Latest / HKB Uncut | A Cosmetic Surgery Podcast / 23. Why Do I Still Look Pregnant? Loose Skin, Muscle Separation, & What Actually Works

Transcript

23. Why Do I Still Look Pregnant? Loose Skin, Muscle Separation, & What Actually Works · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_00: Uh we we need to make sure our listeners understand like mini doesn't mean better.
• 0:03
  SPEAKER_01: No.
• 0:04
  SPEAKER_00: Right?
• 0:04
  SPEAKER_01: I mean, how many times do you see like minis that are just not great that just needed a full and I think the listeners really need to understand this because a mini in our hands, what I understand a mini to be, could be different than what another surgeon calls a mini.
• 0:24
  SPEAKER_01: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:28
  SPEAKER_00: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance, and what you need to know before you book a procedure.
• 0:38
  SPEAKER_00: I'm Dr.
• 0:39
  SPEAKER_00: Bill Cortesis.
• 0:40
  SPEAKER_00: And I'm Gorov Bahardi.
• 0:42
  SPEAKER_00: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
• 0:50
  SPEAKER_01: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 0:58
  SPEAKER_01: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
• 1:15
  SPEAKER_00: Bill, today we're going to talk about mommy makeovers and uh kind of things like options, timing, recovery, who's a good candidate, um, and just kind of get into some of those details.
• 1:25
  SPEAKER_00: Um, first and foremost, what is mommy makeover?
• 1:28
  SPEAKER_00: I kind of hate the word, but it's it kind of works, but what is it?
• 1:32
  SPEAKER_01: You know, these are great procedures.
• 1:34
  SPEAKER_01: Honestly, it's one of your passions.
• 1:36
  SPEAKER_01: We do a lot of these procedures.
• 1:39
  SPEAKER_01: But in essence, it's any combination of breast surgery with body contouring.
• 1:44
  SPEAKER_01: It's been named mommy makeover because a lot of times women post-children come in to have their bodies restored.
• 1:50
  SPEAKER_01: They want to get back to where they were pre-babies and potentially even better than they were pre-babies, and that's why it's been called the mommy makeover.
• 1:57
  SPEAKER_01: But I think in a generalized term, it's anytime you do body contouring surgery, and what does that include?
• 2:03
  SPEAKER_01: Liposuction, any variation of a tummy tuck or excisional tummy surgery with breast surgery at the same time.
• 2:10
  SPEAKER_00: Yeah, and sometimes it could even it could be an eyelid surgery, it could be a facelift, it could be a labioplasty, so it's really anything after the amazing women that we're surrounded by, you know, are have you know given their bodies up to bring new life into the world and they want to get reclaim what's theirs.
• 2:25
  SPEAKER_00: You know, is it is it all cosmetic, is it all just aesthetic, or is there is there more to it than just like they just want to look better?
• 2:34
  SPEAKER_01: No, you know, a a lot of times it's uh it's more than just the the aesthetic part, right?
• 2:40
  SPEAKER_01: It babies take a toll on a woman's body emotionally, physically, you name it, it does a lot.
• 2:48
  SPEAKER_01: And oftentimes from a physical standpoint, you know, when you have a a child and you get pregnant, your rectus muscles are sort of hold everything in place and keep your posture and um keep everything nice and your core nice and tight, separate.
• 3:04
  SPEAKER_01: And especially after multiple pregnancies, they separate even further.
• 3:08
  SPEAKER_01: And so the way to restore that functional status for that individual is to actually repair that musculature.
• 3:16
  SPEAKER_01: And unfortunately, I get asked this question all the time, and I know you do as well.
• 3:20
  SPEAKER_01: Um, can I can diet and exercise fix it?
• 3:23
  SPEAKER_01: Unfortunately, no, it takes an individual like a plastic surgeon to come in and actually do the procedure to repair that rectus muscle.
• 3:30
  SPEAKER_00: So I have done cases with you uh a couple of years ago, and I've done some myself where we've actually taken care of women who are these are the fittest of the fittest.
• 3:39
  SPEAKER_00: They're they could whoop my, you know what, and they could whoop yours too, that are true fitness junkies, trainers that had multiple kids that are shredded, but they still have a diastasis, which is a separation of six-pack muscles.
• 3:51
  SPEAKER_00: So, you know, actually performing that repair obviously gave them a stronger aesthetic look and gave them a stronger core, but like functionally really enhanced them.
• 4:00
  SPEAKER_00: And so I think it's really amazing how you can actually improve someone's function.
• 4:04
  SPEAKER_00: So, you know, we love aesthetic surgery because so many times out of most, or more times out than others, we can actually improve form and function.
