You name the diet and Sue Morello probably tried it, for she started one at least as often as every January from as long ago as sixth grade. But, sorely lacking in discipline, she failed at all of them and instead packed on more pounds. She peaked at 540.

"I'm 4 foot, 11³/₄ inches tall. I was as wide as I was tall," said Ms. Morello of Berkeley Hills in Ross, coordinator of surgical education at Allegheny General Hospital.

"I wore a size 64 dress. I couldn't find pantyhose. ... I wore muumuus, those big loose dresses they wear in Hawaii. I had to wear sandals."

She also had to buy two seats on airplanes and ask for armless chairs in restaurants. She couldn't fit close enough to the steering wheel to drive a car.

It continued like that "until one day, like an alcoholic, I decided I couldn't take it anymore and decided to do something about it."

The turning point -- and this is not intended as bathroom humor -- came when she got trapped for two hours in a public restroom at Station Square. There simply wasn't enough room in the stall for her to maneuver herself into position to get and use the Charmin, and she didn't know what to do.

"That was my low ... my turning point," Ms. Morello said. "That was on a Saturday. On Monday I looked into bariatric surgery."

At the time she was 40 and weighed 500 pounds. That was 10 years ago. Now she weighs about 153 to 155.

But bariatric surgery was not an immediate solution.

Her first procedure was a VBG, an abbreviation for vertical banded gastroplasty, an operation no longer performed, in which part of the stomach was stapled shut.

"It didn't work," Ms. Morello said. When she failed to lose weight, the surgeon, whom she declines to identify because he eventually went 0-for-2, went back in and discovered there were no staples in her stomach. The stapler had failed to release them.

While he was in there he went ahead and did a revised VBG. This one failed in a different way.

"Every time I ate I threw up," Ms. Morello said.

And, again, weight loss was minimal, so she continued her search for a surgical solution.

"The only reason I did it was because I wasn't losing weight," Ms. Morello said. "My motivation should have been my health."

She looked to Dr. Joseph Colella, director of and surgeon with Allegheny Bariatric Surgery at AGH, like West Penn, UPMC and Sewickley Valley hospitals a designated Center of Excellence.

Dr. Colella did what was called a conversion from the VBG to a Roux-en-Y gastric bypass. In that procedure, a new, small stomach is created and part of the old is taken out. A piece of the small intestine is connected to the new stomach, which processes food. What's left of the old stomach does all the other usual functions.

But some adjustments had to be made in the procedure on Ms. Morello: When Dr. Colella opened her up he discovered her stomach was "nothing but a shrunken fibrous scar." He took out all but a small piece, which he used to make the small stomach, also called a pouch.

"It was a very high-risk surgery," Dr. Colella said.

"I love that man. He saved my life," Ms. Morello said.

His surgery was a success. Ms. Morello not only recovered, she began to lose weight.

"I was probably 490 at the time of the second surgery. From the gastric bypass I fell to 240," she said.

But she still was a long way from her goal.

"My absolute goal weight was 175," she said. "I'm 4-11. I'm never going to look like Twiggy. You have to be realistic. ...

"If I got beneath that, more power to me."

The problem was that once she got to 240 pounds, she once again stopped losing weight. The reason: Though she was losing fat, the skin that once stretched over it had lost its elasticity and hung in folds over every part of her body from the shoulders down.

"It looked like elephant skin. Just layers and layers of skin," Ms. Morello said.

Seven or eight months after she realized what had interrupted her weight loss, she started thinking about having surgery to remove it. The procedure is called body contouring, or a body lift.

"Because I work in the medical field, I know people all over the nation," she said. "I could have gone anywhere. I did my research."

Her choice was Dr. J. Peter Rubin, head of the Life after Weight Loss Center at UPMC.

"He's the best at what he does, the very best," Ms. Morello said.

That was three years ago.

A person cannot just walk into Dr. Rubin's office and make a date for body contouring. First he or she has to meet a list of qualifications.

They include: timing, preferably at least 12 to 18 months past gastric bypass surgery; a BMI, or body mass index, as close to goal as possible but preferably under 30; good nutritional status; good control of any residual medical problems; no serious psychosocial issues; and, perhaps most important, the prospective patient cannot be a smoker.

