Mummy Makeover - II

Mum Makeover Part II – Interventional options

In Mummy makeover part I we discussed about some options of preventing problems & non-interventional options to get back to the pre pregnancy state.

Here in this post we shall discuss about the interventional options available and a few of the same.

For ease of understanding, let me divide them according the regions of involvement and the options.

Broadly we can divide the changes into:
1. Generalized skin changes.
2. Changes to the face
3. Changes to the breasts
4. Changes to the Abdomen
5. Changes to the hips / thighs

GENERALISED SKIN CHANGES:

Generally there aren’t too many changes that occur in the skin proper except for maybe more of dryness, cracking of the lips, and most importantly the “dreaded Stretch marks”.

Dry Skin:
As with any other reason for dryness, keeping the skin soft and supple is accomplished by using moisturizing & body lotions. Generally twice a day massages will help take care of this problem.

Cracked lips:
are problems especially during the later stages of pregnancy and early period post delivery. Same as with the skin, moisturizing with the use of lip balms and keeping yourself hydrated will go a long way in controlling this problem. Wetting the lips by saliva and biting them will only worsen the problem and also cause the lips to darken.

Stretch marks:
I wish I had a sure shot solution to this problem. If I did, I would be a millionaire in a few years. But, as I already mentioned in my previous blog on the same subject, the best way to treat stretch marks is to prevent them. But, am sure many of you are thinking that I’m the doctor here and I should be offering some solutions instead of saying it is untreatable. Well, there are a few options, but all have their limitations and none of them has a 100% success rate. This is because the stretch marks are due to breakage of the inner elastic dermal layer of the skin while the epidermis is still intact over it and all the treatments we have are external and aiming at promoting collages and scar deposition in the broken dermal layer of the skin.

The treatments work better in early stretch marks which are “pinkish or reddish” in appearance but not very promising in late established “white” stretch marks.

1. Chemical peels: there are various types of chemical peels which are basically long acting peels which promote collagen deposition in the deeper dermal layers of the skin. Some of the peels also tend to lighten the hyper pigmented areas, which are often associated in the stretch marked areas, which causes them to stand out more. By lightening the darker areas it helps camouflage the stretch marks better.

2. Dermaroller: This is an instrument, which works on the principle of “Microneedling” which basically means to puncture the skin with small micro needles so that there is no pain but the injury promotes collages synthesis in the deeper layers of the skin where the actual problem lies. This has shown decent results but it takes a long time for the results to be apparent. The procedure itself takes around 15 minutes to an hour depending the size of the affected area. The procedure is repeated every 4-6 weeks for 5/6 times..

3. LASER: Laser’s use the power of light to heat the deeper layers of the skin thereby promoting collages synthesis in the deeper layers. This works well in early stretch marks (pink stretch marks). Multiple sittings are required, at intervals of @ 4 weeks.


CHANGES TO THE FACE:

Most of the changes that occur during pregnancy like puffy face, dry skin and lips, are reversed post delivery. The most common change that stays on usually are pigmentation problems especially in the cheek area called “ Melasma”.

This is a problem that can be treated with a combination of peels, microdermabrasion and some skin lightening medication. But of course, skin protection from sun is an important part of the post treatment care.

As the hormonal status returns back to normalcy, the water retention and puffiness of the face also comes down. But gentle toning exercises help speed up the process.


CHANGES TO THE BREASTS:

The breasts and the abdomen are the commonest areas to bear the brunt of pregnancy. The most common problems following childbirth and breast feeding are, loss of breast volume, sagging breasts, stretch marked skin excess.

This is because during pregnancy the milk glands in the breast enlarge to replace fat in the breasts and post breast feeding involute to their original size. But, sadly the fat does not return to the breasts and if the skin has a lot of stretch marks, it does not shrink to the new reduced volume, causing sagging.

There are a few options when it comes to correcting these problems. If one feels comfortable with the size of her breasts when wearing a bra and is worried only about the sagging, she needs a “Breast Lift”. If she feels, the size in a bra is small, then an increase in volume is also needed, wherein a “Breast Augmentation or Breast Augmentation with Lift” is indicated.

