Mommy makeover and scuba diving

Mommy Makeover

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Member Response:

JennyK, Great to hear you have found a fabulous sport to enjoy. Scuba diving is amazing! We do allot of athletes in our office (runners, yoga & Zumba instructors). I usually recommend they do not participate in their strenuous activities for at least 6 to 8 weeks following a Tummy Tuck or Mommy Makeover (MMO). You will only do your MMO once in your life. Take some time out to recover. Best, Gary R Culbertson, MD, FACS

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DIEP Flap is red

DIEP Flap Breast Reconstruction

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Member Response:

You should contact your surgeon and be seen urgently. Best, Gary Culbertson, MD

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MOHS repair on nose

Skin Cancer Removal

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Member Response:

nosemohs, Usually the defects are closed very soon after the Moh's surgery is performed. Did you have a Slow Moh's procedure & the wound is still open/unrepaired? Best, Gary R Culbertson, MD

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DESPERATE FOR HELP/ ASVISE PLEASE

Breast Augmentation

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Member Response:

Mrs Wilcox, You occurrence was unfortunate. The wound apears to be healing. Consider showering every day with 4% Chlorohexadene soap. PolyMen to the open wound & the Manuka Honey you are presently using. The PolyMem you can get on Amazon (https://www.amazon.com/gp/product/B003XCTBE8/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1 ). Normally, you do not require antibotics with this wound care regiment. It may take another 6-8 week to heal? If things deterorate consider a wound care center. Best, Gary R Culbertson, MD

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When can the wound be stitched?

Tummy Tuck

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Member Response:

victim25, So sorry to hear and see your outcome from an Abdominoplasty. I hope this was not done as "Tourist Plastic Surgery" and you are not a smoker. You have seen the three colors of a wound as it progesses or heals: black or brown- dead or necrotic tissue that should be/needs to be removed, yellow- healing from the inside out and finally red- ready for closure. Anticipate, the wound vac can allow you to heal more rapidly from the inside out. This can can take many weeks. When the wound is red it is ready for closure. As Dr. Scwarz stated the most concervative approach is a skin graft. Many months or a year latter the scar could be revised. Another approach is to elevate the abdominal skin and close the wound with large advancement flaps. The post opertaive seroma rate can be high. Only consider per-suing this option with a body contouring surgeon that is familar with this process. The treatment of your condition is not going to be quick. Be Patient! Gary Culbertson, MD

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Platysmal bands

Neck Lift

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Member Response:

LoLo Langdon, Sounds like a simple matter of communication & expectation. As others have said the procedure of Platysmaplasty is typically not for animation or movement of the platysma. If what you are experiencing is of great concern there is a simple solution. It is injection of Botox into the platysma to stop the banding with animation of your face. Consider an ASPS member in your are familar with this procedure. Best, Gary R Culbertson, MD

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Botched eyelids and doctor takes no accountability

Eyelid Surgery

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Member Response:

WOW! That is not good. Looks like you had a Blepharoplasty & then a Fox Lift? That not a tatto...?? If what you saying is correct then, your next step is too get copy's of your opeartive report and pre-operative pictures from your surgeon. Then, consider a medical-legal expert in your area. Hopefully, one of the second options you recieved will serve as a expert witness. If not consider seeking out an Occuplastic Surgeon that provides that service. Yes, we offer these expert witness services for attorney's at my facility (https://garyculbertson.com/attorney-services/ ). Best, Gary R Culbertson, MD

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Tummy Tuck after Epigastric Hernia Repair

Tummy Tuck

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Member Response:

Ms New, You may want to consider a second option. If your epigastric hernia is not too large it mat be repairable at the time of your TT. We commonly perform umbilical hernia repairs at the time of LipoAbdominoplasty's. Consider seeking out a ASPS surgeon in your area. Best, Gary R Culbertson, MD

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how can tiny eyes be enlarged

Eyelid Surgery

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Member Response:

maplechaos, You will require an examination and review of your previous surgery's to answer your questions. Consider requesting a copy of your previous operative reports on your eylid surgery's. Then, consider a consult with an ASPS member in your area that specializes in Occuplastic Surgery. Take your records with you to the visit. Here is link that may be of assistance: https://garyculbertson.com/facial-plastic-surgery-before-and-after/ .Best, Gary R Culbertson, MD, FACS

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Mechanical Valve in my Heart

Breast Augmentation

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Member Response:

Normally, patients that have had mechanical heart valves placed are on permanent anticoagulation therapy. If you are on a permanent blood thinner then, a breast augmentation surgery would not be a good idea. Best, Gary R Culbertson, MD, FACS

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Panniculectomy / tummy tuck

Panniculectomy

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Member Response:

angela427. Great question. Consider trying to get rid of your seroma first. A post operative seroma can be a cause of increased complications with the other surgery’s you are considering. You are only going to have these types of surgery once so, consider doing it in the safest environment possible. Please note that many insurance companies will not allow a medically necessary surgery to be performed at the same time as a medical unnecessary cosmetic surgerys like a Tummy Tuck. Check with your Insurance Carrier & Hospital to make sure that combining the two is OK. Best, Gary R Culbertson, MD, FACS

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Complications after tummy tuck

Tummy Tuck

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Member Response:

Thanks You for the Great Question. Yes, you are correct. Get an evaluation BEFORE any surgery or stopping your blood thinners. Just like folks bleed (i.e. hemophilia) there are people who clot. Since you are on anticoagulation therapy for your PE consider going back to a Hematologist for surgical clearance. See if they want you to come off the blood thinners to do a Hypercoagulability work up (i.e. blood tests). The last thing you want is another DVT/PE. Best, Gary R Culbertson, MD, FACS

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Please Help

Rhinoplasty

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Member Response:

WOW!! Saddle Nose Deformity. Most Common from Trauma and/or Drug Abuse. Can be a very complicated process that may require more than one surgery to correct. Smoking and continued drug use could be considered contraindications to surgery. Be prepared to receive serial smoking and drug tests. Approach a training program in Plastic Surgery in your area. This may dcrease your costs dramatically. Best, Gary R Culbertson, MD, FACS

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Pulmonary embolism

Tummy Tuck

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Member Response:

sabby43, Yes, you would be determined to be at increased risk for perioperative PE/DVT with a Tummy Tuck or Mommy Makeover. Plastic Surgeons & hospitals today often screen/ evaluate their patients for this possble life threatening event BEFORE surgery. There is a light at the end of the tunnel. Consider seeing a Hematologist for a Hypercoaguabilty profile/work up and/or consider getting a Factor V Lyden Defeciency blood test. A positive Factor V Lyden Defeciency test can be considered one of the conditions of patients with hypercoaguability that requires anticoagulation before surgery. Many plastic surgeons today are going to consider giving theirTummy Tuck or Mommy Makeover patients an anticoagulant like Xeralto or Eliquis after their surgery if they have an increased risk for PE/DVT. In our office this is done in all our Tummy Tuck or Mommy Makeover patients as part of a Critical Pathway of Care to reduce perioperative complications. Seek out an ASPS member familar with PE/DVT.

