Q: I have had frontal headaches for about 10 years. A low-dose Botox injection cut the pain of my headache from a nine to about a five for seven weeks. Then last week, I was back to a nine again. Is there a procedure for more permanent relief? If so, do you think insurance will cover it?
A: You might have had more significant migraine relief with a higher dose of Botox. Three months or so is a fairly standard period of time for the duration of Botox’s effects. If Botox is effective in the supraorbital area for migraine reduction, then surgical decompression of the supraorbital and supratrochlear nerves should provide similar (and hopefully greater) and more sustained relief than the injections. This is done through an endoscopic technique from small incisions in the scalp behind the hairline. Generally, 70 percent of patients will have a noticeable and sustained reduction in the frequency and severity of their headaches with surgical nerve decompression. The remaining 30 percent is a mixture between those who are “cured” and those who saw limited to no benefit. Insurance is very strict about not covering migraine decompression surgery. They have a hard-line stance that it is still “experimental.” There is a lot of published information from studies on the effectiveness of migraine surgery, but this has not swayed their stance.
Q: I have had three c-sections, bowel obstruction surgery, hernia surgery and a hysterectomy. I’m wondering if getting a tummy tuck would be possible for me. Also, would I be a viable candidate for the insurance to cover this procedure?
A: It would be impossible for me to say whether you are a good candidate for a tummy tuck based on your complex abdominal surgical history alone. However, I have seen many patients with similar histories, and they all were perfectly good candidates for tummy tuck surgery. So based on your information alone, I would assume that you would be a reasonable candidate. One of the very good benefits of a tummy tuck in patients with complex abdominal surgeries is that many of the abdominal scars as well as the loose skin and fat can be removed and traded for one single horizontal scar placed low on the abdomen. Often, one gets a simultaneous pubic lift as well. Insurance does not cover this, nor do we attempt to process it for elective cosmetic tummy tucks. While you have a complex abdominal history and likely numerous contour deformities from them, these are still cosmetic and not functional issues.