Stage 1 Excess Skin Removal Following Gastric Bypass - LBL/Arm Lift

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I had Gastric Bypass in June 2015 and have lost...

I had Gastric Bypass in June 2015 and have lost 160 pounds. Excess skin removal is a must and as my PCP and Bariatric Surgeon said "the icing on the cake after all the hard work". My dietician has said I need to wait until at least 2 years post-op, but my PCP, Bariatric Surgeon and therapist (from bariatric surgeon) all say they see no reason to move forward, so here I go!

I first discovered Dr. Peter Fisher of San Antonio on another website for weight loss surgery patients. (I live in Dallas, so San Antonio is about 5 hour drive away which seemed doable). I then researched Dr. Fisher on this site and have found nothing but great reviews and found his procedure for lower body lift to help maintain waist and hip ratio and not a boxy lower body to be the reason I wanted to pursue his services. I first saw him on May 25 and liked him immediately. (He told me even with all the extra skin that I had a good figure! What's not to like?! :0) ) I originally scheduled for September but had to change due to job change and now I am just over 2 weeks away and excited and nervous all at the same time!

Dr Fisher's plan for me is Stage 1 - LBL (which includes Extended Tummy Tuck, Butt Lift, Mons Lift and Outer Thigh lift likely with some lipo) and an Arm Lift. Stage 2 (no less than 3 months later) will be Breast Lift & Augmentation and Lateral Thigh Lift (including inner thighs). I do not have the 2nd procedure scheduled yet but hoping I can go in February or March of 2017. Stage 1 surgery is approx. 8-12 hours long. I will stay 2 nights in the hospital and then stay at an extended stay hotel for at least 2 weeks post-op. I am HOPING I will be able to drive myself home on the 28th, but that remains to be seen. I will have family/friend help from day of surgery (Thursday) until following Tuesday and then on my own for a few days before another friend joins me on Saturday/Sunday and then on my own again. I have gone through many major surgeries with only a couple days of assistance (4 shoulder surgeries, Hysterectomy, Gastric bypass, bi-lateral kidney stents and MANY kidney stones), but this one makes me a bit more nervous as I just don't know what to expect with drains and compression garments and such. Depending on when post-op appts are scheduled, I may have to take a taxi or Uber to the drs office but that will be ok. It is very close. (Maybe there is a shuttle at the hotel? I will ask.)

I have rented a lift chair/recliner, bought a toilet seat riser and walker and grabber stick. Ordered my Stage 2 compression garment (capri length then up to under my breasts with suspenders) and arm sleeves for after the bandages come off. (Not sure if these are right but best I can figure for now.) I will go down for pre-op on Monday and then stay a few days getting settled including grocery shopping and whatever else I forgot.

I have complete confidence in the dr and his staff. The length of time of the anesthesia concerns me the most (and my family sitting out in the lobby enduring 11 or 12 long hours). I just wish I had more knowns so I could have better expectations, but that's not how this stuff goes I guess. The 2nd stage will be easier just because I will know better what to expect.

Anyway, I have gotten so much advice and courage from others posting here, so I thought I should start a review of my own in hopes to help people with same questions I had. I cannot say I will be brave enough to post pictures, but I MIGHT be willing to send a private message to someone if they really wanted to see the results (and they are as spectacular as I anticipate they will be). I will cross that bridge when I get there... Any advices from fellow Dr. F patients or those who have gone through LBL and/or Arm Lift are more than welcome! I will keep this updated as I go through the process.

Pre-op & Marking DONE!

So I had my pre-op appt today. Quite odd standing there naked and having skin pushed and pulled and drawn on and erased and drawn again PLUS taking of pictures. He is certainly a perfectionist and what else could you ask for is such a surgeon?! Truly an artist's eye. It was awkward but actually much less so than I thought I would be. Dr. Fisher and Joann (his nurse) are so wonderful. I know I am in good hands. I would be lying if I said I wasn't anxious but Dr. Fisher said he would consider it odd if I wasn't nervous. I just changed in to my pjs for the night and had forgotten about the marks until I saw myself in the mirror. What a shock! Ha! I am quite a sight!

