- Hi, I'm Susan Taylor with Scripps Health
in San Diego, California.
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As we age, our skin tends to sag
and lose it's tightness, it's elasticity.
Baggy, droopy eyelids, sagging breasts
and stretchmarks after you've given birth,
that bulging belly, which despite diet and exercise
you just can't get rid of.
Oh the joys of aging.
Well the good news,
there's plastic and reconstructive surgery
that can help you regain some of your pre-pregnancy shape.
We like to call it the mommy makeover.
Joining us to talk about that, is Dr. Salvatore Pacella,
who is head of Plastic and
Reconstructive Surgery at Scripps Clinic
in Delmar, California.
- Thanks so much for being with us doctor.
- Thanks for having me Susan.
- So why does the skin sag as we age?
- As we tend to age, the natural glue
that keeps our skin attached at the under surface
of the body tends to loosen up over time,
and that causes pretty tremendous sagging of skin over time.
- So let's go from top to bottom, what's affected,
let's start with the eyelids.
Is this because we've been putting on
and taking off makeup for decades that the
skin starts to stretch out and sag.
- Not necessarily. - No.
This is really, you have to think about this
as the complete continuity of the brow
with the upper eyelids.
So when your brow gets saggy what happens is
you tend to see that quite a bit
in the upper eyelids as well.
So it's really one complete unit that we're talking about.
- So the droopy eyelids,
they can actually get in the way of your vision,
is that correct?
- [Dr. Pacella] Absolutely.
- Your peripheral vision, looking straight ahead?
- Usually your peripheral vision.
It tends to obstruct things while we're driving,
I tend to have patients that come in that say,
"You know I don't notice a car coming up on the side of me"
and that can be quite dangerous sometimes.
But cosmetically it's also very important to
rejuvenate around the eyes.
- So let's talk about the eye lift, what's involved?
- So, the eye lift is a relatively simple procedure,
takes about 30 - 45 minutes,
and it involves removing a bit of skin
from the upper eyelid.
In addition, many times as we age,
we tend to lose fat in the upper eyelid.
So sometimes we can take a little strategic fat
from the abdomen, put it in the eyelid
and rejuvenate the upper eyelid.
- And what are the side effects and risks to this
type of surgery?
- Fairly minimal, little bit of bruising afterwards,
recovery is relatively quick.
Sometimes patients can get some dry eyes
for a short period of time afterwards,
but that recovers actually quite quickly.
- When you say you recover quickly,
what do you mean by that?
- Probably within about one to two weeks mostly,
- [Susan] Okay.
- Most patients can go back to work after that time,
or resume their lifestyle, working out, etc...
- And what about the brow lift and the forehead lift?
- (laughs) So the brow lift is a little bit more extensive,
we're talking about relatively about two weeks of recovery.
That involves a small incision
that's hidden right within the hairline,
and it's really designed
to raise the brows to a much more natural position.
- And then what about the forehead lift?
- Same thing, brow and forehead are really
referring to the same concept.
- So you're moving them up
and you're getting rid of the wrinkles in the process.
- [Dr. Pacella] That's correct.
- Okay. And a lot of this can be done as outpatient surgery,
you don't necessarily have to spend the night
in the hospital?
- Correct, outpatient surgery is preferred actually,
we want you to recover comfortably at home,
we want you to be around your family,
we want you to eat your own food and your own diets,
sleep in your own bed.
- So let's talk about the neck, that crepe like skin,
I affectionately call it the turkey neck. (laughs)
- [Dr. Pacella] Yes.
- What can you do for that?
- Well, so for that procedure, in fact, I'll also say
that as we sort of get into the age of technology,
we're always looking at our phones,
we're always looking downwards.
Once when we used to stand up and have good posture,
now we're all sort of hungover and crooked down,
and so that tends to exacerbate the neck quite a bit.
There's a fairly good procedure for that,
it's called a lower face and neck lift.
Little bit longer of a procedure,
takes about three to four hours to perform,
also done under outpatient procedure.
But it can really do an extensive job
of tightening up the neck.
- And then what about breasts,
sagging breasts after breastfeeding?
- We have some great procedures for that.
So, depending on what a patient would like,
so for example, after pregnancy
many women noticed that the breasts have dropped down a bit,
they've lost a lot of volume.
