Latest / Alabama The Beautiful: The Eastern Shore Cosmetic Surgery Podcast / Body Lift: What Recovery Really Looks Like, Week by Week
Transcript
- Dr. Gardner (00:00): Get behind the wheel of your car with it turned off. Pretend a little kid pulled out in front of you on a bicycle, practice slamming on the brakes, look right, look left. If you're uninhibited by pain or discomfort and you're off narcotics and anything that'll cloud your focus for more than 24 hours, then I think it's reasonable for you to be able to start doing some driving. Dr. Koehler (00:19): Were you the safety officer in your class when you were in school? Dr. Gardner (00:23): I was a boy scout, but yeah. Announcer (00:28): You are listening to Alabama the Beautiful. Kirstin (00:31): I'm Kirstin Jarvis and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler and Dr. Gardner. Dr. Koehler (00:39): Hey. Kirstin. Dr. Gardner (00:39): Hey, Kirstin. Kirstin (00:40): All right. Today in the hot seat is Dr. Gardner. We are going to talk about body lifts. And we know that a body lift is one of the biggest transformations in cosmetic surgery and one of the biggest recoveries, but what the road really looks like from surgery to six months out is what we're going to talk about today. So life after a body lift. Dr. Gardner (01:04): Got it. Kirstin (01:06): Okay. So let's talk about the first week. Now that we've had our big surgery, everything's handled. This is a major operation. So what does the first week of recovery really look like? Dr. Gardner (01:19): I mean, I think the first week is a lot of soreness, maybe some bruising, swelling. Those are kind of the garden variety problems that any procedure's going to have. They can be accentuated a little bit just because the incision goes all the way around. We are disrupting lymphatics. And so as long as, again, you're following our post-op routine, most people do fairly well, plus the addition of our new painkiller Journavx, which is a non-narcotic. We've seen significant, I would say, or not significant, but improvements in how people feel. And plus they're not having to take narcotics. We're not worrying about constipation as much, but that first week can be kind of rough. Again, we do everything we can to mitigate that post-op pain on the front end by doing pain blocks to the abdominal wall intra-operatively. And I think that helps quite a bit. But yeah, patients are going to be up walking the day of surgery that night, right? (02:21): Because everything we do post-op is to decrease problems such as risk of blood clot, risk of pneumonia. And just by being up and walking, you're going to mitigate those risks. So that's the first week. Soreness, you will be walking, eating kind of light, I say the first couple of days, just because some people can have some issues with post-op nausea from the anesthesia. But the first week is not terrible, but it really depends on the person. Everybody's created differently and some people just tolerate things a little bit better than others. But yeah, I think patients still tend to do really well that first week. Kirstin (03:02): Do y'all both have the same protocol as far as garment wear and recovery in the first few days? Dr. Gardner (03:09): Yeah, our protocols are standardized. They're really the same. Maybe there's a few little nuances here and there, but by and large they're the same because again, we want to take away questions, frustration. And if you've got two different protocols, sometimes it can be a little bit difficult to navigate. So we want consistency across our nursing staff as well as all the post-op care. So we try to keep it consistent. So we like binders initially post-op. At some point you'll change to what they call a FAHA or a more of a fitted type garment that you can shimmy into, but that really comes after the drains come out. Yes, sir. Typically our drains, if we're doing a full body lift, I like to put one on each side of the posterior incision, basically where the buttock flap is. And then I typically put two on the front. (04:03): So there's typically three to four drains after a body lift, and they can come out whenever that output drops. So that might be a week, it might be a little bit longer than that, but we try to get them out as quickly as we can. Kirstin (04:17): So weeks two through six, when everything is kind of slow and you're kind of steady, what does a week by week progress look like through the first six weeks? Dr. Gardner (04:29): There's probably not a whole lot to see for most people. I will say once the drains come out, people just feel like a different person till it really tends to motivate them. So if we can get those drains out in the first week or two, then most people are feeling pretty good by then. But your activity's going to increase. Now, the big thing is not doing heavy lifting, straining, or vigorous activity. And that's because we're going to sew those six-pack muscles back together or do what we call a rectus plication. And by doing that, it's pretty uncomfortable. When we put big stitches in muscle, it pulls, it tugs, and every time you move or try to get out of bed, most people will feel that. Some again more than others, but most people still do really well. So I don't want to try to instill any fear into a patient. (05:19): I mean, I had a patient that, I don't know, recently that I thought was going to be a little bit, I was a little worried she might be a little wimpy post-op, but she did fantastic, took very little pain medication and honestly just sailed right through everything. So I always think, well, maybe I can tell who's going to do what I can't. And that's just an individual thing. Patients really, the ones you think are not going to be very tough post-op, they surprise you. But yeah, I mean, I know it seems like a scary surgery because it's a big surgery, but again, patients just tend to do well. And like I said, with the addition of this new pain medication, we're seeing some really good recovery or easier recovery post-op. Kirstin (06:05): What does the timeline look like for going back to work or driving or working out? Dr. Gardner (06:11): Yeah, so driving, I let patients go back to driving typically when they're off narcotic pain medication or Valium or anything that might affect them. Muscle relaxers can affect people as far as their mental awareness. So once you're off the medications and uninhibited by pain or discomfort, meaning you don't want to be a distracted driver. So if you're driving and all of a sudden you feel a twinge, you turn a little bit and you feel a twinge in your belly and it kind of causes you to maybe lose your focus for a second, you don't want to be driving. So once you're uninhibited by pain or discomfort, off narcotics or anything that might cloud your sensorium for more than 24 hours, I think it's reasonable to start doing some driving. Typically, that's going to be about a week to 10 days after surgery. I don't know what that's going to mean now that we've switched over to this non-narcotic post-op. (07:08): Patients may be able to drive a little bit quicker, but the key is safety, safety, safety. Again, you don't want to be a distracted driver. And so I always tell my patients, get behind the wheel of your car with it turned off. Pretend a little kid pulled out in front of you on a bicycle, practice slamming on the brakes, look right, look left. If you're uninhibited by pain or discomfort and you're off narcotics and anything that'll cloud your focus for more than 24 hours, then I think it's reasonable for you to be able to start doing some driving. Dr. Koehler (07:37): Were you the safety officer in your class when you were in school? Dr. Gardner (07:41): I was a boy scout, but yeah. Dr. Koehler (07:44): Hey, one thing I just thought I'd bring up because I've seen it so many times and I've gotten to the point now where I just pre-warn the patients ahead of time because inevitably I'll see people back, it'll be six weeks after surgery and they all say, "What's going on with my pubic area?" And they feel like they got a sock stuffed in their pants or something like that, that they've had a sex change or something like that. They're so full down there. And I always say, "I promise I didn't make it any bigger." But there's swelling. The gravity pulls it down to that area and it sort of stops in the pubic area. And so that goes away. I don't know how you tend to tell people, but I tell them, "Get ready for it. You can ask me in six weeks, but I'm going to tell you right now, it's normal." I always like to tell them ahead of time because I got that question so many times. (08:37): I'm like, "Oh man, I just got to tell people because it does go away, but it takes several months to resolve." Dr. Gardner (08:43): Yeah, I agree 100%. I remember in residency doing inguinal hernia repairs and you get a little bleeding. Next thing you know, gravity pulls everything down and guys' testicles are turning purple and swelling. And same thing, they're wondering what in the heck's going on. They're wearing two jock straps to try to keep the swelling down. So fortunately we're not dealing with that, but you're right, gravity always works. It pulls everything down. And so sitting on top of that tummy tuck incision tends to swell more. And like you said, the pubic area. And it can be quite impressive. So yeah, get ready. Kirstin (09:22): Let's talk about scars. Dr. Gardner (09:24): Love it. Kirstin (09:25): The trade. It's the big trade that everyone knows about and signs up for. So with a body lift, there's one big scar essentially. How do you set that expectation before surgery? Dr. Gardner (09:38): So it's a great question. We talk a lot about this pre-op because again, you're going to see me at the initial consult, the pre-op visit, the morning of surgery. So we get several times or several chances to discuss all this, but scarring is inevitable with any kind of surgery. The good news is that most patients that have lost significant weight or want a total body transformation, they're very accepting of scars. Now that doesn't mean that we're going to try to give you as many scars as we can. And I've had some people online that kind of push back against this and saying, "Those scars are terrible. Nobody wants those scars." Well, beg to differ. If you lost 100, 150 pounds and you're trapped in a whole bunch of excess skin, and every time you go to the gym, you're wearing two spanks, you're usually going to be very forgiving of scars. (10:33): And I've had people cry on me post-op just because post-op day one when we see them back, and it's because they look in the mirror and they're like, "Oh my gosh, where's all that skin?" And they just get so excited to the point that it becomes emotional sometimes. So I would argue that patients can be very accepting of scarring if they get the shape that they want and they get rid of that extra skin that's driving them crazy and has been for years. So those are the keys. The other thing is I talk a lot about post-op taping and compression. And if you will tape and wear good compression, you are going to have a much better scar. So I preach that. I have them buy the tape. I show them how to put it on and we change it about once a week. And that's the nice part is it's not like you're changing tape constantly. (11:23): It's literally once a week. I just saw my thigh lift patient today and I've been seeing her weekly. And I don't do that for a lot of cases, but sometimes if I've got somebody who I'm kind of handholding a little bit and I changed her tape again today and I showed her how to do it and she's going to tackle it from here on out, but she's done really well, but the taping makes such a difference and I just can't hit that home enough. Tape and compress. Get rid of the swelling as quickly as you can. Lymphatic massage. Those are, I think, the three things. Tape, compression, and lymphatic massage. And then protein. So let's say four. Eating adequate protein and taking care of yourself post-op. Kirstin (12:06): Okay. When does this swelling