Dr said he felt quite sure that I was going to recover really well and get great results. I can't wait! Here's hoping the next 2 days go by fast.... Will update all as soon as I can after surgery to let you know how it went.

3 days post-op

Surgery went really well. Dr was very happy with the results and told my family I was the "perfect case". The pain isn't really that bad as long as I don't move. Moving on the other hand is a different story. I got terrible itching from the morphine and eventually had to get them to discontinue that and move me over to Percocet. I have a TINY bit of itching on Percocet but nothing like it was. I take bendryl or I go the dr to write a prescription for Hydroxine HCL (Attapex?) which help with the itching a lot.

Can't believe how small my arms are and big my but is! :) Sleeping in a recliner but I have no issue with that. Very glad I rented the lift chair, brought a toilet seat riser and a walker. I wouldn't survive these first few nights without! I still have someone with me for 2 nights and then I will be alone a few days before a friend comes for he weekend and the alone again. I think that will be all the help I need until time to go home (will need help packing and lift the luggage as well as driving).

Can't wait until the swelling goes down and I can really see the results but it is already 1000% better so just can't wait until 3 months down the road when the swelling is so much better!

5 days post-op - Swell Hell!

Hi all! Still doing pretty good here. The pain isn't unbearable. I mean, don't get me wrong, I need the pain med, but all in all, really less pain than I thought. The swelling though - OMG. I had no idea. And I don't mean "oh look my pants don't fit", I mean " seriously if I accidentally get stuck with a sharp object, I may spew and fly all around San Antonio like a deflated balloon cartoon"! Man that part is really uncomfortable. It pulls the skin SO tight. Dr. Fisher is still a top doc (and even more so now). He gave me his cell number to text him and I hesitated to use it but finally asked at what point I should be concerned about the swelling - I mean is my skin really going to rip apart like it feels? He texted me right back saying he would call in Lasix and within minutes, I had a call from the office confirming they had called it in to the correct pharmacy. What service! He even then texted me this morning checking in to see how I was doing and making sure I had my post-op appointment. The Lasix seems to be helping a little (but I have only taken 3 doses at this point). I know it will improve, plus I know I am not drinking enough which may be part of the problem.

The drains are looking great and I have my first post-op scheduled for Friday. Will be very excited to talk to him on Friday and hopefully get the drains out and first compression garment put on. (I am still wearing the binder given to me at the hospital. I wear it pretty much 24/7 except when I just need a break before I break in half. Most of the time I don't even notice it is there.

I am on my own now (my last help left at 6 p.m. yesterday) and honestly it was a relief to finally be alone. Love my friends and family but too much noise! :) Still sleepy but not awful. Spending my entire time in my lift chair recliner rental which I HIGHER recommend (could not have gotten through without). Also, the toilet seat riser is a must have especially if you are my height - 5'10". I am staying at Homewood Suites Extended stay and the toilets are VERY low. :) Hotel is clean and quiet. Lots of things close by. My friend walked to CVS yesterday to pick up my Lasix - less than 1/2 mile.

And forgive me if I have said this before (I cannot remember and did not read earlier posts) but my a$$ is AMAZING! :) I'm talking Kim Kardashian booty! He said it will drop a little but for now, I am loving that! Can't wait to see what it looks like in clothes! The saddle bags are gone and I almost cried. I have stood in a mirror nearly my whole life (seriously since I was a teenager) and held that skin up and thought "couldn't we just cut that part off". And now it is gone. Again, I cannot wait to see how I fit in jeans not to mention yoga pants! (I have high expectations here! :) ) And my arms? Well I did cry. Another part of my body I have always hated and have always avoided wearing shirts with too shot of or nil sleeves. By next summer, I will be rocking sleeveless tops! Cannot wait!

