Over the past several years there has been a hype over mommy makeover surgery, which is a combination of two or more procedures that improve the post-pregnancy body of women. However, a new trend is now emerging, which some surgeons dubbed as grandma makeover surgery.
According to a survey released by the American Society of Plastic Surgeons, patients aged 55 years and older accounted for 23 percent of the total cosmetic plastic surgeries performed in 2016. This means that last year alone, more than 387,000 procedures were performed in seniors, a 4 percent increase from 2015.
Eyelid lift, facelift, and forehead lift, all off which are facial rejuvenation procedures, were the most commonly performed surgeries on seniors. Nonetheless, body contouring surgeries such as tummy tuck, breast lift, and liposuction were also popular, according to the survey.
Contrary to popular belief, the patient’s chronological age does not increase the risk of postoperative complications, says leading Los Angeles plastic surgeon Dr. Tarick Smiley. However, he warns that patients over the age of 65 are more likely to suffer from certain conditions as compared to younger people.
In an attempt to ensure patient safety during grandma makeover surgery, Dr. Smiley highlights the importance of conducting lab screening and consultation to determine any risk factors, many of which can be eliminated or at least controlled through lifestyle changes and medications.
In general, the right candidates for grandma makeover, says Dr. Smiley, are healthy seniors who have realistic goals and expectations.
Another common safety protocol is to limit the operative time to four hours. A team of researchers at UT Southwestern Medical Center in Dallas, Texas, has suggested that after 4.5 hours of surgery the risk of complication could triple.
And after about seven hours, the risk of complications following a surgery increased 4.7 times.
Aside from the operative time, other independent risk factors include smoking and use of blood-thinners (aspirin and non-steroidal anti-inflammatory drugs) well in advance of the surgery. Hence, it has become a common practice among plastic surgeons to require their patients to avoid them 2-3 weeks before and after their operation.
Despite some of the challenges in grandma makeover surgery, a study involving patients who have had some type of facial plastic surgery has suggested that seniors scored significantly higher in satisfaction rate compared to younger people. The researchers attributed this result to the older patients’ more realistic goals and expectations.
Gynecomastia surgery results should not just look “flat.” First and foremost, great surgeons know the importance of eliminating all the surgical stigmata—i.e., nipple collapse, visible scars, and asymmetry—paving way for the most natural-looking appearance of the male chest.
The surgery is reserved for men whose overdeveloped chest is caused by the excess glandular tissue, which will not come out of liposuction cannula alone. Hence, it requires an excision-based surgery to flatten out the chest appearance.
But the caveat with the excision-based approach is the risk of visible scar, which can put off men who tend to be secretive about their plastic surgery, says leading Los Angeles plastic surgeon Dr. Tarick Smiley.
In order to achieve high patient satisfaction rate, Dr. Smiley highlights the importance of hiding the scar, which is done by placing it precisely at the lower border of the areola whose texture and color makes it perfect for concealing the incision site.
Meanwhile, the pictures below show a male patient who underwent gynecomastia surgery about two months ago. It should be noted that he has spent years exercising and eating healthy, which resulted in his great physique, except his chest that remained “full” and with its nipple pointing downward.
Just two months after this patient’s gynecomastia surgery and the scar has already healed nicely.
Due to the discordant appearance between his chest and the rest of his body, he was deemed as a good candidate for gynecomastia surgery. Furthermore, his well-tested commitment to healthy lifestyle would be the key to the preservation of his results.
It should be noted that gynecomastia surgery results are almost always expected to be permanent, although large weight gain and the use of anabolic steroids or certain drugs and supplements may affect or even reverse the surgery.
During surgery, Dr. Smiley was able to remove a large chunk of excess glandular tissue, which he first separated carefully from the overlying skin. Nonetheless, he left behind enough tissue to achieve a smooth chest contour.
The surgery demands precise tissue excision because over-aggressive removal can lead to nipple collapse and contour irregularities. After all, men in general are reticent about their plastic surgery and so all efforts are made to eliminate telltale signs.
Before and After Photos.
The safety of mommy makeover surgery is the utmost priority of any prudent surgeon. While it is true that combo procedures may pose some challenges due to the possibility of increased bleeding and higher surgical trauma, leading Los Angeles plastic surgeon Dr. Tarick Smiley says there are well-established parameters that promote patient welfare.
Mommy makeover surgery is any combination of body contouring surgeries designed to improve the patient’s post-pregnancy body. While it involves a highly customized approach, it usually combines some type of breast enhancement and tummy tuck.
This patient’s surgery involves tummy tuck and breast implant with lift, a combo procedure that typically takes 3-4 hours.
Dr. Smiley says that most combo surgeries involving the breasts and tummy are completed 3-4 hours, which is within the “safe operative time.” Medical literature has shown that the operative time is an independent predictor of complication, with one study concluding that after 4.5 hours of surgery the risks could triple.
The study, which was conducted at UT Southwestern Medical Center in Dallas, Texas, has also shown that after about seven hours, the risk of complication could increase by up 4.7 times.
Hence, a more extensive mommy makeover might be performed in stages to minimize risk of complications, as suggested by experts.
To further promote patient safety, Dr. Smiley highlights the importance of performing surgeries attended by a board-certified anesthesiologist, who not just administers the anesthesia, but also monitors critical life functions such as oxygen level, breathing, blood pressure, and heart rate.
