Life After Significant Weight Loss: Reconstructive Surgery and Healing with Dr. Frank Lalezar

In this episode of Beyond My Diagnosis, I sit down with Dr. Frank Lalezar, a board-certified plastic surgeon who specializes in post-bariatric reconstructive surgery for people who have lost a significant amount of weight.

We talk openly about what happens after the scale stops moving, when excess skin, discomfort, rashes, and mobility issues remain despite incredible health improvements. Dr. Lalezar explains why reconstructive surgery is not about vanity, but about quality of life, function, confidence, and completing the journey people begin when they commit to bariatric surgery.

Drawing from my own experience losing 140 pounds, we discuss the emotional side of letting go of the body you once had, the importance of trust between patient and surgeon, and why this phase of care deserves just as much thought and intention as weight loss itself.

In this episode, you will learn:
• Why post-bariatric reconstruction is considered reconstructive, not cosmetic
• What a panniculectomy is and why it is often the first procedure patients choose
• How excess skin contributes to pain, rashes, infections, and mobility issues
• Why proportion and balance matter more than size
• The difference between lifts, reductions, and body contouring procedures
• How muscle repair and core strengthening factor into surgical outcomes
• Why compression garments are essential for healing and pain reduction
• How lifestyle habits affect long-term surgical results
• Why insurance may cover post-bariatric reconstructive surgery
• How to choose a surgeon you trust for such an intimate process

About Dr. Lalezar:
Dr. Frank Lalezar is a board-certified plastic surgeon in New York City who focuses on post-bariatric body contouring and breast reduction surgery, including procedures performed through insurance. His work helps patients complete their transformation after massive weight loss by restoring comfort, function, and confidence.

Learn more about Dr. Lalezar:
http://www.drlalezar.com
https://www.nybreastreduction.com
Instagram: @drfranklalezar
Instagram: @NYBreastReduction

Transcript

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Hello, this is Michelle Weston with Beyond My Diagnosis, a podcast about living with a chronic condition, but choosing to make choices that are for lifestyle changes and behavior changes to improve your quality of life. Today, I have a very, very special guest. Now, those of you who've gone through bariatric surgery, one of the downsides, and there's mostly upsides of losing a lot of weight and improving your health, is that you get to here that you can have plastic reconstructive surgery, which will remove all of that, well, as much as we can of the extra skin from losing 100 pounds, 130 pounds, 150 pounds. And that's a lot of skin. For me, I had a peniculectomy 100 pounds down, and I just stopped there, but that was my choice. Most of my friends have gone on to do their, under their arms and inner thighs and sometimes a breast lift, sometimes a butt lift. Whatever you need to make you feel wonderful and great about your body, with that kind of time that you spent and the care that you spent to lose the weight, it's important to do this. So today, I have Dr. Fran Lalaizar here in New York City, and he's going to talk to us about why he really likes to work with patients who are having reconstructive plastic surgery. And I use the word reconstructive first because it is more than most plastic surgeons do. It is not for everyone. So why I'm saying that is you're going to look for someone who is a good match for you, who understands this extra skin, this change of body, this new person. It's not just a facelift. It's not just a breast lift or a breast reduction. This is your whole body. This is a big deal. So Dr. Fran Lalaizar, welcome. Thank you so much. Thank you so much for having me, Michelle. I appreciate it. What a pleasure, really. So you know, this is a big deal. And people who have lost over 100 pounds and start this journey, it is so fascinating to see them go through this because I'm sure you agree. You have to find a doctor who you feel is a good match for you and you feel comfortable with and you say, you know what, I love the way that I've seen the pictures of people that you've helped and I'm going to entrust you with this extra person that we want to get rid of because I've lost all this weight and take me down to who I am now. So talk to me about why you started to do more reconstructive surgery. Of course, you have your practice of breast reductions and facelifts and so forth, but why this interested you and why I decided it would be great to have you on the show. Absolutely. Well, thank you again for having me. And it really is a special topic. Patients who've undergone bariatric surgery have gone through a significant change in their lives. And when they walk into my office, they're halfway through their journey. They've lost the weight. They're healthier. They feel better. But there's still things that are bothering them. There's a lot of excess skin and that can lead to a lot of symptoms, whether it's around their abdomen, their breasts, their legs, their arms. And