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

Patient Talk- Post 1- Tummy Tuck

This was a feed back I got from a very sweet patient of mine. SO i thought I had to share with you all. And she even offered to talk to anyone who is contemplating a surgery.

I thank her for her kind comments. SO here goes.....She call's it...

Absolving the Ab

All my life, I had always been careful and particular about my appearance, though only to the point of looking well-groomed and neat. My self-esteem needed that and so did the job I was doing.

After my son was born, for ten years now, every morning, when I looked in to my wardrobe trying to decide what to wear to work, I would get in to a fit of depression. None of my favourite blouses fit well any more, my favourite trousers wouldn’t hide that bulge any longer. I am not fat as in fat, I was alright from the front but I hated my silhouette from the side as there was no hiding that tummy, the big fold of skin in the lower abdomen that no tights or body shapers could flatten. I would settle for clothes which were made of thicker firmer material, 2 sizes larger than what I should actually wear, desperately trying to hide the ab’s abnormalities.

I have been in to exercising for as long as I can remember, inconsistently yes, but enough to realize that no amount of crunching had any effect on those bulges. That’s when I read about abdominoplasty.

As the days went past, and fitness caught on as a raging fire in India, I saw more and more folks my age around me, doing things to get fitter and look better. I felt more compelled to do some thing and soon. Every time there was a milestone in my life, I would say this is the time to do it.

But then fear of pain from past surgeries (have gone through 2 earlier) and lack of enough awareness about these options, would scare me away. I would put it off.

Another reason I was putting it off each time, was because I was misguided in to thinking that I would need to take 4-6 weeks off to do this. Given my current commitments, there was no way I could afford to take this much time off for something that wasn’t mandatory.
So came another of that milestone thing and here I was reconsidering surgery. I said I would at least ask around and gather information afresh. That’s when I chanced upon the website of “Cosmesis India( www.cosmesisindia.com)” – a group of doctors in India, with a presence in Bangalore who were in to cosmetic and plastic surgery.

I decided to go for a consultation – a single consultation wouldn’t harm, would it? So I was talking to Dr. Surindher and I went to meet him. He confirmed the same inference – only surgery could get rid of that skin fold. When I asked him the benefits of this non-compulsory procedure, all he said was that his earlier patients came back and told him that they can now look at themselves in the mirror without hating themselves. He also said I would recover in 1 week – I could go back to normal routine in a few days as opposed to the 4-6 weeks I had heard earlier.

So this is quite feasible, isn’t it ? – I began thinking. The more I talked to the doctor, the more convinced I was that I wanted to do it now and with this institution.

I was very apprehensive about the whole procedure, knowing fully well what a surgery entails having been through 2 earlier. I knew I wanted to do it – been wanting to for years now. After talking to the doctor, I was quite convinced now that they only way to get rid of the ugly bump in my lower ab was through this surgery, but garnering courage to face it was quite a feat.

I must thank the doctors(anaesthetist included) for trying to put me at ease. They assured I will be covered by pain killers for the first few days. I am terrified of pain, so no matter what they said, I WAS terrified.

But somewhere at the back of mind, based on the diagnosis and explanation of the doctor, I knew I had to go through it. So I mustered courage and prepared to face it. Having thus made up my mind, I tried not think anymore about the decision…I did not let anyone talk me out of it.

I went through the pre-op motions like an automaton – trying not to let my mind think..blanking out completely. Actually on the operating table as I waited to get in to the OT proper..I shut my mind, closed my eyes and drifted off to sleep until a nurse woke me up.

Then I was asked to pose for “Before” pictures, I wish I could have seen my own dead-pan face at that time..pity the doctor took pictures of my ab only.

During my previous surgeries, I had tried to fight the anaesthesia…but of course nobody wins the fight, just that it takes longer to settle down in to that deep sleep and I used to come around out of it in quite a troubled way.. So this time, I just decided to give in to it quietly and calmly.
But I do know I was breathing hard out of tension, again both the Surgeon and the Anaesthetist tried to relax me. The Anaesthetist, true to his word, fixed the IV with little pain and then gave me heads up that he was going to give me anaesthesia. I then just closed my eyes and let myself fall asleep. And I did, real real quick.

