I put the question out to my Instagram asking what you wanted to read about when it came to plastic surgery and responses were wide. This post focuses on mindset, medical clearance, choosing a surgeon, consultations and costs, and places I used to research. In the next few posts, I'll dive into preparation/what I bought, recovery, including time off work, compression, and more.
Depending on the responses and questions that come up, I may go in-depth on sub-topics in solo posts in the future. I am NOT a medical professional and nothing written on my blog should ever be taken as medical advice. I am one story and experience. Finally, if you want to see photos, please see my Instagram feed, including multiple highlight reels (and don't forget to follow).
The Mindset
Please let go of feeling selfish for having plastic surgery and stop worrying about what other people think. There are so many real barriers to plastic surgery (e.g., time from work, money, access, good health, knowledge, etc.) that you should for damn sure get out of your own way. I will underscore this for the parents, but especially the mamas, out there. I see you. You love and appreciate your body, your love your kid(s), and they also kind of wrecked shit. Whether it was breastfeeding, carrying the miracle for nearly a year while it pulled your muscles apart, you now want to renew it. YES, YOU SHOULD!
Despite my decision to be an open book, it's actually no one's business. Your body is your home and you're the boss. You share how much or how little you feel like sharing. I don't care if you want perkier breasts or you're looking to reconstruct the entire body after massive weight loss (like me) - live your best life!
That said, I would always encourage anyone considering plastic surgery to talk with a mental health professional about feelings associated with their body. I see a therapist every other week and it has been incredibly helpful to process before, during, and after. Talking about it helps you get present with feelings, fears, false stories you're telling yourself, worries, and more. Once you do this, you can articulate your goals to your surgeon and understand if your expectations are reasonable. Don't expect changing the aesthetics to change your internal dialogue if you're someone who has lots of ANTS in their brain (automatic negative thoughts) or you're waiting to be happy until you have plastic surgery. For me, it has enhanced my happiness and confidence, but it was not dependent on it.
Plastic Surgery is Major Surgery
Be sure that your medical team will clear you for surgery. If you have any medical conditions you should be prepared to get medical clearance, but each surgery practice may ask for its own sets of tests, including routine bloodwork. If you see any specialists, such as cardiologists, rheumatologists, etc., be prepared to loop them into your plans even if you have a condition that is well-controlled. Don't get clearance too early because you likely need to be within about 30 days of surgery - your surgeon's team will give you guidance.
For both rounds of my surgery, I was under general anesthesia for six hours. That's a long time and your body needs to be able to withstand that and the healing you'll need to do afterward. I had routine bloodwork (especially looking at my iron levels, which ran the low-end of normal), my rheumatologist clearance since I'm on a low dose of prednisone and that can impact healing, and I had a physical and general cardiac clearance from my PCP. If you're a bariatric surgery patient who has had lowish-iron levels, potentially plan for more time between procedures if you're planning multiple. I gave myself 5 months and I'm glad that I did. I had iron infusions between since my iron dipped to the low range.
Finally, one of the biggest fears I read in online groups is that there is this overwhelming fear that something will happen to them on the operating table (mama guilt loves to surface here!). Here, I find data comforting. In one study in 2018, complication rates were less than 1% for outpatient procedures. There is nothing without risk, but know that if you are a healthy person, the chances of major complications are statistically low. The same is true for bariatric surgery, by the way. If you're an otherwise healthy person, the risk of dying on the table during a sleeve gastrectomy is about that of gallbladder removal -- nearly unheard of. Still, don't hide your medical history - it is for your safety.
Finding a Surgeon
Even if you're planning plastic surgery in a year or two, it's not too early to start doing your research. Many surgeons are booking more than six months out for a consultation and even farther out for surgery. You can use the American Society of Plastic Surgery connect to locate a board-certified plastic surgeon near you, but word-of-mouth, practice websites, Instagram, and other social media platforms are a great way to see real patients results from surgeons, especially if you're willing to travel.
