Repost of a wonderful article by a Mommy Makeover patient!

This is a WONDERFUL article written by a woman who has had a "Mommy Makeover" surgery.  

Although I wish I could boast about this being MY patient, it is not.  She is an excellent writer and I feel she sums up her experience in a lighthearted and sincere manner. 

However, I truly believe that anyone considering this type of surgery could benefit from reading this in order to help prepare for their experience!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

10 Things I wish I'd known before a Mommy Makeover

By JenBob

After getting a mommy makeover, I came up with a top 10 list of things I wish I knew ahead of time!

1. Guilty as charged.

As most moms do, I tend to put everyone else first. A lot of times that is why women tend to feel like they have lost their identities. It’s hard to spend that much money on yourself, especially for aesthetic reasons. It seems okay to spend it on a car or a trip, but for some reason the thought of spending that money on your body is frowned upon. To some that may seem vain or boastful. For me it was about a self confidence that I had yet to achieve, a love of self that I have longed for my entire life. When I look in the mirror I like what I see now. When I feel good about myself…inside and out…I am a better woman, a better wife, and a better mom. It is absolutely normal to feel guilty about spending money on a mommy makeover and it is okay to finally put yourself first. It is the best money I have ever spent…just ask my family.

2. What to tell the kids.

This was a big one for me. I am a mom of two young girls (5 and 2). I grew up with a horrible body image and the last thing I wanted was to implement that to my daughters. I was concerned about what to tell the oldest, the two-year-old really didn’t understand. I thought about saying, “Well, you and your sister ruined my body while I was pregnant with you both.” But then I thought maybe that was too harsh. (Note the sarcasm). I have tried really hard not to down myself in front of them, calling myself too fat, or commenting on my huge belly. They see me exercise and make healthy choices, but I didn’t want them to know that I didn’t like my body. So I tried to keep it simple. The day before surgery I told my oldest daughter that I was going to have an operation to fix my tummy (I didn’t go into the whole booby thing). She of coursed asked why, I told her because the doctor said so. I was prepared for more questions but she seemed satisfied with that. I was informed by the ladies on this site that the best thing to do with boys, if they are older, is tell them you are having female surgery. They will shut right up and have no more questions. Nothing is more embarrassing than talking female issues with your mom.

3. I’m a big girl now.

Most mommy makeovers include lipo and a tummy tuck. Which probably means you will be lucky enough to wear a skin-tight crotchless compression garment. I, as most women, chose to wear panties over this outfit so I didn’t feel as it all my “stuff” was being squished out. (Think of baboons….ewww, or don’t.) Now, the tricky part here is the first couple of days after surgery. You will spend quite a bit of time on the toilet the first time you try to pee, similar to what it is like after giving birth. After a couple tries, it gets better. However, when you are taking pain medication and muscle relaxers on a regular basis, your mind may be fuzzy a bit. I had the great luck of forgetting I had those panties on and peeing straight through them…twice. Yes, not once, but twice. I was starting to think I might have to revert back to diapers but I graduated and learned how to use the potty like a big girl. Also, you will probably not poop for several days at first, so expect a good 3-5 days worth of poop on your first time. With that being said, consider pulling your garment down for that endeavor. The back to front wiping thing can be tricky in that thing. I’m just saying, not that it happened or anything…..I’m just saying…okay…next subject please.

4. Hello Dolly!

If you decide to get implants please remember that objects may appear larger than they actually are. When I first took a glance at my new girls, I thought “Holy Mary Mother of God, what have I done?!” I looked like Dolly Parton, or for younger ones, Beth from Dog the Bounty Hunter. This is NOT your final look. Please don’t freak out. The swelling takes a while to go down and for the implants to “drop” into place. After about a week your PS will probably give you the go ahead to start massaging them. Massaging the implants will help them soften up and find their final resting place. Your significant other with love this, and surprisingly, so will you. I was shocked to find how much I actually liked touching my own breasts. It sounds perverted, I know, but if you are used to your “ladies” hanging out down by your belly, then you will see how nice it is to hold them, let go, and be fascinated that they no longer fall down so low anymore. I can now understand why men are always holding onto their own “boys”. They are proud of them. I have caught myself with one hand on the remote and the other on one of my breasts. So relax, and let the boobs fall where they may.

