Ok. If you have followed this blog line so far, you are aware that the last blog entry discussed the no-no’s of trying to regain your pre-baby figure and some of the things that the Hollywood starlets are rumored to have tried to achieve that goal. I ended that piece with a short note about how most Hollywood starlets really get that figure back: the hard old-fashion way of diet and sweat. Of course, most stars actually started watching their diet and shape even before they became pregnant and continued to watch their weight and exercised while pregnant. Very few starlets “let themselves go” during their pregnancies and therefore their recovery is easier and quicker. Of course, genetics does also come into play. But what happens when you have done all of the dieting and the exercise and there are still issues about your post-baby figure that you cannot seem to resolve? When is it time to visit the plastic surgeon?
First, there is no really hard and fast rule such as you must wait at least a year after having your baby before you can do anything about those post-baby changes. There is a lot of variability amongst women and how they recover after delivery-some “bounce” right back and others will take longer. It is not that one woman is a “slacker” and the other woman isn’t, it’s that every woman in an individual and are all made differently and will all heal and recover differently!
There are some treatments you can start very quickly after pregnancy. Things such as skin treatments to erase some of the pigmentation changes that some women get with pregnancy can be addressed very soon after delivery. Even if the mother is nursing, there are some options for decreasing melasma-often called “the mask of pregnancy”. Melasma is a facial pigmentation change that often occurs with pregnancy but also can occur due to medications such as birth control pills or hormone treatments. Some patients with melasma can start treatment as soon as they feel ready to start after delivery. When possible, treatments such as IPL-(Intense Pulse Light therapy)- or facial laser treatments such as the Active FX system can significantly reduce or even eliminate the facial pigmentation changes associated with pregnancy and sometimes birth control medications. These treatments are performed in our Medical Spa under our medical direction. Some other treatments such as topical skin care products may have to wait until the mother has stopped nursing to avoid any risks to her baby. Again, a consultation with one of the St. Louis Cosmetic Surgery Medical Spa staff can develop a program that fits the mother’s time schedule to correct the facial changes of melasma.
One of the most asked about issues is how to get rid of stretch marks after pregnancy? Here’s the bad news first, you can’t! Stretch marks are a ripping of the skin tissues from the inside towards the outside-just the opposite of a laceration which is a cut from the outside in and just like a laceration, you cannot completely avoid a scar but you can make it look better. If the stretch marks are very red and raised, you can use IPL-Intense Pulse Light-therapy to decrease the redness and speed the fading process of the stretch marks. I emphasize this point, DECREASE the stretch mark’s redness: not get rid of the stretch mark!!! Far too much money is wasted on phony treatments and procedures that promise to get rid of your stretch marks. They are a waste of your money, your time, and in some cases, your health as they may cause more harm than good. I have always said, the person who invents the cure for stretch marks will be richer than Bill Gates. So the goal with stretch marks is to decrease their visibility while understanding the limitations of the treatments available.
Moving on, what can be done about the tummy after pregnancy? Why is it that you can do hundreds of crunches, sit-ups, and follow every program offered on those infomercials and yet still have that lower abdomen pooch? The answer has to do with the anatomic changes that occur to the abdomen due to childbearing. Human females carry their babies anterior, that is they carry their babies in the front of their bodies unlike a female dog which carries its puppies laterally. Because the front of the abdomen has to expand and stretch to accommodate the growth of the baby, the skin and the muscles of the tummy are often stretched beyond the point they can rebound and retract back to their pre-pregnancy position. For some women, this process of stretching beyond recovery can occur after multiple pregnancies and with other women; it just takes one pregnancy to cause the permanent changes to their tummies. Remember, your parents told you life is not fair! When this situation occurs, often the recommended treatment is an abdominoplasty-commonly nicknamed a “tummy-tuck”. Sometimes liposuction alone can correct the changes due to pregnancy but if the lower abdominal fullness is due to the stretching of the abdominal wall and muscles or the abdominal skin has numerous stretch marks and laxity, liposuction will not be able to fully correct these problems. An abdominoplasty is a procedure that allows the plastic surgeon to tighten the abdominal muscles and wall and then remove the excess loose skin and fatty tissues. Short of a lower body lift, there is no other procedure that gives the precision and results of an abdominoplasty. Many patients ask about having a mini-abdominoplasty and to borrow a line from Dr. Peter Fodor, a past-president of the American Society for Aesthetic Plastic Surgery, “The problem with the mini-tummy-tuck is that not many women qualify for it!” Simply put, the tummy tuck procedure has to be tailored to fit each woman’s problems in order to get the best result possible. When patients ask me about the incision, I discuss with them my philosophy about tummy tucks: we are making a trade. We are getting rid of something that is difficult to hide in clothing and almost impossible to hide in a swimsuit or undergarments for something that can be hidden under most clothing, most swimsuits, and in most undergarments-thongs don’t count! I also remind my patients that their incision sites will fade and become even more difficult to see as time goes by. I used to say I was successful with a tummy tuck when my patients became a “tucker”-she tuck her shirts in and when the patient who told me that she would never, ever wear a two-piece swimsuit comes back to the office with the photo of her on the beach in her two-piece. Yes, we have even had some patients top that after their incisions have faded but I’ll let you figure that one out. The point is, in order to get the maximum result-which is what you want-you cannot compromise. Performing the wrong tummy-tuck procedure, one that is not tailored to the woman’s unique problems and concerns usually results in a more distorted tummy appearance.
Can you perform other procedures at the same time you have a tummy-tuck? The answer is yes for most women but of course this must be customized to fit every woman and her individual needs and concerns. I rarely perform a tummy-tuck without some liposuction of the tummy and love handle areas but again, it varies according to each patient which is the way it should be!
What if you are planning to have more children and have a lot of loose skin in your abdomen? For some patients, a “skin-only” tummy-tuck will be the answer but that is something to address with your plastic surgeon at the time of your consultation.
What if you have a tummy-tuck and then get pregnant? Can you successfully carry your baby? The answer is yes but of course, your OB-GYN will need to be made aware of your precious surgery and possibly make some adjustments to your pre-natal schedule. What will happen to your tummy afterwards? In some cases, the tummy does rebound well but in other cases, a revision of the tummy-tuck may be the correct choice.
This really just touches the surface about abdominoplasty procedures and a full consultation with a Board-Certified Plastic Surgeon is your next best step. At St. Louis Cosmetic Surgery, we have four Board-Certified Plastic Surgeons who can help you decide if a tummy-tuck is right for your “Mommy-Make-Over”.
Tummy-tucks are great procedures and most patients will tell me their only regret is that they did not do it sooner.
NEXT: Mommy-Make-Over’s and Breasts-is there hope?
Herluf Lund MD