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Mommy Makeover

Q: I have had two children and am very unhappy with the loose skin of my tummy. What would be better for me – a mommy makeover or a tummy tuck?

A: The abdominal procedure can be either a full or mini tummy tuck though less commonly it may just be liposuction. The breast procedure can be a breast augmentation, a mastopexy, a mastopexy augmentation or even a breast reduction. So, if you want to improve the appearance of your breasts in addition to addressing your abdomen, then a mommy makeover would be what you would want; otherwise, it would just be some form of a tummy tuck.

Body Contouring after Massive Weight Loss

Q: I have lost 110 pounds after my gastric bypass. Now I am left with extra skin everywhere. The areas that bother me the most are my tummy, breasts, and arms. What do you suggest?

A: After this much weight loss, there is virtually always circumferential laxity of the skin of the trunk, marked flattening, deflation and elongation of the breasts, and hanging bat-wing deformities of the upper arms. One strategy to address these problem areas would be a staged post-weight loss body contouring approach. The first stage could involve a tummy tuck with a belt lipectomy. This is a circumferential excision of skin and fat with underlying tissue contouring and tightening and would encompass the lower trunk including an outer thigh lift and a buttock lift. The second stage, possibly three or more months later, would consist of a breast lift with implants and upper arm lifts. If an inner thigh lift is desired, it can be performed during either stage.

Q: I have these rolls of extra skin on my back. Is there a procedure that can treat these?

A: Direct excision of the extra skin and fat can be performed. This frequently can either be done alone or, more commonly, combined with another procedure such as an arm lift or breast lift.

Q: I smoke 1 pack a day of cigarettes. Will this affect the results of a full body lift?

A: Procedures involved in lower body lifts are quite extensive and complex and do disrupt blood flow to the affected tissues. Cigarette smoking also leads to a significant decrease in blood flow to the tissues by causing the vessels to constrict, reducing blood inflow and therefore depriving the tissues of their needed supply of oxygen. The combination of the two could be disastrous with regard to tissue healing and viability. There would be an extremely high risk for the development of dead tissue (necrosis), delayed healing, separation of wounds, infections, and widened scars.

Therefore, smoking would be a contraindication for performing these extensive procedures. You need to stop smoking starting at least one month prior to surgery and continuing until at least four weeks after.

Arm Lift

Q: After my losing 70 pounds, the skin of my arms hangs down and gets in the way. Would an arm lift help this?

A: An arm lift is the ideal procedure to address this excess skin. It involves the removal of the hanging skin and recontouring and redraping of what remains. The scar is usually in the shape of a “T” and extends into the armpit area.

Q: As I get older, I notice that the skin of my arms is hanging more and more. Should I consider an arm lift?

A: The scars from an arm lift are not short and generally are not inconspicuous. The contour improvement obtained from the lift would be far outweighed by the scars that would result from the procedure. The risks here outweigh the benefits. If your skin has relatively good elasticity and contains a modest amount of fat, consideration can be given for conservative liposuction which may just require one tiny incision.

Q: Is an arm lift a very painful procedure?

A: In general, the discomfort level during the first few postoperative days is fairly mild and easily controlled with a small amount of pain medication. More than anything, there is a tightness that can take several days or longer to resolve.

Labiaplasty

Q: I just had a labiaplasty yesterday and my labia are very swollen. Is this normal?

A: Yes, it is very normal for your labia to swell for a period of time following labiaplasty. It can take several weeks or longer for much of it to subside.

Q: How soon after a labiaplasty can I have intercourse? My husband wants to know.

A: At minimum, I strongly recommend waiting at least five to six weeks after surgery in order to allow adequate healing to occur, swelling to subside and soreness to largely resolve. Then, you can do it gently as tolerated.

Q: Can I apply ice directly to my labia in order to reduce the swelling?

A: Do not apply ice directly to your tissues – it can cause significant and permanent damage. Instead, I strongly recommend applying a cool pack to the area for five to ten minutes a few times a day in order to decrease the swelling.

Q: How soon can I wear tight fitting jeans after a labiaplasty?

A: Typically, I recommend against wearing tight fitting clothing for at least five to six weeks because you do run the chance of disrupting your surgical repair.

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