• 4:13
  SPEAKER_00: You know, sometimes all the extra skin, like when when you have that extra skin, that ledge or breasts that are sitting and touching the skin of the of the upper admin, women hate boob sweat.
• 4:22
  SPEAKER_00: There's one thing I've learned.
• 4:23
  SPEAKER_00: They hate boob set.
• 4:24
  SPEAKER_00: And and getting rid of boob sweat is like the best.
• 4:28
  SPEAKER_01: I think women hate sweating anywhere, not just in the in the boob area.
• 4:32
  SPEAKER_01: But you know what's crazy?
• 4:34
  SPEAKER_01: You know, you you bring up function thing.
• 4:36
  SPEAKER_01: How often do you do a tummy tuck?
• 4:37
  SPEAKER_01: The the the patient comes back and they're like, hey dog, my back pain's gone.
• 4:41
  SPEAKER_01: Or hey dog, I didn't realize it, but I had some incontinence and that's improved.
• 4:45
  SPEAKER_01: It's amazing, right?
• 4:46
  SPEAKER_01: Like it's just amazing.
• 4:47
  SPEAKER_01: You do the procedure, it takes care of that that distinct problem.
• 4:50
  SPEAKER_01: So, again, to your point, we're taking care of both their functional status as well as their aesthetics.
• 4:55
  SPEAKER_01: You know, when people talk about the body contouring G, like what options are are we looking at there for a patient?
• 5:02
  SPEAKER_01: And then I'm gonna go into fine-tuned details because uh patients always come in, they're like, hey doc, I want a mini tummy duck reverse or full, but I won't I won't get into that in a second.
• 5:11
  SPEAKER_01: But let's let's talk about options for the tummy part.
• 5:14
  SPEAKER_00: Honestly, it's it's it's I would say that it's a combination of like what their anatomy is showing you, like what what the issue is when you examine them, but also what's their concern.
• 5:24
  SPEAKER_00: Like, too often, like one thing we can't do as plastic surgeons, we can't be like, this is what you need, young lady or young man, if we're doing the male surgery.
• 5:31
  SPEAKER_00: It's got to be like, you know, what what's going on?
• 5:34
  SPEAKER_00: What can we do to help you, you know, feel your best and reconcile with how you feel, with how you look.
• 5:40
  SPEAKER_00: And the same is with like a torso or a tummy.
• 5:42
  SPEAKER_00: You know, sometimes they're like, I hate my belly button, I hate these stretch marks, I hate the ledge, I hate um all this skin excess, um, or I just feel like I'm like pregnant all the time and I'm not.
• 5:54
  SPEAKER_00: People are asking me, what how many weeks am I?
• 5:56
  SPEAKER_00: And it just pisses me off.
• 5:58
  SPEAKER_00: And I think those are the reasons where it motivates some women to come see us, even the ones who are like, I'm never ever gonna have a tummy tucker surgery.
• 6:05
  SPEAKER_00: I think, you know, it's it has this little stigmata.
• 6:08
  SPEAKER_00: Like a lot of women, they they don't they want to be natural, they don't want to have to have a elective cosmetic surgery.
• 6:14
  SPEAKER_00: I mean, they these ladies are working, they have kids, they got real responsibilities, and who the hell wants downtime?
• 6:20
  SPEAKER_00: But I think it depends.
• 6:21
  SPEAKER_00: Like, so some women, depending on what their um anatomy is like and how much excess they have, they could be a candidate for what you were talking about earlier, a mini tummy tuck, right?
• 6:30
  SPEAKER_00: Where there's basically no skin excess and it's all muscle separation.
• 6:34
  SPEAKER_00: But most of the time that's not the case, right?
• 6:37
  SPEAKER_00: And you need to do some form of a full abdominoplasty.
• 6:40
  SPEAKER_00: So, you know, sometimes they're just like, well, I mini just sounds so much better.
• 6:43
  SPEAKER_00: Well, like I we we need to make sure our listeners understand like mini doesn't mean better.
• 6:47
  SPEAKER_00: No, right?
• 6:48
  SPEAKER_00: I mean, how many times do you see like minis that are they're just not great that just needed a full and I think the listeners really need to understand this because a mini in our hands, what I understand a mini to be could be different than what another surgeon calls a mini.
• 7:04
  SPEAKER_01: Right?
• 7:05
  SPEAKER_01: Some people call a mini not doing anything to the muscles, right?
• 7:08
  SPEAKER_01: But what does a mini tummy tuck mean to you and I?
• 7:11
  SPEAKER_01: Yeah.
• 7:11
  SPEAKER_00: So a mini tummy tuck means that there's muscle separation, diastasis, that's going to be corrected.
• 7:16
  SPEAKER_00: There is excess skin below the belly button, okay?
