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

"Mummy Makeover" ... I

“A Mom Makeover!”

Sounds trendy doesn’t it???

Well not really, it’s new packaging of the procedures already being done, as we shall discover in the process of this blog and the next.

Why the mom makeover at all?

The woman being the one to create life, goes through many changes physically during the process of pregnancy, giving birth & nursing the child. In a way, it is a sacrifice she makes to create and bring forth a new life.

But, the question still remains, why the makeover at all. What are the changes that occur which need to be corrected.

Doc, I jus saw myself in the mirror today and I was shocked, as I couldn’t recognize the person I saw in the mirror. It was definitely not me..!!!

This is a common complaint women come to us with. During their pregnancy, the mother and everyone around are concentrating on the eating, weight and the unborn child’s well being. After birth it is again the child who is the center of attention, after that till the child starts going to play school, the mother is totally neglecting herself. Then one fine day when she has a little free time from kids and family, she looks at herself and cannot recognize the person in the mirror.

It is not intentional, that this happens. It’s just how things are prioritized in life. I’m not saying that we do not need to give attention to the child during that period. Just that, a little bit of attention to the mother during the pregnancy, childbirth and post birth period, will go a long way in her not having to feel that way a few years down the line.

So what exactly am I talking about here?

To simplify the understanding of what needs to be done, let me first start by enumerating and discussing few of the issues that form the basis of the problems to be corrected in a Mum Makeover.

1. The Tummy: The abdomen, especially the lower abdomen is the area which bears the most insult during pregnancy. Because of the growing womb, the skin is stretched, the muscles are stretched, and there is collection of fat because of the weight gain. Post childbirth, the skin stays loose, has lot of stretch marks, there is a prominent bulge in the lower abdomen because of the loose muscles. All these are compounded by lack of physical activity concentrated to the specific area. Also, with more women now going in for cesarean sections, the lack of activity in that area get further delayed.

2. The Hips: This area is genetically programmed to carry more fat in a woman (the pear shape). More so during pregnancy and post pregnancy. This is genetically the reserve, which the woman accumulates during pregnancy. Combined with less physical activity in the immediate post partum period, tends to get worse.

3. The Breasts: The breasts also bear equal brunt of the pregnancy and post delivery period. During pregnancy and lactation there is development of the milk glands to produce milk for the newborn and hence as they develop they replace the fat that is present in the breast. Once the period of breast-feeding is over, the glands get back to their pre pregnancy state, but the lost fat doesn’t come back and that is the reason for the breast looking empty and sagging. Also because of the stretch marks on the skin of the breast, the skin doesn’t shrink back to the reduced volume giving it the appearance.

4. The Vagina: Post childbirth, the vaginal canal is stretched and like any muscle that is stretched a lot, it needs toning to bring it back to its normal size and tone. In fact in the west this has been used as a punch line to ask people to go in for caesarean sections… “ Have your child the C sec way and keep your passage the honeymoon way”. But that is not required, the vaginal passage was physiologically meant to stretch and contract. But a few things have to be kept in mind, as we will discuss later on in this blog.

5. The Face: Post pregnancy and childbirth many women tend to have pigmented patches on their faces called “ Melasma” which just persists even after childbirth. This occurs due to hormonal changes during pregnancy. Also some patients might have a double chin or a more rounded face as part of the generalized weight gain seen during this period.

Now that we know what are the few changes, which occur during the period starting from getting pregnant to one realizing that their whole body image has changed, is there something we can do to reduce these insults if not prevent them altogether?

The good news is YES…!!! There are things, which one can do during pregnancy and in the immediate period following childbirth to help prevent or at least reduce the changes that are occurring in the body.

Pregnancy Care:

The whole aim of the “pregnancy care” concept is to help the mother to be to take care of her body by doing small things to prevent future problems. The main problem during pregnancy is the weight gain and the increasing abdominal girth. When this rapid weight and circumference gain is more than what a person’s skin can tolerate, the dermis which is the supporting layer of the skin ruptures leading to stretch marks. So to prevent stretch marks the best thing that one can do it just spend 10 minutes each in the morning and night out of 24 hours to do a little something to help keep the skin supple to prevent stretch marks. The areas to be concentrated on are the abdomen (more so the lower abdomen), the breasts, the buttocks and the thighs.

The best way to keep the skin supple is to moisturize it. It could be with the help of oils or body lotions. Just take 10 minutes out of your daily schedule to gently massage the areas with a body oil or body lotion. This when done over the period of the pregnancy will make the skin supple and allow it to stretch easily as the mother gains weight and the abdomen gains circumference. This is true for the breast as well as other areas as mentioned before.

This simple step can prevent a lot of the problems later on. Also the second trimester is the most important period to do this because in the last trimester the weight gain and the circumference gain is very rapid and doing it then will not give the skin sufficient time to become soft and supple enough to stretch.

Post Child Birth:

Post delivery the single most important thing a mother can do to help her regain her figure and push her tummy back is the same thing that our grand mothers used to advice. That is the use of a binder or as the grand mothers would advice tying a sari around the abdomen tightly.

This helps in two ways, firstly it is pushing the skin back to its normal position and allowing it to shrink as it normally should and secondly it is also pulling the muscles together to the normal position they should be in. Hence, this when done properly for the next few months will greatly help in one getting back to the pre pregnancy state. Of course if the stretch marks are too bad then the shrinkage might not be to the extent that is desired for, as the skin is like a rubber band broken at multiple places, but even then the muscle toning itself is enough reason for one to use the binder.

This can be done for patients who have undergone C-Sec’s too. After the initial week or two of the healing time for the wound, the binder will help as mentioned above.

The other things that the mother can do are to continue the oil massages to the body and to get into some sort of regular physical activity. Be it morning walks or evening walks or treadmill, etc. I know there would be lot of women shaking their heads n saying… “ What does he know.. He’s not a woman! How do we find time for it? ” But for that, ladies.. let me just say one thing… “Its not easy agreed but if you do it.. it will benefit you. You are preventing a surgical procedure and getting back to how you were and not letting things get out of hand…!” So you work out the math!

As far as the vagina goes, the easiest way to help tone the pelvic musculature to get back to what it was is to do some basic exercises called Kegel's Exercises. The aim of these exercises is to strengthen and fortify the muscle tone of the muscles of the pelvic floor which in turn. It basically involves contracting your pelvic muscles and keeping them contracted for a period of time and doing this in cycles all through the day. The best part of this exercise is that it can be done anywhere and anytime and doesn’t need any equipment.

So now that we know what are the few things one can do to prevent things from getting out of hand and one finally landing up in the so called “ Clutches” of the “Cosmetic Surgeon”, I hope more and more to be mothers will take better care of themselves to prevent or reduce these problems.

As, I will be dealing with the specific surgical management of these problems and the actual “Mummy Makeover”, I think this blog should have been titled…” Tips to prevent a Mom Makeover”.

Happy reading…

Dr.Surindher