My WLS program doesn't give people a goal weight number but I met their "goal" back in Nov of 2012 and my own personal weight goal of 130 or less I made in April of 2013. My program will refer you to a Bari Plastics program if you have maintained your weight loss for 3 months and have remained caffine free, alcohol free, smoke free, gotton all labs and attended all post op appointments with they. They will vote as a team if this has happened and then refer to the Bari Plastics program with is a group of plastic surgeons they work with that work with WLS people and worked up a list of prices at a somewhat discounted rate. I asked about it at my one year post op apt in June 2013 and got the paperwork end of June. My appointment with plastic surgeon is next Monday, 7/29/13. I don't know if I will even have plastic surgery but is a informational appointment where they find out what is bothering you the most and go through with you the process and costs and stuff. I have heard things do move around for a year or more after at goal weight too. I have been working out with weights and other strength training at gyms since Jan 2013 and at home workouts before that. I have been obese all 48 years of my life so my skin isn't gonna snap back as good as others who were just fat for a certain amount of time in their life plus I am 49 almost 50 years old too. The appointment cost me $100 to do and not covered by insurance. If I do any plastics they won't be covered by my health insurance either. I don't have any skin irrratations either that would help insurance covering it either. My upper arms bother me the most cause I have great muscle definition on them now from lifting but there is still all the loose skin underneath that bothers me so if I had anything done it would probably be that.
My legs still do not look thin though. I think they will always look heavy, granted not as big as they were with me at 270 pounds but still thick looking. I have muscle definition in them but still fat looking I feel.

I haven't looked into any plastic surgery (yet) so I have no idea whether these are reasonable prices or not, though I agree going to another country for cheaper surgery would be scary to me.

I am curious, if you don't mind sharing, how long have you been at your goal weight? I'm within 5 pounds of mine, but I've heard that the skin can continue to change (getting back into place) up to one year after reaching goal, and to not worry about/think about the loose skin until at least one year after achieving goal. Plus, I'm lifting weights and continue to hope that will help and that I might not need surgery. I'm not sure what kind of look I'll end up with, if I don't want to consider plastic surgery. There's definitely still some problem areas where the fat seems to be the last to want to leave (hips/back of legs).

Best of luck, whatever you decide to do.

Here are my notes I took from my Plastic surgery consult appointment yesterday. Sorry it's long but I had alot of quesitons!

Plastic Surgeon Consultation 7/29/13 3-4:15pm

Plastic surgery prices: This is the list of prices for the procedures at the Bari Plastics program in my town if you are a WLS patient and have been referred to that program
Bilateral Mastopexy (2 breast lifts) $6692
Bilateral Augmentation Mammoplasty/Mastopexy with implants $12,098
Bilateral Augmentation Mamoplasty with implants $6566
Barchioplasty (Bilateral Arms) $6232
Body Contouring:
Abdomnioplasty: $8052
Thigh lift: $6892
Hip/buttock lift: $6292
Mini face lift $6327
Full face lift $9389
The price includes the surgery fees for the surgeon, anesthesia and hospital charges (including 23 hour observation stay if needed). If a hospital stay is longer than 23 hours there is an additional $450 charge per night for this.


How many times have you done plastic surgery on former WLS patients?-10-15 people a year
How many years?-11 plus years

Ask to see before/after pics of patients of my size/frame that lost the amount of weight I have to see results?
Go to Springfield Clinic of Plastic Surgery to see pics.

How long should I wait till I have first procedure? 12-18 months after reaching my personal weight loss goal since weight/fat move around still that long after reaching my goal?
As long as I am at my weight I am happy with and have maintained that weight for 3 months plastic surgery can be done now.

Does abdominoplasty include paniculumectomy?-Yes

Panniculectomy vs tummy tuck vs. fleur de lis Tummy Tuck what is the difference and do they offer all these here?-Yes all offered here but tummy tuck or fleur de lis Tummy Tuck would be best for me. Dr. thinks the fleur de lis might be done for better results. Might do a circumferential tummy lift.

What is the difference between a Bilateral Mastopexy (2 breast lifts) $6692 Just a lift
Bilateral Agumentation Mammoplasty/Mastopexy with implants $12,098 Lift with Implants
Bilateral Augmentation Mamoplasty with implants $6566 Implants only, no lift
He thinks I need both, would do lift first and later do the implants.

Complications and rate of complications?-Not a smooth incision line when healed, Unfavorable scaring, fluid collection, wound opening up, dog ears-These don’t happen a lot but can happen. It won’t be perfect, they try to make it look perfect but there will still be unsmooth lines with the scaring.


Proposed results? Where would incisions be on these procedures?-upper arm-This could be done in combo first surgery since it bothers me the most. Incision would be in inner arm. Would be able to take all loose skin off from under armpit to right at elbow area.