• 7:20
  SPEAKER_00: Not much excess skin above the belly button.
• 7:22
  SPEAKER_00: So when they're sitting up like this, there's not too much skin here, there's skin down low below the belly button, and there's a muscle separation and very little fat, she could potentially be a candidate for a mini tummy tuck.
• 7:35
  SPEAKER_01: But still, and for you, that means you're plicating that muscle, you're repairing that muscle all the way stem to stern.
• 7:43
  SPEAKER_01: Correct, right?
• 7:43
  SPEAKER_01: Where some individuals won't do it above the belly button.
• 7:47
  SPEAKER_00: I can't tell you how many times I've had people, and you've had this too, where they come in and they say, Yeah, the doc said they could only they for many they just tighten just from the um uh the pubis to the belly button, which makes no sense.
• 7:58
  SPEAKER_01: It does it.
• 7:58
  SPEAKER_01: So, how do you address the upper part of the abdomen in those cases where again minis aren't minis everywhere?
• 8:05
  SPEAKER_01: So, how do you address the upper abdomen?
• 8:06
  SPEAKER_00: Yeah, so then there's the concept of umbilical float.
• 8:09
  SPEAKER_00: So, what you do is you you dissect all the way, you lift up the skin all the way to the belly button, and then you separate the belly button off the chest wall.
• 8:14
  SPEAKER_00: You have to do something called a float where you don't make any incision on this skin flap, but you lift it up, and then you have to work through a tunnel.
• 8:20
  SPEAKER_00: So it's a little bit more work.
• 8:22
  SPEAKER_00: You have to put the patient in deep Trendellenberg, you know, obviously have him laying back, and then you dissect all the way to the xiphoid process here, and it's a long tunnel sometimes.
• 8:30
  SPEAKER_00: So the reason why most surgeons don't do it is because it's a pain.
• 8:32
  SPEAKER_00: Yeah, it's harder to do.
• 8:33
  SPEAKER_01: It's a much harder procedure than a regular tummy tug.
• 8:36
  SPEAKER_01: But again, a lot of patients don't necessarily know that, and many is more difficult.
• 8:40
  SPEAKER_00: But the overwhelming majority of patients have stria, which is stretch marks, all around the belly button.
• 8:45
  SPEAKER_00: They have looseness up here when they sit, there's almost this roll effect, and and they want to get rid of that.
• 8:50
  SPEAKER_00: And so most of the time you need to do a full abdominal plasty, and a full abdominal plasty is more effective at getting rid of that skin excess.
• 8:58
  SPEAKER_01: You're you're still taking care of the same problems, you're removing excess skin, you're tightening the muscles.
• 9:05
  SPEAKER_01: We typically end up doing liposuction with either one of these procedures, but the difference is what you do with the belly button.
• 9:12
  SPEAKER_01: Right.
• 9:12
  SPEAKER_01: Whether or not you have a scar around the belly button.
• 9:14
  SPEAKER_01: Right.
• 9:14
  SPEAKER_00: You have a scar around the belly button.
• 9:15
  SPEAKER_00: And like, I'm gonna tell you, like, most of the patients who are like who are seeking myself out or you out, I don't know about you, but they're like, I like your belly buttons.
• 9:24
  SPEAKER_00: Yeah, and and it's a it's a really it's an interesting concept, and they're different kinds of belly button aesthetics that we can do it however you want.
• 9:31
  SPEAKER_00: So if you have a belly button that you like, it sounds crazy, but bring it in.
• 9:34
  SPEAKER_00: Let us see.
• 9:35
  SPEAKER_00: Because like we literally can alter the approach to get that belly button.
• 9:39
  SPEAKER_00: You know, there there is a lot of times patients will come in though and they'll they'll have this concept of like, I need a short scar, I need a short scar, I don't want a long scar.
• 9:46
  SPEAKER_00: Oh my god, that scar mortifies me.
• 9:48
  SPEAKER_00: You know, it's one of those things where I think it's we have to get them to understand, like, you you you obviously want a short scar, but you want the best outcome, you want the best contour.
• 9:57
  SPEAKER_00: So, you know, scar length.
• 10:00
  SPEAKER_00: I mean, are you trying to keep the shortest abdominal plastic scar every time?
• 10:03
  SPEAKER_01: No, I'm gonna be honest with you.
• 10:04
  SPEAKER_01: You know, the more I've been doing this, the longer I've been doing this, patients care about scars, but they don't.
• 10:09
  SPEAKER_01: They care about their aesthetic outcome, what it looks like.
• 10:12
  SPEAKER_01: If you put the scar in the right location, right, where they can hide it under their undergarments, um, bikinis, whatever they they're fine with that that scar.