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mild ptosis: eyelid surgery &/or brow lift to make eye area more symmetrical?

Eyelid Surgery

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Member Response:

Yes, by your photo's it looks likeleft upper eyelid ptosis. You will require an examination to determine exactly what is going on with your left eye. Consider an ASPS member that does Occuloplastic Surgery in your area. Here are some photo's to review before your consult: https://garyculbertson.com/facial-plastic-surgery-before-and-after/ . Best, Gary R Culbertson, MD, FACS

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Insurance

Breast Reduction

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Member Response:

RobinP, Coverage of a Breast Reduction is determined by the Insurance Carrier. Doctors no longer dictate health care. Insuance company's do becuase, you are paying them for the covered services. Check with your personel insurance plan to see if they cover the surgery you are considering. Best, Gary R Culbertson, MD, FACS

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Help! Unknown reason for boils after bbl

Buttock Lift with Augmentation

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Member Response:

Soto76, I am so sorry to here you are in this predicament. Return to your orginal surgeon for some answers. If you feel uncomfortable about doing this then, consider asking for a referral to an Inectious Disease Physician. If this has not been done already you are likely to require an extensive evaluation (i.e. CT Scan or MRI, tissue diagnosis to rule out fungus, etc.). Hope this is of assistance. Best, Gary R Culbertson, MD, FACS

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Abdominoplasty with hernia repair

Tummy Tuck

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Member Response:

Strongly agree with Dr Johnson. You most likely do not require an abdominoplasty to fix/repair your umbilical hernia. Get you symptomatic umbilical hernia fixed through your insurance carrier. Do not expect to get cosmetic surgery like an abdominoplasty with hernia repair as a covered service by your insurance carrier. Best, Gary R Culbertson, MD, FACS

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Discharge from my belly button 6 years after tummy tuck

Tummy Tuck

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Member Response:

Akaexhale, Take a look at your operative report. A common cause of this type of event could be a non-dissolvable braded suture (mersaline, ethibond, etc.). A post operative patient can get a chronic draining stitch abscess from these types of sutures. That is why many plastic surgeons today use sutures that are monfilament and dissolve away with time on their cosmetic (adbdominoplasty) patients (PDS, etc.). PDS (polydioxanone) sutures are much more expensive sutures and can even have antibotics embedded into the suture material. Best, Gary R Culbertosn, MD, FACS

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Malignant hyperthermia

Tummy Tuck

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Member Response:

There are different types of MH. Consider getting pre-operative clearance from your internal medicine practitioner or cardiologist. Then, consider a facility/plastic surgeon in your area that is very familiar with peri-operative management of MH. Sometimes this means you may have to go to a major medical center. For instance our facility is a AAAASF level C facility and utilizes an Anesthesiologist. Of course we have done patients with MH. Special precautions are required in the MH patient that can make your TT a bit more expensive. Unfortunately, we are over 6 hrs from your location. These are the some parameters that you might consider BEFORE your surgery. Best, Gary R Culbertson, MD, FACS

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Where do I find a surgeon to diagnose my paradoxical adipose hyperplasia

Body Contouring

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Member Response:

Paradoxical Adipose Hyperplasia (PDH) is a well known complication of fat freezing devices like CoolSculpting. Your insurance carrier most likely will not cover any treatment for your condition as it arouse from a Aesthetic or Cosmetic procedure. Consider addressing the issue with the vendor- CoolSculpting. If they provide no resolution then, consider legal assistance. Best, Gary R Culbertson, MD, FACS

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Nasolabial folds

Liposuction

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Member Response:

Alot more data is required to answer your questions. You most likely we require and examination, view old photo's, etc. Seek out a ASPS member near your area familiar with non-surgical facial rejuvenation. Best, Gary Culbertson, MD, FACS

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Double chin

Neck Lift

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Member Response:

hey1,all, Thanks for the photo's. Unfortuately, surgery most likely will be the solution to your concern. Yes, you appear to be a classic male Neck/ Face lift. The issue is not just your skin but the deep cervical structures. An examination would be required to make a definitive plan. Cardiac Clerance for such a surgical procedure would most likely be required at your age. Consider someone in your area that is an ASPS member familar with these procedures. Best, Gary R Culbertson, MD, FACS

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Tired of Saggy Breasts

Breast Reduction

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Member Response:

A breast reduction usually envolves dropping at least two cup sizes. A breast lift or mastopexy usually envolves dropping at least 1/2 of a cup size. Both procedures normally include a lift. Best, Gary R Culbertson, MD, FACS

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having more than 1

Breast Reduction

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Member Response:

Usually, your ASPS member will take you down in size with a Breast Reduction to the breast being proportional to body size or smaller than your body size. The approximate amount to be removed is usually estimated per-op and submitted with your other significant data to your insurnace carrier with your photo's. Here are a few examples: https://garyculbertson.com/breast-plastic-surgery-before-and-after/. Best, Gary R Culbertson, MD, FACS

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Inquiring

Facelift

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Member Response:

Consider seeing the practitioner that manages your AODM first. An A1C can assit in determining if it is OK to proceed. Ask for Surgical Clearance. Then, pursue an ASPS Member in your area familar with FaceLifts in Diabetic patients. Best, Gary R Culbertson, MD, FACS

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What would be needed?

Tummy Tuck

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Member Response:

Yes, there are different types of TT's and patients that consider TT's. You appear to be one of the most common that we see. The Cosmetic or Aesthetic TT. Consider looking for a ASPS member in your area the primarly focuses in on LipoAbdominoplasty's in athletes. "Women are Hourglasses & Men are IceCream Cones." Best, Gary R Culbertson, MD, FACS

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Hernia repair and tummy tuck

Tummy Tuck

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Member Response:

Agree with Dr Glassman. Look for someone in your area that is an ASPS member & very familar with TT's. Best, Garty R Culbertson, MD, FACS

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Blood Clots

Mommy Makeover

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Member Response:

Yes, you have a very serious issue. Consider getting clearance/ direction from your HEMATOLOGIST! They might be able to guide you through the appropriate peri-operative treatment required in your case and identify the cause of your issue (i.e Factr V Lyden Deficiency??). Make sure to conviey to your surgeon your issues with DVT/ PE. Best, Gar R Culbertson, MD, FACS

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Looking

Tummy Tuck

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Member Response:

chiefsugar, Of course hernia's are fixed at the time of a Tummy Tuck. We do them all the time. Please look at the link here to see if there is someone that looks like you: https://garyculbertson.com/body-plastic-surgery-before-and-after/ . There are exclucsions such as, patients with LARGE RECURRENT Hernia's or hernia's already fixed with mess that have come back. Consider discussing your concerns with a member of the ASPS. They are experts in Abdominoplasty's and Lipo-Abdominoplasty's. Best, Gary R Culbertson, MD, FACS

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Belly still looks like this 9 years postpartum

Tummy Tuck

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Member Response:

Pretty normal appearance for someone seeking out a Cosmetic Tummy Tuck. Consider an ASPS member in your area. They are experts in Body Contouring. Best, Gary R Culbertson, MD, FACS