When I came around, it was trouble less and peaceful this time. I looked around, strange surroundings, I knew I was in the post operative ward. I asked the nurses for the time, they said 3.00 p.m. and I was like..Wow…I remember only up to about 10.30 a.m. I kept feeling thirsty and wanted to keep sipping some water.

Not much of pain, just a weird feeling lingered. Then, they wanted to shift me to my room. This was quite a job and since they moved and jostled me a little bit, it hurt.

Then I was back in my room, but kept drifting in and out of sleep. Did not feel nauseous until the doc asked me if I was..then I did. Retched and puked a few times – this hurt too. The doc said that he thought I must have been cursing him. Truth is, I wasn’t cursing him, but the agony of it all had begun to catch up with me, and I was beginning to curse myself for the decision to get this surgery done.

Can I forget the mother of all surgical agonies ? The IV drip and the endless bottles the nurses keep changing ? Needless to add, the thrombosis and the coldness in the arm. I couldn’t sleep at all, kept looking at the fluid go drip drip drip into my other arm (cause the previous one had already bulged). My thoughts on whether all this was really worth it, began to strengthen. I begged the nurse to not add another bottle, but she wouldn’t give in. She finally did, at about 3 a.m., only after which, I fell asleep.

Second day – I woke up to a good cup of coffee. The nurse promptly came back and started the drip again. Legs and whole ab area felt like dead wood. I noticed there were two blood drain pumps on either side of me and one end of each… long tubes..were inside my ab!!! Yes, really inside. The nurses came frequently to clear the blood that collected in these pumps. Wasn’t a pleasant sight for sure.

And you know what was more frightening than the sight of those pumps ? The thought that they had to come out sometime and surely that wasn't going to be painless. Then another doctor came- I did not know what he was up to, but he was trying to get me to sit up. Sit up, can you imagine that on the very next day ? – he explained that it was necessary to move to ensure the seeping blood does not clot. But I just couldn’t, was feeling so tired and faint, not to mention the pain. It was such a big effort, thought I will just pass out. After a lot of hard work, I was finally on my feet, but then I couldn’t walk !! Fear..nothing else, the doctor assured me. He helped me sit in a chair, wasn’t too bad once I sat down, just a very tired feeling. So that was my first attempt at getting out of bed post surgery. Of course, I got back in to bed with some difficulty(nurses again helped me a lot here), vowing never to get up again !!

But no, come evening, and the doctor had a mind of his own !!! He promptly came and made me get up again, this time made me walk a bit too. Not too bad again. Slept peacefully that night because I had succeeded in cajoling them in to removing the IV drip even though I could still see a couple of bottles remaining on the table. To top it, he made me put on a tight garment on the abdomen as if the existing agony there wasn’t enough. He said that was important to keep the swelling in check. Yeah ok..whatever !!

Day three – so far so good. My worst fears were going to come true…the doctor came by again – this time with an agenda to remove those tubes stuck inside me. I was hoping he wasn’t serious but he was. He wouldn’t give me local anaesthesia, said it won’t pain much. It did – to be honest – not much though. But like I had been reassured, I was indeed feeling less constrained now and bolder to sit up, walk about a little more.

That night, I couldn’t sleep – was this all worth it ?? That question kept coming back to me.

Day four, woke up to renewed energy, got up, freshened up and was cleaning the room. Yes, cleaning the room myself, putting things in proper places. The Doctor walked in on me, he said he was happy to see me up and about. I forced a smile on my face.

He said I could go home.
So again, I went through the process of getting discharged like an automaton. Reached home – climbing 2 flights of stairs – was in deep pain.

Physically, I was a lot more comfortable now. And I actually began realizing that the tight pressure garment that the doctor gave me, was indeed helpful in feeling more secure about the tummy whenever I moved.

The medicines I was asked to take, covered most of the pain unless of course I was delaying the next dose. There was intense burning under the skin of my stomach some times. There was also the feeling of lots of creepy crawlies playing under the skin – this was something the doc had warned me about. If not for his warning, I would have surely been petrified by that feeling – since its truly weird and something one wouldn’t have experienced earlier.