• 10:21
  SPEAKER_01: Yeah.
• 10:22
  SPEAKER_01: So I I think it's more of the the uh the overall aesthetics.
• 10:26
  SPEAKER_01: I think the most difficult patient in terms of body contouring, as we were talking about from the mommy makeover combo, is the patient that's in between a mini and a full tummy tuck.
• 10:37
  SPEAKER_01: Right.
• 10:37
  SPEAKER_01: I think those patients are difficult because what we're talking about isn't a nuance here.
• 10:41
  SPEAKER_01: If you can't remove all the skin from above the belly button to that scar location, oftentimes you end up having to have a vertical scar.
• 10:50
  SPEAKER_01: And so those and those patients are in between a mini and a full tummy tuck.
• 10:54
  SPEAKER_01: And you know, sometimes it's difficult to explain that to a patient and let them, but you and I both approach it the same way.
• 11:00
  SPEAKER_01: We let the patient decide on what they want to do.
• 11:02
  SPEAKER_00: Totally.
• 11:03
  SPEAKER_00: And like in and we're not opposed to other concepts.
• 11:05
  SPEAKER_00: And the biggest thing is we don't want to do the same thing every time.
• 11:07
  SPEAKER_00: So we're we're we we can do different things.
• 11:09
  SPEAKER_00: So in those patients, I had a patient who I was actually had to schedule, but then she decided, no, I want the maximal tightening, and we changed the approach.
• 11:15
  SPEAKER_00: But on that patient who had a similar thing you were talking about, what we did is we did a hybrid or a kind of a composite abdominal plasty.
• 11:20
  SPEAKER_00: So what we can do is you can do a mini approach.
• 11:22
  SPEAKER_00: So you do a mini approach inferiorly, you do a small reverse um abdominal plastics in the breastfolds, and then you do Renuvion with it in skin tightening.
• 11:31
  SPEAKER_00: So, like at the end of the day, like it really is up to the patient, right?
• 11:35
  SPEAKER_00: And we can kind of come up with novel inner innovative approaches and so that we can basically get what you want.
• 11:41
  SPEAKER_00: And the main thing is just setting expectations for us.
• 11:43
  SPEAKER_00: It's like at the end of the day, we just want you to patients to come back and be like, oh my God, you you did exactly what you said you were gonna do, or you did a little better.
• 11:50
  SPEAKER_00: You don't want to under-deliver.
• 11:52
  SPEAKER_00: Um, that's the only thing we want to over-deliver or at least meet expectations.
• 11:57
  SPEAKER_00: You know, the one thing that we we haven't talked about yet, which is really important, is that almost every mommy makeover, quote unquote, or or you know, body contouring procedure after having kids is associated with posterior truncal approach, too, meaning what do you do?
• 12:11
  SPEAKER_00: And like a lot of times patients come and say, Hey, have you have any concerns back here above your buttock in that hip roll area?
• 12:16
  SPEAKER_00: And a lot of times you're like, I haven't really thought about that.
• 12:19
  SPEAKER_00: And I I always bring it up to them, but why is it important to have that discussion and approach that area?
• 12:24
  SPEAKER_01: Again, when we look and evaluate the patient, we're not we're not taking care of just a patient in two dimensions.
• 12:31
  SPEAKER_01: We really want to take care of the whole unit collectively.
• 12:34
  SPEAKER_01: And I think if you do that, you get an ultimately better outcome.
• 12:38
  SPEAKER_01: So I bring it up with every patient.
• 12:41
  SPEAKER_01: Hey, let me let's look at your posterior trunk, let's look at your lower back to see how it complements the front, to see whether or not something needs to be done there.
• 12:49
  SPEAKER_01: Oftentimes it's just liposuction, occasionally you need to extend the incision a little bit further back.
• 12:54
  SPEAKER_01: Sometimes we need to address the buttocks area because, again, the common misconception, a lot of mommies come in and they're like, I don't want a Brazilian butt lift.
• 13:04
  SPEAKER_01: You know, I I don't want fat grafting because they don't want what they understood fat grafting to be the buttocks.
• 13:12
  SPEAKER_01: But you and I have a slightly different approach in the fact that it we're doing it more for shaping than we are for volumizing.
• 13:19
  SPEAKER_01: Right.
• 13:20
  SPEAKER_00: That's a pure distinction.
• 13:21
  SPEAKER_00: It's like volume redistribution, right?
• 13:24
  SPEAKER_00: The the other thing I would say is that that that I would say the modern or the contemporary mommy makeover at HKB, we are um always reconstructing the muscle core.
• 13:38
  SPEAKER_00: We're trying to eliminate skin excess and give natural, elegant, athletic contours.
• 13:43
  SPEAKER_00: We're trying to address areas that have lost volume, like the buttock.