In the meantime, I rest and try to heal and sleep and just trust each day to be a little better.

Don't hesitate to send me any questions. And PS - if any vets out there have swelling solutions, I am open to them ALL. I have tried ice and heat but Dr. Fisher wants you to be careful with those since the areas are numb and I won't be able to feel if the skin is getting damaged by ice being too cold or heat too hot.

8 days post-op - Making great progress

Got 3 drains out today! Only 1 remaining. The drains are such a personal thing from patient to patient and he cannot estimate how your body will handle certain things. We are, after all, all individual human beings. :) I am thankful to have the ones out that I do but also thankful that he is attentive enough to leave in 1 if medically necessary - and it clearly is. We will see how much output by Monday and then decide next step.

Dr says everything looks great. He is very pleased and was also concerned if I was pleased. I am. Very. My butt skin was truly awful - not just ugly but so uncomfortable. At only 8 days post-op, I already have better quality of life with this change. I cannot begin to imagine how much more so it will be in 2 months or even a year!

I am still so sleepy but Dr said it was totally normal. There was a LOT of surgery and best I can do is rest and give my body time to heal. I am praying for no openings, so even more reason to rest. (Well that and I truly cannot keep my eyes open sometimes. Seriously every time I turn on the computer, I fall asleep mid-typing.... It will get better.)

Have I mentioned lately how great his staff is too? I took Uber to the appt today (first time I have used Uber - very handy). Anyway, being alone (and well maybe she would have done this if I wasn't alone) but Joann was kind to carry my bag, help me change clothes, etc. I feel very cared for in this place.

Ok see I fell asleep and lost my train of thought so I don't know what else I was going to say.... :D Will come back and post more later if I can remember...

Day 12 - Making progress

I still have 1 drain in. Ready for that to go. I know it is necessary (for me anyway) so I'm really not complaining but will be nice when I can wear pants again. It should come out Thursday or Friday and then I will go home. Not looking forward to that 5 hour car ride but better than a 5 hour car DRIVE which I originally thought unwound get away with. Today I went to Walmart for a quick trip. (I used Uber and the guy was great! He waited for me while I ran in for a few things.). I was walking pretty quick and able to do but had quite a bit of pain in my left hip. (Still sore tonight. Not sure what that is but made a not to be sure to ask Dr about it at next appointment.). It was nice to be out of the hotel and know that I could move around a little but 45 minutes away from my recliner might have been a bit too much. I am definitely tired but having said that, today was definitely a day of progress. Last night, I went the 12 hours without pain meds for first time since surgery. Not gonna lie, that first hour getting on top of the discomfort and getting up to go to the bathroom was a struggle, but I survived. Then I survived my afternoon trip to Walmart and have managed not to take a nap all day (first time since surgery). I imagine I will be tired tomorrow after my escapade today but hopefully each day gets better and better. And it gives me a glimpse at being normal soon.

Had a bit of a meltdown 2 days ago which I expected honestly and felt coming on. I know it's totally normal - what have I done, why couldn't I do it without surgery, what have I put my family through, could have spent the money better, etc. But once I got past that (or quite honestly maybe even during it), I still kept thinking that this was totally worth it.

Some of you have asked about pics. I don't actually know that I am comfortable posting pics and I didn't take any pre-op pics. I suppose I could get them from the Dr, but I haven't requested yet as I am just not sure I want to see them. But I did take one today of my tummy. Even with a little swelling (which is greatly improved), you can see how flat it is and the waist I have. I am lying down so it is likely a bit flatter than standing but still pretty cool to look at - especially only 12 days post-op.

