The topic involving mommy makeover safety protocols is quite extensive and “hifalutin” and so leading Beverly Hills plastic surgeon Dr. Tarick Smiley has only focused on the most important issues, which he has explained on his recent Snapchat videos.
The celebrity plastic surgeon regularly posts videos and images involving different plastic surgery procedures on his Snapchat account and other social media platforms as a way to help raise patient awareness and safety.
(Note: Mommy makeover is a combination of body contouring surgeries that reverse the effects of pregnancy. Arguably, the most common “combo procedure” is tummy tuck with some type of breast enhancement, or liposuction.)
Dr. Smiley, a board-certified plastic surgeon who has performed thousands of mommy makeover surgeries, says the first step to ensure patient safety is to conduct lab screening.
The extent or “specifics” of lab screening may depend on the medical history of the patient; hence, no one should hide or omit any part of this critical information to avoid complications or less than optimal results.
Dr. Smiley says that after passing his lab screening, his board-certified anesthesiologist also conducts his own physical exam to further ascertain that the patients are healthy enough to sustain the surgery and its ensuing recovery.
To further ensure mommy makeover safety, he oversees his four surgery center facilities, all of which have been fully accredited by state health regulators. Accreditation means that they adhere to the strictest patient safety standards; are staffed by licensed medical practitioners; and follow the guidelines to prevent infection and contamination.
Even the ventilation systems of his four accredited facilities are designed to curb air-borne pathogens, says Dr. Smiley.
One of the challenges of mommy makeover or any multiple surgeries procedure is the increased bleeding. Hence, Dr. Smiley may use an equipment called Cell Saver, which is particularly helpful in large volume liposuction.
Cell Saver collects the red blood cells from the fluids removed during liposuction so these can be re-infused into the patients and thus no significant blood loss has occurred. Ultimately, they experience quicker recovery and avoid lethargy and dizziness, which usually follow after a multiple plastic surgery procedure.
Breast lift with tummy tuck is a common mommy makeover combo surgery. Because of the operation’s extent, this is only reserved for healthy patients who can handle the ensuing recovery, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted on his Snapchat account a case study involving a female patient who requested breast lift with tummy tuck.
The patient flew from Hawaii to have her surgery conducted by the celebrity plastic surgeon who performs over a hundred mommy makeover surgeries every year. (In one Snapchat video post, he revealed that he has already operated on more than 7,000 tummy tuck patients.)
The patient had large areola that aggravated the appearance of her drooping breasts. For this reason, Dr. Smiley recommended reducing her areolar complex to achieve a more proportionate, youthful result.
Using a cookie-cutter device, he delineated the new smaller areola by removing some of the dark-pigmented skin from its border.
After reducing the areola—ensuring that the resulting scar lies precisely at the dark-light skin junction to make it undetectable—Dr. Smiley then used vertical incisions between the nipple area and the breast crease to elevate the tissue, leading to a perkier appearance.
To further achieve impressive breast contour, Dr. Smiley placed incisions parallel to the breast crease; hence, the resulting scar lies precisely at the natural skin fold for its optimal concealment.
(Note: The overall shape of the scar resembles a nautical anchor, thus most surgeons call this breast lift technique as anchor lift.)
While the vertical scar of the anchor lift is in a more obvious location, Dr. Smiley says it generally heals and blends nicely into the background after 6-12 months. However, this is only possible with proper wound closure technique in which there is no or very little tension on the skin surface.
Aside from closing the wound in several rows to eliminate superficial tension, Dr. Smiley says he prefers absorbable sutures, which are known to promote favorable scars and are less likely to cause the appearance of “railroad tracks.”
After breast lift, Dr. Smiley proceeded to tummy tuck in which he used a hip-to-hip incision to remove the sagging skin and repair the abdominal muscle that had become separated due to pregnancy. The resulting scar has been made very low that the patient can wear a scanty two-piece bikini without any problem.
Overtime, the hip-to-hip tummy tuck is expected to fade and shrink almost to the width of a human hair.
Once the incisions from mommy makeover surgery are fully healed, Dr. Smiley recommends the use of silicone sheet and gel; the goal is to hydrate the scar and allow it to fade into the background.