5. Phantom of the itch.

I knew going into the tummy tuck part of the mommy makeover that my belly would be numb. It is a freaky and strange feeling. It is almost like you are rubbing on someone else’s tummy. I had heard before about people who have had an arm or leg amputated and still felt the feeling of it being there, the phantom limb syndrome. I was not prepared for that with my belly. Every now and then, I will get an itch, go to scratch it, and realize it is where my belly is numb. Scratching a numb belly doesn’t relieve the itch. Simple right? Well I have a masters degree and it took several times scratching before I got that one.

6. Sit. Stay. Good girl.

Once again, most mommy makeovers include a tummy tuck. This is a huge procedure and as most of you have surely read, it is a good idea to take off as much time as possible from your job. I was fortunate enough to take 2 weeks off from my PAID position. I capitalize paid, because as all moms know, the mom position is considered a “non for profit” position. Rarely do we moms put in a request for vacation from that position, so therefore we tend to work every day of the year, even if we are taking a vacation from our “paid jobs”. As most moms, I am an expert at multitasking. It was killing me to sit there and not do anything. The first 3 days or so you have no choice, your body will not allow it. I will admit that I probably did more than I should have. Looking back, I wish I would have taken more advantage of the quiet time and rested and relaxed. I was convinced that if I didn’t do it, it wouldn’t get done, and it wouldn’t get done right. I was wrong. Trust your loved ones. My husband was amazing. He became Mr. Mom and was pretty darn good at it. I have never given him enough credit in that department. Granted, it may have not been done the way I do it, but he stepped up and took charge. And if you don’t have someone doing those household chores….so what. Just take this time for yourself and give your body a chance to heal.

7. All aboard...the Bi-Polar Express.

This is a BIG one. Having your body cut upon, stitched up, and hung up to dry is traumatic. Throw a few pain meds into the mix and you will turn into an emotional tornado. I was known to go from ecstatic to tears in 6.9 seconds flat. Top that!! Be aware that this will be an issue, and emotions will be crazy. Explain this to your loved ones and the people caring for you so they don’t call the men in white coats with the strait jackets. When I felt teary, I would cry. It’s ok, you have a permit to go crazy, take advantage of it. When I was feeling really down and out, I typically would go to bed and nap it off. Use this site. Realself.com is full of women who are going through the same thing. Use them to lean on and talk to. The ladies I have met on here have been A HUGE support to me and I couldn’t have gotten through this without them. Well, I would have, but I would have probably been divorced and sitting in a mental institution. Thanks Ladies!!!

8. Let's get physical.

Most people who are looking into plastic surgery are doing so because exercise has not been effective on certain areas of the body. There are only so many chest flies one can do before you realize they won’t make your boobies stand up and say hello. However, there are some who think this is the alternative to diet and exercise. If that is you….you are wrong. I truly believe my fitness level aided in my recovery time. And I know that I will have to work twice as hard to keep my new body looking tip top. The more active and healthy you are before surgery, the better your recovery will be. You will heal faster, feel better sooner, and be back to the gym before you know it. As you heal, stay away from processed and salty foods, soda, and fried foods. You will swell like the Stay Puff Marshmallow Man and be so uncomfortable. When your doctor says its okay, get back into exercising and let your body lead the way. It will tell you what is too much and when to quit.

9. Don't be naive: do the research.

When I decide to do something I go full speed, head first. In this case, you need to know what you are getting into. When I began this journey, I had no idea that there was a difference between a Board Certified Plastic Surgeon and a Board Certified Cosmetic Surgeon. Now, I will not step into the argument of who is more qualified; just know who you are dealing with. Ask around; find people who have used him/her. The doctor will give you referrals, but let’s face it; they are not stupid enough to give you someone who is unhappy with their work. If you know anyone who has had plastic surgery get as much info from them as possible. There will always be someone who is unhappy with a certain PS or procedure they have had done. But there is a HUGE difference between a “well, I just didn’t like his/her bedside manner” or “I just didn’t see a huge difference in my lipo” and the “he completely disfigured me”. Be wary of the flashy salesman. Go with your gut and ask LOTS of questions. The good ones will sit with you and take as much time as needed.