Hotel - Homewood Suites San Antonio Northwest

Hey one more thing - I am staying at Homewood Suites and I just want to say how great they are! I am here alone right now (family and friends in and out) and they have been so accommodating. Shuttle took me to my dr appt yesterday and then ran me up to CVS later to get my med and waited while I got it filled. I have been using Uber some too which has been very handy but just wanted to give a plug for the hotel and their staff. They have been amazing! Oh and they have a great little breakfast and afternoon happy hour that is great for a change of pace especially for those of us here alone without transportation to go get any other food. (My kitchenette is well stocked with groceries which my family and friends took care of while they are here.) You can have them pick up groceries for you too. Just give them a list and money. Anyway, if you are looking for a place to stay while in town with Dr. Fisher, I do highly recommend this place. They have a special price with Dr. Fisher's office (and depending on how long you are here), so be sure to call to request that when you are booking.

3 weeks post-op Update

Didn't realize it had been so long since I updated! I have been home a week now and at 22 days post-op (can't believe it is that already), I am starting to feel more myself. I have noticed a dramatic reduction in "pain" level in the last week. In fact, I am not so sure I would say I have any pain at all. Mostly I am uncomfortable from the swelling. Still a little rundown but no need for naps. In fact, I am feeling well enough that I have to be careful not to overdo it.

The drive home from San Antonio (well ride home - my sweet cousin brought me home) went fine. It was about a 6 hour drive in all and I did well. We stopped a couple of times so I could get out and walk around a little. Towards the end, I felt a little car sick (should have never looked down at my phone) and I was definitely more swollen. I was in bed by 7 pm and slept off and on for the next 14 hours or so! Feel like I have been making rapid improvement since then though!

I found someone that specializes in Lymphatic Drainage Massage which is supposed to help with post-op swelling. (It is also used in treatment of cancer patients and I remember my aunt going to this massage when she was recovering from breast cancer.) I have only been once so far but I noticed a difference immediately. The swelling did come back but I was told to expect it and have to have several visits before I will see marked difference. Fine by me! It was relaxing and I am up for whatever it takes to speed along the healing.

Compression garments - yuck. Just yuck. I have several and each one has different pros and different cons. Generally when I put it back on, I do feel pretty good for a while but eventually it just feels too tight and I take it off. Being tall makes it tougher to use the 1 piece garments as it is just too short through the torso. I find the 2 piece garment to work a little better (i.e. part of it goes from below knees to just under my breast, then I have a separate piece for my arms). I must say I really do like the separate arm thing. It is sort of like a bolero type jacket with opening for whatever bra I want. I got it from Leonisa and I like it because it fits more like a jacket instead of just the arm pieces which I feel would have cut into my underarms. Besides a lot of my swelling is in the side boob area and this jacket helps contain that. I get more and more used to it. And I know it will be worth it, but I confess that I do not wear it as often as I should. (Sorry Dr. Fisher!! I am trying! I promise!) As the swelling goes down, it does get more comfortable and it is a catch 22 since wearing it is what makes the swelling go down. (Ok, now I feel guilty and I am going to get up and put it on again. :) )

I haven't gone back to work yet - well not in the office. I am working from home and feel so much more clear minded this week. I actually feel like I could go back but it is an hour drive away and that concerns me the most. I am able to drive but more short distances around town. I was out today for about 4 hours straight and was quite ready to come home and lie down. I am going to attempt to go back in the office for a couple of days next week at least part of the day and see how it goes. I am very blessed that I have a job that gives me such flexibility. For those of you who do not, I recommend a minimum of 4 weeks off work and preferably 6. (And hear this - even if you can work from home - make sure you do not have to that first week! Every time I tried to turn the computer on, I would just get more sleepy. Plus the stress of it all really made me feel worse and the more I felt I couldn't work, the more stressed I felt. Next time, I will absolutely make plans to do NO work that first week so I won't be worrying about it!) Luckily we also have Thanksgiving week coming up, so I have several short work weeks ahead of me anyway.