Many women that come into my office say that
during pregnancy they actually like
the size and shape of their breasts,
so many times we have a few arrows in our quiver,
so to speak.
We can utilize breast implant
to restore some fullness to the breast,
if the breasts are hanging down lower
we can do a breast lift or a combination of the two.
- And what about stomach,
the weight gain that you have during pregnancy?
- So plastic surgery is not really
a substitute for weight loss.
So prior to going into plastic surgery,
really want you to be at your stable weight,
so where we think we can really help patients
are after pregnancy if you've gone back to working out
and you just can't get that pooch of the belly gone,
plastic surgery can help with that.
An abdominoplasty or a tummy tuck, is a common procedure,
little bit more of extensive procedure,
takes about four weeks to recover from that.
Also an outpatient procedure,
but it can make your tummy really snug and really tight.
- And what about stretchmarks?
What's the cause of stretchmarks and how can you fix those?
- So stretchmarks are caused by a loss
of the collagen underneath the skin.
It's oftentimes caused by rapid weight loss
or weight gain.
Also we see it in pregnancy,
there's a stretching of the abdomen
and stretching of the skin.
Sometimes laser treatment can help with stretchmarks,
but unfortunately, many times the best method
to treat stretchmarks is to simply do surgery
and remove those stretchmarks.
When we see those in the lower abdomen,
a tummy tuck is a great operation for that.
- Okay.
We want you to hold this thought, we're going to come back
and talk about it in a couple of minutes.
We referenced it as we said hello,
we're gonna talk about the mommy makeover,
so just hold on, we'll come back and talk about that.
Talk a little bit more about body contouring,
so that's body sculpting
and surgical techniques.
Explain what that is. - Sure.
- So this commonly a procedure we perform
in patients who have lost a substantial amount of weight,
50 to 100 lbs. say. - Wow.
And oftentimes that can be coupled with some
sagging skin of the arms, the chest, the thighs, etc...
We also see it in the abdomen and breasts.
So body contouring really refers to a combination
of both surgery and non-surgical treatments
such as liposuction which can remove fat
from different areas.
- So how does liposuction work?
- So liposuction is a really minimally invasive technique,
we make a small cut in the skin and utilize a cannula,
or a device to manually remove the fat.
It can do a great job of contouring the skin.
If your skin is stretched out however,
liposuction doesn't work all that well.
If we have a good amount of elasticity in the skin,
that tends to be the best for patients
who require liposuction.
- And when you talk about the tummy tuck,
explain it a little bit more.
- So tummy tuck is a open surgical procedure,
so you're asleep for this procedure,
and what that involves is making an incision that goes
from hip to hip, we make it right within the underwear line
or bikini line, so to speak, so the incision is hidden,
and we lift up all that skin from underneath
the surface of the abdomen.
oftentimes this can be coupled with tightening
up the muscles on the inside of the abdomen.
Your belly button stays in exactly the same place,
and then we sculpt and re stretch the skin around it
so that the skin can be nice and flat
and nice and tight.
- And these procedures, some of them are, as you say,
minimally invasive, but generally,
how long do they take and what's the downtime?
When can you get back to living
at the speed of your life? - Sure.
- It all depends on the type of procedure.
Some of the facial procedures are an hour or two.
Some of the body contouring procedures may be several hours.
In general, most of the procedures, we don't want to
go over about four or five hours in the operating room.
So the recovery varies,
recovery for something like a tummy tuck
is rather extensive, you probably need to be
off of work for about two weeks potentially.
We don't want you really working out or lifting weights
for about four weeks after surgery.
But some of the facial procedures,
you know, one week recovery potentially.
We can go back to work with a little bit of makeup,
we can hide some of that bruising.
- The people who've lost a lot of weight,
because they maybe had weight loss surgery,
and they've got a lot of that loose, excess skin.
Is that a long recovery period too,
to get rid of that excess skin?
- It's about the same, particularly if we're doing
a tummy tuck or a body contouring procedure.
- Okay, we referenced this a couple of minutes ago,
let's come back and talk about this,
the mommy makeover (laughs) what does that entail?
- So mommy makeover is a great procedure,
very popular in our communities.
So mommy makeover commonly refers to the combination
of a tummy procedure with a breast procedure,
so very commonly we see a tummy tuck done at the same time
as say a breast implant or breast lift.
- And you can do that at the same time?
