[lostinthenet3]

Question 1 where are you located? Question 2 do you do ps on men. Question 3 how does a lbl work on a male and do you preform them. I am a 36 yr old male who has gone from 475 lbs down to 230 lbs and I have quite a bit of loose skin that I want removed. I also would like to have some lipo done on the existing fat depostits on my abodmen so that I will be able to see my ab mussels. I would be a self pay and I am looking into what options there are out there. I would likr to have the surgery Augest or Sept of 2007 as I am running in the boston marathon in april and I have two breast cancer walks in may and early augest. That I have done for the past 3 years. I go to the gym 5 days a week and work out for 2 -3 hrs 1and 1/2 is my cardio on weight days and 2+ hrs on non weight days. I have increased my bicepts and tricepts to eliminate most of the bat wings that I developed but have found nothing to fix my lower abs.

Doug.

[DocSanae]

Hi Doug,
FYI, Dr. Oliver's self-intro thread is here.
There's a link to his practice in his post. I hope looking through that will help you some.

[Pillows]

Hey Doug, welcome to the boards. Wow that is an amazing progress you have made. I think it is awesome that we are starting to get more men on here to balance us out and keep us in check. I hope that you stick around and let us get to know you better. Hopefully you can provide us with some before and after pics. Wow, you have a great workout regimine. I am very impressed. I have fallen in love with the gym here too, and I find when I don't go as often I am really cranky to be around. Best of luck in your plastics.
Janae

[droliver]

Doug,

congrats on your success!

I'm located in Birmingham,AL

As to your case... removing large excess of skin is fairly straight forward. Aggressively thinning these areas simultaneous to post-bariatric surgery can be tricky, much more so then other abdominoplasty cases where we routinely combine liposuction or direct defatting. You have to release the skin and fatty layer from the abdominal wall a great deal to take the "slack" out beyond what people close to their ideal weight who've never gained/lost large amounts of weight. This process of disection disrupts a lot of the normal blood supply to these tissues. Adding liposuction is another hit to this blood supply & when we combine it we have to limit how much we undermine the skin or you end up with areas of skin loss.

The hardest area to address completely is the upper midline due to these concerns over blood supply. I've gotten more detailed in my consultations over what I can & can't do with this upper midline area in people with a thick fat deposit or real loose skin. You end up with either a small bulge (which can be liposuctioned later on) or some loose skin which would seem to be needed to be "tucked" upwards. I think in women this may be able to be addressed if they subsequently have breast work done and you can work this skin out towards a scar under the breast.

[Pillows]

So Doctor Oliver, from your description and in your opinion, generally speaking would it be better for a woman to get the lower part taken care of first so that if there was the issue of extra skin that it would be taken care of when the breasts were done later? That is a really good point to take into consideration when planning your plastics if that is the case and good to know. I understand of course that you can only make generalizations and that it is somewhat of a one on one basis, but that would be good info to know for future reference. My hubby asked me if I had to only get one part done which one I would choose, my breasts or my tummy area and I originally said my breasts since with men, they tend to overlook how flat your tummy is if your boobs are impressive...lol. Now I might have to rethink that answer and plan on the tummy first so that any residual could be taken care of easier with the breasts. Thanks as always for participating on this board Dr. I enjoy learning from you.
Janae

[droliver]

I think for most people the abdomen is clearly the biggest bang for the buck. As I mentioned, I've just been getting more specific with some of the observations re. what can be done (safely) with a single surgery. People who are close to their ideal weight with good skin quality don't tend to have this residual fullness (when they're heavy) or loose skin (when they're "deflated") like you get after massive weight loss.

A second bite at the apple during a later breast procedure seems like an intuitively good way to address these issues by either tucking the skin up into the closure of a breast reduction/lift or doing focal liposuction of the epigastric fullness.

One way this can be addressed is doing vertical excisions of skin during the abdominoplasty to take in the horizontal component of laxity as some advocate. The problem with this is adding a long vertical scar on the abdomen if they didn't have a previous open surgical incision as well as an increase in some potential complications due to tension/blood supply issues where the horozontal & vertical incisions meet

[Pillows]

OOOH ouch. As always Doc, thanks for all the info and things to consider. I am sure that I will be looking into some procedures later, but will try my best to minimize what I can naturally in the meantime to save on money and pain.
Janae