so we want to take them to the finish line. We want to help them get there to really the last point of their journey so they can really feel as comfortable as they can. How I got into this, I did my board certified plastic surgeon and I did my training at Montefiore in the Bronx. And we had a very, very large bariatric program there. And this is when we were bariatric surgery. We were really starting to see the advances over the past 10 to 15 years. And so as we saw more and more patients taking advantage of this opportunity, more and more insurance is being able to cover this. I got more and more training with patients. And so as I saw the change and the impact that we're having on people's lives, it really inspired me. And unfortunately, in the big cities, you don't see a lot of doctors who are taking the opportunity to help these patients. And I know what a struggle it can be for patients. I see it every day. I see patients who have been going around to different doctors trying to get an answer, trying to find some help, and they've been unable to find it. And it's an honor for me to be able to help these patients because I see how grateful they are and what an impact it has on their lives, both in the quality of their lives, their mentality, how they feel about themselves, their confidence. It's just an amazing change to see for them. And I love hearing about people's journey and really being able to see where we can take them. So, you know, I love that he is enjoying this. Matéfior is in the Bronx. It is a huge, incredible hospital. And to be trained there is great because you get such a mix of personalities, you know, different lifestyles, different levels of, "Am I super ultra rich? Am I not ultra rich?" And so it's important to understand everybody wants to have the body return as close as we can after losing over 100 pounds and so to a place where we're comfortable. And when he says, "What happens underneath breasts or underneath arms or underneath a fold of extra flesh on your stomach?" Because a lot of times we get rubbing, we get rashes. And so people are breaking out in dermatological problems because what you want, rashes all the time on your arms every time it rubs. And those of you who know, you know, women, especially our legs rub together. So imagine that 24-7, 365 all the time and causing such redness that it's painful. So that's where we get, guys, when we've lost all this weight and we want to let go of that person we've lost. And that's how I look at it. I lost 140 pounds. So there's an entire person that is off of me. And that's a big deal. And that was 16 years ago. And it's important that everybody be able to get access to what they want to change. What do you see the most of, I'm curious, that people come in if they can choose one part to take care of first? Sure. It's typically the abdomen. So patients have lost a significant amount of weight. And they'll have a lot of excess skin along their abdomen. We call it the panis. So there'll be a lot of wounds, rashes, sores underneath the excess abdominal skin that can be really uncomfortable. It's hard to walk around. It's hard to find clothes that fit properly. And people are not comfortable wearing the clothes that they want to wear. And it's hard because, you know, you feel like you've lost this weight. You should feel good. And then there's all this extra skin. And they're just not able to really reap the benefits of all the work that they put in after the surgery. And so that's the most common... The first step for most. It's the first step. And we call the procedure that they undergo is called a panichaelectomy, where we're removing that extra skin. That panis. That panis, exactly. And I always tell patients, we're trading scars for shape. So they'll have a... Oh, I like that. Yeah. So they'll have a incision that runs a low lying incision that runs along the lower aspect of their belly, just like a tummy tuck. But it's well hidden and it gets rid of that extra skin and it really accomplishes their goals. And it's a quality of life issue as well. Yeah. I'll tell you, I had it 15 years ago. It is such a little line and there's so many incredible scar healing lotions, patches, things that help us create just as thin a line as we can get with that. It's even those of you who want to wear a bikini, you can still wear that bikini when you're setting up marking people. You really look and say,"Where do you want to be? What are we looking at?" Now, always let the doctor give you an idea. Don't go, "No, I wanted this low." No, don't be unrealistic. Be realistic. So after that, do you think that if somebody had to choose something and I'm being specific now, do they go to a breast reduction or a breast enhancement? Because some of us lose so much, we don't have much left or vice versa. Yeah. So typically, first, they'll get there. I'll see a lot of people asking for their abdomen done and then they'll move up to the breast. So there, we're either doing, if they've lost a significant amount of weight, we'll be doing a breast lift. And that way, we're removing extra skin and we're able to use whatever volume they have in order to help create fullness to the breast. A lot of patients may still have a lot of breast tissue