- [Dr. Pacella] Safely yes.
- Safely. Okay. And then the down time from that?
Because you're doing two procedures at the same time
is it longer?
- Actually, you get a little bit of synergy with recovery,
so for example, if you're recovering for the tummy tuck
and that's about three to four weeks,
breast procedure recovery is about two weeks,
you sorta get the benefit of recovering from both
at the same time. - At the same time.
- So it's a very popular procedure.
- So, we talk about the mommy makeover,
does skin sag for men as well,
is there a 'daddy do-over'? (laughs)
- There is (laughs)
Commonly we see men in their late thirties,
early forties, after their wives have children,
they tend to gain just as much weight
or lose the ability to fit into their pants,
so that's commonly something we see, myself included.
- (laughs)
- So, common procedures in men,
body contouring procedures such as liposuction,
men tend to wear their fat
a little bit more around the abdomen and lower back area,
so that's a very common procedure.
Many men can develop a symptom called gynecomastia,
where we sort of get some tissue around the chest area,
liposuction can be a very powerful
and very common procedure for men in that regard.
- And what about the risks to plastic surgery?
- So any surgery has risk associated with it.
You know, we don't wanna approach plastic surgery
as just say, going to the hair dresser.
That's one of the beauties of being at Scripps,
we're a large health system, we do all of our surgeries
within a certified operating room.
We have board certified anesthesiologists
with us at all times.
But surgery is serious, and we wanna make sure
you're very healthy going into surgery,
so we oftentimes recruit our medicine colleagues,
or your primary care doctor
to make sure that you're healthy enough to go for surgery.
- And what about the side effects
to these types of surgeries?
- So with any procedure there can be side effects.
There can be side effects with anesthesia,
that can include some nausea,
potentially some vomiting after surgery.
And then there are specific,
potential consequences after the surgery
related to the surgery that we've done.
So for example, patients may have
some extended pain after surgery, that oftentimes goes away.
- Swelling?
- Swelling can occur, sometimes strategically
we wanna place the scars in a specific area,
sometimes the scars can be rather red or visible
for a couple months after surgery,
that oftentimes fades over time.
But in general, very safe and very reliable procedures.
- Who is not a candidate for plastic surgery?
- Well I would say that, usually everyone is a candidate
for plastic surgery if you're healthy enough.
So what I mean by that is
if you have a bad heart or bad lungs,
that's something we wanna evaluate ahead of time
with your cardiologist or your primary care physician.
Patients who are on blood thinners,
oftentimes we approach plastic surgery very cautiously,
we wanna work with your medicine doctors
to determine a safe interval or a safe window
to perform surgery.
- So plastic surgery has come a long way
in the last 20, 25 years, what's the biggest change?
- I would say that one of the biggest changes
in plastic surgery has been the use of fat transfer,
this is what we were alluding to earlier.
So we've really understood a lot about aging,
particularly in the face, over the last several years.
What we've seen is that,
if we follow patient's photographs for many years,
not only does the skin become saggy,
but we tend to lose a lot of fat
in the cheeks, or upper eyelids or in the temple area.
So we've had a lot of technology and a lot of science
behind removing fat from different areas of the body,
packaging it up, purifying it,
and re injecting it into different areas of the face.
And that can really make a huge difference
and make surgery look very, very natural.
- And it's also much more more minimally invasive now
than it was decades ago.
- [Dr. Pacella] That's correct.
What questions should you be asking yourself
before you decide to go down the path
towards plastic surgery?
- So I think a critical thing to ask,
for patients to ask themselves, number one is,
what are we trying to get out of this?
Are we trying to change our appearance,
or are we trying to fix areas that are relatively stubborn?
So I think really understanding what each patients'
wants out of surgery is very important.
Second thing I think is exceptionally important,
is that if you seek plastic surgery,
you wanna do so from a board certified plastic surgeon.
Board certified plastic surgeons have gone through
all of the education, all of the training,
and operating in accredited facilities
that will be affiliated with a hospital.
Patient safety is key.
- Any final thoughts, doctor?
- I think as we sort of go into the new millennium,
I think we're gonna see even more changes
in plastic surgery.
Minimally invasive surgery is becoming very popular,
and we're just seeing new advances in technology,
it's a very exciting field to be in.
- Thanks so much, Dr. Pacella.
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