Preparation for mommy makeover surgery is critical to achieve optimal results and reduce risk of complications. The idea is to help the patient reach her highest normal range of health, says leading Inland Empire plastic surgeon Dr. Tarick Smiley.
Mommy makeover is considered a “large” surgery because it typically combines two or more procedures in one surgical setting. Common combo techniques include breast augmentation with lift, tummy tuck with some type of breast enhancement, and tummy tuck with liposuction of the flanks.
While any body contouring surgery entails being near one’s ideal weight, drastic weight loss in the month leading up to the operation is greatly discouraged because of the ensuing malnutrition, muscle loss, and possible dehydration (due to low calorie diet), which can all affect healing.
If the patient is overweight, weight loss should happen gradually (just 1-2 lbs. per week) and is started way ahead of the surgery.
Following superb diet months prior to surgery can also make a huge difference in healing. A good rule of thumb is to increase protein consumption (it should account for 15-25 percent of the total calorie intake) and avoid or at least limit processed carbs and foods high in refined sugar, sodium, and fats.
Some doctors recommend supplementation about a month before and after surgery to ensure that their patients are getting enough iron, vitamin A, vitamin C, vitamin B12, and other micro-nutrients that play a critical role in healing.
Before taking any supplementation or herbal remedy, a prudent patient should always ask for her doctor’s permission first. It is important to note that some vitamins and supplements are known to increase bleeding or interfere with anesthesia or painkillers.
Aspirin, non-steroidal anti-inflammatory drugs, anticoagulants, and some antidepressants can also increase bleeding and aggravate the amount of postop bruises. The general rule of thumb is to avoid them 2-3 weeks ahead of the surgery and about a week afterward.
Smoking also has detrimental effects on healing. Not only it increases the risk of bleeding, infection, and skin necrosis, it also makes smokers susceptible to heart disturbances and lung-related problems following a surgery. For this reason, complete cessation for a minimum of three weeks before and after surgery is critical.
Lab screening is another important aspect of preparation for mommy makeover. It is ideally performed not later than 10 days prior to surgery to ensure the patient has achieved her optimal health.
Mommy makeover revision surgery becomes necessary because of three basic reasons: inadvertent pregnancy, significant weight fluctuations, and botched results from the initial procedure.
A mommy makeover surgery is any combination of body contouring procedures that generally focus on improving the appearance of abdomen and breasts, areas that are highly susceptible to the effects of pregnancy.
Leading body contouring expert Dr. Tarick Smiley says all efforts are made to avoid the need for mommy makeover revision, adding that it always starts with proper patient selection—i.e., the patient must be near her ideal weight and is done having children.
Nevertheless, “inadvertent” pregnancy and drastic weight fluctuations do happen, which can change if not reverse the results of tummy tuck, breast augmentation, and breast lift, which are the three most common mommy makeover procedures performed by the celebrity plastic surgeon.
Oftentimes, mommy makeover revision is possible provided that the patient’s weight has been stable for at least six months and/or she has fully recovered from the “trauma” of childbirth (it takes about 6-12 months); however, a longer waiting period is deemed necessary if one chooses to breastfeed.
It is important to note that the hormones that trigger the body to produce milk have some effect on skin elasticity or shrinkage; hence, the patient must wait at least six months after weaning, says Dr. Smiley.
All efforts are made to avoid additional scars in mommy makeover revision, so the surgeon would simply use the previous incision sites. However, some patients may have to accept a longer scar to achieve the optimal breast shape or to preserve the natural curves and contours of their tummy.
For instance, a patient who previously had a mini tummy tuck (its scar is typically 4-6 inches in length) but later gained weight or became pregnant may need her scar extended from hip to hip, which is the standard technique, to achieve a flatter abdomen and a narrower waistline.
Also, a patient who had a modified form of breast lift (less scarring) may have to accept the scars from the standard technique (it uses an anchor-shaped incision for additional lifting effect) if she requires a more extensive revision.
In the event of botched mommy makeover surgery, Dr. Smiley says it is of critical importance to wait at least six months before a revision is attempted. The idea is to wait for the skin to relax and the implants (in the case of breast augmentation surgery) to settle.
Performing revisions too soon is like “hitting a moving target,” hence the results are harder to predict, he explains.
