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  • #16
    Originally posted by Tangler View Post
    I will avoid surgery if at all possible. No thanks.
    Good rule of thumb

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    • #17
      Obesity medicine physician here. I see lots of patients who would benefit from liposuction/panniculectomy/abdominoplasty but fail to get the procedures due to lack of insurance coverage.

      Lipedema is a relatively common disorder with atypical adipose distribution, usually in the lower part of the body from the pelvis down to the ankle although there are other distributions. Seen only in women with progression and pain development. The only treatment is tumescent liposuction although not covered by insurance which considers this a cosmetic condition.

      Similarly many patients I see post-bariatric surgery significantly benefit from truncal resection of redundant tissue but it continues to be difficult to get this covered. Even the patients who struggle with healing large incisions eventually are usually very pleased they had the procedure.

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      • #18
        Originally posted by SunShineBottom View Post
        Obesity medicine physician here. I see lots of patients who would benefit from liposuction/panniculectomy/abdominoplasty but fail to get the procedures due to lack of insurance coverage.

        Lipedema is a relatively common disorder with atypical adipose distribution, usually in the lower part of the body from the pelvis down to the ankle although there are other distributions. Seen only in women with progression and pain development. The only treatment is tumescent liposuction although not covered by insurance which considers this a cosmetic condition.

        Similarly many patients I see post-bariatric surgery significantly benefit from truncal resection of redundant tissue but it continues to be difficult to get this covered. Even the patients who struggle with healing large incisions eventually are usually very pleased they had the procedure.
        Out of curiosity, what's the career outlook for obesity medicine?

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        • #19
          Originally posted by laserbeam2016 View Post

          Out of curiosity, what's the career outlook for obesity medicine?
          Go out in public and have a look around. There's your answer.

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          • #20
            Originally posted by Eye3md View Post
            Tummy tucks are just awful procedures, IMO. Not an awful thing for the surgeon to do, but awful for the extreme nature of what the pt endures. Big huge cut of the lower abdomen, where a chunk of that area is cut out, and then the now wider incision is pulled back together. Very tight for the pt, and they Dedi have to know it’ll take a while for them to feel like they can straighten all the way up and stretch. My wife had lipo but not the tummy tuck. She’s glad she did it, a year later, but it was quite bothersome to her for the first week or so. She was very bruised and swollen. Had to wear compression garments around all the areas that had lipo performed, and this was uncomfortable being worn 24/7. It’s been a little over a year, since her lipo, and she looks great (I thought she looked great before it as well) and she’s very happy she had it done.
            This is a gross caricature and misrepresentation of a tummy tuck. Yes its a big procedure, but it also isnt indicated for everyone. You should have a big obvious reason to do it, ie, excess skin from preg, c section scar, etc...Lipo shouldnt leave you bruised all over, rare, happens but rare. People can usually stand up the next day, even if it seems tight or we dont want them too.

            They are not extreme, generally take about 1-1.5h and the pt is doing very well darn quickly. Most women compare it to a c-section, except no newborn to contend with.

            All these procedures are absolutely worth it for the pt that will benefit from it. Its a trade off like everything else. I am def different as anyone here knows and I tell people every week they dont need a tummy tuck or the trade off isnt worth it, and it has to be. For me its pretty simple and easy. Go to enough docs and someone will do your procedure.

            Pts are generally super happy, its awesome and even if socially/medically people want it to be otherwise it isnt, people are very happy and feel better and I am happy for them and happy to be a part of it. Ofc again, I dont do anything I think isnt indicated, talk people out of surgery all the time (not a great trait I admit), tell everyone no one "needs" anything, etc...

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            • #21
              Originally posted by SunShineBottom View Post
              Obesity medicine physician here. I see lots of patients who would benefit from liposuction/panniculectomy/abdominoplasty but fail to get the procedures due to lack of insurance coverage.

              Lipedema is a relatively common disorder with atypical adipose distribution, usually in the lower part of the body from the pelvis down to the ankle although there are other distributions. Seen only in women with progression and pain development. The only treatment is tumescent liposuction although not covered by insurance which considers this a cosmetic condition.

              Similarly many patients I see post-bariatric surgery significantly benefit from truncal resection of redundant tissue but it continues to be difficult to get this covered. Even the patients who struggle with healing large incisions eventually are usually very pleased they had the procedure.
              Its because they wouldnt benefit. Lipo and contouring arent weight loss procedures. Theyre skin procedures and little spot correctors. Post weight loss procedures on the other hand are amazing, and thats what most people actually need first, weight off then surgery to take extra skin. Largest pannus ever removed was only 35 pounds and it nearly hung on the ground of an otherwise normal weight person. Fat takes a lot of space but doesnt weigh that much.

