Online Health Chat with Dr. Silvia Rotemberg
August 20, 2010
Cleveland_Clinic_Host: If significant weight loss or the normal effects of aging or childbearing have left you uncomfortable with your body’s appearance, preventing you from confidently doing things you enjoy, you may be a candidate for body contouring surgery. Body contouring refers to a number of different procedures that can improve body shape and contour, tighten excess or loose skin and enhance body image. Areas most commonly treated include the abdomen, the inner and outer thighs, the hips, arms, breasts and neck area.
If you have dieted and exercised and still have stubborn fat and skin that you can’t seem to get rid of, this webchat will help you learn more about liposuction, abdominoplasty (tummy tuck), and other procedures that can help improve your body’s shape and restore your confidence.
Dr. S. Cristina Rotemberg is board-certified in Plastic Surgery. Dr. Rotemberg completed fellowships in Plastic Surgery and Aesthetic Surgery at Cleveland Clinic. She also completed her residency in Plastic Surgery at University Hospitals in Cleveland. She specializes in the full range of cosmetic surgery procedures, including all body contouring procedures, cosmetic surgery of the face, breast and abdomen, laser surgery, cosmetic injectables, and minimally-invasive cosmetic surgery.
To make an appointment with S. Cristina Rotemberg, MD or any of the other specialists in our Plastic Surgery Department at Cleveland Clinic, please call 216.444.4646 or call toll-free at 800.223.2273, ext. 44646. You can also visit us online at our new Cleveland Clinic Cosmetic and Plastic Surgery Center website at www.clevelandclinic.org/RenewYou
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Cristina Rotemberg. We are happy to have her here today for our chat on Body Contouring Procedures. Let’s begin with the questions.
Body Contouring Procedures After Weight Loss
shanell: I am interested in getting the body shaping surgery. I had gastric bypass surgery and want to get rid of some excess skin. I want to lose another 30 pounds then have the surgery done. I have taken the pictures needed for surgery possibly three years ago. I have also seen a plastic surgeon three years ago. If a person is healthy what is the risks? I would like to know a ball park figure of what it cost for this type of surgery and do they do payment arrangement through the job and can I get some of the payment paid through the insurance?
Speaker_-_Dr__ S.Cristina _Rotemberg: The surgical risks are the same as with other surgeries. If you have a lot of co-morbidities (other chronic illnesses such as diabetes, high blood pressure, history of blood clots) you are more prone for complications like wound infection, non-healing wounds and bleeding. Smoking will also increase the risk of complications.
Regarding the cost you would need to speak with our financial advisor in the department. Sometime insurance will approve removing the excess skin of the abdomen if you meet your insurance policies criteria.
slynch0: I had gastric bypass surgery 5 years ago and lost about 150lbs that I have maintained since. I have strongly considered getting a tummy tuck to remove the excess abdominal skin, but am concerned about the recovery time and the amount of time I won't be able to exercise or limited movement after the surgery because of the location. Can you provide any insight into post-opt details for an average patient with this concern?
Speaker_-_Dr__ S.Cristina _Rotemberg: The recovery time is usually 4-6 weeks. Usually you can start brisk walking around 3-4 weeks and most patients return to their normal exercise routine around 6-8 weeks.
weed: After weight loss there is a lot of skin on the abdomen. If it's removed, what happens if the woman gets pregnant? My daughter is 24. She is is happy with her current weight. It's on the higher end of her desirable range. She wants the abdominal skin "fixed". The docs say she should be able to have kids with the Roux-en-y procedure. My question is: Is it better to be a little on the high end of your weight range and get the skin removed if you think you will have kids. She has a lot of skin so the surgery is recommended now. I'm just concerned about later on in life after she has kids.
Speaker_-_Dr__S.Cristina_Rotemberg: It is always better have the skin removed if the BMI is below 30. If she gets pregnant after she has the skin removed, she will be just like any other post-partum woman with excess skin. She may need a 2nd procedure once she is done having kids.
cbc: I have had significant weight loss over the past 3 years (close to 200 lbs). I am a 41 year old female. I am about where my doctor and I both feel is a good weight for me and I don’t plan to lose (or gain!) any more weight. I am now at the point of considering surgery to get rid of excess skin, some lifts and possible liposuction in certain areas to make my body look as good as it can. In terms of safe surgery, can I have all desired procedures at one time so that I only have to take off work once, or will I need multiple surgeries? Haven’t done much research yet. Just starting my info search.