A few more days passed. Each day, I was visibly feeling better physically. I was moving around more and more. But what about my mental state ? Still confused, as I was feeling like there is a big block of dead wood tied to my stomach. A few folks who visited me did say I looked like I had lost weight – that did not help much. Also, the next event – Suture removal, was on the top of my mind now. I had had a bad experience (appendicectomy) – a very painful suture removal it was. I now couldn’t think of anything else.

I talked to the doctor about it and he suggested I apply a local anaesthetic cream before going for it. So, I did that and went to see him..gingerly…tensed. But just as he said, it wasn’t bad at all. Only thing was, he revealed then, that there is an inside layer of sutures that he would remove a few days later. My heart sank again (how do you apply local anaesthetic cream for internal sutures ??)

So one week had now passed, I was back to doing my usual stuff at home but did not feel good enough to go to work – so I decided to take that week off too. Stayed at home, relaxed, read, ate, slept – blissful existence, coming to think of it. But wait, what about my mental state again ?

That was worse, none of my clothes fit – I was so miserable. Here I was thinking I would be trim again and may have to buy smaller sized trousers, etc – and none of my existing clothes fitted..they were actually tight !!! I cant explain in words, how disappointed I was. So was all this effort just to come to this point ???

I asked the doctor this, he said, it’s the swelling, which will subside soon and I shouldn’t worry. But to us women, unless we actually can get in to those sizes we want to and zip up easily, no amount of anyone else telling helps. I tried not to be miserable, kept trying to hope based on what the doctor said.

New years eve came, decided to get out of this place as I badly needed the change, the doctor said it was ok to travel short distances if I were flying. I did get a change from the miserable disappointing feeling I was having though I still couldn’t sit up or move around for too long without having to lie down flat on my back at regular intervals.

Second week was over too, had to go back to work – also had to remove those internal sutures. Again, I applied the local anaesthetic cream and went to see the doctor on my way to work that morning. Yes, it did hurt a bit more burning than pain though. Subsided quickly and I went to work.

So I went to work wearing my loosest pair of jeans – others still did not fit. Everyone I met remarked that I looked trimmer. But remember that supreme validation that only clothes can give to women ??? I wasn’t convinced still.

The first few days at work were trying. With every passing day, it improved dramatically. By the end of the third week, I was feeling almost normal. Buoyed by this feeling of normalcy, I began trying my other old clothes again. Voila, more were fiiting me now and better than before !!! This edged me on and I mustered enough curiosity to try the acid test – my sheer georgette saree – which I had long given up wearing since georgette has no mercy on unwanted bumps. I actually wore the saree, looked at myself in the mirror – and…and…. I couldn’t believe my eyes !!! It was so nice, my stomach and the whole mid-section looked so neat, due to which the saree draped so well !!! Cry, I did… I wish I could have danced too at that moment. So was this really true ? Had I gotten my contour back after more than 10 years ???? I kept rechecking to confirm. I was thrilled !!

I hadn’t felt that happy in a long time. Believe me, it does wonders to one’s self-confidence. The first person I shared this with was my doctor, without whose firm and gentle support, I couldn’t have gotten to this point at all – I would have chickened out some time earlier and continued to be truly miserable about my tummy for ever.

The fourth week has just ended – a very significant month has flown past !!! I did go and buy a pair of smaller size trousers and a blouse last evening !! And when I try them on now, I cant help spiraling around and preening in front of the mirror. I looked trimmer, firmer and shapelier – therefore younger.

The most impacting comment I got – my father remarking that he felt I was now looking more like his young daughter’s image that was imprinted in his mind (an image that had frozen a few years back for him). Did I need more validation ???

It was worth it after all !! Well and truly worth every moment of it !!

I feel on top of the world !!! Something has changed for me this year...can you guess what ???

Dr. Surindher, Cosmesis India and Bangalore Hospital, Cant thank you folks enough !!!!
I wish more and more women will come forward to help themselves. We are worth it !!

aashu

aashuthegreat@hotmail.com