Boobs-This could be done with upper arm surgery in combo surgery. Would just do a breast lift now and do implants later. Incision might be above breast or at nipple and down the center of breast.
Tummy- fleur de lis Tummy Tuck might be best for me or he could do just tummy tuck but would make sure to tighten up ab muscles under tummy or he might do a circumferential tummy lift. Part of surgery combo 2 with hip butt lift. If does a circumferential tummy lift would also lift upper back area too. Incision would be on bikini line and possible an incision up and down too if fleur de lis was done.
hip/butt-Butt would still be flat but wouldn’t be wrinkled would be done with surgery combo with tummy surgery. This would also help with loose skin around lower back area by waist line also. Incision would be along waist line.
upper thighs-Incision would be at leg line would be part of surgery combo 3 with breast implant surgery.
Implants-Would be done separately from breast lift and part of surgery combo 3 with upper thigh surgery. Incision would be along nipple and down center of breast

Will you need liposuction in addition to the skin tightening? Surgeon didn’t think it would help me any so no lipo would be done. It usually doesn’t last that long is why he doesn’t see at as doing it on me.

Drains how many/how long in?
upper arms-2 in each arm/1-2 weeks left in
boobs-no drains for lift or implant surgeries
tummy-2 drains/1-2 weeks left in
upper thighs-2 drains in each leg/1-2 weeks left in
hip/butt-Forgot to ask but probably 2 drains and left in 1-2 weeks

Recovery time? I have a desk job how much time would I have to take off for diff procedures?
Boobs, tummy, upper thighs, hip/butt-Since I have a desk job probably 2 ½ weeks. Have surgery on a Wed and then go back to work in 2 ½ weeks.

Is a pain ball an option for post-op pain? No not usually with his practice or at Memorial Hospital

How many lbs of skin does he think he can remove?-Not as much as you would think, maybe a total of 5 pounds if all procedures were done. Tummy 3 lbs, Back 1 lb, arms 2 lbs, just estimation.

Does he recommend compression garments? If so, do they provide them to you in cost work up or do you have to pay for them? Special wraps/binders/Vest/sleeves are given to the person after surgery is done and you were those home and keep wearing them and are part of the cost work out. Eventually he would send me to Macy to buy Spanx or that type of compression garments to wear for 6-8 weeks after different areas of surgery that I would have to purchase on my own.
Very important question is to ask about revisions. Sometimes things don't go as planned and you may need a revision-ask if it's covered by him/her or if you'll have to pay. What if I lose weight after Plastics will revision need to be done? How often do revisions occur with your patients? If revision is done he usually will do it when he is doing another combo surgery of mine. Sometimes an additional cost but it depends. Revisions sometimes happen. Depends on the person and their skin and how it heals up.

Lifting restrictions/working out restrictions, how long?-6-8 weeks for most surgeries. Walking can begin right away but weight lifting and stuff like that has to wait till 8 weeks. Water exercise could start in 3 weeks depending on the activity level.
I have a hernia that needs repaired could this be done at same time and save money if my insurance would pay for that part of it?-Yes it could either Hammer/Icazza could do it or even he could do it when the tummy area is worked on.

How do they go about that with the bill? -My insurance would be billed surgeons time on the bill that would go to my insurance co.

Does your office take care credit?-No
financing options?-At this time, none but they are working on some. He doesn’t know what Memorial Bari Plastics programs offers for financing options so I would need to call them to see if they have any.

Is excess skin donated to Memorial Burn Unit? Discounted cost for this?-No, they use cadaver skin. No most hospitals don’t do this anymore. No discounts either.

23 hour observation stay also included in cost so do you usually go in and stay overnight or come in early in the morning have surgery and leave that night?-The observation stay time doesn’t start till after the surgery has occurred and you are admitted to the hospital

Can your office check to see if my insurance would cover any plastic procedures? I have tried to look it up but gotten no luck since it’s a new insurance is why I ask. -In his experience, most if not all insurance companies will not cover these procedures I am thinking about because it is cosmetic type surgery with no medical advantage to having them done.

Lab work, EKG, Chest xray are all include in Memorial Bari Plastics Quotes also so price is all inclusive unless have to stay longer in hospital.

Complications and costs-many times they have been able to get the person health insurance to pay for the cost of bills if complications. He said to not quote him on this but usually they can get insurance to pay for this.

Surgery 1:
Bilateral Mastopexy (2 breast lifts) $6692
Barchioplasty (Bilateral Arms) $6232
Estimated cost total $12,924

Surgery 2:
Abdomnioplasty $8052
Hip/buttock lift $6292
Estimated cost total $14,344

Surgery 3:
Thigh lift $6892
Bilateral Augmentation Mamoplasty with implants $6566
Estimated cost total $13,458

Total cost of all surgeries $40,726

Right now I am waiting to hear from the Bari Plastics group to get the "firm" prices since these are just estimates. Last night I got to thinking and was thinking of having my upper arms done and tummy done first. Those two areas bother me the most so if I only had one combo surgery that would be it, if they would combo those two areas.
Has anyone had upper arms and tummy done at same time?

No this was just my first plastic consult. There aren't alot to choose from in my town and I really don't wanna travel too far if there is complications and stuff like that. This was through Springfield Clinic, I haven't checked with SIU Medical yet. That might be it in our town. I will have to google it and see. I am not going to jump into anything right away due to finances also!

Have you gotten a 2nd and 3rd opinion and quotes?

I had my surgery about 1.5 yrs out from my VSG. I didn't wait till my goal weight because my goals have changed over time. I am happy with my results, and glad that I shopped around before deciding on a Dr.