That's Going To Leave A Mark
Iíve gone back and forth about whether or not to share this here, or how much to say. Not sure if anyone would be interested and Iím generally pretty private. On the other hand Iíve noticed a few other people here have either lost a lot of weight, or are working on it, so it might be interesting or helpful to some.
It would be great if you could just ask your fairy godmother to wave a wand and make it like you were never obese. But I was, and for a really long time and no fairy godmother in sight.
Iíve had surgeons tell me that, even though Iím at a normal weight now I have a greater risk of pulmonary embolism. Poked around on Google to try and verify this, but found nothing really.
My massage therapist has commented that ďyour sacrum is ridiculousĒ, as in really thick and sturdy I guess. She knew I had been heavy, but actually asked how heavy and for how long.
And then there is the skin. Unlike pants, you canít just go buy a smaller size.
Goal pants from about 110 pounds ago. As in it is my goal to never fit these again and if I do just shoot me.
So that was the reason for this long break - repairs - or maybe tailoring, aka excess skin removal.
The timing wasnít related to what has been happening on the scales. I planned to do it this winter, after Christmas and as early as possible to be healed up by summer.
After an in-person evaluation my surgeon said that I didnít have anything to lipo in the areas he was working on; basically neck to hip. He had suggested lipo from photos I had sent, but hands on felt there wasnít anything thick enough to stick a cannula into; mostly just loose skin.
Thatís the short-ish version. If you are curious about this process read on.
For anyone who thinks that something like this (plastic surgery) may be in their future, major reconstruction in the US seems to run about $30K. That is surgery only, not travel or other expenses. There are a few surgeons that do an all in one surgery if you are healthy enough for it; could be 10 hours or more. There are a few more that will do the work in stages. From pictures of the results I have seen quality varies quite a bit, and generally US surgeons seem to produce more of a straight/square figure.
View from my recovery house.
I ended up going with a surgeon in the Dominican Republic. There are plenty of surgery nightmare stories about the DR, and they arenít fake.
One issue is a fungus (IIRC) in the local water supply that can cause major complications if it gets into wounds. So no showering after surgery in the DR...it was sponge baths, wet wipes, and getting my hair washed in a sink.
The second issue is that there are some aggressive and some plain dangerous surgeons there. The lady I stayed with post surgery named three that she particularly will not take patients from.
I chose someone with good patient reviews, good qualifications, a reputation for being conservative, and good after pictures. He is also a member of the International Society of Aesthetic Plastic Surgery (ISAPS) and speaks perfect English. I chose a recovery house generally (and deservedly) regarded as excellent. Both the surgeon and recovery house are more expensive than many, if not most, in the DR.
My cost for airfare, surgery (extended fleur de lis tummy tuck and arm lift), one night in the surgical center, post surgical massage, medications, surgical recovery garment, and 15 nights at the recovery house which includes meals and transportation came to a bit under $9,000. I think Iím about half way through; thighs and backside still need work, maybe boobs.
My chosen doctor requires that patients be in the DR for 24 hours prior to surgery so I had to fly in 2 days before. On my travel day one of the ladies from the recovery house picked me up from the airport. The next morning I went to the clinic where I had blood drawn and visited with my surgeon. After the surgical consult you go to another site to have a chest x-ray.
I had messaged the doctor previously that 2 other plastic surgeons suggested a 360 belt lipectomy for me and I was concerned that he wouldnít be doing that. He felt that an extended tummy tuck was a better choice, that I was not a candidate for liposuction, and, after sleeping on it, we both agreed on doing the fleur de lis (vertical incision).
He explained that he doesnít like the 360 tummy tuck because it completely interrupts the lymphatic system. If you arenít familiar the 360 is the surgery where they cut completely around your midsection. He said that after some time the scar pulls in and there is an indentation around the body. Iíve seen pictures like that. So the plan is to do the backside later. Doesnít make me any happier about being half done though.
Next was the wait for my blood test results.
If my hemoglobin came back under 13 he would only do one procedure.