• 13:47
  SPEAKER_00: We are removing skin when needed, meaning we're not afraid to remove the skin and do longer scars to get a better result.
• 13:54
  SPEAKER_00: And then the other thing is gonna be is breasts.
• 13:56
  SPEAKER_00: When we approach breasts, like the the breast aesthetic now is is definitely a more natural, less of a va-va voom, but for the right patient, we can do that all day long with traditional implants and and breast lifting.
• 14:09
  SPEAKER_00: But there's a there's a huge subset there where like I would never ever have anything to my breasts, but I just wish I fit a little bit better in my bra.
• 14:17
  SPEAKER_00: And they're not necessarily droopy, they just don't have it.
• 14:19
  SPEAKER_00: They just literally the kids suck the life out of them, and they just want to be a full A or they want to be a just a small B.
• 14:26
  SPEAKER_00: They literally want to fill out their bra.
• 14:28
  SPEAKER_00: And I think we should talk about kind of our approach on that and what's changed recently that is really expanding our space.
• 14:34
  SPEAKER_01: I just love the fact that there's so many different options available to patients when it comes to breast surgery.
• 14:40
  SPEAKER_01: And I think the first thing I know where you're you're hinting at, and I'd love for you for you to chat on it, but what I'll tell you is our uh breast surgery is so individualized that every patient that comes in wants something slightly different, and it's up to us as surgeons to figure out the exact look that the patient's going for, give them all the options around what we can do, show them and set appropriate expectations because to your point is some patients are like adamant, I don't want an implant doc.
• 15:12
  SPEAKER_01: I just can't, I'm just not gonna do it.
• 15:13
  SPEAKER_01: I just want to restore kind of things back in the right position.
• 15:16
  SPEAKER_01: I'm okay with this.
• 15:17
  SPEAKER_01: But you need to show them what a lift will do to them, and it may not give them that roundness up top, right?
• 15:24
  SPEAKER_01: And sometimes they need you know an additional device there, like an implant to give them that volume.
• 15:29
  SPEAKER_01: But we do have alternatives, right?
• 15:30
  SPEAKER_01: Fal fac rafting is actually an amazing alternative.
• 15:33
  SPEAKER_01: Now, it doesn't do a great job of sh uh volumizing in certain areas, but it does give you good shape, which which is great.
• 15:40
  SPEAKER_01: But again, and it's all it's all individualized.
• 15:43
  SPEAKER_00: Man, the other thing too is like so this is important because we're this topic of this conversation is mommy makeover, and it's it needs to uh people need to understand that doesn't mean you have to have a big ass surgery, it can mean you have a small thing done, like you have just your breast done.
• 15:54
  SPEAKER_00: But some mommies are afraid, they're afraid that like I have kids, I do not want to get anesthesia, I'm freaked out about it, and I just I just can't, it's too selfish.
• 16:04
  SPEAKER_00: And I'm gonna tell you that I've had several cases I've taken care of recently where we do a small volume enhancement, we're using a new novel technique that HKB was one of the first in the entire country.
• 16:12
  SPEAKER_00: You and I are one of the first people in, you know, in the United States to even use this technique five, six years ago that was even more advanced technique.
• 16:20
  SPEAKER_00: Um, but using this concept of preserve where we're doing these procedures on on women who uh want a small volume enhancement, who want essentially no pain, no recovery, and don't want to have hopefully not have anesthesia if they don't want it, they can have anesthesia, they can have some sedation.
• 16:35
  SPEAKER_00: And it's been it's pretty remarkable.
• 16:38
  SPEAKER_00: I uh I I will have to say that uh initially I was even even I was kind of like I don't know about this.
• 16:42
  SPEAKER_00: I don't know about this thing under local anesthesia, and then I did it, and you've been a part of it, and all of our teams have been a part of it, and I think it's really remarkable that there's an option available.
• 16:51
  SPEAKER_00: There are multiple options actually available for for for women who are interested in doing something, but maybe for the ones who are like, Why I just can't because I can't have that time off.
• 17:01
  SPEAKER_00: I can't have anesthesia.
• 17:03
  SPEAKER_00: Well, you don't have to.
• 17:05
  SPEAKER_01: You can have that under local anesthesia, be out and about within a couple hours after having surgery, which is world, which which is really impressive, and go about your daily activities the the next day.
• 17:18
  SPEAKER_00: And and I think though, what that does remind us though, that it's important for people, and you you've been a huge proponent of this and a lot of other people in our space about this kind of concept of early active motion, returning to activity, moving, grooving, because if you don't use it, you there's always been the term you lose it.
• 17:35
  SPEAKER_00: Well, after surgery, it can be dangerous if you're not moving around.
