Are There Complications that Come with a Mommy Makeover?

The mommy makeover is one of the most popular operations performed by plastic surgeons. The procedure is a combination of cosmetic breast surgery, liposuction, and abdominoplasty. It has been designed to correct changes that occur normally with pregnancy.

Although the procedure is considered to be extremely safe, complications may occasionally occur. These include bleeding, hematoma formation, loss of tissue, wound breakdown, excess scarring, infection, asymmetry and numbness.

Several steps can be taken to minimize complications. These include utilizing an accredited outpatient surgical facility, a board-certified plastic surgeon and a board-certified anesthesiologist. Although, these steps won’t totally eliminate complications, they will hopefully decrease the incidents. 

Simultaneous C-Sections and Tummy Tucks

Abdominoplasty isn't recommended immediately following a C-section for a variety of reasons. These include the inability to make aesthetic judgments immediately following pregnancy, the mother’s overall health status, and the demands of a newborn child on the mother.

The timing of surgery following pregnancy is important and several issues should be considered before proceeding with surgery. It takes time for a new post-pregnancy body to reach its new baseline following pregnancy, and during this transition, it’s impossible to make aesthetic judgments. During this period, stretched skin may contract, a swollen uterus may shrink, and the weight gained during pregnancy may gradually disappear. This process takes 3 to 6 months and needs to occur before abdominoplasty is performed.

Ideally, patients should be within 10% of their ideal body weight and in good health otherwise. The majority of women who have undergone C-sections aren’t in good physical shape and are therefore not optimal candidates for surgery for a variety of reasons. These may include severe fatigue, a depressed immune system, possible blood loss, an increased potential for infection and elevated estrogen levels which can increase the risk of blood clots.

Finally, the demands of a newborn would make the recovery from these combined procedures very difficult. For instance, the use of postoperative pain medications would prevent you from breast feeding. In other words, the abdominoplasty might impact your developing relationships with your newborn child.

For all these reasons, it’s obvious that C-section and abdominoplasty shouldn't be performed together. If you’re considering abdominoplasty it’s important to give yourself time to fully recover from your C-section. Once this has occurred it’s appropriate to consult a board-certified plastic surgeon.  

Chest Wall Tightness after Breast Augmentation

It’s not unusual for patients to complain of tightness of the chest following breast augmentation surgery. This tightness is related to spasm of the chest wall muscles and swelling of the adjacent soft tissue. It’s more common when implants are placed beneath the muscles, but can occur with sub glandular placement as well.

In an effort to minimize these symptoms, a variety of strategies have been utilized. Swelling is managed with compression devices and support bras. Although swelling can be significant in the early post-operative period, it tends to resolve rapidly.

Chest wall tightness can also result from spasm of the chest wall muscles. When this occurs, muscle relaxants and massage are helpful. Massage of the back helps relax the anterior chest wall muscles. These muscles are connected by layers of fibrous tissue and for this reason; massage of the back can help alleviate spasm in the frontal muscles which cover the breast implants.

With time, these symptoms improve and patients are ultimately happy. If you have tightness following breast augmentation, make sure you discuss the issue with your plastic surgeon.

Scar Treatment following Cosmetic Surgery

A large variety of agents are currently available for the treatment of scarring.  At this point in time, there doesn't seem to be a consensus amongst plastic surgeons regarding their effectiveness. Nevertheless, their use appears to be increasing amongst cosmetic surgery patients.

These agents include a variety of topical agents and silastic sheeting. We generally recommend starting them 2 to 3 weeks following surgery as long as no open areas or scabbing is present.

It’ s important to discuss scar treatment with your plastic surgeon. Your surgeon should be able to make an appropriate recommendation. 

The Ideal Weight for Mommy Makeover Surgery

There’s no question that being close to your ideal body weight improves the results from mommy makeover surgery. It also decreases the potential for complications with this type of procedure. For these reasons, we prefer that patients be within 10% of their ideal body weight at the time of surgery.

Unfortunately, reaching an ideal body weight is easier said than done. The vast majority of patients are unsuccessful at losing this additional weight. It’s also important to realize that even when patients are overweight, they can potentially benefit from mommy makeover surgery. We therefore evaluate every patient on an individual basis. We encourage patients to lose weight before surgery and prefer that their weight be stable for at least three months. We realize that some patients will have difficulty losing weight. We therefore encourage patients to be in a supervised weight loss program. Even with that help, some patients will be unsuccessful in their effort to lose weight. Even without weight loss, many of these patients will still potentially benefit from mommy makeover surgery.