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              • #22
                Originally posted by laserbeam2016 View Post

                Recovery was not bad. I took 2 weeks off work. Only used oxycodone once, the rest of the time alternated between tylenol and ibuprofen for a couple of days. Used abdominal binder for a couple of weeks. Did not feel standing up a huge problem, or maybe just because I anticipated it. Went back to work on time without issues.
                Ive never given anything other than tramadol, even when its a full mommy makeover, aug/pexy/tuck. Have never refilled a prescription nor had any complaints.

                For the people discussing med school experiences, no offense but the people at academic centers have very little experience and take what you see with a grain of salt.

                I die every time I see a so called "landmark" paper with 10 surgeon experienced pooled over a year to what amounts to an average private practice surgeons slowest 3 months. Its laughable.

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                • #23
                  Originally posted by wideopenspaces View Post
                  I guess I'm only 40 but so far I'm sticking with sunscreen, daily exercise and reasonable diet. I've never had surgery of any kind and I'm not going to lie, it freaks me out. Not sure I'd ever do it on purpose. My MIL died during a surgery to fix an old gastric bypass procedure, so that colors my perception- is there anything I hate so much about my body that it's worth dying over? Not so far!
                  The only addition for skin is retanoic acid (differin) and maybe lightener, both sold at target btw. Also occasional botox doesnt hurt.

                  No one needs surgery ofc, but some things it can address.

                  I am also in the 'finding going under slightly terrifying', idk, its just the whole no agency part of it, scary.

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                  • #24
                    Originally posted by Marko-ER View Post
                    Yeah, no. Nip/Tuck has really put me off any cosmetic procedures.
                    Seriously? So are we to assume Greys Anatomy is also reflective of reality?

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                    • #25
                      One of our intensivists in the early 1990s had horrific, dolls-head hair plugs, so that was my impression of hair transplants, until the YouTube algorithm decided to serve up Dr. Linkov's channel. Modern results look good:

                      https://www.youtube.com/channel/UCXH...GcVp4-MMbEDW6g
                      Erstwhile Dance Theatre of Dayton performer cum bellhop. Carried (many) bags for a lovely and gracious 59 yo Cyd Charisse. (RIP) Hosted epic company parties after Friday night rehearsals.

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                      • #26
                        Originally posted by Zaphod View Post

                        Seriously? So are we to assume Greys Anatomy is also reflective of reality?
                        Yes. I can't go into our supply room without having to step over people having sex.

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                        • #27
                          Originally posted by Zaphod View Post

                          The only addition for skin is retanoic acid (differin) and maybe lightener, both sold at target btw. Also occasional botox doesnt hurt.
                          No one needs surgery ofc, but some things it can address.
                          I am also in the 'finding going under slightly terrifying', idk, its just the whole no agency part of it, scary.
                          Self image is a mental thing as well. For some, it might be change a persons self perception more than the physical. That would be a success.

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                          • #28
                            Originally posted by STATscans View Post
                            Trying to get rid of that extra fat around the handle, that isn’t going away with diet and exercise?
                            Nothing against plastic surgery, lipo, vanity procedures, etc. You do you.

                            But it's literally impossible to not lose weight if you diet hard enough. Not wanting to do it is a different story however.

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                            • #29
                              So, in 30 years of plastics, I performed just short of 2000 abdominoplasties. It’s a spectacular procedure for those massive weight loss, especially post multiple pregnancies. Not a procedure for gross obesity, although I’ve removed in excess of 15-20 kg. I started doing Lipo with Burkhardt after he brought the first machine back from France decades ago. Subtle improvement usual, some disasters yes, but not the dramatic change with tummy tucks.
                              By the way, anyone who does them without narcotics is nuts. Never touch me or family

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                              • #30
                                In answer to the question about the interest in obesity medicine and what the future holds:

                                There's a growing interest in obesity medicine. The American Board of Obesity Medicine started in 2012 with a little over 200 diplomates and now is up to over 5000 I believe. Those who work in obesity medicine have developed a deeper interest, although most who are certified don't practice full time. Most physicians don't have a great deal of interest in managing obesity--difficult to do, time-consuming, reimbursement can be difficult.

                                Algorithms have been developed that do help guide treatment and since 2012 several medications have been approved by the FDA with likelihood of many more coming in the future.

                                I work in academics and there are very few jobs for obesity medicine physicians that open up each year. Many positions are affiliated with bariatric surgical programs. I suspect that will change in the future. I've enjoyed the practice. After years of a busy family medicine practice (hospital, ER, delivering babies, nursing homes, over-busy clinical practice), I enjoy the no call, no weekends/nights and appreciative patients/referral doctors.

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