The last 3 weeks before my surgery date I was seriously stressing out about flying (yeah, I know it isnít logical that flying scares me more than surgery) and getting my hemoglobin up with supplements, meat and veggies. Iím usually anemic, so this was a big worry.
My results came back 13.8. Big sigh of relief.
Surgery day went smoothly overall. The only real hiccup was that I kept getting dizzy/faint during the markup. Maybe nerves, or maybe not eating...the doctor said it was fairly common. It was eventually done. I took the blue pill and donít remember anything past the double doors leading back to surgery.
This seems like as good a place as any to mention that this was a taxing process. The planning, research, anxiety, time, money, pain, and just generally traveling way outside my personal comfort zone has been hard.
During the markup I was standing nearly naked in a room with 4 people who were basically strangers to me. I usually donít publically exhibit anything much north of my knees or elbows.
Most of the staff speaks just Spanish, which I only speak very little and very poorly. I did this on my own and I was really touched when the other two ladies from the recovery house came to visit me the night after my surgery even though I had only met them less than 48 hours before.
Post surgery my doctor came by and showed me a picture that he had taken of me on the table when surgery was completed. Didnít look like me. He said my surgery was five and half hours and his hands got tired from sewing. Told me that I was in the top 5 for most skin he has removed from a patient. As a resident he worked with a surgeon that had many massive weight loss patients so not exactly exciting to hear.
I did ask him later the weight of what was removed because other people had asked me. He said that he doesnít weigh, but does take pictures which he started to describe. He puts his foot in the pictures for scale.
Yeah, I didnít want to see that.
I had a prescription for pain medication (an NSAID w/codeine), antibiotics, and a blood thinner shot for 7 days. The pain was a little tough to manage the first 3 days (pain started before the next dose was due), but when I was done with them at day 7 I was okay and didnít take anything more. I had drains under my arms and in my groin. The one for my arms was out after just one day and the groin drain was removed day 5. I didnít have lipo so I didnít drain as much or for as long.
At the start I was in pain and just very tired, I ate, visited the clinic, and took a lot of naps. And walked - doctorís orders - several times a day with a walker for the first week or so. Yep, shuffling around in a granny dress pushing a walker while wearing basically a full body girdle and sporting crazy witch hair from humidity - the glamourous life.
The giant girdle (aka faja) was no fun. Lucky me, no lipo meant I was only supposed to wear it around the clock for 2 months instead of 3 months. When the lipo foam pads were stuffed in there I felt like a walking sofa. I didnít make it 2 months.
The full kit...faja, lipo foam, compression stockings, arm compression, and a drain.
Around day 8 or 9 I started feeling well enough to be homesick. I was very ready to be in my own familiar space. The recovery house was great though. The owner goes above and beyond to take care of her patients. I would say it was like staying with your mom if your mom were a trained nurse that doesnít nag about your personal life and employed a cook to make you healthy meals (meat, cooked veggies, salad, avocados, rice & beans, fresh pineapple juice).
A quick aside: I had known that tipping is very common and expected in Latin America more so than in the US. I actually saw the owner of my recovery house slipping cash to one of my nurses the morning after my surgery, presumably for extra care and attention. So I made sure to give the cook I nice tip before I left.
My last day I had my final appointment with my doctor who removed most of my non-dissolving sutures. He is a good communicator and would answer questions before I even asked them. Probably means they are common questions; still nice.
He explained that the sutures look raised now and that it is normal and intentional as they will flatten out. If he didnít sew them so that they are raised now then they would be sunken later. This way they should be flat, and in my case (if the trend holds), thin and pale enough to be barely remarkable.
Also pointed out that my belly button may seem a little small, but that it will stretch. He used to make them normal sized for all patients, but he noticed that in his caucasian patients they would stretch out and end up a little too large so that he needed to revise them. He is kind of a perfectionist - excellent in a surgeon.
I mentioned that I had been having trouble with being dizzy/lightheaded.
In reply he told me that was to be expected and he was surprised that I hadnít fainted in the first days after surgery because of the large amount of tissue that he had removed. Iím not sure why he didnít tell me that directly after surgery.