left even after they've lost weight. So that's a breast reduction and a breast lift at the same time to reduce the breasts, lift them up and really help. Put them back where they were. Absolutely. I make their bodies proportional, right? You want to make everything fit properly. And explain that because I don't think... When plastic surgeons are looking at things, they're looking for proportion, they're looking for balance, correct? Absolutely. Absolutely. And we're looking at the body as a whole. You want to make sure that whatever we are doing, it's something that you're comfortable with as a patient and something that fits the rest of your body. And it goes back to what you started this conversation with is trust. And being able to... Plastic surgery is an intimate field. That consultation, as a patient, you're letting it all out there. The doctor is seeing the most vulnerable aspects of you. Absolutely. Everything, guys. That's why you have to find a good match. I had a man do mine. Some women would say, "Oh no, I want a woman to do that." Everybody is different. That's why I'm saying that. That's why I invite different people who I feel are great at what they do and I want you to know that they are around. So Dr. Lizzard is here on Madison Avenue here in New York. So that's why he's actually, in the two and a half years I've been doing the podcast, the first plastic surgeon I've had. So I am thrilled to have you here, honestly. Excellent. Thank you. And I appreciate that. And it's always... It's really... Oh, I love speaking about this. This is a passion of mine. And it's great to be able to allow people...to inform people about the opportunities that they have available. And harping back on the relationship between the doctor and the patient, and when you asked about you want to see where that incision lies, that speaks about the discussion that every patient should feel comfortable having with the doctor. The patient should be able to express what they're looking for and the doctor can express what they can do. And it's a... I don't want to say compromise, but we're really working together to find the ideal balance. For something that works well, for what the patient wants, while also being safe and medically possible. Yes. So when you and I talked, I had mine over 10 years, and you said to me, "Oh, with a paniculectomy, if I can, I actually do a little bit more." And I found that interesting because what you were expressing was that today there's a better way to do a lift of that midsection. So talk a little bit about that, that it's not just you try and do a little bit more, it's not just a paniculectomy, you try and do a...is a body lift? So there are a few different components of what we're doing. So after you've lost a significant amount of weight, things that we notice are there is extra skin, but there's also laxity in the muscles, abdominal muscles themselves. And so we want to work to repair all components of your abdomen and torso to really give that elegant look. And so what we're doing is, one, removing that extra skin, like we mentioned with the panis. Number two, as the abdomen distends and then goes back in, those muscles stretch and they don't go back to where they started from. There's a lot of laxity in that muscle. And in order to really create the shape we're looking for, I'll often do what's called a muscle plication. So we're taking the muscles, we're repairing them, tightening them up, bringing the ab muscles closer together so that one, where it acts like a corset to thin out the waist, but two, we're actually making the core stronger. So a lot of patients who come in for these consultations, they complain about a lot of back pain. They feel they can't do a sit up. They can't engage their core the way they'd like. And so with that muscle repair, muscle plication, we're able to tighten up the muscles, strengthen the core and really rejuvenate the entire abdomen from inside out. That's amazing. It really is. You know, we didn't even talk about that 15 years ago when I had mine to do a plication because I think that we were just getting, I'm all in the middle. So of course what I wanted off first was that panace. I just, you know, to move around that had to come off immediately. So and it's an easier one. Just doing the panace itself is an easier one to heal from. It's not as long. Let's talk about when, after you've done that, what the steps are. I know that I've seen my friends, my best friend had a body lift and thigh and underarm. She had a breast lift she had. And some of it was done a number of pieces together. And I know that the one thing that had to happen was you have to keep wearing that corset. It's pretty much all the time for six, eight, how many, how many weeks do people have to wear that corset? Because it's keeping everything the doctor has done in place. So you're taking it and it's just think of stitches. It's all stitched together and you're keeping those stitches as close as you can together guys. And that's really important for it to heal the best, tightest, smoothest, most beautiful way that a plastic surgeon is envisioning. Because he is envisioning. He's envisioning you as Dr. Lelozar said, a whole person, 365. He wants to make sure