• 17:38
  SPEAKER_00: So actually, moving around being active is really important.
• 17:41
  SPEAKER_00: And so, even with these big surgeries that we're doing, I mean, the night of, even if you're doing a circumferential abdominal plasty and a breast surgery, like a big six-hour surgery, they're they're walking.
• 17:51
  SPEAKER_01: Yeah, it's controlled motion, right?
• 17:53
  SPEAKER_01: You know, if you do it the right way, you're actually benefiting the patient long term.
• 17:58
  SPEAKER_01: So big, big, big proponent of it.
• 18:00
  SPEAKER_01: You know, one of the things that you and I do a lot of, not talked about a lot, but it's something that can also be done under local anesthesia, and we've both done it under local anesthesia.
• 18:10
  SPEAKER_01: It goes, it fits into this mommy makeover category is the C-section scar revision.
• 18:16
  SPEAKER_01: How often do you have patients that come in, they're like, Doc, I look great.
• 18:20
  SPEAKER_01: I'm one of the lucky few.
• 18:21
  SPEAKER_01: I didn't have any issues, uh, I don't need a tummy tuck.
• 18:25
  SPEAKER_01: But what drives me crazy is when we're in my yoga pants, you can see this little bit of a ledge.
• 18:30
  SPEAKER_00: Yeah.
• 18:31
  SPEAKER_01: What causes that?
• 18:32
  SPEAKER_01: Yeah.
• 18:33
  SPEAKER_01: And how do you address it and fix it?
• 18:34
  SPEAKER_00: Because we do a lot of it.
• 18:36
  SPEAKER_00: What he's talking about is when when someone has a C-section, especially if they've had multiple C-sections, there tends to be this concept of like an invagination or it's like this valley that is formed.
• 18:45
  SPEAKER_00: So there's like a there's a ledge above and a ledge below, and there's you know a tether where the actual scar is stuck to the abdominal wall.
• 18:53
  SPEAKER_00: And it's caused by, you know, when at the time of closure, especially if there's secondary procedures done where the skin is kind of brought together, but the deep stuff, everybody, even the skinniest of skinnies, has a little fat layer that's under there.
• 19:06
  SPEAKER_00: And that's called that subcutaneous fat.
• 19:07
  SPEAKER_00: And there's another layer called a scarpus layer, it's like a it's like a investing fascial layer.
• 19:12
  SPEAKER_00: That tissue normally exists.
• 19:14
  SPEAKER_00: So when that tissue exists, the skin's there, and there's a whole layer below that's attached.
• 19:18
  SPEAKER_00: When this is healed, it's healed like this.
• 19:20
  SPEAKER_00: So it's just skin, skin, and then the abdominal wall fascia is there.
• 19:23
  SPEAKER_00: So there's not that that buffer layer that's in there.
• 19:26
  SPEAKER_00: So that won't typically go away.
• 19:28
  SPEAKER_00: Now, people would say, well, I've I'm I'm doing cupping, I'm doing massage, my physical therapist is working on this, all this stuff, and like it doesn't go away completely.
• 19:36
  SPEAKER_00: I mean, it's it won't just disappear because there's a void of tissue and scar there.
• 19:40
  SPEAKER_00: And so we can do this in a lot, you're right.
• 19:43
  SPEAKER_00: A lot of times we'll add this on as a little additional procedure.
• 19:45
  SPEAKER_00: Sometimes it's a focal procedure where you just literally excise that area, excise that valley, and then when we close it, we close it almost in a in the opposite orientation where you close it kind of heaped up just a bit so that when it comes down and relaxes, it's flush and that deep tissue is connected there.
• 20:01
  SPEAKER_00: But that that's a really interesting thing to do, and has pretty much no real downtime.
• 20:07
  SPEAKER_01: And it's you're basically using the same scar that a patient already has, maybe a little longer, so we can cut everything out, and you take care of the problem.
• 20:15
  SPEAKER_01: Success rates are super high.
• 20:19
  SPEAKER_01: Patients are over the moon ecstatic about it, and a lot of people don't know that that can be done.
• 20:23
  SPEAKER_00: Totally.
• 20:24
  SPEAKER_00: Yeah, you know, and it it just goes to show that there it's like we we say this, I feel like a broken record that you know everybody's unique and all of our moms are unique, so they will likely have an interest in unique different things, and that basically anything can be done, and it's figuring out kind of what's the best situation for them.
• 20:44
  SPEAKER_00: And then also like planning.
• 20:46
  SPEAKER_00: I would say, you know, one thing we should we can talk about before we close out is this idea of like when is the right time?
• 20:52
  SPEAKER_00: Like, when when should they do this?
