Ask Dr. H.

I am a 33 year old mom with 5 kids struggling with degenerative back problems and an overhanging abdominal apron that reaches my mid-thighs and causes sores from perspiration. I have started losing weight but I still have a way to go: I am now 285 down from 330. I want to exercise but the overhang is keeping me from staying at it! Can I get it removed and the abdominal muscle separation repaired?

You should be very proud that with 5 kids you are working out and trying to get your body back! Your weight loss of 45 pounds is a solid start. As you have found out, your overhanging apron may be getting lighter as you lose the pounds but it is also getting longer. The forward pull of the excess skin and the rubbing can be very uncomfortable. In a perfect world, your best approach would be to lose all of the weight you are planning and get down to your “normal” weight and BMI before considering surgery. That would give you the best results and the safest recovery since high BMI patients tend to get more complications including slow healing and recovery as well as having a less pleasing aesthetic result.

However, some patients need the physical and psychological boost of getting their fatty apron removed during the weight loss process to make exercising easier and reduce the weight pulling on your low back. In my practice, I have found that this can be a good interim solution with faster recovery and return to your normal life than a full abdominoplasty with muscle repair. This is called a panniculectomy. Only skin and fat is removed from the bottom of the abdomen, mainly the apron. Once healed from this surgery, you can resume your exercise and diet program and keep up your momentum with improved comfort and hygiene. Once at your best weight, a full reconstructive abdominoplasty could be considered with abdominal muscle repair, reshaping your stomach area, and re-positioning your sagging belly button.

Going forward with a full tummy tuck before you have reached your personal best weight would likely require you to totally re-do your surgery when you finally do get to your goal! And with your current extra weight, your risk of complications that might keep you from your kids and normal Mom duties are very high. The interim step may be just the worthwhile action you need to move you on to your next level of achievement!

An in-person consultation with a Board Certified Plastic Surgeon who is very experienced in abdominoplasty and treatment of weight loss patients would be your next best step, to see if the benefits of panniculectomy would outweigh the risks for you, and at what weight you might be a candidate for a full reconstructive abdominoplasty to restore your abdominal shape.

Best of Luck to you!
Dr. H

I am considering face and neck lift and wonder if the type of procedure I need to have can be done under just sedation.

Thank you for your question and your photos. Your pictures indicate relaxation of the jawline, sagging of the neck skin and muscle and likely fatty deposits under the neck muscle (platysma). An in person examination would be best at determining this. The parts of your cheeks that show on the photo seem a bit deflated, showing loss of volume that is very common as we age, and gives a worn appearance. To get the kind of neck improvement that most women want from a face lift, I would recommend a direct neck lift with tightening of the sagging neck muscle under the chin, removal of the hidden excess fat layer from under the muscle. The remaining skin excess (the bunches that form around the ear) would be pulled upward and removed via a typical face lift. Key to the longevity of this kind of surgery is the tightening of the deep layer to create a base that holds you up and then the skin does not have to be pulled overly tightly in an attempt to hold all the other lax tissues up. As you know your skin is inelastic (that’s why it is now sagging) and when pulled on has little strength to resist. Pulling the skin too tightly on its own is a cause of the wind tunnel look and distorted mouth. A softer, more youthful overall appearance could be achieved by conservatively filling the cheek and jowl hollows and irregularities with fat harvested from your abdomen or other unwanted fat pad.

A procedure that addresses multiple areas and deals with the deep layers of tissue is the best approach to achieve a natural rested appearance. This kind of lift is best performed under general anesthesia to maximize comfort and safety. In my practice we use a board certified physician anesthesiologist to administer anesthesia and this creates a very high level of safety. Most patients get restless and generally uncomfortable after an hour or 2 of sedation. Injections needed to ensure local anesthesia that must accompany a procedure under sedation are uncomfortable needle injections (in every area to be treated) and the fluid injected may cause excess swelling that hides the true shapes of the face. Anesthesia today is extremely safe due to advances in monitoring and new techniques and drugs only recently available. Recovery is also much more rapid with our short acting anesthetic agents. That makes general anesthesia the best choice for multi-plane/deep layer face and neck lifting.

I had a Thread Lift about 10 years ago when they were quite popular and the “threads” are probably still there. I am now planning to have a facelift in the near future and am wondering if these threads need to be removed.
I have encountered many of these sutures placed for lifting purposes during the Thread Lift or Feather Lift procedure. When they are visible in the surgical area during a facelift, I routinely remove them. Ordinarily, these threads are no longer holding anything anymore, and many times have broken in the interval. Most of them are permanent and non-reactive suture material and do not need to be removed if they are not causing any puckering or irritation.
I was bending over my mirrored dressing table and caught sight of my reflection. I couldn’t take my eyes away!!! There was enough skin hanging for 2 faces! Help! Horrified at 52.

A. Unfortunately, you “flunked” the loose skin test. As we age, time, sun and gravity wear away the elasticity of the skin and sagging starts. You sound ready for a facelift. This surgical procedure is a great solution to sagging skin since its purpose is to tighten and lift sagging skin for a fresher more youthful appearance. You can simulate the correction of a facelift by placing fingers in front of the ear and pulling upward (gently!) to tighten cheek and jawline and by pulling neck skin up and back from just below the earlobe.A great procedure at any age (when needed), a facelift can transform your sagging outer appearance into a reflection of your energetic and youthful attitude. While a dramatic improvement awaits “Horrified”, she need not have waited so long to take action. The small steps needed to maintain beauty and youthfulness are much easier than emergent “rescue”. Looking great all the time can be attained with planning and early intervention, keeping your outer self and your inner spirit in harmony.