"I fit all the criteria," Ms. Morello said. "I had quit smoking" when she was hospitalized for the Roux-en-Y bypass.

"He's all about health," she added of Dr. Rubin. "You have to promise to eat so many grams of proteins. You have to take your vitamins."

Ms. Morello promised.

Still, there were other considerations besides the usual surgical risks like bleeding, infections and fluid collection under the skin.

"Patients are told 'big skin, big scar, the bigger the surgery, the bigger the recovery,' " Dr. Rubin said. "It has to be a very thoughtful process."

Ms. Morello had no fear of surgery in general, and the prospect of scars didn't faze her. She couldn't even wear a skirt anyway because of the folds of skin that hung from her upper legs. "I decided if I can fit in my clothes better and have a scar, so be it," she said.

Likewise, she wasn't put off by the thought of a long recovery, and, she wasn't put off by one last, big consideration: the price.

At the time, health insurance companies did not pay for any of the procedures. (Now, many will pay for lower belly work if the skin folds are causing skin irritations or rashes or lower back pain.) Ms. Morello's surgeries -- Dr. Rubin does the work over two operating days -- would cost her about $50,000 total.

"I had to decide what was more important," she said. "I was lucky. I didn't have any kids, so I wasn't borrowing from anyone's college fund."

Dr. Rubin usually does arms and the lower body on the first day and the upper body on the second, but Ms. Morello's were reversed.

The first surgery, which included the bra lift procedure he invented, was on June 24, 2005, a Friday. Ms. Morello went home wearing an Ace bandage around her breasts. The following Tuesday, she and her husband returned to Dr. Rubin's office for removal of the bandage and her first look at his handiwork.

Dr. Rubin told Mr. Morello to bring a full-length mirror closer to his wife. Her husband was doing that when the doctor removed the bandage.

"My husband tripped over the chair, and I said, 'Oh, please don't tell me this is an Alice in Wonderland mirror,' " Ms. Morello said.

The second set of surgeries, done Oct. 28, 2005, was equally satisfying.

The recovery, however, was difficult. She dropped to between 126 and 130 pounds, but, she said, "I still wasn't healthy. I'd had two huge plastic surgeries in a few months. I was still recuperating."

Nevertheless she said she would do it again "in a heartbeat."

Besides, she added, "if you follow Dr. Rubin's instructions, everything heals."

She has and with great results. The scars on her underarms and around her waist are so thin and faded that they're barely visible, and the ones under her breasts are covered by the breasts themselves. When she and her husband of 4¹/₂ years went to Mexico last year, she went topless on the beach.

"I called and told Dr. Rubin that and he said, 'Can you put a sign on them that says "Body by Rubin"? ' " she said.

Her life has changed "immensely."

She sits in armchairs and needs only one seat on an airplane. She drives a car. She rides behind her husband on his motorcycle.

She wears clothes from the junior and petite departments, and some of the tops are fairly low-cut, a fact that has drawn a few complaints from a couple of other AGH employees. "They're jealous," she said.

"I like looking down at [her breasts]," she added. "I never wore a bathing suit."

She got contact lenses, dyed her dark hair blonde and let it grow. She wears it in girlish waves and easily passes for a woman 10 years younger. Her 12-year-old nephew told her she's prettier than Paris Hilton.

Yet, sometimes her self-image still is that of an obese woman.

"I'm not 540 pounds, but I don't see what others see," she said.

For example, she recently called out to her mother to come near while she was in the shower. When her mother opened the curtain, Ms. Morello said, "I asked her, 'Mom, where's my butt?' " She said, 'This is your butt.' "

"[Self-image] is an issue," Ms. Morello said. "I'm told it takes a long time."

After what she's been through, she's obviously willing to wait.

---

Correction/Clarification: (Published Aug. 28, 2008) This story on bariatric surgery as originally published Aug. 27, 2008 did not mention that West Penn Hospital is among local Centers of Excellence for bariatric surgery. The West Penn Bariatric Surgery Center is currently a designated Center of Excellence by the American Society of Bariatric Surgery, American College of Surgeons, HealthAmerica, United Resource Network and Cigna.