that when you're moving, you're feeling like, oh my God, this is my body. And that's an art. It really is an art. This is not, you know, this is not just removing your gallbladder. It's a little different. Yeah. But you, seriously. It's definitely a combination. It's a combination of art and science. Right. It really is. It's using scientific principles and combining it with the artistic experience to be able to give you that look. And you mentioned the corset or what some people may have heard on Instagram or on some of the social media sites now. It's a faha, which is the compression garment. It's a compression garment that we're wearing. We have patients wear that. I, in my practice, I have them wear that for eight weeks, 24 seven. And then for an additional four weeks, four to six weeks, 12 hours a day. And just like you mentioned, it's helping to keep everything in place, help keep things tight and helping to reduce your swelling as well so that things do really soften up and even out. And I've seen it in patients who refuse to listen to instructions. They won't wear the garment and they really stiffen up. They don't feel good. Explain stiffen up. I really would love you to explain that to stiffen it. They stiffen up. Explain what that means because one of the hardest things me as a health and wellness coach and me as a patient advocate is getting patients to understand we're asking you to do certain things in order for you to have the best result. We're not just like saying, Oh, we need you to wear this corset. Well, I don't feel like wearing the corset for today. It's like, no, there is a reason why you're being asked to do something. And in the end, you will be happier if you understand. So you just said things start to tighten up. What is that? What does that mean? What does it feel like for a patient? Sure. I like to, I like to, I like to scare people a little bit because I want them to understand this is a big deal. It's a big deal. You thought losing 100, 150 pounds was a big deal. You're doing this. This is your next big deal. And you have to take this as seriously as you did when you were losing the weight. Absolutely. And, you know, no one wants to be told what to do without an explanation, right? So that's great that we're discussing so that you keep so that everyone understands why there is a little bit of a reason method behind the madness, as we say. So basically what's going on is your body after surgery, your body goes into an inflammatory stage and the body, especially the areas where we've operated on, there's a lot of inflammation, there's a lot of swelling. The body is pushing a lot of blood there because it's sensed that something's going on and it needs to repair, which is a great response for the body to have. What without, unfortunately, if we don't wear our compression garments to help reduce some of that swelling, what can happen is that fluid all stays there and the body starts to really get, the skin starts to get really hard. It really feels like almost like a rock, right? Because it's so tight and swollen. And without wearing these compression garments, the body stays like that. It can be really uncomfortable for patients. And that's when they really start to have the most pain. So these two of them. And what becomes painful? So you're saying that there's more pain when you're not wearing the compression garment and you're not letting it heal correctly. What is the pain? Is it just because of the restriction of the tightness of the skin and the muscle? Fluid accumulating in that area. That swelling just accumulating in that area and not being able to, the compression garments really help to prevent as much fluid from accumulating. And it helps to allow that fluid to be reabsorbed by the body. If we don't have those mechanisms there, the fluid builds up and stays there. And that's what creates a lot of the discomfort. Okay. Okay. Now I'm going to ask you a question. I'm sure you see men and women. What is more done, let's say for men in regards to women, breast enhancement, of course, is important would be the next thing. Pinicullectomy, I think it's across the board, men and women. Yes. Not bad. So when it comes to men, as you mentioned, Pinicullectomy is typical. And men will go on to another area that really bothers them is their chest. Oh, okay. They'll have a lot of excess skin there as well because fat did accumulate in that area too. And so oftentimes we'll be doing similar to, we'll be doing like a gynecomastia procedure where we can remove any excess breast tissue along with extra skin that's there in order to help give better shape to the chest of the male chest as well. Yeah. So you don't have this drop down pointy. You're lifting up and understand both men and women, we have muscle that is above the breast that you can pull up and you can give more, there's a ton of muscles. I shouldn't just say one muscle, but there's many muscles. So for guys, you can lift that up and we're putting it back in place. And everybody's different. Some people want to, for women, they want to be more enhanced. I didn't. I kind of liked having a smaller chest, but just my boob is back where they should be as opposed to lower where they shouldn't be. So, right. So