I had two local consults in Memphis, one with a St. Louis surgeon, and the one in Peoria, IL. My personal criteria in a surgeon were:
board-certified
extensive experience with bodies following massive weight loss with lots of recent before and afters on their website or social media
good connection with the surgeon and rapport with their staff.
I wanted a surgeon who was super f***ing talented, smart, and kind. I see a lot of people who say 'kind' does not matter. It matters to me. It's a hard pass from me and you will never be on my medical team if you are an insufferable prick - regardless of how talented you might be.
I also have a high bar for responsiveness and access. It's not personal, but y'all run a business so get it together and call me back, read the email, and I want to know I can reach you if I feel like something is wrong. FWIW, I hold myself to those high standards too and consider myself highly compliant and diligent as a patient.
a 'yes!' to the question 'do I trust this person with my life?'
be local to Memphis (or within 50 miles) or near a good friend or family member, if possible. This was the only point I was flexible. Location was less important to me because I knew I'd probably have to travel and could afford to do so.
I follow a lot of individuals on social media who have had plastic surgery after massive weight loss and someone sent me the Instagram account of Dr. Babis Rammos. Imagine my surprise when I realized he was only 15 minutes from where I grew up and where all of my family lived! I knew if the consultation went well he'd be my guy. Staying with my mom was an amazing perk and I didn't have to rush recovery since I could work remotely too.
Consultations and Costs
Most consultations will cost you $100 or more. You're paying an expert for their time and demonstrating you're serious about getting something scheduled. Many, but not all, will apply that fee towards your surgery costs too. There will be three major components of cost: the surgeon's fees for the type of procedure, operating room cost, and anesthesia. These will vary based on the surgeon's rates and where you live. There's no magic number of consults you should get, but having a few is just good consumer behavior for the major investment and for your health.
I emailed Dr. Rammos' office on November 30, 2020, for a consult and heard back within a day. The first available was two months later in early February 2021. I went in person where I filled out detailed paperwork, spoke extensively with the nurse and office manager, and then explained in detail the areas that bothered me the most to Dr. Rammos. The bottom line was that we were all in agreement on the game plan when I left the consult except for breast size, which I decided later by sharing photos and bra size ideal. I booked the first available day that had a 6-hour stretch, which was June 30, 2021 (I parlayed the July 4th holiday in my time off). I scheduled the second round at the same time for the Tuesday before Thanksgiving (November 23) to also reduce the amount of sick time I needed to take too. To hold my dates, it was 10% of the surgery costs with full payment due within 30 days of each procedure.
Honestly, I spent 50 or more hours reading about procedures, experiences, and lurking in Facebook groups and on Instagram before I even booked a consult. For the most part, my consults recommended very similar procedures. For example, 4 of 4 surgeons told me an FDL tummy tuck would be necessary due to the amount of skin I had above my belly button. 4 of 4 said I needed a breast lift with my augmentation, etc. Everyone was impressed I had a healthy butt left after 200+ pounds of weight loss - haha!
Many patients figure out costs through word of mouth, Facebook groups, and looking at averages online, but the best way to know price is to get a consultation with the surgeons you are interested in performing the work. The problem with averages is that they are just that. You can use the American Society of Plastic Surgeons' website and click through procedures for the average surgeon fees. For example, the average breast augmentation surgeon’s fee in 2020 was $4,516. That does not include anesthesia or OR costs.
Finally, many of you have asked what I paid for my plastic surgery and how I paid for it. I was able to utilize insurance for medical necessity for my extended tummy tuck (FDL) and muscle repair due to excessive rashes, sores, and infections (which I had well documented from doctors). For my breast lift, augmentation (implants), lipo to the flanks, extended arm lift, and medial thigh lift I paid just over $33,000. It would have been over $40,000 without insurance. I had saved and made pre-surgery payments and was able to pay $20,000 cash directly to my surgeon's office. I financed at 0% using a Capital One Venture credit card (got the bonus of earning airline miles!) for the remaining $13,000. My surgeon's office had a partnership with a financing company that had various credit card options and personal loans. The better your credit, the better the rates and options. Definitely ask the office manager or surgery scheduler what financing options the office has, if any, if you expect you will need to borrow in part or whole for your surgery.