Speaker_-_Dr__ S.Cristina Rotemberg: You will most likely not going to be able to obtain the body you are looking for in one operation. Total body lift in one setting is not a safe operation and can have a lot of complications.
Facial Plastic Surgery
Nelson: What is involved with a neck lift? I am in my 50's and hate the double chin that is forming. Where are the incisions? How is the incision closed (sutures?) What is recovery time.....? And last - what is the approximate cost?
Speaker_-_Dr__ S.Cristina Rotemberg: Sometimes you do need a facelift in combination with a neck lift. The scar is in front and behind the ear as well as 1" scar under your chin. The sutures all dissolvable. Recovery time is about 2 weeks.
Again, our financial advisor would be able to answer your questions. The number to contact is 216.445.1331. For appointments you may call 216.444.6900.
Nelson: I have one eye lid beginning to droop. When is the best time to have this procedure done - meaning how bad does it have to be? Are both eyes done even it only one is an issue?
Speaker_-_Dr_ S.Cristina Rotemberg: Eyelid droop requires a ophthalmology consult. If visual field tests are failed, we can send a letter to insurance and some insurance will approve the procedure. They may approve one eye only. If you are doing this for cosmetic reasons we usually do both at the same time.
berta: Jowl (excess fat) removal – outpatient? Recovery time?
Speaker_-_Dr__ S.Cristina _Rotemberg: Jowl excess requires a facelift procedure. I usually recommend the patient stay overnight at the hospital or at a hotel close to the hospital. Recovery time is about 2 weeks.
weed: In your opinion, what is better a facelift or the injectables, for the folds women in their fifties who are seeing folds around mouth nose, and crow’s feet?
Speaker_-_Dr__ S.Cristina Rotemberg: Injectables are volumizers and there are good for deep creases and folds but they do not lift. It depends on the individual patient and desired outcome.
Arm Lift Surgery
tennispro: I am considering having arm lift surgery, but have heard there is bad scarring. Is this truly a concern or only if not done properly? I am fairly young (early 40’s). If I have this done now, will I have to have it redone as I age? More than once?
Speaker_-_Dr__ S.Cristina _Rotemberg: With the arm lift procedure there is a long scar that goes from your elbow to your arm pit. Patients will scar differently. If you already have a scar anywhere on your body and you do not like the way it appears, you most likely will not like the arm scar from this procedure.
Breast Plastic Surgery
krutt: I have a scheduled initial consultation for a breast reduction. After reading up on the Internet and chatting with others, it has been recommended that I also have implants put in, in order to get the ‘perkiness’ and lift I want, but have not had with my larger breasts. Is this something that is commonly done or needed? I will ask my physician when I go for my appointment, but I would like to be informed when I go.
Speaker_-_Dr__ S.Cristina Rotemberg: This depends on the amount of breast tissue that is to be removed with the reduction. Usually an implant is not necessary. If you have thin, saggy breasts then you will most likely need a lift with an implant.
captuck: I am seriously considering having a breast reduction. Does insurance cover this if it is done on the suggestion of my doctor, for health reasons?
Speaker_-_Dr__ S.Cristina _Rotemberg: First you should inquire to your insurance carrier the requirements and weight necessary to be removed from the breast. Most insurance will cover a reduction if the breasts are very large and heavy.
bobbie: What exactly causes symmastia? How common is it as a complication of surgery and what can be done to prevent it?
Speaker_-_Dr__ S.Cristina _Rotemberg: If the implant is too large for your breast diameter then this could happen. Too large of implants on a small person can create this effect.
kids2: What are the complications of breast augmentation? I have had to have a couple of capsulectomies. Do the complications differ as to the type of augmentation (i.e. implants placed under the muscle)?