settle enough to see the real contour of your new body? Dr. Gardner (12:13): So some people, well, again, depending on how much we're doing, meaning if we're doing a lot of liposuction, you're going to see in a media with that one week visit, when you take that binder off, you're going to see some definite improvement. But that what I call microscopic swelling. So I say there's macroscopic with the big swelling, microscopic, the small swelling. It takes months and months and months for that to go down. So I always say, if you're going to have, let's say we did a Lipo 360 and we do a lot of lipo. I tell patients, it's going to be six months until you see what I would call the final result, and maybe even nine months. Meaning that the macro swelling has gone down in weeks to maybe four to six weeks, but that micro swelling, it takes another several months. So four to six months, you're going to see most of that gone. (13:02): But I always tell people it takes up to a year to see the final result, meaning gravity's going to have some say in this and we have to see where you are with skin laxity. But yeah, once the swelling goes down, you're going to see that probably in six months. Kirstin (13:17): What about tightness and numbness? What's normal and what kind of fades on its own? Dr. Gardner (13:24): So tightness and numbness, we want it to be really tight at first. If post-op day one, you're pretty loose, that's not a great sign, especially if you have massive or post-weight loss skin where it's been stretched out and there's no elasticity and the collagen shot and you got a lot of stretch marks. So I like to see that tightness. And again, what I would call appropriately tight, right? Because too tight, we can worry about skin necrosis and widening of scars, those kinds of things, but it's got to be pretty tight. If it's not, then I think we're going to have more issues maybe with needing to maybe take some more skin down the road. But yeah, that's what I would say. Kirstin (14:04): Okay. Dr. Gardner (14:05): Tightness is good. It's going to get better. It's going to relax, but time heals everything and it just takes time in a lot of these situations. Kirstin (14:14): Okay. Six months and beyond when your life is now changed. Once they're healed, what do people say about clothes and movement and comfort? And how do results hold up long-term? Dr. Gardner (14:29): I think they hold up really well. I mean, again, everybody's different. I will say this, a lot of patients. Now, let's say you've got somebody that's lost a lot of weight, over a hundred pounds, but they still have some to go. One thing that I do notice is once we get a lot of that initial skin off, it's kind of a jumpstart. And you might see them even lose more weight, another 20, 30 pounds, and that's going to affect their final result because that weight matters. And not that they necessarily have to have something done, but I have seen that where they come in, yes, they've lost a ton of weight and we take off a bunch of skin. All of a sudden they see this new body in the mirror and they have almost this renewed sense of, all right, I'm going to knuckle down and lose this extra little bit that I have. (15:20): And again, they may do that, they may not, doesn't matter to me. We just want them happy. But that's the thing that I do see is sometimes it's a jumpstart. You might even lose a little more weight, which could cause some skin laxity, but that's okay. We can always come back and deal with that. The other thing I see is patients will maybe start a GLP-1. Maybe they hadn't been on one. We did some skin surgery. They get motivated. They hop on a tirzepatide or a semaglutide and they lose a little bit of weight. And so it's never a bad thing. Kirstin (15:53): Yeah. So if someone is staring down a recovery that's this big, what makes it worth it? Dr. Gardner (16:01): Oh gosh. Well, I mean, in fact, I don't know the last time I had somebody say that it wasn't worth it. Even the patients that might get some minor complications, like a little wound problem or something like that, they're still happy. And when you can see, and if you follow us and you see the pictures of the skin that we show, it's amazing how much skin we remove in some of these surgeries. And patients are just happy. So I would argue that if you're on the fence about this and you're tired of wearing two or three spanks every time you go to the gym, and you're tired of rashes and things maybe rubbing together that shouldn't, thighs, arms, and you're limiting your wardrobe because of the extra skin, then take a chance. Be bold and do something for yourself because a lot of these patients, they haven't done anything for themselves. (17:00): They've always been kind of working for the family and doing this and that. And if you want, take some time, do something for yourself. And this is a big thing. It can be transformative. And you kind of trade one problem for another. You lose all the weight and now you just gained all this extra skin. And I've had plenty of people say that, that, "Hey, I lost this weight, but I gained all this skin and I really almost wish I was big again because then I wouldn't be dealing with all this floppy skin." And I think that's terrible because when you look at the health benefits from losing the weight, far outweighs, you're adding years to your life. It far outweighs the unfortunate, unhealthy effects of the metabolic syndrome that comes with being overweight. Kirstin (17:50): Yeah. Okay. Do you have a burning question for Dr. Koehler or Dr. Gardner or me? You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. Thanks Dr. Koehler and Dr. Gardner. Dr. Gardner (18:06): Thanks, Kirstin. Dr. Koehler (18:08): Thanks. Kirstin (18:09): Get back to making Alabama beautiful. Announcer (18:14): Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about Eastern Shore Cosmetic Surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @easternshorecosmeticsurgery. Alabama The Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.