Plastics consult #2...confused!!!
So I had consult #2 with Dr. Mitchel Krieger in Fairfax. This man is the guru of body contouring of post bariatric surgery patients. Wrote a book with the other guru I'd heard of out of Texas, Dr. Lomonico I think it is.
Anyway, he has a much more conservative approach than consult #1. Also about 10K higher to get the work done that I want to get done and he won't do it all at once, so it will add a second recovery period. Ouch. And if there is anything that would keep me in the hospital an extra night or two, that number goes up 650 a day! Double ouch. First doc said he'd do the lower body lift and inner thigh lift the same day. This doc says no way. First doc said he'd do the hidden scar for the thighs--this doc says that procedure does not provide a good outcome at all. This doc also said he'd like to do a fat graft to the backside which cranks the price up 3500+, but he wasn't insistent on it. So just for the LBL I'm looking at 15K where the other guy said 17K for LBL and inner thigh lift. So to do the LBL and inner thighs I'm looking at about 25K with this doc (give or take 2-3K with pathology and hospital stay stuff) instead of the 17K. Scares me there is such a discrepancy in price and procedure between the two. I go see a 3rd doc on the 8th. Hopefully he will fall on the side of one or the other regarding procedures and safety and am hoping his price will be somewhere in the middle.
Of course I'd really like to knock out the LBL and the thighs at the same time, but I don't want to compromise safety or outcome, so we'll see what #3 says. Also considering a breast lift at the time of the LBL if I don't do the thighs. Money, money, money...ugh!
Just wanted to pass it along to those interested!
Have a good weekend everyone!!
Denise
Anyway, he has a much more conservative approach than consult #1. Also about 10K higher to get the work done that I want to get done and he won't do it all at once, so it will add a second recovery period. Ouch. And if there is anything that would keep me in the hospital an extra night or two, that number goes up 650 a day! Double ouch. First doc said he'd do the lower body lift and inner thigh lift the same day. This doc says no way. First doc said he'd do the hidden scar for the thighs--this doc says that procedure does not provide a good outcome at all. This doc also said he'd like to do a fat graft to the backside which cranks the price up 3500+, but he wasn't insistent on it. So just for the LBL I'm looking at 15K where the other guy said 17K for LBL and inner thigh lift. So to do the LBL and inner thighs I'm looking at about 25K with this doc (give or take 2-3K with pathology and hospital stay stuff) instead of the 17K. Scares me there is such a discrepancy in price and procedure between the two. I go see a 3rd doc on the 8th. Hopefully he will fall on the side of one or the other regarding procedures and safety and am hoping his price will be somewhere in the middle.
Of course I'd really like to knock out the LBL and the thighs at the same time, but I don't want to compromise safety or outcome, so we'll see what #3 says. Also considering a breast lift at the time of the LBL if I don't do the thighs. Money, money, money...ugh!
Just wanted to pass it along to those interested!
Have a good weekend everyone!!
Denise
Check out my blog--menumealplanning.com. Tales of making meal planning managable, family fodder, and everything else under the sun.
RNY 2/3/09, LBL/BL w/Augmentation 9/16/11
Start weight: 335 Current weight: 185 Goal weight: Whatever the hell I can maintain without driving myself insane!
*6.5 lost preop
Based on the consultations I had and the two surgeons who had sessions at the OH conference in Cincy last year, an increasing number of plastic surgeons are no longer doing thighs at all because 1) the approach where they cut in the leg crease usually does NOT give a good outcome unless you have very little excess skin and it is almost all in the upper portion of the thigh (rather than any of it being down toward the knees... it is very difficult to just pull all of that skin upward and get a natural look, and it creates a lot of tension on the delicate skin in the crease area), and 2) even with the long incisions on the inner thigh, which they say gives a much better result, patients tend to be unhappy with the scarring. In case they did not tell you, the rate of skin necrosis is higher in leg procedures than for other procedures because the skin is already very thin as is the rate for incisions opening up and creating wider scars because the tension on the thigh incisions is greater than on other areas.
As you said, perhaps the third surgeon will be somewhere in the middle. It is hard to know whether it is truly worth the extra money when there is no guarantee of what the outcome will be with ANY surgeon.
Be sure know what each surgeon's policy is on follow-up visits and complications. Some include only a certain number of post-op visits (or include onyl visits for a certain period of time) without charging you for the extra office visits. If you end up with necrosis or some otehr complication that requires MONTHS of additional follow-ups, if you are paying for those visits that could change the cost considerably! Also ask what the policy is on scar revision if a scar opens up and heals strangely because, again, that could cost you a significant additional amount if the surgeon will not revise it without charge.