10. Avoid the Debbie Downers.

We all know one….the Debbie Downers, the buzz kill. And most of us will have to deal with a few after surgery. It is really hard when you feel that you don’t have the support from your loved ones. The choice to have a mommy makeover is strictly yours and hopefully you are doing this for you and only you. I have had a few family members of mine that I surprisingly haven’t received support from. It is hurtful, especially since they saw me struggle with my weight and self esteem issues for years. A lot of people will see it as a “waste of money”. I started feeling the need to explain my reasoning for having the surgery. I wanted them to know that it was not out of vanity, or selfishness. But remember the old saying “Those convinced against their will, are of the same opinion still.” It really doesn’t matter. As much as I wanted them to hear me out and understand my reasoning, they won’t. If they love you, they will keep their negative comments to themselves and support you no matter what. But you may have those who love you yet still feel the need to give their opinion even when not asked. My response to those people would be a nod and a smile. (Believe me, I know it’s hard) If you want, throw in a “please keep your negative comments to yourself” or a “if you don’t have anything nice to say…”. But my advice is to steer clear of the “screw you” sort of comment. It is just not worth it. As long as you know why you are doing this that is all you need. For me, being able to look in the mirror, smile and for the first time in my life, love what I see…well that is priceless to me. And for those who can’t see past the money or their opinions, they are missing out on watching someone they love transforming into the person they have always dreamed of being.

For more information or to ask questions directly about Mommy Makeover surgery, visit my website!  

Liposuction Q & A with Dr. Karen Horton

1. How soon will I see liposuction results?

The results of liposuction take at least three months, up to a full year, to be evident.  As with any surgical procedure, you can expect some swelling, bruising, numbness and discomfort that will take a few weeks to resolve.

Postoperative tissue swelling, known as "edema", tends to persist in the tissues that underwent liposuction.  Edema feels like firmness and woody texture to the tissue, sometimes with dimpling of the skin and/or a darker pigmentation.  This is entirely normal; edema is the body' s response to injury! (just like a "goose egg" swelling of the scalp with a bad fall). Initially after liposuction, you may in fact gain weight, despite the removal of a few pounds of fat!  This is again due to edema - the body holds on to extra water as part of its injury response.  

Do not weigh yourself for at least a few weeks after surgery, at least until after the bruising has resolved (2-3 weeks).  When bruising is gone, your healing will be well on its way.  You will notice your clothes begin to fit differently (better) after the first three months, and every single month you will notice subtle but significant changes. The results are permanent!

Remember to be patient after having any Plastic Surgical procedure!  Any type of surgery takes up to a year for every last bit of swelling and tissue edema to go away.  Plastic Surgery is an investment in your body.  You will need to continue your regular exercise regime (beginning at 3-6 weeks postop, or when you receive permission from your Surgeon), a nutritious and balanced diet, and healthy overall lifestyle. 

 2. What anesthesia is used with Tumescent Liposuction?

During liposuction, a fluid mixture commonly called "tumescent solution"containing normal saline (sterile salt water), epinephrine (adrenaline) and a local anesthetic (Lidocaine) is injected into the areas of fat that your surgeon has marked for removal before surgery.  Tumescent solution functions to help "puff up" the fat cells for suctioning, decrease bleeding and limit bruising, and to make the area numb both during and for many hours after surgery. 

After the tumescence is infiltrated, it is allowed to circulate for at least 10 minutes in each area.  This is to maximize the "vaso constriction" effect of the epinephrine (to shrink the blood vessels in the fat and under the skin, to help avoid their injury). 

The local anesthetic will keep you comfortable after surgery, although this is not the only method of anesthesia used during liposuction in most cases .Most of the time, you are also fully asleep under general anesthesia, or at a minimum under intravenous sedation so that you do not feel or remember anything during surgery. 

Next, through tiny "stab incisions" that are placed in natural creases of your body, a thin and blunt-ended wand known as a "cannula" is inserted to permanent suck out fat cells.  These incisions are later closed with sutures(stitches), a dressing is applied over each incision, and you are placed in a postoperative compression garment.  The purpose of the compression garments is to limit swelling and bruising, encourage skin contraction, and to keep you as comfortable as possible. 