it was, you know, we had a whole thing. He's like, but you need to be a C. And I was just like, I don't need to be a full C. He's like, but look, if you put this in, look at how fabulous those look. I said, you know what? I come from fashion houses and magazine publishing. If I get a really good bra, I can look like that in my clothes. That's me. I'm a misnomer. I am not. I am definitely a misnomer. I am the outlier. Honestly, I am right. I am not, you know, and so wanting to have just, just have my smaller breasts put back was my request. You know, my husband has ever, has never complained. So obviously it's fine. And you know, and everybody has their thing. So realize that you can adjust to you on what you want to be, you know, and what, what you want to look like, you know? And so it's a great important part of having bariatric surgery is finding that plastic surgeon, of course, board registered surgeon. Absolutely. You need to meet with them. It's not something you just do on phone. It's not something you just scheduled to do something. Oh, my friend had it. I'm just going to schedule. No, you're not. I want you. Here's the patient advocate talking. I'm putting my patient advocacy hat to see at least two plastic surgeons because you want different differentiating opinions and how they work. And one, it's just like cookies. Do you like chocolate cookies or do you like shortbread cookies? Get make sure that that person is what you are looking for, is what you are comfortable with. And no, don't use cookies as you know, but that was the quickest thing. That was the quickest thing that came to my mind. Not that I'm even a sweet eater, but that has nothing to do with it. But understand that you have choices and I want you to be in control of choices. I think that plastic surgery and why I had Dr. Lillazar on is so important because it makes all that work become more real and more permanent. Realize, and Dr. Lillazar, I love your opinion on this. This is just like losing the weight and you learn maintenance. It's the same for maintenance with plastic surgery. Gaining weight after you've had plastic surgery. Dr. Lillazar, is that a great idea? More than like 20, 30 pounds. What happens? Well, that's this is a great point you brought up is because a surgeon, a lot of people think they come to a plastic surgeon, they get a quick fix and they don't have to. And that's it. And that's the result forever. And it's definitely not. That's one part of things that you need to change. Lifestyle habits are super important after surgery. If you want to maintain those results, if you really want to be able to keep up with all the work that's been done, maintenance is very important. And that means life dietary habits need to be maintained or improved. Exercise habits need to be maintained or improved. And muscles return, right? Muscles return. So we put these muscles in a position and they return when you do your work. I do Pilates. My core strength is good because I'm constantly checking in on that. When I go to my exercise class, I am pushing against that, which is important to me. That was what I wanted to do. But the other thing is talk a little bit about the zipper for arms and that and also a little bit because I think the relative in the same line when you have your thighs, inner thigh is taken in and having excess skin removed there. What is that like? Absolutely. So the arms are another area, huge area that patients are upset about. They've lost the weight. Bat wings. We're talking about bat wings, guys. Bat wings. Absolutely. Absolutely. So there's a lot of excess skin. So they don't feel comfortable wearing a T-shirt. They can't wear that dress, the sleeveless dress that they want because there's so much extra skin there and they're very uncomfortable with that. And so, you know, we do an arm lift or a brachioplasty where we're able to remove all that extra skin from the elbow into the armpit and sometimes even along the chest as well. And we do that by making an incision that runs from the elbow into the armpit or axilla. And that's how we can really tighten things up and give better shape to the arm. And it's a well-hidden incision. If you're wearing a dress and your arms are to your side, nobody would be able to see that. Exactly. But arms don't just stay to our side. We don't like we're not like superglue and our arms just stay to our side. Sure. If we are lifting, you know, again, I spend a lot of time in marking and ensuring the placement of that incision so that it stays super low, it stays super thin and so that it's well hidden. So even if you are raising your arms or you feel comfortable and that incision should be well placed. So it's really not in sight and it stays super thin. Like it just helps because people always are curious what is happening with that. And how in today's light, how do you feel about the for a breast enhancement? The what do they call the the we have what do we have what the different kinds of. Implants. Yeah, thank you. Missed that word. Implants. Thank you. So when it comes to breast surgery, there's been a lot of change in standards. OK, we're seeing that patients are moving one. Patients are moving more towards a natural and more elegant and more subtle