It’s important to realize that weight loss following mommy makeover surgery can affect the final result. This could even result in the need for revisional surgery. For these reasons, it’s important to thoroughly discuss this issue with your plastic surgeon. 

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When to start basic cardio exercises after breast augmentation

Recovery varies from patient to patient following breast augmentation surgery. We generally recommend that patients avoid strenuous activities including running for at least six weeks following surgery.

Running in the immediate post-operative period has the potential to cause the breast to bottom out. The constant bouncing of the implants within a freshly formed breast pocket can cause the pocket to expand inferiorly. Capsule formation acts to stabilize the implant pocket, but may take weeks to occur. In some cases, two weeks may be adequate, while longer periods may be necessary in other cases.

Physics suggest that larger implants would be more likely to stretch the pocket and skin, while compressive support bras would minimize the phenomena.

Early resumption of strenuous activities such as weight lifting may be associated with post-operative bleeding and hematoma formation as well. For this reason, these activities should also be avoided.

In some cases, low impact cardio exercise such as elliptical, spinning and stair stepping exercises may be resumed as early as two weeks following surgery.

It’s very hard for women who exercise regularly to give up their work out routines. For these patients, it almost represents an addiction. If you’re considering an early return to strenuous exercise, it’s important that you discuss the issue with your plastic surgeon before proceeding. Your surgeon will have important information regarding your situation and when it’s safe to resume all activities. 

Coolsculpting Complications

Coolsculpting has been available in the United States for several years and in Europe for a much longer period of time. Over 50,000 patients have undergone Coolsculpting safely with minimal complications.

The procedure involves placing an applicator head over the involved area. Suction is then applied, which draws the soft tissue into the device where it’s held in place. The skin and fat are then cooled in a controlled manner. Upon completion of treatment, the involved area is gently massaged to smooth contour irregularities that have been created by the device.

Patients typically describe an uncomfortable feeling as if a block of ice was being held against the area. Within ten minutes, the area becomes numb and patients become more comfortable. At this point they are able to read a book, watch a DVD, listen to music or sleep.

                
A small number of patients experience bruising and swelling which spontaneously resolves in 2-3 days. Occasionally, patients experience pain which is often described as dull and achy. This also resolves quickly.

                
Rarely, nausea can occur when abdominal Coolsculpting is performed and is probably secondary to traction on the abdominal contents. This is fortunately uncommon and quickly resolves on its own.

These problems occur sporadically and don’t appear to be modulated by mechanical factors such as applicator size. At this time, no long term complications have been identified with this procedure. The procedure is associated with high satisfaction rates and is an excellent option for treating localized adiposity. 

Pre-Operative Blood Testing

The vast majority of patients who are undergoing cosmetic surgery have preoperative blood testing which includes a CBC. This test has several components which are critical elements of the preoperative evaluation. These include the platelet count, the white blood cell count, and the hematocrit and hemoglobin levels. Each of these measurements is extremely important. The platelet count measures the patient’s ability to clot blood, an elevated white blood cell count is an indicator of infection, while the red blood cell count, hematocrit, and hemoglobin all measure the body’s oxygen carrying capacity.
 
Occasionally other blood tests are performed in combination with a CBC based on your physical findings.

If you’re concerned about your preoperative blood testing, it’s appropriate to consult your plastic surgeon. Your surgeon should be able to discuss these lab values in detail.

Massage After Liposuction

There are no scientific studies that conclusively demonstrate that massage is helpful following liposuction. Despite this, many plastic surgeons utilize massage as a routine component of postoperative care following this procedure. They believe that massage minimizes internal scarring, decreases edema, and helps remodel soft tissue.

It’s not unusual for patients to complain of swelling, tightness, and stiffness following this procedure. Massage and an early return to physical activity seems to help with these issues. For these reasons, plastic surgeons often recommend gentle massage and stretching exercises after liposuction. These are usually started 7 to 10 days following the procedure. Initially these maneuvers cause mild discomfort which quickly resolves with time.

If you’re planning liposuction, it’s important to discuss this issue with your plastic surgeon. In many cases, massage will be an important part of your postoperative care.

General or Local Anesthesia for Liposuction?

Tumescent liposuction represents a significant advance in the management of localized fat collections.  When this techniques is utilized with local anesthesia alone the response varies from patient to patient. The majority of patients appear to do well and have good results especially when smaller amounts of fat are removed. Unfortunately, we frequently see patients who have had significant pain and discomfort during the injection process when local anesthesia is used alone. 