3. Who can perform Tumescent Liposuction?

Liposuction is a surgical procedure, and should be performed by a specially trained Plastic Surgeon.  Most Plastic Surgeons have completed at least 5 years of surgical Residency at an accredited University, with an additional year or two of subspecialty training.  At least two years, and up to six of these years should be in Plastic Surgery for a Physician to call themselves a "Plastic Surgeon". 

In the United States, it is important to seek out a Board-Certified Plastic Surgeon who is credentialed by either the American Board of Plastic Surgeryor the Royal College of Physicians and Surgeons of Canada (equivalent licensing Boards).  Unfortunately, not all Physicians are Board-Certified. Another good resource is the American Society of Plastic Surgeons (ASPS)and/or the American Society of  Aesthetic Plastic Surgeons (ASAPS).  Entry to these professional societies is limited to Plastic Surgeons who have been in practice for a minimum number of years, are certified by their respective Boards, and are reviewed and accepted into membership by their peers. 

It is up to you, as the patient, to do your homework not only to learn about your surgical procedure, but about your potential Surgeon!  Board Certification is unfortunately not a requirement to obtain a medical license in the U.S.  In Canada and other countries, Board Certification is a rule; a Doctor cannot obtain a medical license without this certification. 

In addition, many non-Surgeons (Family Doctors, Internists, Dentists) or Doctors with other specialties (Oral Surgeons, Ear, Nose and Throat, OB-GYN)take a weekend course on liposuction and begin offering this treatment at a discounted rate to their patients.  Beware!  Just as you would not go to a foot specialist for open-heart surgery, you should not trust your body and your life to a practitioner who does not have the training and experience in the procedure you are seeking. 

Lastly, be cautious of the terminology "Cosmetic Surgeon", and certification and the like.  Nearly anyone can call themselves a "cosmetic" anything -most of the time, it means very little!  The American Board of Medical Specialties (ABMS) and the Royal College of Physicians and Surgeons of Canada (RCPSC) only recognize University-accredited training programs in Plastic Surgeon for certification. 

 Again, be cautious and take your time to research your Doctor the same way you would research your nanny, a new school for your child or a contractor for your home.  There is only one of you, and you are a very valuable commodity!  Be sure to put yourself in the hands of the best practitioner for the job. 

4. How safe is Liposuction?

Any surgical procedure carries with it potential associated risks, such as the risks of anesthesia, early risks of surgery, and late risks.  Safety is always the number one goal!  Most surgeries are performed in the operating room or an accredited out patient surgical facility with appropriate intraoperative and postoperative monitoring to ensure your procedure goes as safely and smoothly as possible. 

For liposuction specifically, possible early risks include persistent numbness of the surgical area ("anesthesia" of the skin) that can last weeks to months, pins-and-needles or electric shock sensations of the skin as the nerves are waking up ("paresthesias"), or sometimes unpleasant sensations("dysesthesias") as a temporary experience.  Bruising is common for at least 2-3 weeks after surgery, and swelling may persist for 3 months or more.

Potential late complications can include uneven contour of the skin or rippling, darker pigmentation of the treated areas, or asymmetries between sides of the body.  Differences between your right and left sides will likely be pointed out by your Surgeon preoperatively.  Although symmetry is always the goal, you may never be an exact mirror image from one side to the other - no one is! 

As long as the procedure is performed by a Board-Certified, specially trained Plastic Surgeon with a great deal of experience in liposuction, the benefits of liposuction usually far outweigh the risks.  You should also be healthy and physically fit enough to undergo surgery and have clearance from your Primary Care Physician before having any elective surgical procedure. 

 5. What areas are most common body regions treated with Tumescent Liposuction?

 Fat deposition is primarily based on genetics.  Every woman' s body is different, and your area is likely a little different from your best friend' s.

 

The most common areas of the body that are appropriate for liposuction are the lower abdomen hips, flanks (sides or "spare tire" area), inner and outer thighs, the upper neck beneath the chin , upper arms and the "butttockroll" (the area immediately below the buttocks). These regions are the trouble spots that most women (and some men) deposit fat and are stubborn to diet and exercise.