• 20:54
  SPEAKER_00: How do they figure out what's the right time?
• 20:56
  SPEAKER_00: How much help are they gonna need?
• 20:58
  SPEAKER_01: Well, I mean, I think there's a couple hard fast rules, right?
• 21:01
  SPEAKER_01: Without a doubt, that we we can go ahead and cover.
• 21:04
  SPEAKER_01: If if a mom is still breastfeeding, you know, you need to hold off on that three to six months before you end up doing breast surgery.
• 21:11
  SPEAKER_01: So that's that I think that's a hard fast rule that you know most surgeons ascribe to.
• 21:15
  SPEAKER_01: The second one's weight loss.
• 21:17
  SPEAKER_01: Um, we kind of want you to be at kind of your your steady state weight where you're gonna want to live.
• 21:22
  SPEAKER_00: If you're we don't necessarily care what the weight is.
• 21:25
  SPEAKER_01: No, I people always say ideal weight.
• 21:27
  SPEAKER_01: I really don't care about the ideal weight.
• 21:29
  SPEAKER_01: What I don't want to see is fluctuations of weight.
• 21:31
  SPEAKER_01: I want to be at a steady state for a period of time, then I'm okay with you doing surgery.
• 21:37
  SPEAKER_01: And I think another one is this one's not a hard fast rule, but it's one to consider is are you done having kids or not?
• 21:45
  SPEAKER_01: Right.
• 21:45
  SPEAKER_01: Right?
• 21:46
  SPEAKER_01: Uh you know, uh you've already had two kids, you're contemplating in a third.
• 21:49
  SPEAKER_01: Do you go do surgery or do you wait?
• 21:51
  SPEAKER_01: Or, you know, and that's a topic in of itself.
• 21:54
  SPEAKER_01: But I I think the first two are pretty kind of you know, hard, fast rules.
• 21:58
  SPEAKER_01: The third is something heavy.
• 22:00
  SPEAKER_01: Hey, you need to have in the back of your mind to think about before you go down this road.
• 22:03
  SPEAKER_00: And how about um what should they do to prepare?
• 22:06
  SPEAKER_00: Like what do they need to think about from a logistics standpoint?
• 22:08
  SPEAKER_01: Yeah, I mean, you you got a couple of things to worry about, right?
• 22:11
  SPEAKER_01: You have to find somebody who can take care of you post-operately because that first week to 10 days is is rough.
• 22:17
  SPEAKER_01: I'm not gonna lie.
• 22:18
  SPEAKER_01: I mean, depending on the the type of surgery you do, if it's just breast surgery, a little bit of scar stuff, relatively easy recovery.
• 22:25
  SPEAKER_01: But if we're doing, if you're talking about a full tummy tuck with muscle placation, big surgery, big recovery, you need you're gonna need some assistance for that first week to 10 days.
• 22:34
  SPEAKER_01: So think about having somebody to help you figure out what your home situation's like.
• 22:39
  SPEAKER_01: Does your spouse work?
• 22:41
  SPEAKER_01: Um, can your spouse be home with you?
• 22:43
  SPEAKER_01: Who's gonna help with the kids?
• 22:44
  SPEAKER_01: Um and I I'll tell you, you know, those are important concepts to think through.
• 22:50
  SPEAKER_01: So timing is really important.
• 22:52
  SPEAKER_01: So think about that before you actually schedule surgery, right?
• 22:55
  SPEAKER_01: Do you have any other big ones that you like to talk to patients about?
• 22:58
  SPEAKER_00: No, I think I think it's um I think if they're thinking about this, I think it's it's always a good idea to to come in and talk it out with us, have a console.
• 23:08
  SPEAKER_00: I'm not I don't I think that it's always good to just kind of prepare and understand kind of what it's gonna entail.
• 23:14
  SPEAKER_00: The other is I would tell I I want to tell patients is you know, if they're you know, whoever's gonna be taking care of them or their spouse or family, they can come in too, so they can understand the gravity of the situation, understand the situation.
• 23:26
  SPEAKER_00: And then also um a little bit about like kind of how how going over practical things like you know, making sure they know like when how when they can pick up their kids, when they can drive, when they can sit for long periods of time.
• 23:39
  SPEAKER_00: How they're gonna sleep, that's how they're gonna sleep, right?
• 23:42
  SPEAKER_00: And then other strategies, you know, when we're around so many patients, and you know, if you deal with family members who've had this, you know, like the real deal, like you know, you what kind of recliner you need, when you need a walker, when you need X, Y, and Z.
• 23:54
  SPEAKER_00: Um, and I think that those are really important.
• 23:57
  SPEAKER_00: And the other is like getting them actually to talk to other real patients.