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safety of combining procedures during a single surgery

Breast Implant Removal

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Member Response:

First, consider getting surgical clearance from your primary care physician or cardiologist. Yes, palstic surgeons that are members of the ASPS combine these procedures in healthy patients. Best, Gary R Culbertson, MD, FACS

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Will i be eligible for insurance coverage

Breast Reduction

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Member Response:

Insurance company's dictate health care coverage. Most insurance carriers are going to base the amount of breast tissue resected per breast in a patients breast reduction based upon a patients height and weight (BMI). A minimum resection weight per breast can often be 400 grams. In terms of weight remember there are 454 grams in a pound. A breast lift or mastopexy typically can have a lower weight of breast resection. Breast Lifts are considered "Cosmetic Surgery" and not normally covered service by the majority of health care insurance carriers. Best, Gary R Culbertson, MD, FACS

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Swelling on one side for last 10 years

Tummy Tuck

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Member Response:

An evaluation and some radiological studies most likely would be required to answer you questions. Though very expensive an MRI with contrast or weighted images may give you a much better insight into what has happened. Make sure to take your old operative reoport and pre- operative pictures to whomever you consult. Consider an ASPS surgeon very familar with revision cosmetic Abdominoplasty's in your area. Best, Gary R Culbertson, MD, FACS

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4 Months Post Lower Bleph - What are These Creases?

Eyelid Surgery

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Member Response:

What you see appears perfectly normal. That is the lower eyelid skin as it approaches the lower periocular skin. Sorry, you have a very good result. Best, Gary R Culbertson, MD, FASC

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Fix diastasis recti and umbilical hernia in one operation please?

Tummy Tuck

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Member Response:

Yes, your issue is not that uncommon. Groin & belly button hernia's are usually fixed at the time of a patients cosmetic surgical procedure. Please take a look at the Before & After/ Body Plastic Surgery/ Girth- LipoAbdominoplasty at out Web Site: Patient #10 (https://garyculbertson.com/body-plastic-surgery-before-and-after/ ). Tummy Tuck's or LipoAbdominoplasty's are not a service covered by your insurance carrier. Hernia repair can be and is usually done as a seperate procedure at a different sitting. Best, Gary R Culbertson, MD, FACS

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Insurance and Tummy Tuck.

Tummy Tuck

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Member Response:

A Tummy Tuck (TT) or Abdominoplasty are two entirely different things. They are like oranges & pineapples. A TT is a much more complicated surgical procedure that can include tightening of the abdomenial musculature, liposuction and countouring of the abdomen to produice an appealing abdominal appearance. A TT is considered to be Medically Unnecessary or a Cosmetic surgical procedure by insurance carriers. A Panniculectomy (Panni) is the simple removal of abdominal skin. These surgical procedures are two entirely different procedures and have two entirely different billing codes. The best way to think about it just like car repair after an accident. You are driving a vintage Chevy Nova and have a wreak. The front of the vehicle needs to be fixed/ replaced. At the the auto body shop that is covered by your auto insurance company you request/ demand a Rolls Royce front end. The parts and repair codes for these cars are entirely different. A TT is not a Panni. Best, G Culbertson

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How likely is a muscle repair to rupture and would you know about it?

Tummy Tuck

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Member Response:

Consider contacting your surgeon. Post operative abdominal swelling associated with an abdominoplasty could be a seroma. Best, Gary R Culbertson, MD, FACS

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Postoperative Concern

Eyelid Surgery

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Member Response:

A examination most likely will be required to address your concerns. Consider seeking out a second option with a local ASPS member that performs Occuplastic Surgery. Best, Gary R Culbertson, MD, FACS

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safe for me?

Tummy Tuck

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Member Response:

Can you have a TT? Yes, you can but, you are VERY HIGH RISK. Consider first getting whatever data you can on your Coagulopathy. You may be asked to SEE A HEMATLOGIST to confirm your Factor V Lyden deficiency. If you realy have this condition PREVENTIVE MEASURES MUST BE TAKEN BEFORE ANY SCHEDULED SURGERY. Ask your hematologist to make recomendations for peri-operative care with your surgery. This normally means ANTICOAGULATION PRE-OP. Peri-operative bleeding risks can be dramatically increased. Consider your elective cosmetic surgery in a hospital setting where you can/ should be watched closely after surgery for complications. For you this most likely would NOT BE AN OUTPATIENT PROCEDURE. Best, Gary R Culbertson, MD, FACS

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Is drainless tt better?

Tummy Tuck

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Member Response:

An examination would be required to answer your question(s). Yes, if you are just having a TT without liposuction then, most plastic surgeons will utilize progressive tension sutures and may not use drains. If you are having a LipoAbdominoplasty it can be a different story. Plication of the abdomen with a TT is normally based upon your history and an examination. For example if you have had more than two children or C-section’s plication of the abdomen is often a necessity for good result and obtaining that pre-pregnancy appearance. In our practice it is very unusual to see anyone for a TT who has not had multiple pregnancy’s unless they are a massive weight loss patient. Consider looking at the different types of patients that undergo TT’s to help answer your questions (https://garyculbertson.com/body-plastic-surgery-before-and-after/ ). Hope this is of assistance. Best, Gary R Culbertson, MD, FACS

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Tummy tuck after multiple pregnancies

Tummy Tuck

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Member Response:

Normally, Yes. An Examination & Evaluation would be required to make this determination. After this many preganancy's you may be what we call a "Prune Belly". If you have lost a significant amount of weight you could also be a " Massive Weight Loss Patient- MWL". Then, seek out a member of the ASPS in your area. They are experts in Body Countouring Surgery. Best, Gary R Culbertson, MD, FACS

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Appropriate margins

Ear Surgery

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Member Response:

Pat2020, Sorry to hear about your recient situation. Fortunately, something can be done about it. Consider discusing your concerns with your surgeon but, here are some referances that should be of assistance: (1) Marins of resection on ear- 1 to 2 cm (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5977960/ ) (2) SLNB- YES (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4674429/ ). Best, Gary R Culbertson, MD, FACS

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Tummy tuck and lipo

Tummy Tuck

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Member Response:

Thank you for this question. Yes, if you have a family history of DVT/ PE you should seriously consider a Hypercoagulation work up. This is normally a series of blood tests to determine if you have the propensity to form blood clots. The most most imortant is called a Factor V Lyden Deficiency. Just like there are congential conditions that can make you bleed (hemophilia) there are many conditions that can contribute to you forming a clot. These blood clots can form in you legs or pelvis (DVT) and break off and go to your lungs and cause a Pulmonary Embolus (PE). A PE can be fatal. Now the GOOD NEWS. ASPS plastic surgeons are well aware of the increased risk for DVT/ PE with LpoAbdominoplasty. Patients are recommended to be screened to see if they are at increased risk for DVT/ PE. Many utilize methods to prevent DVT/ PE like giving their Abdominoplasty patients medications after surgery to prevent DVT/ PE. Consider discusing your concerns about perioperative DVT/ PE. Best-Gary

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Eyebrows set too high, not sure if it’s the brow bone or the actual eyebrow.