Areas that are not appropriate for liposuction include the knees, lower legs, ankles, lower arms, or the face (with the exception of the front of the neck).  These areas are not usual areas where fat is stored, and liposuction in these regions is risky for injury to nerves, tendons, blood vessels, and the skin. Liposuction is also not applicable to internal abdominal fat - the fat that is deposited around the internal organs.  It is also not a treatment for obesity or for weight loss.  Liposuction is for body contouring only! 

6. Can I have other operations with Tumescent Liposuction?

 Liposuction is commonly performed together with other procedures - for instance breast augmentation, breast lift or reduction, abdominoplasty, or a face lift.  So long as the total time under anesthesia is not excessively long (I limit my patients to maximum 8 hours of elective surgery). it is safe to have combined procedures with liposuction. 

 7. How does the Tumescent technique reduce risk of infection?

Vasoconstriction of the blood vessels may slightly decrease the risk of infection, as the blood flow to the area to be suctioned is reduced temporarily during the operation.  However, the risk of infection is very low as a baseline risk for liposuction.  Usually, a single dose of intravenous antibiotics is given immediately before surgery in the operatingroom.  Oral antibiotics are often continued for a few days after surgery to also prevent infection. 

Eat-Sleep-Plastic Surgery!

 

This is my new favorite T-shirt!  It sums up my life, from a day-to-day basis.

This picture was taken by one of my patients while I was doing rounds at the hospital one early morning.  

Cool T-shirts like this and other custom messages can be ordered at CafePress.com.

The Jakarta Post Article - The Brave New World of Plastic Surgery

I was recently interviewed by San Francisco freelance writer, May-lee Chai, for an article in the Jakarta Post, Indonesia.

Click on the images for a full-size version of this article on Plastic Surgery.

Research pays off when choosing a breast implant surgeon

When you are considering breast augmentation, be sure to research both the procedure and your surgeon extensively.

Learn as much as you can about the procedure using online sources (visit reputable websites such as the American Society of Plastic Surgeons (ASPS) or the ASAPS website) that do not feature only one surgeon, and that provide data on national statistics and safety issues.

Visit a surgeon who is experienced with breast augmentation, and is Board-Certified by either the American Board of Medical Specialties or the Royal College of Physicians and Surgeons of Canada (these are the only two Boards recognized by the American Societies for Plastic Surgery and Aesthetic Plastic Surgery).

Write your questions down for your surgeon, and ask to see before-and-after photographs of typical (not just the best) patient results. Ask to speak to patients who have had the procedure before.

Do your homework! Ensure you have found a good fit with the surgeon in terms of personality, office environment, and aesthetic goals for the procedure.

Karen M. Horton, MD answers: Sacramento Tummy Tuck doctor recommendations

Q:

I live in Oregon but I am spending 3 months with a friend in Sacramento. I have been searching the internet for a quality doctor in Sacramento, CA to perform a tummy tuck. This will be the biggest surgery of my life and I want quality work. Any success stories out there?

A:

2 seconds ago

By Karen M. Horton, MD - San Francisco Plastic Surgeon

A tummy tuck is a wonderful procedure and one of my very favorite operations to do!

For women who have completed childbearing, an abdominoplasty makes up the abdominal portion of a "mommy makeover".

For anyone considering surgery, my advice is always this:

Do your research and homework before deciding on a Plastic Surgeon!

The internet is often a good start, but word of mouth and referrals from other doctors is also a good source of information. Think about how you found your dentist, a realtor, your childcare giver, a plumber... You will be trusting your body to this person! Do your 'due diligence'.

Following your online research, visit a number of surgeons in person - bring a list of questions with you, and bring a friend to act as another listener and objective observer. Ask to see before and after photos - both of the best results, but average results. Ask to speak to former patients about their experience with the doctor.

There should be a "good fit" between you and the physician - in terms of personality, aesthetic goals for the procedure, office staff atmosphere, etc.

Often, making the trip outside your immediate area is worth it. If you don't find someone directly in your town, consider going to a larger cosmopolitan area for treatment. You will probably stay overnight in the hospital or surgery center after a tummy tuck, and you are usually seen 3-5 days after surgery in the surgeon's office for your first follow up visit.

I see many out of state patients for surgery. I recommend my out-of-town patients stay in the near vicinity (within a 3 hour drive) for at least 2 weeks before traveling home.

Best of luck to you!

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.