• 24:01
  SPEAKER_00: You know, luckily we have a lot of patients who are who'll who will vouch for us and talk about kind of their experience.
• 24:07
  SPEAKER_00: Um but I think this is one that you know it takes a little bit of planning, it's very important, it's a big deal thing.
• 24:12
  SPEAKER_00: We take it very seriously.
• 24:14
  SPEAKER_00: Um you know, at the end of the day, I tell patients, and I'm sure you feel the same way, like we care more about their outcome than they do.
• 24:22
  SPEAKER_00: It's it's so, so important.
• 24:23
  SPEAKER_00: And so we don't take any of this lightly.
• 24:26
  SPEAKER_00: Um, you know, obviously from the standpoint of um we want them to be happy, but we also want them to get back to their normal and be the incredible people that they are for their families, for their spouses, for their workplace environment.
• 24:39
  SPEAKER_00: And so it's it's a it's a big deal thing, and I we're lucky, I'm lucky to have such incredible women surrounding us and getting to take care of them on a day-to-day basis.
• 24:50
  SPEAKER_01: Is not dissimilar to you know the the the delivery process and the post-delivery process in regards to the fact that you know women get pregnant.
• 25:01
  SPEAKER_01: There's a lot of research done on pregnancy, how the how the pregnancy part will go, um, how the delivery part will go, and then there's the aftermath of the the baby, right?
• 25:13
  SPEAKER_01: And then they're like, oh my god, what just happened to me, right?
• 25:16
  SPEAKER_01: And and similar is having surgery, right?
• 25:20
  SPEAKER_01: Like you do all this preparation in regards to all right, I'm having surgery, I'm doing all my homework, is this the right surgery in the right place?
• 25:27
  SPEAKER_01: Am I getting the right procedure?
• 25:28
  SPEAKER_01: You have the procedure, and then you're like, oh my God, the yep, here it is.
• 25:33
  SPEAKER_01: And I and I know you think the same way, it's like recovery is is just as important.
• 25:38
  SPEAKER_01: And like we're really big on making sure that they have access to us, they have access to our team, that they have access to all our recovery tools that we have here, um, all our nursing staff, because that's a big part of this, right?
• 25:51
  SPEAKER_00: And you know, the other thing too, you're you're you're alluding to, I think, but if not, I'll bring it up, is the when people have when women have kids, there's this postpartal blues.
• 26:00
  SPEAKER_00: There's 100% post-surgical blues.
• 26:02
  SPEAKER_00: And it's it's a normal phenomenon.
• 26:04
  SPEAKER_00: And so for patients to understand that going into it, but then also for family members to know that too, so that they they know that like this is this is going to happen, and it's a common thing.
• 26:14
  SPEAKER_00: And I always tell patients when they have this, it's like you know, you're gonna get have this done a day or two, and your your maximum swelling is gonna set, and you'll be uncomfortable and be like, Oh, why'd I do this?
• 26:20
  SPEAKER_00: And you look down, you'll be like, Okay, I did it because I look awesome, and it's gonna get better.
• 26:24
  SPEAKER_00: But but there is that that happens.
• 26:27
  SPEAKER_01: There's a nice love-hate relationship, like you're really excited, sure.
• 26:31
  SPEAKER_01: You know, day one, day two, you kind of don't know what's going on.
• 26:33
  SPEAKER_01: You're like, oh, you expect that it it's really around day four to seven that you're like questioning your sanity and and going, Oh my god, did I do the right thing?
• 26:43
  SPEAKER_01: Right.
• 26:44
  SPEAKER_00: And a lot of times it's because you have to be idle, you're not doing all your normal stuff, and like once you kind of immerse yourself back into like life, it's actually better.
• 26:53
  SPEAKER_01: You and I both have to have had surgery, and I'll tell you, it's tough, and you know, it helps you empathize a little bit with patients and to know what they're going through.
• 27:03
  SPEAKER_00: Yeah, crazy patient.
• 27:04
  SPEAKER_01: And emotionally, it's it's a roller coaster, right?
• 27:08
  SPEAKER_01: It's a it's in a it's it's definitely a roller coaster.
• 27:10
  SPEAKER_01: And just you know, lean on your team and the the staff and the docs to be there for you.
• 27:16
  SPEAKER_00: Well, we appreciate everybody listening.
• 27:18
  SPEAKER_00: Um, mommy makeovers are really uh a tremendous amount of fun, they're super satisfying to us.
• 27:23
  SPEAKER_00: Um, any questions that you have related to this topic, please hit us up at any time um via our social media platforms and please tune in to our podcast going forward.
• 27:37
  SPEAKER_01: Thank you for listening to HKB Uncut.
• 27:40
  SPEAKER_01: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 27:44
  SPEAKER_00: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.