Lora
As you said, perhaps the third surgeon will be somewhere in the middle. It is hard to know whether it is truly worth the extra money when there is no guarantee of what the outcome will be with ANY surgeon.
Be sure know what each surgeon's policy is on follow-up visits and complications. Some include only a certain number of post-op visits (or include onyl visits for a certain period of time) without charging you for the extra office visits. If you end up with necrosis or some otehr complication that requires MONTHS of additional follow-ups, if you are paying for those visits that could change the cost considerably! Also ask what the policy is on scar revision if a scar opens up and heals strangely because, again, that could cost you a significant additional amount if the surgeon will not revise it without charge.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
Very good questions Lora. I didn't even think to ask about follow-up stuff. I figured my list of the 150 questions I had about covered it!! This guy did say if he did the thighs he'd only need to take the incision down less than halfway to my knee because the bulk of my excess skin and "volume" is only that top 1/2 of the leg. My friend had the thighs done and the incision went down past her knee. Poor thing has a horrible scar. I DO NOT want to trade one area of self conciousness for being self concious about a scar! I am feeling like time is of the essence because of some things going on at home, but this is no time to rush. I'll just keep asking questions here and take my notes and make my calls.
Thanks for the suggestions!!
Thanks for the suggestions!!
Check out my blog--menumealplanning.com. Tales of making meal planning managable, family fodder, and everything else under the sun.
RNY 2/3/09, LBL/BL w/Augmentation 9/16/11
Start weight: 335 Current weight: 185 Goal weight: Whatever the hell I can maintain without driving myself insane!
*6.5 lost preop
I had all 3 procedures done, at seperate times. I would NOT reccommend doing the thighs and LBL at the same time. I did the thighs last and alone (inner thigh lift and lipo) and felt it was by far the toughest recovery- i am so thankful I had that procedure done alone.
I did a breast lift/reduction at the same time i did my arms and then about 6 weeks later a LBL. As far as recovery you could probably do the LBL with the breast lift, but some doctors will not perform the two together as you are pulling skin in opposite directions. Also- post LBL I spent 2 nights in the hospital, post inner thigh lift, 1 night in the hospital; and as much as I wanted to go home, I belonged there and was grateful to stay; long time under anesthesia, pain managements, limited mobility post op- lots of factors to consider.
I did a breast lift/reduction at the same time i did my arms and then about 6 weeks later a LBL. As far as recovery you could probably do the LBL with the breast lift, but some doctors will not perform the two together as you are pulling skin in opposite directions. Also- post LBL I spent 2 nights in the hospital, post inner thigh lift, 1 night in the hospital; and as much as I wanted to go home, I belonged there and was grateful to stay; long time under anesthesia, pain managements, limited mobility post op- lots of factors to consider.
Christine
Breast Lift/Brachioplasty January 18, 2011
Lower Body Lift March 3, 2011
Inner Thigh Lipo/Lift May 4, 2011
LOVE this kind of feedback. Exactly what I need to hear about. I've heard the thighs are ROUGH to recover from. My doc did say he would do the LBL/BL at the same time, but would NOT do implants at the same time because of the issue you mentioned and there needing to be time for healing and settling before you add the implant to see where things will really wind up. I'm kind of counting on a 2 night stay after the LBL. My friend who had arms, BL, TT, and inner thighs done all the same day would up stuck in the hospital for 4 days. I've had some pretty serious rash issues, but this doc does not seem to be inclined to press the insurance issue. Says that if the rashes respond to conservative treatment they won't cover them. Well they respond if I put a steroid based cream on them all the time--that's no way to live. I'm wondering if it is because he doesn't have to worry about insurance--people pay their money and that's that. But obviously every cent helps. I will insist they pursue it if I go with him. No harm in trying. Did you go through insurance at all?
Thanks for the great info!
Thanks for the great info!
Check out my blog--menumealplanning.com. Tales of making meal planning managable, family fodder, and everything else under the sun.
RNY 2/3/09, LBL/BL w/Augmentation 9/16/11
Start weight: 335 Current weight: 185 Goal weight: Whatever the hell I can maintain without driving myself insane!
*6.5 lost preop
Well, here's how it works. My surgeon charges a fee and then the hospital has a 'cosmetic package' which is an hourly rate (about $2300/hr)- and this includes OR/anesthesia/recovery room.
Breast lift/brachio- insurance covered breast lift in its entirety, my surgeon was therefore able to write off most of my OR time to that surgery so I only paid an for an hour in the OR- plus the surgeons fee for brachioplasty (6k)
LBL- a portion (I suppose the 'panniculectomy') was covered by insurance, which means they also picked up my OR/anesthesia/recovery time and the 2 night stay in the hospital. I paid the surgeon's additional fee (4k).
