Question:
Can someone give me advice on getting approval for plastic surgery (arms and TT)

Im only 5 months post-op. But, I know that once I reach goal, I will need plastic surgery on my arms and stomach. Ive lost 130 pounds so far (down from 391 to 258) and my skin is seriously beginning to sag. I have so much excess skin under my arms and on my stomach that I can barely stand to look at myself naked. Im happy with my success so far. But, Im only 30 and know that I dont want to go through the rest of my life with all that excess hanging skin. I just wanted to get some suggestions from those of you out there how the approval process works. Im thinking I will definitely have to pay for my arms out of my own pocket. But, with my stomach, Im already having serious back problems from the excess weight of the hanging skin and unfortunately Im thinking the problem will worsen as I continue to lose. Obviously I wont be giving this a final consideration until at least a year out. Just wanted to get some advice in advance since this is already on my mind constantly. Thanks :)    — c B. (posted on January 13, 2003)

January 13, 2003
Hi cb...I don't have any info about getting plastics (my insurance co, Kaiser, won't pay for it), but I wanted to comment on the fact that you're only 30....and yes, I agree, you are young and if I was 30 (I'm 49), I'd do what I had to to pay for plastics, even take out a loan. You've got a long work life left to pay for it yourself, if you need to. I hope your insurance will at least pay for you TT. Hugs, Joy
   — [Deactivated Member]

January 13, 2003
Most surgeons will recommend that patients wait approximately 18 months post-WLS before their reconstructive surgery. This gives the body time to "bounce back" from the major WLS, and also allows time for optimal weight loss. You wouldn't want to get a major "nip and tuck", then lose more weight and end up very dissatisfied with the end results! I always suggest that patients obtain consultations from at least two plastic surgeons, not only for price comparisons, but also to determine if there is more than one approach to achieve the desired goal, and which approach best meets the patient's needs. Having a great bedside manner is an appealing quality in a physician, but the most critical factor is the surgeon's experience and expertise. Most plastic surgeons will submit a letter of medical necessity, as well as frontal and profile photographs, to the insurance provider(s). The photograph session is embarrassing, but essential....after all, a picture DOES paint a thousand words :-) My plastic surgeon told me to expect an initial denial, and that we would probably need to appeal because I was requesting an armlift as well as a panniculectomy. It apparently is rare for insurance providers to approve brachioplasty (armlift) procedures. My secondary provider approved immediately with no questions asked; my primary denied and forced us into the appeals process. I was not required to appear in person before the appeals committee. I prepared a packet of information which included a copy of the plastic surgeon's original letter (and did not re-submit the photos); accompanying letters of medical support from my PCP as well as my bariatric surgeon; my own long and detailed personal letter outlining the physical and emotional reasons that this reconstructive (NEVER "cosmetic") surgery was important to me; and finally a copy of the 1996 Position Paper from the American Society of Plastic Surgeons, entitled "Treatment of Skin Redundancy Following Massive Weight Loss". This can be obtained from www.plasticsurgery.org/profinfo/pospap/skin.htm. My primary provider approved both procedures (done during one surgery/overnight stay in the hospital) one week after receiving the appeals packet. If you receive a denial, keep pushing! I had my panniculectomy and brachioplasty in November 2001, and couldn't be happier with the results. Feel free to email me privately if you have further questions: [email protected]. Best wishes!
   — Diana T.