Of course, the safety of mommy makeover surgery also largely depends on the attending plastic surgeons. With the proliferation of professional organizations and board-certifying bodies, Dr. Smiley says that the American Board of Plastic Surgery remains the “gold standard” as all its members have passed rigorous background check, training, and oral and written exams which they are required to take every 10 years.
He says that members of this prestigious medical board must adhere to strict rules specifically created to protect patient wellbeing and to promote safety. For instance, they can only perform their surgeries in an accredited operating room.
Unfortunately, most state laws allow any doctor to offer cosmetic surgery even if he has no specific training in such a highly niche practice. In fact, some podiatrists, oral surgeons, and obstetricians have been operating “beauty clinics” that offer breast augmentation and facelift, which is a detriment to public safety and health.
Some states such as New York even allow non-specialist doctors to perform cosmetic surgeries without being accompanied by a nurse or an anesthesiologist.
Hence, Dr. Smiley says that as a prudent consumer, one must verify his or her plastic surgeon’s certifications by the ABPS. Other reputable specialty professional organizations include the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.
And lastly, the use of innovative technologies and techniques has bolstered patient safety during combo plastic surgeries, says Dr. Smiley. One good example is the Cell Saver, a piece of equipment that collects red blood cells that are re-infused into the patient while still on the operating table and thus keeps blood loss to a minimum.
With more than one-third of the US adult population considered obese, over the recent years there has been an upsurge on the number of bariatric or weight loss surgery. While this a life-saving procedure, some patients remain dissatisfied with their appearance due to their large redundant skin and hanging fats that no longer respond to further diet and exercise.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says thigh lift is one of the most common requests of massive weight loss (MWL) patients, citing a survey showing that about 4,800 patients underwent the procedure last year alone.
This is an incision pattern used in outer thigh lift surgery.
According to a 2016 survey released by the American Society of Plastic Surgeons, about 55,200 MWL patients had some type of body contouring surgery.
Dr. Smiley says that post-MWL thigh lift is often just a component of a series of body contouring surgery due to the natural distribution of redundant skin that also affects the abdomen, buttocks, breasts, and upper arms. Oftentimes, the patients also develop a varying degree of sagging neck and jowl, he adds.
Meanwhile, he explains some surprising thigh lift facts:
- All efforts are made to hide the scar within the natural skin fold—e.g., groin and gluteal fold.
While a good surgeon will make every effort to create incision patterns in which the resulting scar runs within the natural skin fold, the scar length will still depend on the extent and location of loose skin. Hence, inner thigh lift for MWL patients entails a vertical scar on the inside of their leg that may even reach their knee.
- Outer thigh lift is often a component of lower body lift.
As a stand-alone procedure, outer thigh lift uses an oblique incision between the top of the leg and hip, resulting in a V-shaped scar pattern. But due to the natural diffusion of excess skin, occasionally the incision is extended across the circumference of the torso, leading to a belt-like scar.
With a lower body lift, the outer thigh, hips, anterior abdomen, and buttocks are simultaneously lifted and their contours improved.
- Most patients described their recovery after medial thigh lift “tough.”
Due to gravity and persistent swelling, the medial thigh lift incisions are susceptible to wound breakdown. In fact, it is not uncommon to have small separations in the incision, which mostly do not require a surgical closure although they can result in additional healing time.
In general, it takes three weeks for most patients to be able to return to work and another 3-4 weeks before they can gradually start doing more rigorous activities.
- Medial thigh lift is best performed separately from tummy tuck.
Tummy tuck often elevates the sagging mons pubis, while the inner thigh lift pulls down the skin to improve the contour of the leg. Due to the opposing tension, it is often ideal to perform them separately.
Over the past several years, plastic surgeons have been using a biological mesh that serves as an internal bra to hold the breast shape and maintain its “perky” appearance long term. However, some experts say that due to its flat or two-dimensional shape, its contouring effects on a curved surface such as the breast could be limited.
To rectify the inherent problem of flat-surfaced biological mesh, one company has released a three-dimensional scaffold called GalaShape. Unlike its earlier design, this new breast lift technique has a curved surface with a rim that closely resembles a bra cup, which can be easily wrapped around the breast and fixed to the tissue.
Photo Credit: galateasurgical.com
According to the company website, GalaShape is a biological mesh made of poly-4-hydroxybutyrate that triggers minimal inflammatory response. Thus, once positioned beneath the breast it triggers the body to create more collagen or scar tissue, which will hold the new contour of the breast.
It takes between 12-18 months before the biological mesh is completely absorbed by the body, leaving just the internal scar tissue to support the perky appearance of the breast long term.
The use of biological mesh, or any type of scaffolding or internal bra, is sometimes referred to as scarless breast lift technique because it only entails one incision that fades into the background—i.e., precisely at the border of the areola.
Despite the invisible scar, leading Los Angeles plastic surgeon Dr. Tarick Smiley says that scarless breast lift only works in patients with mild to moderate sag, which means that the areolar complex has not drooped way below the breast fold.
Should the areolar complex sag below the breast crease, Dr. Smiley says the traditional breast lift remains the best approach. This involves incisions around the areola, which then go down the midline and across the base of the breast, resulting in an inverted-T scar.
The traditional breast lift relies on soft tissue rearrangement to improve breast projection and shape. When done properly, most surgeons would agree that the use of additional materials like biological mesh is unnecessary.