look. Whereas 10, 15 years ago, bigger, bigger is better was kind of the idea. Now people are going for a more subtle look. And a lot of patients are opting to not go ahead with the implants any longer because they feel comfortable with just having that nice shape. But the patients who do 99, 99 percent of my patients have silicone implants. There are other options. We have saline implants as well. And the difference there is just one is filled with silicone, one is filled with saline. Saline is water, guys. Yeah, it's just salt water. And I personally love working with the silicone implant. I think the shapes look better. It maintains itself better. Again, it's a patient choice. And the technology has improved significantly over the past number of years, where we're able to really give a great shape and it's long lasting and it looks natural and patients are super happy. And what about is there a time limit to do they have to be replaced? What happens with silicone or saline implants? Is there 20 years and then we have to look at replacing? I mean, you know, great question. Manufacturers typically recommend that those implants are changed every 10 years. But if I have a patient, they had implants placed 10, 15 years ago and they're doing fine. There's no issues. We'll continually monitor them, make sure everything looks good. But if they can keep them, then we'll keep them. I love it. And what's great about Dr. Glazar is his staff in the world of plastic surgery. They're normally not completely under insurance and the whole thing is not paid by insurance. But there are a number across the country who choose to have a staff that is very knowledgeable. And normally they have case managers or people who've worked with health insurance companies calling and seeing what can be paid for money put in from insurance in regards to having a panicalectomy, having plastic surgery for reconstruction after bariatric surgery. And what I also love was Dr. Glazar is working on that. So if you're someone who doesn't have a slew of cash and wants to do this, look for an office that is trying to see what can we get the insurance company to help put towards me feeling the best I can after this big accomplishment of losing all this weight. Right. Absolutely. Yes. So we specialize in doing post bariatric contouring through insurance. We have a staff that works on doing this all the time and we will advocate on your behalf to the insurance companies to work to get these procedures covered so you can take advantage of the benefits that you have with your insurance so you can get to where you want to go. Yeah. And this all this information, it's a lot, you guys. I know those of you who are listening, even if you're married to someone, you have a friend who's lost a lot of weight, consider sharing this information with people. Because one of the gifts of having a podcast and talking about chronic conditions is there are things that we do to improve chronic conditions that I want you guys to share. You know, a plastic surgeon is just as important for people who've lost all the weight as finding a great nutritionist to move forward with. Because we all have moments where we need some help, some new guidance on things. And I want all of you out there who are listening to really be the best of you that you can. And this was a very specific show. Because I have two chronic conditions, I wanted to share information with somebody I really feel comfortable with and trust and make sure that you know what's out there. On the podcast, Dr. Lala Lazar, can you say your website? It's www. Dr. Lala Lazar.com. Okay, so Lala Lazar is L-A-L-E-Z-A-R.com, guys. And on my substack, you'll also see Dr. Lala Lazar's website so that if you don't remember, go to substack and I will have a little thing in regards to the interview when the interview goes live. I loved talking to you today. Of course, we will see you again for some other things that come about. It's important for people to have someone that they can trust to share information and not be so rigid. But understand that somebody who's lost all this weight is looking to be the best they can. You know, we're not looking to be Barbie dolls, especially those of us who've lost all this weight. We're looking to be the best of ourselves. And I think that that's your mission, especially with people who've had bariatric surgery and now are reconstructing their lives, literally. Absolutely. Absolutely. Thank you so much. It's really been a pleasure. Thank you. Likewise, it was a pleasure. Thanks for tuning in to this episode of Beyond the Diagnosis. If something we talked about today resonated with you, if you're craving deeper understanding, better support, we just want to know you're not alone on this journey. Make sure to subscribe to my free substack at michelleweston.substack.com. That's where I share personal insights, expert takeaways, and extra resources to help you stay informed, empowered, and one step closer to the clarity you deserve. And if you found this episode helpful, leave a review or share it with someone who needs to hear it. Your voice helps this message go further. Until next time, keep asking questions, keep trusting yourself, and keep going beyond the diagnosis.