Maybe he thought that suggesting it would make me more likely to faint?
If he had though I expect that the recovery house owner would have put me in a downstairs room. I went slowly and held the bannister, but that wouldnít matter much if I actually blacked out.
The trip home was long and not fun.
I became even more swollen which I wouldnít have thought possible. I did receive another blood thinner shot prior to flying and was advised to get up and move around during the flight.
My ankles in the Miami airport. Where the compression sleeves end the swelling expands.
If you ever have to fly post surgically (particularly an international flight) do get a letter from your surgeon for wheelchair service at the airport and use it. Yes, I was terribly self conscious and Iím sure there were people wondering what was wrong with me since Iím not that old and didnít have anything obviously wrong with me. But travel now involves a lot of waiting in lines besides the walking and I was told not to lift more than 5 pounds.
In Santo Domingo there was a wait at check in, then security, immigration, and boarding. In Miami there was customs re-entry, a required baggage claim, a baggage re-check, security again, then travel to the gate (a long way) and finally boarding. For perspective in Miami I had a two hour layover. I arrived at my departure gate about 20 minutes prior to boarding even with all the assistance and cutting some lines due to the wheelchair. I meant to tip the people that helped me and was annoyed that I didnít get two of the Miami assistants because I hadnít been expecting to be handed off.
I thought going into this that I had a good idea of what to expect about recovery. Iíve had surgery before, so the incision related pain I was expecting. The dip in mood - aka ďwhat the hell was I thinking?Ē - I expected. And I knew I would be swollen and it would take awhile to go away. At 3 weeks post op I was still fluctuating around 152 and measuring 2-3 inches larger than before surgery in my hip, waist, and bust.
What I didnít expect was that the swelling would be so widespread...head to toe. And I didnít expect the swelling to hurt.
At the peak my hands looked like latex gloves filled with water and my feet and ankles looked like when I was about 8 months pregnant. When I was pregnant though it was a gradual process and I donít recall any pain from it.
My forearms hurt me the most. I discovered my feet were painful too when I tried to nudge an empty cardboard box with the side of my foot and it felt like pushing against a deep bruise. But my feet were mostly propped up when I wasnít walking. It is a lot tougher to not use your arms. I had a painful tight pulling sensation every time I fully extended my arm - reaching for a glass, putting an arm in a sleeve, closing a car door.
So, fine, Iím not supposed to lift more than 5 pounds.Thatís really annoying, but whatever. Being hurt by piddly everyday stuff like opening the drapes, turning on a lamp, and pulling on blankets in bed was really frustrating.
21 days post op I had an appointment with at my local doctorís office to remove the remaining sutures. My surgeon had left a couple in each arm and several in the belly button because they werenít ready to come out before I left Santo Domingo.
23 days post op there was a little complication.
Around mid-day my right arm started to hurt just above the elbow. It felt tight and sore; a nagging kind of pain. Then it got worse. Felt like someone had punched me hard - a swollen throbbing muscle deep bruise. Actually took some ibuprofen.
Red, swollen, painful, the diagnosis: cellulitis.
Prescribed 10 days of bactrim at a weekend clinic and was told to follow up with my primary care physician. Just when I finally seemed to be getting my gut straightened out from the prior round of antibiotics.
Yeah, thatís not pretty. Cellulitis in my right arm.
Oddly I also started to feel much better around the same time. My surgeon had advised me that one of the drugs used in anesthesia would cause a low mood, but that it would pass. So that took about 26 days, or maybe it was just a little relief from swelling. My waist was down an inch that same day. Dizziness let up too.
Rocking over 100 inches of incisions here (yeah, measured out of curiosity) and at this point I was feeling good about the fact that none had opened up. From my research it seemed like most openings happened week 3, so I tried to be on good behavior and not over do it.
27 days post op and... pop, pop, pop...felt a line of sutures pull out.
What kind of stupidity was I up to?
Getting out of bed to go pee at 4 am. Sigh...