That's all I have for now I think. I am still thrilled with the results. My arms look amazing and actually the incisions are already fading! I just started using BioCorneum on them this morning so no way to know if it will help or not, but I paid for it, so I am willing to give it a go! Even the incisions for my LBL don't look too bad. I haven't started using scar cream on those yet. Will likely do so this week.

10 1/2 weeks post-op

Wow I didn't realize how long it has been since I posted an update! Still doing well but still swelling. I saw Dr. Fisher on Dec 5 (7 1/2 weeks post-op) and he was very pleased with the results. He said he didn't see the swelling that much that day, but it has persisted. I am getting Lymphatic Drainage Massages and I do think they help (or at least I can certainly tell when I haven't had a massage in over a week as the fluid definitely builds up. And the masseuse confirmed that (thank goodness wasn't just my imagination as I thought I might be losing my mind!). I contacted Dr. Fisher earlier this week and got a 2nd round of Lasix to see if that would help with some of the fluids but 4 days in, I haven't seen much of a difference. There is still also a lot of numbness and tightness which drives me a bit nuts! I do wear my compression garment off and on. Not sure I can tell a big difference in the swelling at day's end with or without the garment. I really did not expect to still have the swelling and tightness and numbness at this stage, but then again, I don't know that I really understood what I was getting in to when I went in to the surgery. The results are great though and other than the uncomfortableness of it all, I haven't had any complications. I hope I can come back here at 6 months post-op and then again at 1 year and have NO signs of any of this and only be thrilled with my results! (I am assured that is going to be the case!)

And though I may be COMPLETELY crazy, I have decided to move forward with Stage 2 which is Breast Lift / Augmentation and Vertical Thigh Lift. Surgery is scheduled for Feb. 14 - that is 4 months from Stage 1. I keep going back and forth, but honestly, if I am going to have swelling (and it appears that I am just that person), then I don't want to wait for it to be completely gone and then start all over. At least I can have some of it overlapping.... Dr assures me swelling is minimal enough that it won't hamper results of the thigh lift so I am moving forward. Realized today that it is only 7 1/2 weeks away! I am also assured recovery from this will be much easier.

Oh Dr F did give me before and after pics. I need to blur some parts :) but will do that and try to post them here. Will also eventually start a new post for Stage 2.

As far as scars and scar cream goes, the scars are very flat though still a bit red (which I did expect). I don't love the Biocorneum because it is sticky (because of the silicone) and is no fun to put the compression garment over. I guess I could try it on the days I don't use compression garment. I have also used Mederma PM which I really like how it soaks in. It is the least expensive I have found but for the 1.7 oz jar which cost around $30, it only lasted about 10-12 days (that is applying 1 to 2 times per day). I also used one called Scarless MD which I really liked but again it was expensive ($60) and only lasted 10 days. I have also used Intensive Healing Cortizone 10. Love the way it goes on and is definitely cheaper but not sure how much it will really help with scars. (One day a few weeks ago, I had some strange intense burning on my right arm and tried the Cortizone since I had it on hand and it helped with the burning and itching so I kept using it until I ran out.) All of it is too soon to say how it does for the scars, but it seems the key is keeping it deeply moisturized and wait it out (and keep it out of the sun which isn't a concern during this time of year since it is winter.) Time will tell how it all works out....

PS - Any great home remedies for the swelling / tightness, I am open to hearing them!!


Ok folks. I really do not love the idea of posting pics but I do know how much other pics helped me, so here goes.... These aren't great quality because they are print outs that I scanned in (and not sure I can figure out how to get them in here, so be patient if they aren't attached to this post :).

The before (on the left of each pair) are 3 days before surgery at markup and the after (on the right) are a few weeks ago at 7 1/2 weeks post-op.

More pics

In these you can really see the difference in upper arms, belly hang and thighs!

Pics - Last but not least!

Really good belly shot and saddlebag/butt

4 month (almost) update

Thought I would check back in and update - AND to say I am a week away from my Stage 2 procedure with Dr. Fisher! (I will start a separate entry for that. I am having vertical thigh lift and breast lift / augmentation.)