Brow Lift

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Member Response:

You are obviously very young. Yes, males typically have a "T" type eyebrow or "Parenthesis: (i.e Brad Pitt & Arnold Palmer). The high arched brow is more chartestic of the female. Consider something simple like Botox to lower your brow at your age. As we age the brow naturally drops. Best, Gary R Culbertson, MD, FACS

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Blood clot

Tummy Tuck

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Member Response:

Consider going to the doctor(s) that gave you the medicine for your DVT/ PE. They can do what is called a HyperCoaguability work up, make recommendations regarding Aethetic surgery & provide prei-operative clerance. This will assit your plastic surgeon in managing your case for a TT. Just so you know the HyperCoaguability work up is normally done with the patient off all blood thinners. Talk with your doctors before you stop any medications. Best, Gary R Culbertson, MD, FACS

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Breast Lift with Fat Graft

Breast Lift

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Member Response:

Yep, we do this all the time. Please remember that fat grafting with a breast lift does add significant financial costs. You could require an additional fat grafting procedure to accomplish your goals. Best, Gary R Culbertson, MD, FACS

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Natural Breast Augmentation

Breast Augmentation

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Member Response:

Great Question! No, you cannot get fat from someone else put into you unless they are a genetically idetical twin. Remember, the two components of the appealing breast are the nipple position & breast size in relation to your body size. Sagging breast can be benefited with a breast lift. Consider a consult with an ASPS member in your area to determine which surgical procedure(s) might be options for you. Best, Gary R Culbertson, MD, FACS

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MMO

Mommy Makeover

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Member Response:

Please consider the advise of an ASPS Member in your local area. Many of us operate on patients with RA for all kinds of cosmetic surgery. Often a pre-operative visit to your Rhematologist or treating practioner for clearance for such surgery can be enlightening. Best, Gary R Culbertson, MD, FACS

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Crepey Neck

Facelift

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Member Response:

The creepy or sharpe neck often requies more than one procedure over time. Consider a definitive Face/ Neck lift not a Mini or Life-Style type lift. Then, if your neck continues to be an issue RF or laser may be required. Best, Gary R Culbertson, MD, FACS

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Nipple Numbness

Breast Augmentation

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Member Response:

Breast are sisters not twins. Loss of nipple senation is often more common with larger implants. Across the board about 50% of women cannot breast feed for whatever reason. Best, Gary R Culbertson, MD, FACS

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Ann Bennett

Facelift

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Member Response:

Ann, There are kinds of Faces & Lower Facelifts just like there are all kinds of cars. Some are more expensive than others. Some last longer than others. There are different types of lower facelifts- threadlifts, mini-lifts (LifeStyle Lift), SMASectomy’s, Deep Planes, etc. Each different type procedure can vary significantly in cost. The effects of aging can make a big difference on what could be required to move back the clock. Patients can present with the turkey gobbler, bullfrog or sharpe necks. Each can take a different amount of time to correct so, costs can vary. Consider bring pictures when you were young when you have a cosmetic consult so, your surgeon can see what you used to look like. Be most concerned with what is wrong, correcting those issues & having a great result. Not the cost. Oh, and make sure you get to see the surgeons actual patients before & after photo’s. Best, Gary R Culbertson, MD, FACS

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Is it safe to do a tummy tuck after a hysterectomy

Tummy Tuck

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Member Response:

Denise, Yep, we do them all the time. Consider an ASPS member in your area. They are Experts in Body Countouring Surgery. Best, Gary R Culbertson, MD, FACS

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How long is the wait?

Breast Implant Revision

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Member Response:

In some ruptured implant patients the scaring can be so severe that waiting to replace the breast implants at a latter date can be the safest option. Waiting until you are completely healed, utilizing a new pocket for the breast implant and not placing a foreign body into a oversized cavity can be a patients best option not only to prevent capsular contracture but, to prevent having a ball in a sack complication. This can and often does take at least 3 months to achieve. Best, Gary R Culbertson, MD, FACS

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Concerns

Tummy Tuck

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Member Response:

Lauren, Great Questions!! Most of our LipoAbdominoplasty are not ideal body weight. Pregnancy following a TT has been possible for most due to the new technologically of advanced sutures like PDS. Few patients that have not been pregnant require abdominal placation sutures. It is normal to be nervous. If you weren’t nervous it wouldn’t be normal. Your biggest concern should be screening for DVT/ PE & its per-operative prevention with your comibined platic surgery. Best, Gary R Culbertson, MD, FACS

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Fluid draining from belly button for a decade after Tummy Tuck

Tummy Tuck

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Member Response:

10 years ago your surgeon may have used non dissolvable sutures to tighten your stomach muscles. This could be a the source of your issue. Your operative report would be of great assistance. Consider an ASPS member in your area for a possible exposed suture/ sinus following your TT. Best, Gary R Culbertson, MD, FACS

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Combined procedures

Tummy Tuck

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Member Response:

Jen1988, Great Question. Can you do a Hysterectomy and a Tummy Tuck together? Yes, you can. Is it in the best interest of the patient for a favorable outcome? No it is not! The second issue you should address is the economic cost. Your insurance carrier should be contacted to determine if they are going to cover the costs for a medically necessary procedure (i.e. Hysterectomy) being done at the same time as a non-medically necessary surgery (i.e Abdominoplasty). Many insurnace carriers will disallow payment for ALL SERRVICES PROVIDED when both surgical procedures are combined at the same time/ setting. If your insurance carrier does decide to cover costs for your Hysterectomy it is very likely you would still be responsible for costs associated with the TT besides the surgeons fee. Some of these costs include Hospital/ ASC fees, Anesthesia fees, etc. These expenses can be rather large. Make sure to address all these financial issues before proceeding. Gary R Culbertson, MD, FACS

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Abdominoplasty with upper abdominal liposuction

Tummy Tuck

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Member Response:

Great question. Just like cars there are different kinds on Abdominoplasty’s. Mini, Formal, Extended, MWL, Girth patients, with or without liposuction, with or without abdominal plication, etc. are some of the different types. Liposuction of the superior abdomen is typically avoided to prevent post-operative compilations in the majority of patients. Every patient can be a bit different. Consider someone in your area very familiar with LipoAbdominoplasty’s. Best, Gary R Culbertson, MD, FACS

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Csections and BMI effects on results.