I do see a lot of people borrowing or cashing out a portion of their retirement accounts. I do not play with retirement and would personally never cash out. You should definitely talk to your financial planner before you do anything, but generally, 0% interest debt (assuming you can comfortably make the payments) is better than a loan against retirement because a loan from your retirement account will reduce the total sum on which you're capitalizing interest.
Payment hack: Open or use an existing credit card that earns airline miles with purchases. I did this for the $20,000 I paid directly to my surgeon's office (I just turned around and made payments from my checking account). I still have 30,000 Southwest points and I've booked 5 round-trip flights to Chicago using my points. If you're interested in the Southwest Airlines Chase Visa, use my referral link and you'll earn 40,000 bonus points after you spend $1,000 within 3 months of opening the account (have to apply by May 30, 2022). Full disclosure: I get 10,000 bonus points if you use my link, but no money or other compensation.
Places I lurked to Build Knowledge
Finally, if you're in the discovery and research phase because it's either too early or you're not sure you want or need plastic surgery - you might just want to see some examples and build some awareness. I think seeing real people who had work done, hearing their recovery, seeing the pace of it, and the emotional response is helpful. You'll, by default, start to read testimonials for doctors or procedures that you want to learn more about and ask about too. You will see the worst of the physical recovery is a sprint, but the emotional recovery is a marathon.
My caveat on lurking and research: please remember the internet is The Bad Place in many ways. It's not a representative sample of plastic surgery users in the same way that it is often not a good representation of patrons of restaurants or visitors at a beach resort. Because the people who take the time to talk about their experience are usually the ones who had a terrible (or mindblowing) experience. So please take the good and make mental notes if any of the bad stuff spurs questions. You will see people like me who will socialize post-surgery, but the majority of people go to social media forums after problems start or they feel uncertain and need reassurance, etc. Not a ton of people go and say "hey, my breasts turned out exactly how I wanted them to look." To be clear, I would never advise anyone making a decision on plastic surgery by observations alone. Talk to a professional.
Facebook Groups & Websites
I love information and seeing examples and stories associated with plastic surgery decisions. It helps calm me. Below are Facebook groups that I am part of and have learned a lot from over the last year or two. The groups are linked below and written exactly like they're spelled on Facebook. You'll have to request to join these and some will have screener questions so be sure you answer them or the admin will not add you, which is not always intuitive on the mobile app (check the full website version if you don’t get added within a day). I do not moderate or run any of these Facebook groups so join at your own risk.
Facebook Groups
Covers various procedures & all members have had massive weight loss or bariatric surgery.
Skin Removal After Weight Loss
Covers various procedures & all members have had massive weight loss or bariatric surgery. Less active than 'Plastics after WLS' in my experience.
FDL: Fleur-de-lis Skin Removal Surgery Community Support And Tips
Many people who have had massive weight loss need an abdominoplasty (tummy tuck) that has a vertical and horizontal incision. This is often determined by the amount of skin you have above your belly button. There are about 850 people in this group, but it's fairly active and I think it's helpful for FDL examples.
A breast lift and augmentation group is sponsored by a doctor's office, but they do not force their services or require you to be a patient to be part of their group. Nearly 30,000 people are in the group as of January 2022.
I have not had a facelift, injectables, or in any way altered my face, but I am interested in the neck lift in the future. I plan to let age do its thing awhile longer
Botox And Filler Support Group (for Ladies) Plus Plastics To Facial Area
Again, never had anything done with the face, but I've been a passive learner here too.
Websites
Gives real patient reviews of plastic surgeons too
Questions or Comments?
More to come in future posts! Leave a comment or send me an email at amberhuettgarcia@gmail.com or message (and follow) me on Instagram @obesitycareadvocate with any questions!