Speaker_-_Dr__ S.Cristina Rotemberg: Implants placed under the muscle have a lower incidence of capsular contracture, but once you have had one severe capsular contracture requiring surgery, you have a high chance of recurrence. Complications are infection & bleeding.
strebs: Is a tummy tuck recommended for someone who is within normal weight and BMI measures but has excess skin/fat in the tummy area due to normal aging and childbirth?
Speaker_-_Dr__ S.Cristina _Rotemberg: Yes - this procedure may be done for situations like this also.
sewing: After having a tummy tuck with liposuction, I have gained about 12 pounds and have new ‘puffiness’ in my arms and my face. My tummy is still flat. Since the surgery, I have started eating healthier and exercising more, so there really should not be the weight gain. I have read that when fat is being removed in one area of the body, it can ‘reappear’ in another area of the body. Can you please discuss this? Is there anything I can do?
Speaker_-_Dr__ S.Cristina _Rotemberg: You may wish to consult with a physician to determine why you are gaining weight. Calories in should be less than calories burn in order to lose weight. A dietician may also be able to work with you in this area.
pon2: How long do the drains stay in with a tummy tuck? I have heard some bad stories about problems with these. Can these problems be minimized? Is there a ‘drainless’ surgery?
Speaker_-_Dr__ S.Cristina _Rotemberg: Usually drains will stay for 1-2 weeks post-operatively.
rich: Can fat be taken from tummy or any part of body & be placed in the face?
Speaker_-_Dr__ S.Cristina _Rotemberg: Yes. This is an option. There is a risk that the fat may not survive and calcify. You may also need a 2nd procedure to achieve the amount of fullness that you are trying to obtain.
weed: How old is too old for stomach procedures. What is the benefit?
Speaker_-_Dr__ S.Cristina _Rotemberg: As long as you are healthy and do not smoke, there is no age restriction. The benefit to having the procedure done is having the excess skin removed and tightening the abdominal muscle.
weed: You said a benefit is "tightening the abdominal muscle" would that help mild incontinence too? I'm weighing the benefits.
Speaker_-_Dr_ S.Cristina _Rotemberg: No- This is two different anatomical areas. Incontinence is treated by tightening the pelvic muscles, not the abdominal muscles.
brazi: Can you please explain what exactly is done with a panniculectomy?
Speaker_-_Dr__ S.Cristina _Rotemberg: Panniculectomy is only the removal of excess skin on the abdomen. There is no tightening of the abdominal muscles performed.
em: I have read and heard about women having a full tummy tuck, but still have problems with loose skin on the flanks. Why? Can’t this be fixed at the same time?
Speaker_-_Dr__Silvia_Rotemberg: Circumferential or lower body lift will remove the excess skin in the flanks, buttocks and back. This can be performed in one procedure. However, for financial reasons people choose to have only the tummy tuck. This may be why the loose skin is still apparent on the flanks.
weed: What is a scar reduction? I had an appendectomy when I was 8yrs old in UK. I have a big scar on my stomach that I have always felt self conscious about.
Speaker_-_Dr__ S.Cristina _Rotemberg: Dermatologists can laser the scar to make the appearance less prominent. If a surgeon will remove the scar, it will end up being longer and still heal the same way as the previous scars. Insurance may consider this to be a cosmetic procedure. The doctor will need to obtain pre-authorization from your insurance to see if it is covered.
weed: How is the Cleve Clinic Plastic Surgery docs organized? Does the same doctor that did my facelift do my abdominal lift?
Speaker_-_Dr__ S.Cristina Rotemberg: Yes. You do have the option to choose a different surgeon if you want to.
mls: What do you think of the life style lifts?
Speaker_-_Dr__ S.Cristina _Rotemberg: I do not perform the life style lifts.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Silvia Rotemberg is now over. Thank you again Dr. Rotemberg for taking the time to answer our questions about Body Contouring Procedures.
Speaker_-_Dr__ S.Cristina _Rotemberg: Thank you very much for your questions.
- To make an appointment with S. Cristina Rotemberg, MD or any of the other specialists in our Plastic Surgery Department at Cleveland Clinic, please call 216.444.4646 or call toll-free at 800.223.2273, ext. 44646. You can also visit us online at our new Cleveland Clinic Cosmetic and Plastic Surgery Center website at www.clevelandclinic.org/RenewYou
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult
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