Start now with a personalized consultation: your path to always looking your personal best.

What about using exercise to get rid of my wrinkles? I’ve seen ads in magazines and infomercials on TV that make sense to me. I’d like to put off having a facelift until I’m 55. S.F. Las Vegas

If it sounds too good to be true… Exercising your facial muscles is exactly what caused the wrinkles in the first place! The facial muscles attach directly to the skin so that when you move them, the skin is pulled to make your facial expressions. Every time you pull your skin with those muscles, you crease or stretch your skin and eventually the skin loses its elasticity and you make a wrinkle or sag that stays even when your face is totally relaxed.There are lots of options besides a facelift to deal with sag and wrinkling of the face and neck. Your best approach is to see your Plastic Surgeon and discuss what bothers you and what is available to minimize that problem. Your skin condition is the issue not your number age, so don’t get stuck on a number like 55! The time to make a change is when it bothers you.

There are two things you (everyone) can start today to minimize wrinkles: avoid sun exposure (stay in the shade and wear sunscreen daily), and stop smoking (it accelerates the aging process).

Other simple things to minimize wrinkling include: Botox injections to weaken overactive muscles that are making deep wrinkles; filler injections to fill in the indentation of the wrinkle and give a smoother, plumper look; and a medical skin care program to maximize the health and flexibility of your skin at any age.

Of course, for the most radical improvement you need the surgical approach: facelift, eyelid enhancement or laser resurfacing. Definitely, the ultimate rejuvenation treatment is surgery. Having been a patient myself, I can certainly recommend the surgical approach: the rewards are much greater! I would have another facelift tomorrow if I needed it. Ask to see my “before pictures”.

I have been dieting and dieting and I just can’t shake that last 10 pounds. Can liposuction get rid of them? F.G. Laughlin
Yes and No. Liposuction can be used to remove fat in any volume from just about any area but that doesn’t mean it’s a good idea. Your health and safety are the most important issue, not what the scale says. Liposuction is a safe procedure if used as intended to refine and reshape the body contours and bring troublesome areas into balance with the rest of the figure.
How do I know when I need a facelift? My mirror tells me I look worn and saggy but I’m energetic and only 45. L.O. Summerlin.
There is never a “correct” age for having a facelift or any other cosmetic surgery. It’s time when you feel you need it. If you look tired and that bothers you, then you are ready. Age numbers are not important: what is 45 really supposed to look like? In my practice, we discuss specifically what you want to change, then identify a “fix” that fits your lifestyle and concerns. That may be a facelift, eyelid lift or even a personalized mini-lift addressing just the areas that uniquely concern you. We don’t believe in “one size fits all”. We have seen 35 year olds that need a facelift and 55 year olds who don’t.A personalized consultation with full discussion of trade-offs and key benefits will be your best approach to looking your personal best.
I’d love to bid farewell to the family curse of heavy thighs but every time I say the word liposuction my mother pretends to have a heart attack! What about safety? D.F.C. Green Valley

It’s truly a shame that so many people have been frightened away from one of the safest and most frequently performed plastic surgery procedures in America because of unfavorable press coverage. Liposuction is remarkably effective in reducing figure faults caused by localized fatty deposits. Anyone who has tried to “spot reduce” with exercise knows that it doesn’t work.Extremely fast recovery, remarkable results, tiny incisions and high marks for satisfaction make liposuction one of the greatest Plastic Surgery Advances of the 20th century. While vacuuming out body fats looks like the magical solution to weight loss struggles, it is best for reshaping the body contours, not for weight reduction.

When you consult with us, we seek solutions to your figure problems and balance that with your health, carefully maintaining a clear safety zone. Safety conscious, informed choice can allow you to join the hundreds of thousands of women (and men) who look great and feel great becase they got the figure improvement they wanted through liposuction. P.S. Bring your mum: the safest way to talk to her about liposuction is with a doctor present!

I have 3 beautiful children but lost my figure in the process. I still look five months pregnant but I’m not “fat”. Sit ups are not helping! What can I do to get my waistline back?

If you are like most women after pregnancy or weight loss, you can do sit-ups all day long and not change your protruding belly. The reason is that the muscles get over stretched permanently or even split, and they cannot function normally. This results in a loose abdominal wall that bulges out when you stand upright, but falls in considerably when you lie down. Your posture is affected and low back pain is common with this condition. Exercise and diet are not the answer, as you have already discovered. The muscles must be surgically tightened back to their correct position so that exercise can actually do something. This muscle repair is an essential part of abdominoplasty or “tummy tuck”. Any excess skin overhang can also be removed at surgery, as well as any fatty excess that remains out of proportion with your general figure. Stretch marks are frequently removed. Restoration of a flat abdomen with a more defined waistline is a common result. Patients have reported unexpected benefits of “tummy tuck”, such as relief of chronic low back pain or even improvement in post pregnancy incontinence.

Many different abdominoplasty procedures are possible in our practice, and the choice is based on what needs to be corrected for each patient. My favorite approach is the limited incision abdominoplasty, that we refer to as the “Victoria’s Secret” tummy tuck, because the C-section type incision can usually be hidden in even smallish bathing suits and lingerie, and there is no belly button incision.

Body sculpture with liposuction in limited areas can also be combined with abdominoplasty. Some of our happiest and most satisfied patients are abdominoplasty patients. It is a great way to restore you figure after weight loss or pregnancy. We can help solve body shape problems when diet and exercise are not enough.

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