What does it mean when they won't do the LBL?

I would really appreciate input on this.    Today I had a consultation with another plastic surgeon.   This one recommends an abdominoplasty and breast lift as the first stage.   He does not want to do a LBL.

He says - the abdominoplasty and the back procedures both involve pulling the skin down and you can't pull either side as tightly when you do them at the same time.   Also, the body is flexed forward for the abdominoplasty, so that pulls on the back incisions.

I am really torn about what to think.   Other surgeons I've talked to will do the LBL and lots of people on these boards have had the LBL.   But what he says also seems to make sense.   So here is my questions.   It is more likely that

A - he doesn't have the experience with doing the LBL to have the technique and comfort level to be confident in that procedure and doesn't want to try it

or

B - there are trade offs and doing a LBL you get it all done at once but with compromises including less tight results, while doing  it in two stages you get tighter results but have to have two procedures and probably have to go back over the abdominoplasty incision to match up with the back.


B makes sense to me but then I wonder about all the doctors who have recommended the LBL.  None of them said, I can get you good results with a LBL or even better results in two procedures.  Why not?     

Does this even make sense?   It is hard enough to figure out who you feel comfortable with, but then when you get contradictory information about what procedures are doable, it makes it even harder. 

thanks --- Alison

I think it's the comfort level and/or experience level of the ps you went to.  My ps and any other experienced ones - from my experience - don't have any problem doing the lbl.  But at least the dr you went to told you his comfort level rather than you find out with bad results.  I would get more consults and definitely not go to that ps.

I remember when I was a hairdresser I wasn't comfortable bleaching hair but it was a very popular thing with women at the time.  Someone could call and make an appt with me for bleach.  I would do it - if I couldn't tactfully talk them out of it - but I didn't like it and prayed all the way through that their hair would turn out ok and not fall out of their head!  My preference was any other color method than bleach.  My point is, my comfort level with bleach caused me to shy away from it and try to get clients to choose something else.  I wasn't experienced enough with it to feel comfortable and know what to do if problems arose.  I think that might be the same type of thing with the ps you went to.  Just a thought, my opinion.  But if he isnt' comfortable I'd take that as a warning and go somewhere else.  LBL's are time tested and proven to be safe with good, tight results - but you have to be confident in your skill level to do it.

i appreciated the info you posted about her question -
i was wondering if you had lbl and if so, did YOU get good thigh results?
i have my appointment next monday and am very curious about what can be done about my thighs
kf

I got great results but I had extensive lipo to inner and outer thighs with the lbl in anticipation of a later vertical thighplasty.  Some lipo will most likely be included but some ps's charge extra.  Mine was extreme to debulk.  I had 12 pounds taken off my stomach and 13 pounds of lipo from my thighs.  I love the saddlebags gone.  However, the lipo does leave saggy skin that won't spring back.  I knew that going in that the lipo was just a precurser to the thighplasty.

i am anxious and nervous and excited about what the PS will say about my thighs
i hate them - but, in reality - they arent the WORST ever!
but, my butt, on the other hand! is bad!
and then i think maybe i am being self ish spending all of that money on my thighs when i'm not gonna be showing them to anyone anyway!
but, if i'm gonna do the butt - i cant have a skinny butt and thunder thighs!
so?
what's a girl to do?
kf

I was completely opposite. My doctor said I would never be happy with just an abdominoplasty, he said I would have continual flaps of skin going around the rest of my body but would be very flat in the front, he showed me by pinching the skin all the way around to my buttocks.

I am very tight and would NEVER go through this process twice...for the same result. I was out of work for a month and cannot afford to be off twice for a procedure that can be done in the same session. I am happy wihth my results and everything feels very tight, I fear your surgeon may not be comfortable as there are hundreds of us who have LBL's.

Best luck on it all, I know how frustrating the initial process can be...blessings!

Because of my medical issues my surgeon did not want to do the front and back at the same time.  So I really cannot comment on the efficacy one way or the other, but I did want to tell you that my incisions do match up!

Red

Alison,

I would go with A.  He's just not comfortable doing LBLs.   Both of the surgeons I saw fully recommended doing an LBL on me saying I would NOT be happy with just a TT and would end up going back to have the backside done.  They both said it is better to do it all in one procedure.  Both of these surgeons are experienced massive weight loss PS and do LBLs all the time. 

My other personal concern would be the cost of going for two major surgeries.  You'd have to pay for facility and anasthsiologist fees twice and that could end up much more expensive.  Unless there is a health reason that he sited (which it doesn't sound like there is) than it seems silly to put you under twice for a procedure that could be done all at the same time.

I had an LBL and am VERY happy with the outcome.  I wouldn't say any tightness was compromised.  And in fact I'm glad that they do bend you forward for the front and that leaves a little give in the back.  Otherwise sitting upright in any sense would be almost impossible and I would think you'd run a higher risk of wound seperation...that however is purely personal opinion and not based off anything my docs said to me!

I would recommend seeing at least one other PS, one experienced with massive weight loss patients and see what they have to say.  Just make sure you don't tell them what the others have said until after they give their recommendation.

I don't envy you having differeing opinions.  I was quite glad with both of the surgeons I saw totally agreed on what I should have done.

Good luck!
Corinna Q

My (very well-respected) plastic surgeon did not do a lbl on me because he was concerned with the amount of time I would have to spend under, and the blood loss. He repaired a very large hernia at the same time as my tummy tuck, and a few months later he did a buttlift. The scars match up perfectly.

Alison,

I had the EXACT same thing happen to me.  I saw different PS's and every one of them said they would do the LBL, but the one I chose to go with doesn't do LBL's.  He said it's for the reason you gave - better results in getting the tummy as flat as possible and that healing from a LBL can be difficult and very painful especially if you're doing a BL/BA at the same time which I am.

This PS is VERY well respected and known in our community and I've heard nothing but good things about him.  So even though I started out wanting a LBL, I'm getting my TT and BL/BA done on January 16, 2009 and then I'll consider doing the backside and maybe my inner thighs.

It really is your personal choice.  If you like this surgeon and fell comfortable with him that's all that matters.

Just my opinon.

Franci