Thigh lift/lipo: insurance also picked most of this up- the surgeon charged me 4k for lipo or whatever. and they covered my night in the hospital.
Truthfully I have absolutely no idea what my surgeon's biller said to insurance to make them cover it, and I had no medical necessity for the surgery- no rashes really, no pain... I just wanted it because i hated the excess skin- I was prepared to pay out of pocket for all procedures.
Breast lift/brachio- insurance covered breast lift in its entirety, my surgeon was therefore able to write off most of my OR time to that surgery so I only paid an for an hour in the OR- plus the surgeons fee for brachioplasty (6k)
LBL- a portion (I suppose the 'panniculectomy') was covered by insurance, which means they also picked up my OR/anesthesia/recovery time and the 2 night stay in the hospital. I paid the surgeon's additional fee (4k).
Thigh lift/lipo: insurance also picked most of this up- the surgeon charged me 4k for lipo or whatever. and they covered my night in the hospital.
Truthfully I have absolutely no idea what my surgeon's biller said to insurance to make them cover it, and I had no medical necessity for the surgery- no rashes really, no pain... I just wanted it because i hated the excess skin- I was prepared to pay out of pocket for all procedures.
Christine
Breast Lift/Brachioplasty January 18, 2011
Lower Body Lift March 3, 2011
Inner Thigh Lipo/Lift May 4, 2011
My insurance only paid for my panni, even though I had well-documented rashes in my armpits (including a history of infected cuts from shaving) from all the excess skin.
I talked to three surgeons about a breast reduction (still a 36DDD) and lift but neither of them was willing to submit to insurance. Both said that I did not have enough actual breast tissue left to qualify. The one surgeon who WAS willing to try to help me get insuracne to cover it doesn't take insurance at all, and since my out-of-network deductible is $2500 and then they only cover 50% beyond that, even fi we could get it approved, it would only cover about $1500 of the $5500... and I haven't finished paying off my tummy tuck yet. So my 48 year old, huge, saggy boobs will just have to stay that way.
Lora
I talked to three surgeons about a breast reduction (still a 36DDD) and lift but neither of them was willing to submit to insurance. Both said that I did not have enough actual breast tissue left to qualify. The one surgeon who WAS willing to try to help me get insuracne to cover it doesn't take insurance at all, and since my out-of-network deductible is $2500 and then they only cover 50% beyond that, even fi we could get it approved, it would only cover about $1500 of the $5500... and I haven't finished paying off my tummy tuck yet. So my 48 year old, huge, saggy boobs will just have to stay that way.
Lora
14 years out; 190 pounds lost, 165 pound loss maintained
You don't drown by falling in the water. You drown by staying there.
IMO don't do the LBL or even a TT with the breast lift/reduction/implants. I did and although I look MUCH better I do believe the results would have been better doing them separately. As another poster stated the surgeon is pulling up and pulling down at the same time probably not the best solution for good results considering our years of obesity and stretched skin.
Be sure to also ask if you haven't yet about revisions, many need to do this and you want the surgeon to cover this in his original price. You may have to (probably will) have to pay again for anestesia and OR room.
I'd really like to have my thighs and backside done, I need to win the lottery, LOL.
Be sure to also ask if you haven't yet about revisions, many need to do this and you want the surgeon to cover this in his original price. You may have to (probably will) have to pay again for anestesia and OR room.
I'd really like to have my thighs and backside done, I need to win the lottery, LOL.
Proximal RNY Lap - 02/21/05
9 years committed ~ 100% EWL and Maintaining
www.dazzlinglashesandbeyond.com
Yeah, I think I'd probably seek a third opinion if I got two very different opinions from two different docs. To help me decide which opinion I think is correct, I might also ask them what they are basing their opinions on. Like, the second doc says the hidden scar doesn't have a good outcome. What does that mean? Doesn't look good, is more likely to get infected, or what? What percent of people with that procedure have a bad outcome? Are there any studies he can point to that show that?
I'm sure money must be an issue for you. I know it would be for me. The most expensive is not necessarily best, but you don't want to just go with what's cheapest if it's not going to be good or safe.
I'm sure money must be an issue for you. I know it would be for me. The most expensive is not necessarily best, but you don't want to just go with what's cheapest if it's not going to be good or safe.
Kelly
Please note: I AM NOT A DOCTOR. If you want medical advice, talk to your doctor. Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me. If you want to know what your surgeon thinks, then ask him or her. Check out my blog.
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