But Will It Leave a Scar? The Top Ten Tips

It happens all the time.. I talk to patients about their surgery, including their scars, I tell them the scars will always be there. And then they ask me: "But I thought I was having plastic surgery?"

Any time you cut through the skin full thickness, you will get a scar as a result. Scarring is your body's way of healing and closing a wound. Scars happen, and nothing can prevent them from happening. BUT, the degree to which they are visible varies widely. Not seeing a scar doesn't mean that there is no scar there. That being said, while scarless surgery does not exist, invisible scars can be a reality.

1. The main factor in scar formation is genetics. If you are someone who scars a lot, then that will often be your fate. If you "heal well," you are already ahead of the game.

2. The second key to good healing is a proper surgical repair using all of the plastic surgery principles of optimal wound healing. This is operator dependent.

3. Optimize nutrition. You scar what you eat. If you have the right stuff going in, you are more likely to do the right things on the outside.

4. Follow instructions. Most patients underestimate how much their instructions can impact how their scars will look in the long run. If you are told to put on cream, use it. If you are recommended to massage, do it. All of these things have an impact; and even if each is a small factor in and of itself, the combined effect and longevity of use can create huge differences.

5. Keep it clean. There are situations in which wetting a wound is a bad idea. But unless you have been told to keep it dry, washing is a good idea. Infection, even on a small scale, can cause a lot of inflammation. Inflammation is the enemy of a good scar.

6. Keep it dry. When it's not being washed, a wound wants to be dry. Excessive wetness, including things like using too much ointment, can create goopy messiness. None of this will help the layers form or the bugs stay away.

7. Avoid the sun.

8. Avoid the sun!

9. Get ahead of problems early. If you think you have a thickening scar like a keloid, or if your scar is itching or burning, go see your surgeon. There are many problems that require early intervention for good treatment, and many interventions that often have success. Get in early for best results.

10. No lotions or potions. As you watch your scar mature and agonize over every change, people around you will have many suggestions for what to put on it. Some will seem reasonable, and others more like strange brews. Bottom line is that if it wasn't recommended by your doctor, it's likely to muck up the pot. Keep it simple.

Scars are unavoidable. Good scars are the goal. 

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But Can You Wear a One-Piece?

When my patients ask me what size they will be after surgery, I struggle with the answer. They want me to use one of the conventional letters (A,B, DD) but these are not exact measurements (read more about why bra sizing makes no sense!). What's more, these letters do not reflect the fact that there is no one size for all.

When assessing what size to make someone, whether bigger or smaller, it's all about proportions and balance. Everything looks different depending on what it is next to. When you make the breasts bigger, the belly looks smaller, and vice versa. That seems pretty intuitive. But what is not always so immediately obvious is the fact that the same size will look different on different people. The exact size breast on a smaller, shorter, narrower woman will appear tiny on someone six feet tall and broad shouldered. The ultimate size has less to do with the bra cup in a vacuum, and everything to do with the overall proportions of the patient. If you're not looking at shoulders, hips, and height, you're not really sizing things up properly.

In terms of clothing size, most women have an overall size. The best candidates for plastic surgery are those who know and maintain their size, but have one element that is off proportion to the rest. For example, someone who has full hips and wears a medium overall but can't fill a B cup bra. That person will always have trouble finding clothing, and spend most of their dress time padding up. Another example is the mom who is a overall size small but has a weak and bulging belly that just can't crumple into a pair of regular jeans. Imbalance.

Imbalances can be obvious or subtle. The best way to know if you are imbalanced is to go one-piece shopping. If you can't buy a one piece or a bikini in a set, you are probably imbalanced. This is not an issue if it doesn't bother you, but if  you're buying three sets of swimwear because nothing works as it should, it may be time to consider your surgical options. In most cases, the target is clear and the goal can be attained. The trick then is not to overshoot; and if you really want to hit a home-run, find a surgeon who can get that "fake out" result for you. If you get to the size you should have had to begin with, no one will question whether or not you came that way. If it fits, it fakes. Just another happy day at the beach. :)


Jawline Liposuction : The Facelift Before The Facelift

Many of my patients have just a little bit of a problem with sagging - especially at the neckline. For most of these patients, it's too soon for a facelift, but it's time to do something.

The feminine jawline is shaped like an egg- oval and smooth. Early jowls will square off the jaw, making it look more rough, wide, and masculine. All of these elements have an aging effect. 

A little liposuction in just the right areas can empty the early jowls, get rid of a double chin, and allow the skin to spring back into a more angled shape on the neck, all in all restoring that youthful look. And all this with a few small incisions that fade over time. 

Recovery and downtime are minimal compared to a facelift, but the results can be dramatic. The skin usually tightens enough for this stage, the jowls disappear for now, and overall it can buy you another ten years. My mantra in my practice is to "make it as simple a road as possible to get to the desired result." In this case, it's often a straight and smooth shot to ten years ago.


If My Belly Is the Problem, Why Does My Back Hurt?

Many people suffer from back pain, and back pain has a huge list of possible causes. But one item on that list that many people don't think of is the other half of their trunk: the belly.

Our bellies are there to do a lot more than just look good in a bathing suit (although that is a great part of it). Our bellies also support our cores, and as a result, they balance out our backs. When I was a kickboxer many moons ago, I remember my trainer used to tell me how important it was to work out my back in order to support my belly. He warned me about doing too many crunches without working on the other side, realizing that if I didn't do a well-rounded job with my workouts I might get thrown off and actually end up injured. He was right- and it turns out it works the other way around too.

So many of us fail to hold our posture, and we work out erratically, forgetting to exercise the "other" muscles that we have. But one key time when this problem really rears its head is after baby-making. Bellies can take a lot of stress, but baby making is as real as it gets. For most moms, by the time you finish, the strength and structure of the abdominal wall is all but lost.

With the muscles off alignment and the tissues all stretched out, even the best of workout efforts are likely to fail. Furthermore, pushing even harder without the right balance can cause an even more extreme stress on your core- and more pain. Rebuilding your belly, whether surgically or non, can sometimes be a huge help in finding that balance and sometimes even in relieving that pain. For some patients, a weak belly can even mean trouble going to the bathroom, since pushing down to get stuff out is another important role that the beautiful belly is supposed to play. Misery.

Your belly wall is actually a bigger part of your overall health than it's made out to be. Ripped abs are sweet, but they are more than just eye candy. A strong and balanced core helps you stand up straight, feel alright, and work that middle the way it's supposed to. Getting a proper assessment can help you figure out what is causing all of that drama- and that's the first step to getting better.


Mommy Rehab?

If you broke your ankle, you would get surgery, wound care, and then 8 months of structured, carefully measured rehab.

If you pulled a muscle, you would be instructed to rest it for at least 6 weeks- how else could it possibly recover?

And yet, after you have children, even several children, even pulled out of you c-section children, there is no prescribed course of rehabilitation. Your mind, your body, your everything is forever different and you can barely recognize any of it. And you are left to your own devices.

Post-partum rehab is a very real, important, totally unexplored field of medicine. What is should look like is physical strength and balance training, belly support, surgical reconstruction if needed, pelvic floor exercises in measured amounts, psychological support, and nutritional counseling. What it looks like now is, "You have issues? What do you expect? You had three kids!"

My mommy mission is to help women start asking the right questions before, during, and after baby-making. I want to help moms recruit the support, information, and professionals that they need to literally get and keep it together. Join us tomorrow at the Motherhood Center, and let's start the conversation. https://www.themotherhoodcenter.com/classes-and-education/#recover-your-belly