, then he or she is a board certified plastic surgeon.   This is the website of the American Society of Plastic Surgery.  In the field of plastic surgery, the American Board of Plastic Surgery is the only Board recognized by the American Board of Medical Specialties (www.ABMS.org).  Weight loss patient are significantly different from other patients seeking plastic surgery.   Weight loss patients have significantly different skin elasticity, muscle tone, nutritional requirements, and healing issues compared to patients who have not lost a significant amount of weight.  Because of these differences, you should seek a plastic surgeon that specializes in plastic surgery after massive weight loss.  This surgeon should devote at least 50% of his or her practice to weight loss patients.  In addition, ask to see many pictures of the procedures you are seeking.  I would ask for at least 30 ?before and after? pictures.  Also, ask to speak with prior patients.  I would ask for 10 names and telephone numbers.    In addition, be very careful: all pictures and contact patients should be weight loss patients.  Also, check your potential plastic surgeon?s reputation on the Obesity Help website (www.ObesityHelp.com).  It is very important to do your research when choosing a plastic surgeon.

Q. Do I need to wait until I have lost all my weight before getting plastic surgery?

A. It is imperative that you have lost all your weight before plastic surgery.  Typically after a gastric bypass, this is at about 10 to 12 months.  Typically after a LAP-BAND, this is at 20 or 22 months after surgery.  Either way, your weight has to have plateaued for at least 3 months before plastic surgery is begun.  It does not make sense to have plastic surgery before weight loss is complete because if you lose more weight after plastic surgery, your skin may not recoil and your results would not be optimal.


Q. What types of PS do most WLS patients need and get?

A. Most weight loss patients, male and female, have at least an abdominoplasty.  Some patients have excess skin and fat of the lateral hips and buttocks.  To address these areas, the tummy tuck is extended posteriorly and converted into a circumferential body lift.  Most women also seek breast reconstruction to include either a breast lift and/or breast augmentation.  A significant number of weight loss patients also seek arm and leg surgery.|


Q. Is it possible to get insurance coverage for my surgery?

A.Yes, coverage depends on your individual covered health benefits, as well as your physical examination and concurrent clinical problems.  If you have rashes underneath skin folds or chronic infections, this may increase your chances of coverage; however, the authorization for surgery is entirely dependent on your insurance carrier.  Depending on your individual insurance carrier and physical examination, I have had tummy tucks, body lifts, leg lifts, arm lifts, and breast lifts covered by insurance. The best thing I can advise is to contact your individual insurance company and request the required medical conditions necessary for reconstructive surgery after weight loss.

Did you know? 100 percent of Dr. Katzen?s practice is devoted to reconstructive plastic surgery after weight loss. Dr Katzen has a multi-disciplinary team to address the many issues concerning weight loss. Dr. Katzen has an 80 percent rate of insurance approval.  Please visit www.BodyByKatzen.com and call 1-888-KATZEN-0 for a consultation.