For this reason, many surgeons supplement local anesthesia with I.V. sedation or general anesthesia to minimize pain and discomfort during the procedure. When utilizing this approach patients can have more fat removed and avoid multiple procedures. The procedure is more comfortable and avoids break through pain which can occasionally occur with local anesthesia alone.

It’s important to realize that all surgical procedures and anesthetic techniques have risks. This is true whether local anesthesia, I.V. sedation or general anesthesia are utilized. Most surgeons who perform tumescent liposuction agree that the anesthetic technique utilized is less important than the use of a certified operating room and the presence of an anesthesiologist. In other words, you don’t want your surgeon to be your anesthesiologist.

Liposuction Alternatives – What are the Options?

The most obvious alternative to liposuction is diet and exercise. Unfortunately, many localized areas of fat are refractory to this method of treatment. For this reason, patients often seek other methods of treatment. 

A large variety of non-surgical alternatives are currently available for treating localized collections of fat. Examples include zerona, coolsculpting, mesotherapy, and endermologie. All of these procedures are associated with varying degrees of success, but none are as effective as liposuction.

Liposuction represents the gold standard that all other body contouring procedures are judged against. This procedure is associated with dramatic results and high patient satisfaction rates. In the vast majority of patients, liposuction is still the best option for treating localized collections of fat.

If you’re concerned about localized fat collections, consultation with a board-certified plastic surgeon who has experience with this problem is appropriate. This surgeon should be able to discuss non-surgical and surgical options. Utilizing this approach, an individualized treatment plan can be developed specifically for you.

What’s the Difference Between Panniculectomy & Abdominoplasty?

It’s not unusual for massive weight loss patients to develop loose, saggy abdominal skin. This excess skin can cause a variety of functional problems including chronic rashes, infection, and back pain. In addition, loose abdominal skin may cause aesthetic deformities which effect self-esteem and self-image.

For these reasons, patients frequently seek corrective surgery following massive weight loss. When this situation arises, a variety of treatment options exist that address the skin, fat, and underlying muscles. These procedures are tailored to the patient’s specific anatomic findings and unique aesthetic goals. 

In some cases, an abdominal panniculectomy can be performed. This procedure involves removal of excess lower abdominal skin. When this skin apron is removed, the umbilicus and underlying muscles are left alone. This procedure has a significant impact on function, but has aesthetic limitations. These include continued upper abdominal loose skin, pubic skin sag, and weak abdominal muscles. 

For these reasons, it’s not unusual for patients to request abdominoplasty surgery. This procedure not only removes excess lower abdominal skin, but also removes excess upper abdominal skin and tightens the abdominal muscles as well. This procedure requires detachment of the umbilicus and transposition to a higher level. It’s associated with improved functional results and dramatically improved abdominal aesthetics. Unfortunately, tightening the abdominal muscles does occasionally prolong the recovery period. 

It’s important to realize that each patient’s situation is unique. For this reason, it’s important to discuss your aesthetic goals with your plastic surgeon. Your plastic surgeon should be able to formulate a treatment plan that’s appropriate for your aesthetic goals and life style. In your case, it may not be appropriate to tighten your abdominal muscles. 

What are ‘Dog Ears’?

Dog ears are abnormal bulges of tissue that typically occur along the ends of surgical incisions. This problem occurs for a variety of reasons, including discrepancies in length of the opposing wound borders and wound closures around curved contours. 

Dog ears can occasionally be seen following abdominal wall panniculectomy. When this occurs, secondary surgery may be necessary. In most cases, this involves a simple excision of the dog ear under local anesthesia. In other cases where the dog ear is large and extends posteriorly towards the back, correction may require extension of the incisions in a posterior direction. In some cases, where an abnormal roll of tissue is present the incision may extend to the midline of the back. 

Although every effort is made to avoid dog ears during the primary surgical procedure, this complication is occasionally unavoidable. When this situation arises it’s important to discuss your options with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses your concerns. 

The Difference Between a Plastic Surgeon and a Cosmetic Surgeon

The term “plastic surgeon” and “cosmetic surgeon” are frequent sources of confusion amongst plastic surgery patients. These terms are often used interchangeably, but actually have significant differences in their meanings.

Plastic surgeons have undergone residency training in plastic surgery. This involves upwards of 7 to 8 years of training in this area of endeavor. The vast majority have undergone testing to obtain board certification in this specialty as well. 