Mommy Makeover

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Member Response:

aleebee, Photo's would be useful but, yes- normally one can position the TT scar so it removes the old C-Section scar. Plastic Surgeons typically are very happy to see a patient with your height & weight. Focus on the top three issues that concern you. When they are corrected you are very likely to be satisfied with your result. Best, Gary R Culbertson, MD, FACS

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After deflation

Breast Implant Revision

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Member Response:

Yep, probably a good at some point. Allot of our patients have them repalced very quickly since most implant company's provide some kind of partial coverage for the service &/ or implants. Rarely, we will have a patient that no longer wants implants & will deflate the contralateral side in anticipation of having them both removed at a later date. Best, Gary R Culbertson, MD, FACS

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2 part surgery

Breast Augmentation

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Member Response:

Amac687, Thanks for the great question. Yes, if the sagging of your breast is major/ severe many plastic surgeons will stage the patients breast augmentation to first provide a major breast lift. This way the patients nipple position is correct & many times one can reduce the incidence of complications (i.e. nipple loss). Then, when everything is in the appropriate position it is a very simple process to perform a breast augmentation. Remember, the two components of the appealing breast are correct nipple positions and breast proprtion to body size. Nobody likes a ball in a sack. Best, Gary R Culbertson, MD, FACS

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Curious about a lot of procedures, unsure where to begin.

Liposuction

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Member Response:

Thanks for the great question. At 5'11-3/4" & 370 to 390 lbs you would be classified as overweight. Surgery and possibly your longevity would best be served with some significant weight loss. Liposuction should not be considered as a weight loss option. Once you are at a more appropriate BMI for at least 6 months then, consider MWL aesthetic surgery. Best- Gary R Culbertson, MD, FACS

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I dev. NF Nec. Fasciitis...gel..implants are broken.

Breast Implant Revision

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Member Response:

You are dealing with two entirely different issues. Necrotizing Fasciitis can be a life threatening disease process. Please get this condition under control/ healed BEFORE you consider any corrective breast implant surgery. Best, Gary R Culbertson, MD, FACS

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Dangerous

Mommy Makeover

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Member Response:

Yes, a circumferential body lift, TT & breast lift with implants is ALLOT OF SURGERY. First, your overall health should be considered. A trip to your primary care physcain may be a great idea for surgical clearance or optimization. Second, consider how you will be mainaged in the post operative period. A trained medical specialist to keep an eye on you for at least the 1st 24hrs after surgery might be a very very good idea. Lastly, address your concerns with your surgeon. Best, Gary R Culbertson, MD, FACS

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Hard bulge upper abdomen

Tummy Tuck

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Member Response:

You most likely have a chronic post operative seroma. Yes, it should drained but, may require surgery to get ride of it. Consider seeking out your primary care health provider in the Canadian health care system. They should be able to direct you for treatment of this post operative complication. Be4st, Gary R Culbertson, MD, FACS

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Waxing after surgery

Tummy Tuck

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Member Response:

Please address this question with your surgeon. They will be most knowledageable about your healing in the post-operative period. Best, Gary R Culbertson, MD, FACS

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Breast Plant Exchange

Breast Augmentation

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Member Response:

A breast reduction is normally considered a decrease in breast size WITHOUT breast implant placement. A breast augmentation normally utilizes breat implants and increases the size of the breast. Exposed breast implants can require removal without replacement. Consider addressing your concerns with your surgeon. Best, Gary R Culbertson, MD, FACS

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What should I expect to need after my weight loss?

Body Contouring

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Member Response:

Congratulations on the weight loss. Keep it up. Once, your weight has stabilized for at least 6 months then, consider a Plastic Surgery consult. View the procedure)s) as no different than buying a boat, motorcycle or small car. Most offices offer credit programs like CreditCare. You can even go on line before your consult to determine what funds you are eligible to receive. Best, Gary R Culbertson, MD, FACS

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3 surgeries and still in pain

Breast Augmentation

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Member Response:

Sheree, Not an uncommon question. Consider starting where you have had your surgery’s. Ask for a copy of your medical record. Focus on all operative reports, pathology reports & breast implant identification materials. These materials & an an examination most likely will be required to answer you questions. Consider taking these materials to an ASPS Member in your area to sort out your concerns and issues. They are experts in Breast Implant Surgery’s. Best, Gary R Culbertson, MD, FACS

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I just want my confidence back

Breast Augmentation

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Member Response:

MomoOf4, Great question. The predominate issues with fat transfer to the breast are most commonly costs, adequate reserves of fat to transfer and breast ptosis or sagging. Fat transfer of the breast works, there can be a limited amount of fat that can safely transferred per setting and often the increase in cup size is between 1/2 to 1 cup size after each surgical procedure. Multiple fat transfer settings can be and are often required. Fat transfer to breast can be as expensive a saline breast augmentation per each surgical procedure. In addition sagging of the breast can be more common in women who have had multiple children and should be addressed to produce the appealing breast. Consider an ASPS member in your area familiar with fat transfer. They are experts in breast surgery. Best, Gary R Culbertson, MD, FACS

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Ehlers Danlos and breast reduction?

Breast Reduction

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Member Response:

Agree with Dr. Johnson. As I remember there are at least six different subtypes of Ehlers-Danlos syndromes. Consider starting with the practitioner that manages your EDS to see if surgery is ok for you. Consider having them document this information for your surgical team. Next, if you desire your insurance carrier to cover your Breast Reduction give them a call to make sure it is a covered service. Their insurance coverage requirements to qualify for a breast reduction are often on-line. Best, Gary R Culbertson, MD, FACS

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Is this true?

Facelift

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Member Response:

Plumplum, Sounds as if you are looking for the most economic approach to have a mini facelift? Bang for your buck is what web all desire. Sutures vary widely in price with some costing as much as 3 to 4 times others. Consider keeping in mind that in some patients mini facelifts can have very limited duration of effect (i.e a few years??) compared to other facelift or facial rejuvenation procedures/ techniques. Gary R Culbertson, MD, FACS

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Disfigured by another

Eyelid Surgery

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Member Response:

Clayja, Wow, this does not sound good. Consider obtaining all your records from your original surgeon that you can get. Focus in on all history & physicals, operative reports and photographs. Then, consider another surgeon in your area that specializes in Occuloplastic surgery. Take these materials to your second option consult(s). Unfortunately, with all the issues you present more than one corrective surgical procedure could be required. Best, Gary R Culbertson, MD, FACS

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28 yr old female seeking medical advise for tummy tuck with lipo to flanks. I lost 86 pounds.

Tummy Tuck

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Member Response:

Hajrie, Great question. Sounds like you have done some reasearch on the VTE/ TT issue. A personal or family history of VTE are two of the most important concerns. Consider a visit to a Hematologist for a Hypercoagulabilty workup. The most important test is called a Factor V Leiden (FVL) mutation test. Then, consider an ASPS member in your area familiar with your concerns. They are experts on the a issue of VTE & TT's. Best, Gary R Culbertson, MD, FACS

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Would this be plastic or reconstructive surgery?