1. Breast Lift (Mastopexy): This is a procedure designed to address the sagging glandular tissue of the breast as well as removing the excess skin. The basic procedure is the same, but many approaches like the classical “anchor incision”, “short scar vertical mastopexy” or a “circum areolar mastopexy” can be used. The gland is reshaped and suspended to the chest wall, the excess skin being tailored to the new breast mound to give it a proper shape.
Problems with a breast lift are usually a scar and the healing time. But apart from that it is a reasonably well tolerated procedure.

2. Breast Augmentation +/- Mastopexy: When the skin excess is not much, only an increase of breast volume in the form of an implant would suffice. In cases where the skin is in excess, augmentation using an implant is combined with a mastopexy. Here the augmentation is performed first and the breasts reassessed for residual sag. If present, the sag is taken care of by a mastopexy at the same sitting.


CHANGES TO THE ABDOMEN:

The abdominal changes are the most common and the most “visible” stigmata of pregnancy and childbirth.

The most common changes seen are loose flabby skin, stretch marks, fatty deposits, lower abdominal bulge and sometimes an upper abdomen bulge too.

The reasons for this have been discussed in the previous post “Mummy makeover- I”. Stretch marked skin does not contract and shrink, hence the loose flabby skin. Because of it the fat deposits stay and the loose muscles inside also contribute to the bulge.

The procedure to correct this deformity is commonly called the “Tummy Tuck” or an “Abdominoplasty”. There are two main variants to this procedure.

1.Regular Adbominoplasty: This is the classical method of correction of the problem. Skin excess is removed (the stretch marked skin below the level of the umbilicus), fat is sucked out with liposuction, the muscles are repaired and the hanging umbilicus, is repositioned to a normal position. This involves hospitalization for a day or two and a scar within the panty line, basically like an extension of the usual “Caesarean scar” but extending from one flank to the other. Simultaneously in selected cases the muscles can be tightened inside to bring the waist in also.

Usually there are drains left in after the surgery to drain out any excess secretions. These come out in 24-48 hours.

It is a common and well tolerated procedure, the main drawbacks being a long scar, though within the panyline. Getting back to routine activities takes around 3-4 days and regular normal work can be resumed within a week in normal circumstances.
Exercises can start within 2-3 weeks but abdominal exercises can be started only after 6 weeks. The patient has to wear a pressure garment (corset) for 6-8 weeks to help with swelling.

2.Mini Abdominoplasty: This is a variation of the regular abdominoplasty in the fact that skin excision is limited and there is no umbilical repositioning. But, liposuction and muscle repair are often needed. This is indicated when the skin excess is not much but there is muscle weakness. The scar is not as extensive as a regular abdominoplasty.


CHANGES TO HIPS / THIGHS:

Changes to the hips and thighs are usually related to weight gain. As mentioned in my previous posts, hips and thighs are genetically prone areas for weight gain in women. Pregnancy weight gain in this area is just an extension of the same. Post delivery exercising does help to get rid of this excess.

In case it cannot be done for whatever reason, then operative options are there in the form of a liposuction. Liposuction as mentioned in previous posts is a procedure to contour certain areas of the body by sucking out the excess fat using small 1cm cuts.


As you can see, many changes do occur during pregnancy leading to changes in the body, some temporary and some permanent. There are options to try and get the body to the way it was but maintenance is required.

As mentioned before, there are no short cuts. All the surgeries are procedures are aimed at bringing the body as near to as it was, but maintenance is required to keep it that way.

Also, as mentioned in my previous post “Mummy makeover –I”, many of these problems can be avoided by a little care during pregnancy and post child birth. So spread the word, pregnancy and childbirth doesn’t have to be so problematic for a woman.

Try and prevent these problems and if you already have them, most of them can be corrected. There is no reason for one to live with them, as there are “options available”!!!


Dr.Surindher

CosmesisIndia