Cosmetic surgeons are individuals who perform cosmetic surgery. This may include plastic surgeons along with a large number of physicians from varied specialties including dermatology, otolaryngology, ophthalmology, oral surgery, and gynecology. In our community, we even have family physicians and emergency room physicians who now call themselves cosmetic surgeons. In this situation, these physicians don’t even have basic surgery training, let alone specialty surgery training.

The bar is relatively high for a physician to use the term plastic surgeon. In contrast, anyone who performs or wants to perform cosmetic surgery can call themselves a cosmetic surgeon. Unfortunately, there are many practitioners with minimal training and experience performing these procedures with very little regulation. It’s not uncommon to see aggressive advertisements that make claims that just can’t be substantiated. In this environment it’s truly buyer beware and for this reason board certification is extremely important.

Even the issue of board certification can be confusing because not all boards are created equal. It’s important that the board be certified by the American Board of Medical Specialist. This organization ensures that the board is reputable. These boards require residency training, testing, and certification. 

It’s important that your surgeon be board certified by a specialty that’s dedicated to cosmetic surgery. Although the vast majority of “cosmetic surgeons” are board certified, in many cases these boards don’t traditionally have anything to do with aesthetic surgery.

Many factors should be considered when choosing a surgeon. These include training, experience, reputation, and certification to name a few. The selection of your surgeon is the most important decision you will make when considering aesthetic surgery, so make it carefully. 

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Acrylic Nails & Fingernail Polish

When cosmetic surgery is performed, safety should always be the number one priority. For this reason, pulse oximetry is used to monitor oxygen levels throughout the surgical experience. This process is started in the pre-operative holding area and is continued throughout surgery and recovery.

Pulse oximetry involves placing a device on the finger which measures oxygen levels through the finger nails. It’s not unusual for patients to present for surgery wearing acrylic nails and finger nail polish. Finger nail polish can interfere with pulse oximetry and for this reason should be removed prior to surgery. In the vast majority of cases, acrylic nails don’t represent a problem when pulse oximetry is utilized. If you have questions regarding this topic, make sure they’re answered during your pre-operative consultation.

Preoperative Testing

When patients undergo cosmetic surgery, safety should always be a priority. The pre-operative evaluation varies from patient to patient and depends on a variety of factors. 

The starting point is a comprehensive history and physical examination. Depending on the findings of this evaluation additional studies and consultation may be necessary before proceeding with surgery.

We generally recommend a mammogram on any patient over forty years of age. An EKG is performed on anyone older than fifty. Laboratory studies are performed on an individual basis and depend upon the medical evaluation. The vast majority of patients have CBC’s and pregnancy tests. 

In many cases, consultation with cardiology, pulmonology, and endocrinology are appropriate based on the patient’s medical history.

It’s important to remember that cosmetic procedures are major surgical procedures that have associated risks. For this reason, safety should be everyone’s first priority.

Wearing Eyeglasses after Rhinoplasty?

We recommend that patients don’t wear eyeglasses for at least four weeks following rhinoplasty. During this period the nasal bones aren’t totally healed and slight pressure can cause distortion, indentation and secondary nasal deformities.

In patients who are dependent upon their eyeglasses alternative strategies are occasionally necessary. When nasal splints are present, eye glasses can be placed directly on top of these stable structures without concern. The splints are usually removed after the first week and other approaches become 

We often recommend taping the eyeglasses to the forehead. In some cases additional padding can be attached to the nasal eyeglass pads as well. 

When patients require eyeglasses to function these maneuvers represent a significant disruption of daily activities. With this in mind, it’s important to remember that the benefits of rhinoplasty will last an entire life time.

Plastic Surgery Financing

For many patients, cosmetic surgery wouldn’t be possible without some type of financing. For this reason, the vast majority of plastic surgeons offer some type of financing program. With the availability of this type of program, plastic surgeons don’t typically take installment payments. They usually require full payment before surgery is performed.

In our practice, we almost exclusively utilize Care Credit. This is currently the most commonly used source of plastic surgery financing in the United States. The company is run by GE Capital. It’s reputable and you can apply for a loan online. It takes approximately thirty minutes to get a response. In some cases, you may be able to get a twelve-month interest-free loan.

Financing isn’t for everyone; make sure you understand the fine print in your contract. Don’t take on more than you can handle. At some point, you will have to repay the loan. It’s important to have all your financing questions answered before proceeding with cosmetic surgery. In our office, we have financial consultants who can help you with this very important issue.