Lip Augmentation/Enhancement

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Member Response:

Consider a visit with an ASPS member in your area for removal of what sounds like a mucous cyst in your mouth. Best, Gary R Culbertson, MD, FACS

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Multiple surgeries

Mommy Makeover

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Member Response:

debbiejen36, Yes, you should have a concern about combining so many plastic surgery procedures in one setting. Consider a visit to your primary care or internal medicine provider to determine is you are healthy enough for the proposed extensive surgery's. Make sure they provide your surgeon with a current list of your medication. Then, approach your surgeon with your concern. Consider asking how, where & by whom you will be monitored in the immediate post operative period ( 24hrs). Best, Gary R Culbertson, MD, FACS

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Loose skin between breasts

Breast Augmentation

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Member Response:

Dreaas, Sounds like you are describing what is called synmastia? This is more common with patients with very large breasts. Often when these patients lay down their breasts are so big they slide up to their necks and chock them. Best, gary R Culbertson, MD, FACS

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Help

Breast Reduction

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Member Response:

Sorry for you daughters outcome. Consider giving your TRICARE representative in your area a call. They should direct you to a plastic surgeon that can assist with your issues. Next, contact the surgeons office that did your duaghters surgery. Ask for the pre-operative pictures & operative reports. A signed release of information form will be required. Take these materials with y'all when you do for a second option. Best, Gary R Culbertson, MD, FACS

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Necklift same as mini Facelift?

Facelift

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Member Response:

Nope, the S lift is not normally considered the same as a Neck Lift. S lifts can often be considered very minimal face lifts of sort duration (2-3 years). Consider a consult with an ASPS member in your area to discus your concerns. Best, Gary R Culbertson, MD, FACS

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Am I too old?

Liposuction

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Member Response:

Florence, Consider starting with your primary care doctor or cardiologist. Get medically cleared or optimized for this surgery. Then, make sure you someone to take care of you afterward. It does not hurt to tag team it. Lastly, consider a surgeon that offers an overnight care facility so, medical personnel can watch you in the immediate post operative period. Yes, many plastic surgeons operate on patients >60. Our oldest TT patient was 72 years old on the date of her surgery. Best, Gary R Culbertson, MD, FACS

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6 months after

Breast Augmentation

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Member Response:

Heather, Sounds like you may have reacted to the implants from your Breast Augmentation. Yes, if you have capsular contracture it can be addressed. Some implant companies even assist in paying for the corrective surgery for capsular contracture. Re-operation costs are usually spelled out before you have surgery. Often the surgeon fee can be waved but the patient can be and often is held responsible for all other fees (facility, anesthesia, staff, lab, medications, etc.), Consider asking your surgeon about these issues. Best, Gary R Culbertson, MD, FACS

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numbness

Facelift

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Member Response:

polly50, These are questions that are best answered by your facelift surgeon. Consider reaching out to them to address your concerns. Best, Gary R Culbertson, MD, FACS

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Breast Reduction and Lipo

Breast Reduction

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Member Response:

Gabby, Your insurance carrier, TriCare, will require a referral to get to a TriCare provider for a Breast Reduction. Consider contacting the TriCare Representative in your area to determine how you get a referral & what doctors are in your network of providers. These providers can answer your questions about a breast reduction following an examination. Your insurance carrier will most likely not cover cosmetic procedures like Fat Grafting or Liposuction. Often when these aesthetic procedures are done at the time of insured procedure the insurance carrier does not cover/ pay for the medically necessary surgery. Best, Gary R Culbertson, MD, FACS

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Ruptured implant

Breast Augmentation

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Member Response:

Old silicone implants when ruptured would leak out a soft silicon gel. This gel could infiltrate into a patients body. The patients body would sometimes react to this type of gel producing a thick sometimes calcified capsule or scar around the ruptured implant. Often these heavy capsules would produce pain/ disfigurement/ etc. and can be difficult to remove. Leaving this reactive tissue inside a patient is not in their best interest. So, in a way your surgeon most likely is trying to communicate the effect on your body of a leaking old silicone breast implant. Best, Gary R Culbertson, MD, FACS

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Bruising or Fat Necrosis, Breast Size and Density after a reduction

Breast Reduction

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Member Response:

We let our breast reduction patients know the first month is maximal sweeping, the second month expect asymetrical sweeling & you will see the final result in about three months. However, breats are sisters not twins. Consider asking your surgeon about your concerns. Best, Gary R Culbertson, MD, FASC

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Risk

Tummy Tuck

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Member Response:

Consider starting with your internal medicine or cardiologist to get medically optimized or cleared for surgery. This will assist your surgeon in determining your overall peri-operative risk. There are issues that can be addressed to assist in reducing your risk with an abdominoplasty. We call these critical pathways of care. They are specific for each different plastic surgical procedure but, very important for LipoAbdominoplasty’s. For example Exparel can be given at the time of surgery to assist in reducing your post operative pain, DVT/PE screening is done and meeting/ making sure someone will care for you for a few days after surgery are just a few examples. Consider discussing your concerns with surgeon BEFORE your TT. Best, Gary R Culbertson, MD, FACS

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Revised rhinoplasty

Rhinoplasty

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Member Response:

Refund policies for cosmetic or aesthetic surgery are often spelled out by your surgeon BEFORE your surgery. These often include written & verbal communications. Consider contacting your original surgeon to express your dissatisfaction & determine under what circumstances they offer a refund. Best, Gary R Culbertson, MD, FACS

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Festoons

Eyelid Surgery

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Member Response:

Festoons are a medical condition of the lower eyelid that occurs with aging. There are several different severity’s. There are different surgical methods for correction depending upon the severity. Consider an ASPS member in your area familiar with occuplastic surgery. Best, Gary R Culbertson, MD, FACS

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Fix festoons that where made worse by another surgeon

Eyelid Surgery

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Member Response:

Festoons are a medical condition of the lower eyelid that occurs with aging. There are several different severity’s. This is a cosmetic condition that may have not been addressed with your original surgery. There are several surgical methods for correction depending upon the severity. Consider an ASPS member in your area familiar with occuloplastic surgery. Best, Gary R Culbertson, MD, FACS

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Mommy Makeover Costs

Mommy Makeover

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Member Response:

ShaniceG, An examination would be required to make an exact determination as to which procedures would be best for you during your Mommy MakeOver. Consider writing down your concerns. Rank them in the order of importance. Lastly, consider an ASPS member in your area familiar with Mommy MakeOvers. Costs of these procedures vary across the country but often start at >$10K for a Mommy MakeOver. Best, Gary R Culbertson, MD, FACS

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chin augmentation

Facelift

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Member Response:

lexiii, The double or triple chin or neck can be one of the most difficult neck lifts. An examination would be required to make a determination of how best to address your concerns. Consider an ASPS Member in your area familiar with Facial Plastic Surgery. Best, Gary R Culbertson, MD, FACS

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Looking for answers

Breast Lift

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Member Response:

redheadlady, This is an issue you have addressed with surgeon BEFORE surgery. Ask then now what they anticipate your approximate final breast size will be. Normally, breast reductions in a reduction of at least two cup sizes. Best, Gary R Culbertson, MD, FACS

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Breast augmentation with dermal fillers

Breast Augmentation

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Member Response:

Robin lynn, Sounds like breast implants are going very well for you. Consider removing your implants, letting everything settle down & then review your options. While dermal fillers are very unlikely to be of assistance it is possible that serial fat grafting to your breast may be the ticket. Best, Gary R Culbertson, MD, FACS

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Post Breast Reduction

Breast Reduction

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Member Response:

Hannah, For Next Steps consider obtaining a copy of your BR operative report & if possible your Pre-Operative Photo’s. Take these materials to an ASPS member in your area that is familiar with breast reductions for a second or even third option. They should be able to give you your options. Best, Gary R Culbertson, MD, FACS

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7 weeks post partum from c section

Tummy Tuck

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Member Response:

Naralynn, Consider a Tummy Tuck when you are at least 6 months postpartum and near your pre-pregnancy weight. It wise to make sure you are done having children?? Best, Gary R Culbertson, MD, FACS

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Botched?