Women's Plastic Surgery featured in the CRAVE San Francisco publication!

See the CRAVE SF website for additional information!

Tips for finding a good Plastic Surgeon

From the LA Times, July 19, 2009:

If you're considering any type of cosmetic procedure, consumer watchdogs and medical organizations recommend you check up on your doctor first.

What's the best way to find a qualified surgeon?

According to Dr. Jean Loftus, author of "The Smart Woman's Guide to Plastic Surgery," the biggest problem with finding a qualified surgeon "is that as insurance reimbursements have gone down, the number of unqualified physicians who call themselves plastic surgeons has increased, so finding a plastic surgeon who's qualified is hard sometimes." Every doctor "is board certified in something," she added, "even if all they've done is a year internship after medical school.

"Here's the bottom line. . . . If you want to know that your plastic surgeon is properly certified, the meaningful question to ask is, 'Are you certified by the American Board of Plastic Surgery?' " [or the Royal College of Physicians and Surgeons of Canada? (these Boards are equivalent and are both recognized by the American Society of Plastic Surgeons)].

The ABPS (abplsurg.org) recommends you go to plasticsurgery.org or surgery.org (the American Society for Aesthetic Plastic Surgery). The status of a physician's license can be found at www.medbd.ca.gov, California's medical licensing board website. American Board of Plastic Surgery?

Let's say the doctor is certified by a Board of Plastic Surgery. How do you know that doctor will produce good results?

Said Loftus, "Anybody who's interested in plastic surgery should see somebody who perhaps performed surgery on somebody else they know who got good results and was happy with their care," Loftus said. In addition, "they should ask the doctor to speak to a patient who's been unhappy with their results. Any doctor will give potential patients the names of happy customers, but how does that doctor handle patients that are unhappy?"

How many doctors should a potential patient consult?

Loftus recommends patients interview two or three.

What about all these advertisements for $3,000 breast augmentations and other procedures that seem to be priced ridiculously low? Is there a way for patients to determine if corners are being cut when prices are so substantially reduced?

"It's tough," Loftus said. "On the one hand, you get what you pay for. On the other, you've got a lot of plastic surgeons seeing their revenues drop with reduced numbers of patients. Ask questions. Does the price include anesthesia fees and operating room fees? Both can add substantially to the cost of the procedure. In some cases they might be advertising just the surgeon's fee and leaving out the other fees."

-- Susan Carpenter

Ask The Expert - Breast Augmentation

Karen Horton, MD, MSc
Expert
Plastic and Reconstructive Surgery
California Pacific Medical Center

Dr. Karen Horton is one member of a unique all-woman Plastic Surgery practice in San Francisco. She specializes in breast reconstruction after cancer and cosmetic surgery for women.

She is one of very few Micro-surgeons performing state-of-the-art reconstructive techniques for the breast, including the DIEP flap, SIEA flap and TUG (inner thigh) free flap. Dr. Horton regularly performs “mommy makeover” surgery to rejuvenate the breasts and bodies of women who have completed childbearing.

Visit http://www.womensplasticsurgery.com/ for more information.

See Dr. Horton's profile

Question of the Week:

I’m considering breast implants. What should I look for (beyond board certification) in selecting my plastic surgeon?

Karen Horton, MD, MSc answered:

For any surgical procedure, you should do your homework!

This includes breast augmentation. Your Plastic Surgeon should be Board-Certified in Plastic Surgery. Remember that any surgery, cosmetic or not, is a major procedure!

Your Plastic Surgeon should get to know YOU. The doctor-patient relationship is very intimate, and your surgeon needs to know all about your past medical history, your home life, exercise schedule and your goals for surgery.

There should be a good “fit” in personality between you and your surgeon. If necessary, visit a number of doctors until you feel you have found the very best fit for you!

Ask to see before and after photographs, both of the very best results, and average results as well. Ask to see images of scars and make certain you understand what the healing period and expected down-time will be like.

Talk to other patients who have had the procedure you are thinking about. Your Plastic Surgeon can give you a list of names and phone numbers of their patients who have had surgery and who are willing to share their experiences – good, bad, and ugly – with you.

Aim to become an informed, educated and empowered patient, even before you have surgery! This will enable you to have the best possible outcome.