Can you avoid any of these problems before the weight loss you someone’s decided to come to you and you’re working with them right now so is there a way to at least ameliorate this a little bit to stop it from happening too badly I will tell you the only way is pretty much avoiding the excess weight gain that’s unfortunate one of the things so cyst issues are gonna be one of the things that I’ve noticed Edie is that what will happen is if patients work out or do some exercise sometimes some of this if they’re able to some of that volume that is lost with fast fat is replaced by increase in volume and muscles sometimes some of these discrepancies are less noticeable but it doesn’t mean it doesn’t happen it’s just a little bit in masqueraded by that volume being replaced by muscle instead of by just a skin what about and I just want to make sure because I know we’re going to talk about this what types of body contouring options are there for that sort of that sort of frame well once you’ve lost the weight you’re gonna have excess skin and I told you the most important thing is first talking with the patient and seeing what bothers them the most one of the most common things that will happen I think the biggest thing that bothers a patient because it affects their functional their function of starters as well as their lifestyle is the excess skin around the abdomen and this is an area that we would excise we will do almost what it’s a let’s call a penny colectomy when you excise the skin that that lands in front of the genitalia and parent and perineal area and sometimes we do this circumferentially sometimes we do a combination of an abdominoplasty which will go higher and then it can be 360 so the patient will have in this single surgery essentially you will excise all of the skin considering the skin in the back you will elevate some of the gluteus and you will excise the skin in this area you