At first it was more shocking and annoying than painful; opened up 3-4 inches on my left hip that bled quite a bit.
My husband wasnít on board with surgery at all, was more bothered by the fact that I went out of the country, and was already stressing over the arm infection.
Wake him up? Nope.
Cleaned up, back to bed, and contacted my surgeon in the morning. He said he had never had a patient open up like that; so long after surgery and such a big opening.
Incision that opened on my left hip.
Went to my primary care clinic after the family was off to work and school. Had a follow up on the infection a few days later and they referred me to their plastics group for follow up.
34 days post op had an appointment for wound care. The nurse practitioner was very nice. Having the wound cleaned and samples taken for culture was very unpleasant even with the lidocaine. Recommend giving that a pass if you can.
She said it bled very easily (all the bleeding had been stressing me out) and that meant there was good blood supply. Asked her how long for it to be closed up and she said since my health is good (non-smoker, not diabetic) it would be about 3 weeks. AarghÖ
Got another 10 days of bactrim too because the infection hadnít completely resolved.
I was released to do some cardio after 4 weeks, but wasnít supposed to lift more than 5 pounds for 10 weeks. I made it six.
Started back doing a little resistance work...not very heavy or a lot of sets/reps. 6 weeks off was enough to lose what seemed like a lot of strength and stamina to me. Even doing just a little would make me sore for a couple of days. Bummer since previously I was almost never sore at all.
48 days (7 weeks) post op and I was back at the wound care clinic. I thought the part that had opened up was looking good; finally closed up with no seeping or bleeding. The hard lumpy bit where the infection had been was nearly all gone. Looked good to the nurse practitioner too. She congratulated me on healing up so quickly and warned against overly stretching the new skin because it is only a few cells thick. Said give it another week to 10 days.
Good to know because my squat depth seemed lame and I was thinking about stretching to help that. Decided it would just have to suck for a while more.
As far as weight/body composition it was hard to tell what the heck was going on for awhile. Dieting was right out and I couldnít move around much. The swelling seemed to be mostly gone at this point, but the weight and inches hadnít changed much. My waist went back to where it was before surgery, but my hip and bust were both still up 3 inches and that 152 wasnít going anywhere.
I went into this hoping that I would just have a smaller waist since that is where the most skin was coming from. Seems like whatever mass I lost in the way of skin I put right back as body fat. Probably not getting under a 29 inch waist unless I get very lean, and even then organs, so who knows...short waisted and I guess they have to go somewhere.
Checked in again at 8 weeks post op because the majority of swelling was supposed to be gone then. Scales were only down 1 pound, but the hip and bust were both down an inch each. Still had a raised area along the vertical incision that is supposed to resolve over time.
I survived round one. Still have some occasional tightness/pain around my incisions. In some ways it seems to have increased, maybe because of nerves healing since skin sensation is more normal too.
You have to remind yourself that every day will be a little better. Quitting the girdle was a happy day. Being able to shower normally and not deal with any bandages/tape/dressing got a little happy dance too. First spin class after 2 months off? Awesome. I sucked (needed more recovery), still felt great.
Got some racing stripes and a little road rash.
Fleur de lis tummy tuck.
Arm lift scar.
Hip incision that had opened.
I have been having fun shopping for sleeveless clothes. The scars are visible, but just donít bother me as much.
On the fence about this one.
Time to get back to normal and plan round two. Worried that I might need three, but I really hope not.
Wow, Holly...just wow! I don't know if I'd be brave enough to have undergone everything you did. You look great and I completely appreciate your sharing this so thoroughly.
Thanks a lot for sharing!
That must have been so hard to do, I can only imagine how proud you must feel to have accomplished this!
Congratulations, may you be well!
Current cut: 80kg to 75kg
90kg to 80kg
Road from 100 kg to 72 kg:
First Round RFL
Second Round RFL
Congratulation on your looking good, get healthy journey.
Thank you much for sharing your story. I usually read others logs to get motivation, try to find answers. Your log would helps others include myself. Thank you much for sharing your story.
Start 189 lb