Liposuction

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Member Response:

beckys1111, That is an unfortunate outcome but not that uncommon. Consider obtaining a copy of your operative note from your surgeon & your pre-operative photo’s. Take these materials to an ASPS member in your area that specializes in correcting cosmetic surgery. This data & an examination would be required to address your concerns. A second or third option may be very educational & informative. Best, Gary R Culbertson, MD, FACS

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have an appendectomy scar

Tummy Tuck

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Member Response:

Sure, we do TT's omn patients with appendectomy scars all the time. Consider a ASPS Member in your area for an evaluation. Best, Gary R Culbertson, MD, FACS

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whole body help

Body Contouring

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Member Response:

Tammy, First detrmine if you are healthy enough bto have surgery. Seek out a primary care practioner in your community & obtain clearance for general anesthesia. Second, rank the ares of your body from 1 on with 1 being the area of greatest concern. Lastly, consider an ASPS member in your area for an evaluation. They should be able to give you approximate costs for corrections of your concerns. Best, Gary R Culbertson, MD, FACS

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Breast revision pain after 17 weeks

Breast Augmentation

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Member Response:

Jane, Consider obtaining your operative reports from your Breast Surgery’s. Then, consider seeing a Pain Therapist & another ABMS Plastic Surgeon that specializes in breast augmentation surgery in your area. Send or take your records with you to these visits. It never hurts to get another option from a different contractor. Best, Gary R Culbertson, MD, FACS

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coolsculpting effective if underweight?

Body Contouring

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Member Response:

Agree with Dr Dowbak. Start with a primary care physician to determine the etiology of you low BMI. They most likely may recommend a nutritionist. I would not waste my funds on CoolSculpting with a BMI of 16.8. Best, Gary R Culbertson, MD, FACS

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I need answers

Liposuction

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Member Response:

Tiffany, This is a very common question we recieve from callers to the office. Your present physical state can significant affect your health & longevity in the future. If you have tried diets & weight loss programs, not made any progress then, consider surgery for weight loss. These types of surgery include a gastric sleeve or a GBP (Gastric By-pass Procedure). The latter appears to have the most success. Best, Gary R Culbertson, MD, FACS

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Liposuction of the bra rolls

Breast Reduction

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Member Response:

Amanda, Braw rolls very dramatically and can extend arround to your back. Often to correct this you have to be moved in to an appropriate position durging surgery (back or side). Liposuction of the flank of the breast under the armpit is commonly performed during many patients breast reduction surgery's. The correction ususally stops at the arm pit. Consider discussing exactly what, where & how the liposuction your are requesting is to be done with your surgeon before surgery. Best, Gary R Culbertson, MD, FACS

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Previous surgery

Tummy Tuck

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Member Response:

Sally, The first thing you should be concerned about at 72 before surgery is your overall health. Consider a visit to your primary care practioner or cardiologist & request surgical clearance for a general anesthetic. They will commonly do some testing (EKG, etc.) & provide you with a report. At this point then consider take this data to an ASPS member in your area that specializes in the surgery you desire for an evaluation. Have we done patients your age? Sure, but often an overnight observation is required in an extended care facility to make sure things go well after their surgery. Best, Gary R Culbertson, MD, FACS

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No definition in neck

Liposuction

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Member Response:

As many others have said an examination would be required to determine exactly how to address your concerns. The good news is that there are some fantastic new ways avaliable to correct the issues you have pointed out. The neck/ face lift as developed by Dr. Jacono is just one ( https://www.newyorkfacialplasticsurgery.com/deep-plane-facelift ). Consider seeking out a ASPS member in your area that is familar with these techniques. Best, Gary R Culbertson, MD, FACS

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Insurance Issues

Breast Reduction

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Member Response:

Brittany, Insurance coverages are like cars. Some are real basic like a Dodge Neon with very little extra’s. Often this is called catastrophic insurance. Some have much better components with broader coverage. Insurance companies determine heath care coverage not doctors. Consider switching to an insurance plan that covers the service you desire. Or, consider paying for it yourself. It is no different from purchasing a ATV or motorcycle. Often ASPS members will offer a package price for a surgical service like a breast reduction. Best, Gary R Culbertson, MD, FACS

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Pain medication

Tummy Tuck

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Member Response:

Tammy, The answer normally is yes. But, this a question you should be asking your surgeon. They are more familiar with your medical history & should be able to guide you through pain control in the post-operative period. Best, Gary R Culbertson. MD, FACS

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Tummy tuck

Tummy Tuck

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Member Response:

Tammy, You are correct. That is a lot of surgery in one setting. It can be done safely. Make sure that your overall health has before accessed before the surgery (i.e. medication history, cardiac risk, etc.) and that appropriate post operative care has been made available to you. There may be several days were you may not be able to fend for yourself? Best, Gary R Culbertson, MD, FACS

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Cost

Tummy Tuck

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Member Response:

Zoranda, Yep, happens allot. Most patients are not aware that CoolSculpting really only works in about 60-65% of patients who are candidates for the treatments. Results can take several months to see. Results from TT’s are usually immediate. TT’s are not minor or non-invasive procedures. Consider contacting a member of the ASPS in your area. Best, Gary R Culbertson, MD, FACS

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Breast reduction

Breast Reduction

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Member Response:

Erica, Thank you for this question on insurance coverage. Your insurance company is correct you require a visit, evaluation & a request from your surgeon for pre-authorization or pre-approval for your breast reduction. Most insurance carriers will have some document regarding what they consider are the requirements for their clients to achieve to have this surgical procedure done. These are often available on line. These are very often different from one insurance carrier to another. Consider calling your insurance carrier back to obtain their criteria for approval for a breast reduction. In todays world insurance carriers dictate health care coverage not doctors. Best, Gary R Culbertson, MD, FACS

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Reconstructive Abdominalplasty

Tummy Tuck

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Member Response:

CharityF, Yes, technology has improved & costs for medical services have increased over the past decade. Consider trying to get copies of your old operative reports to assist your surgeon in determining what your previous contractor has done. Yes, many patients have Mommy MakeOvers. It does slightly reduce overall costs. In our area one the SE USA you are looking at a cost over $10K. Consider seeking out an ASPS member in your area to get specifics regarding your concerns. Best, Gary R Culbertson, MD, FACS

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Advise

Breast Augmentation

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Member Response:

kayla32, I cannot tell but, I believe you are discussing a Breast Augmentation (BA) versus a BA with a Breast Lift or Mastopexy?? Often if your breast are saggy or ptotic a breast lift can be required. If one simple puts in breast implants in a patient with saggy breasts a very large breast implant could be required. Sometimes this has the appearance of a “Ball in a Sack.” Remember the components of the appealing breast: (1) the size of the breast in relation to your body size & (2) The position of the nipples. When the two are combined/ corrected the appealing breast is obtained. Hope this data is of assistance. Best, Gary R Culbertson, MD, FACS