Mommy makeover combination procedure aims to reverse the effects of pregnancy such as sagging breasts, barrel-shaped abdomen, and exercise- and diet-resistant fats. But to achieve long-lasting results, the patient should be near her ideal weight and is done having children.
While mommy makeover combination procedure performed in Los Angeles plastic surgery is highly individualized due to varying anatomies and cosmetic goals, most patients choose to combine some type of breast enhancement surgery (implants and/or lift) and tummy tuck.
The combination of breast enhancement surgery and tummy tuck makes sense: The patient will only pay for one anesthesia and surgical facility fee. Another bonus is that she will experience recovery just once.
Despite the benefits of mommy makeover combination procedure, it remains in the patient’s best interest to limit it to less than 4-6 hours to reduce the risk of complications related to bleeding, fluid imbalance, and high surgical trauma. This safety guideline applies to all elective surgeries.
While healthy young patients might be allowed to have breast enhancement, tummy tuck, and liposuction all at the same time, they might be required to have an overnight stay just to err on the side of safety.
Patients who need a great deal of work (e.g., full tummy tuck with flank liposuction and breast augmentation with lift) are generally advised to have their surgeries in sequence to avoid poor healing and increased risk of deep vein thrombosis or blood clots in legs that could travel to the lungs.
Full tummy tuck in itself is an extensive procedure that many surgeons suggest to only perform liposuction along the waistline once the patient has fully recovered from the initial surgery. However, the ideal approach and “timing” will depend on several variables such as the patient’s health, amount of surgical trauma, and operative time.
Breast lift and augmentation surgery are also routinely combined, although in some occasions it is better to perform them in sequence. This is particularly true for women with significant ptosis (droop) and/or there is a desire for larger implants.
Larger implants can lead to excessive tension on the breast lift incisions (around the areola, along the submammary fold, and vertically between the nipple and the breast crease), which ultimately affects healing. In this scenario, it is best to perform each surgery at least six months apart.
However, patients who want a conservative amount of augmentation and only require minimal lift can have combo procedure without having to worry about the increased risk of complications.
Mommy makeover breast augmentation may pose some unique challenges because pregnancy is known to cause breast involution—i.e., enlargement and eventual “shrinkage” of breasts after childbirth/breastfeeding. To a certain degree, this may contribute or result in skin laxity, empty-looking upper cleavage, and/or breast sagging.
The aforementioned side effects of pregnancy are more apparent in women who were unable to control their weight.
photo credit: canfieldsci website
Mommy makeover surgery is a general term used to describe any body contouring procedure whose aim is to reverse the effects of pregnancy. And because the breasts are particularly susceptible to physical “changes,” breast augmentation is one of the most commonly sought procedures to date.
Contrary to popular belief, breast augmentation is not only accomplished by placing implants to add more volume. It is also critical to reshape the breasts or address pre-existing condition such as sagging or deformity to achieve optimal results from the surgery.
As previously mentioned, pregnancy could affect the shape, projection, and appearance of the breasts. For this reason, experts at the California Surgical Institute highlight the importance of lengthy discussion and comprehensive physical exam to achieve results that will satisfy both the patient and her surgeon.
While not a “strict” rule, silicone implants favor a lot of patients seeking mommy makeover breast augmentation to compensate for their tissue or skin laxity, which makes them susceptible to visible rippling and palpability. These implants are filled with silicone gel that feels like the glandular tissue and fat.
Saline implants, meanwhile, are filled with water-like solution; hence, the risk of rippling and palpability is perceived to be greater. As a result, most surgeons only use them in women with sufficient soft tissue coverage (at least a full B cup) and will almost always position them beneath the chest muscle, as opposed to above this anatomical layer (with only the tissue and skin encasing them).
Should there is a true case of drooping in which the nipple falls at the level of or beyond the submammary fold, a simultaneous breast lift is performed with mommy makeover breast augmentation. This ancillary procedure reshapes the actual tissue with the use of internal sutures, instead of remodeling just the skin, which over time settles.
Sometimes, it is better to stage mommy makeover breast augmentation and breast lift; this is particularly true for women who need a great deal of work. The idea is to minimize tension on the skin and injury to the blood supply, leading to more predictable healing and better cosmetic results.