As to this Stage 1, I am loving the results, but for me (and I hope this helps someone) - I am still swelling some and I my butt is still sore to lay on in one position for too long. (Doesn't seem to be an issue when I am sitting in a chair at work or driving though.) Still a lot of numbness in arms, thighs, hips and stomach. I would not describe anything I have as pain, but I would say that I am surprised by the constant feeling of "tightness". (I described it too someone as having on pantyhose that were too tight and kept falling down and you can't pull them up! :) ) So sort of annoying but I am told that the "tightness" is a good thing; otherwise, I wouldn't have the results I wanted. I am also told that my brain will eventually adjust to the feeling and I sure hope so (and I do think it will). I can say that I still see improvement each week, so at about 16 weeks now, I expect to feel even better in 6 months! Wish me luck on my next adventure!

Stage 2

In case you want to continue to follow my story though my next stage of transformation - here is the link -

5 month update

So 5 months post-op today (and 1 month post-op from my Stage 2 which you can read under separate entry). Still have the tightness I mentioned above, but Dr. Fisher reopened and retightened my hips in my Stage 2 procedure as they had fallen a little. Dr. said it happens and often the 2nd time it is done, it tends to stay up better. All to say, I cannot really discern the tightness from the 2nd procedure or the first, but I will say that it seems the "same" and not worse which I consider and improvement given I am only 1 month post-op from the 2nd procedure (if that makes any sense at all..) Despite having the incision lines reopened, the LBL scar (360 degree) is looking really good. I still have swelling on my backside just above the "crack". Dr. Fisher jokingly (I hope) told me last month he was going to make me wear compression for 6 months after this 2nd stage. (Frankly, I am just someone who swells. Always have been but interestingly, I saw this post on YouTube yesterday where a plastic surgeon was saying that those who had massive weight loss seem to have prolonged swelling. Would be curious if there were any studies about that. BUT even before my weight loss surgery, I had random swelling.)

Tummy still looks great (in fact seems even flatter after Stage 2 somehow). Still numbness there too but nothing annoying.

My arms still swell occasionally and I still have some numbness in my arms. The scars are flat but still fairly red. They did get wider (likely due to the swelling but also my scars tend to do that). I ordered some DermaBlend leg and body make-up yesterday so I can cover those scars and wear short-sleeves (and eventually sleeveless!!). I know the scars will eventually fade, and if they don't, I think there are things that might be able to be done with lasers to help. Plus eventually I think I won't care as much. I am just a little self-conscious of it right now. But it is WAY better than the skin and fat hanging down that I did had! Trust me, even if I cannot cover them up and they never fade, I would prefer this version of me 110%!
San Antonio Plastic Surgeon

I have not had my surgery yet but have corresponded with Dr Fisher and Stephanie a couple of times in addition to meeting Dr Fisher in person, and I am more than confident in his skills. His bedside manner is right up my alley and exactly what I need in a doctor. He is very easy to get in touch with and not that I will bother him often, but it is nice to know that he can be contacted if needed. Will update the review as I go through the procedures but I anticipate nothing but more glowing review. UPDATE: 8 days post-op (1st surgery) - I wish I had a better ability to express my thanks in words. This man is truly an amazing man - not just surgeon and artist but human being. He truly cares. And not only can that be all too rare in the health care world, it tends to be very rare for a surgeon. But this guy - he is your guy. Don't hesitate to choose him. And then - trust him. Don't beat him down with how you think it should be done. He is the expert. He is the one you have trusted your body and health to. Let him do his work. And PS - have you ever had a dr let alone a surgeon give you his cell number and tell you to text him with any questions at all? And he means it! AND he even texted me the following day to check on me and then remember again today at my post-op to check on the situation I was worried about. See, I just cannot say enough good about this man....

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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