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Blood pressure and time

Tummy Tuck

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Member Response:

debbiejen36, These are questions that should have already been addressed by your surgeon & their team BEFORE such an extensive set of cosmetic surgical procedures- BBL/ Lipo / TT?? Yes, patients with HPB have Aesthetic Surgery all the time. 5 hrs of surgery can be safe if certain precautions are instigated. Please address all these issues with your surgeon. Best, Gary R Culbertson, MD, FACS

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Sketchy Dr

Liposuction

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Member Response:

Great question!! We get something like your concern allot in the office. The best way to describe what you are seeing is a NEW CONTRACTOR with limited experience starting out in a business endeavor. Would you let this individual or group replace the roof on your house?? What if the price is 50% or 75% less than, the other roof contractors in your community. When your roof leaks & the NEW CONTRACTOR is no where to be found what will it now cost you to get your roof fixed?? Be cautious of what appears to be too good to be true?? When it is something important like your body my suggestion is do it right. DO SOME HOMEWORK!!! Seek out a trained contractor with experience. These are ASPS Members right there in your community. Best, Gary R Culbertson, MD, FACS

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Re: Tummy tuck and health

Tummy Tuck

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Member Response:

A good place to start is with your primary care doctor or cardiologist. Ask for pre-operative cardiac clearance for an elective general anesthetic procedure. This has been a standard in our office for decades. If they say you are OK then, seek evaluation by an ASPS member in your area for a TT. Best, Gary R Culbertson, MD, FACS

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Symmastia

Breast Reduction

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Member Response:

sindyny, Synmastia of the breast can be associated with Giagantomastia. The breasts can become soo large that they produce a uni-breast. Patients often complain they cannot lay flat on their backs or their breasts will slide uo to their necks beginning to choke them. Correction of the symastia at the time of your BR can often be the best solution. This is commonly performed as part of a patients BR in our office & by members of the ASPS. Best, Gary Culbertson, MD, FACS

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Plastic reconstruction surgery

Tummy Tuck

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Member Response:

Do not have a panneculectomy at the time of your gastric by-pass. This could increase your peri- operative complication rate & hopefully you will loose allot more weight. This large weight loss could significantly affect the result of your excessive skin removal. Best, Gary R Culbertson, MD, FASC

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Breast augmentation

Breast Augmentation

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Member Response:

Sure, Mommy Make-Overs are done routinely. Seek out a member of the ASPS in your local community. They are experts in safely performing combined plastic surgery procedures. Best, Gary R Culbertson, MD, FACS

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Tummy tuck

Tummy Tuck

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Member Response:

Your first step should be to seen your cardiologist or primary care physician & see if you can be cleared for this type of surgery. Your safety is key. You may not be healthy enough to have such a procedure done? Then, consider a cosmetic consult with a member of the ASPS in your area. They are experts in body contouring procedures. Best, Gary R Culbertson, MD, FACS

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Do I need to remove implants?

Breast Reduction

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Member Response:

No, consider just taking out your implants. They have been in for >20 years. Let things settle & see how you are doing. Then, consider an evaluation for a reduction or lift if you are still having issues. Best, Gary R Culbertson, MD, FACS

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Eyelids are uneven. Can I choose which eye to change?

Eyelid Surgery

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Member Response:

Excellent question!! Eyelid asymmetry can be due to allot of issues such as a lazy eye (eyelid ptosis), a falling brow (brow ptosis), etc. A face to face would be required with an examination to make the exact determination as to what issues are involved and how best to address your concerns. Consider a member of the ASPS in your area. They are experts at Occuloplastic Surgery. Best, Gary R Culbertson. MD, FACS

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After insurance approves tummy tuck does a letter of payment is asked

Tummy Tuck

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Member Response:

The issue most likely is your understanding of the verbiage utilized in Plastic Surgery. Let me try to explain. A “Tummy Tuck” is a laymen term for what is commonly referred to as an Abdominoplasty. This procedure commonly includes tightening the abdominal musculature loosened/ stretched during pregnancy, liposuction of the patients flanks & removal of the excessive lower abdominal skin. An Abdominoplasty is an Aesthetic or Cosmetic procedure that is not a covered service by almost all insurance carriers. A second procedure that can be covered by an insurance carrier is called an panniculectomy. This procedure involves the simple excision of the patients lower abdominal skirt of skin called a pannis. These are two entirely different things, like two different parts to a car have different code numbers and costs are significantly different. I like to tell my patients that it is like comparing a VW bumper to that of a Rolls Royce. Best, Gary R Culbertson, MD, FACS

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How do you know if your stomach fat is visceral or over the muscle?

Liposuction

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Member Response:

Great Question!! As a patients Weight or Body Mass Index (BMI) & Waist Size or Girth Increase the possibility of increasing the size of their visceral fat also increases. This can most accurately be determined by an MRI with weighted images/ contrast but also by body fat measurements. To determine if your fat is above the muscle (subcutaneous), below (visceral) or significantly located in both positions consider seeking the advise of an expert. Any member of the ASPS could make this determination with an examination & testing if you desire. Best, Gary R Culbertson, MD, FACS

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uneven breasts following surgey

Breast Reduction

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Member Response:

Sorry to hear about your outcome. May I make some suggestions? Breast asymmetry following breast surgery can be somewhat common. Your first month is usually the time of maximum swelling, asymmetrical swelling can be most common in the second month & the third month you get to see the final result. Immediate post operative swelling can be a sign a hematoma or blood deep in the wound. This usually associated with significant bruising. Write down your concerns/ issues (3 max) & bring someone with you to your next post operative visit. If it is not for awhile ask to set up one earlier. Consider getting a copy of your pre-operative pictures, operative report and history & physical from your surgeon, ASC or hospital before the visit. Try to approach the practitioner in an informative but, non-conversational way. Point out your concerns by showing them the result. Consider asking how they would correct your issues. Listen!! Try not to block them out. Best, Gary R Culbertson, MD, FACS

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Tummy Tuck Pricing

Tummy Tuck

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Member Response:

Many ABMS/ ASPS members list a price ranges on line. Look in your local area for one of our members. What is actually more important than cost are the issues that need to be addressed with surgery and your overall health. Make sure you understand what may be required/ involved to correct your abdomen & breasts. The procedure can be rather expensive. A Mommy Makeover is not a minor procedure. It is a major surgical procedure. Review with your surgeon what safety measures will be utilized to reduce your surgical risks. Cost should not be your primary concern? Best, Gary Culbertson

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Remodel scar from surgery at birth

Body Contouring

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Member Response:

Yes, this is something we have done in our Surgical Center several times. You would require an examination to determine which surgical procedure(s) would be best for your condition. Consider a consult with an ASPS Member in your area. They are experts in Reconstructve Surgery.

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