Q: Mommy Makeover procedures have gained popularity recently. Would this be a way to address a loose belly after pregnancy?

Nothing’s more annoying to a mother of small (or any size) children than seeing another mother wearing a skimpy 2 piece showing off her abs of steel. The truth is, she’s unusual and incredibly lucky, or…. she’s had a tummy tuck. The condition of the tummy following one or more pregnancies is much like the condition of the skin of some one who has had massive weight loss. The skin loses much of its natural elasticity and becomes loose, stretched out and, occasionally saggy. Only a very lucky few have an unusually strong genetic resistance to this elastic damage. Once it happens, no amount of diet or exercise can restore the original tone. That’s not to say that excellent diet and exercise can’t achieve the best possible degree of health and tone. It simply won’t tighten the skin.
Tummy tuck or “abdominoplasty” is the surgical procedure in which which the excess skin and fat between the pubis and the belly button are removed. Once things are pulled together, the entire abdomen is often so tight that it takes a few days to stand up fully straight. But when you do…..! The scar can be quite long, and the belly button itself is not moved but sutured to the newly tightened skin improving another troublesome area. Another bonus is the internal tightening of the muscle which has usually become relaxed or even widened in the mid-line following pregnancy. There is also a “mini-tummy tuck” which is effective when only the lowest part of the tummy needs to be tightened. Many women actually have tummy tuck and breast lift or augmentation at the same time. Since the breasts and the tummy seem to suffer the most with pregnancy, this seems to be the most common combination (mommy makeover) operation.

As we posted in our blog last month, Dr. Zeff and members of our surgical team are traveling to Haiti on May 23rd. Local Exeter News-Letter interviewed our staff regarding the upcoming trip which can be seen by following this link: Stratham plastic surgeon, staff to help in Haiti

Despite Haiti no longer being front page news, the Haitian people continue to face overwhelming health challenges as they try and recover from the catastrophic earthquake that struck their homeland on January 12, 2010. The human loss and suffering has been tragic and is ongoing, which is why we are excited to announce that six of us will be travelling as a surgical team to provide much needed specialized plastic and reconstructive procedures to the victims of the quake. Our travel has been facilitated through The LEAP Foundation (a non-profit 501 (c) (3) organization) which has provided a continued surgical presence since the first relief planes were allowed to land in Haiti. Although LEAP has made the arrangements for this trip, there is a cost associated. Each team is responsible for their expenses of airfare, housing, and transportation in Haiti, as well as the supplies and medications to cover 50 cases for their week.

Like most of you, we have always wanted to help when disasters like this occur but often wonder how much of our contribution actually goes to the suffering. Now we have the opportunity to assure that any donations go directly to the needs of the Haitians. We are donating our time and skills and team members will bring limited personal affects as carry-ons, allowing each of us to check 100 pounds of desperately needed medical equipment.

Here’s how you can help. If you would like to help support us financially (no amount is too small), 100% of donations will be applied towards funding medical equipment and supplies for our team’s trip. Donations can be made directly to the LEAP foundation via their website: www.leap-foundation.org, or via mail to: The Leap Foundation, P.O. Box 7452, Dallas TX 75209. It is important to reference “Dr. Zeff” and “May 23″ in the comments or memo section. Checks can also be given to our front office and we will forward them to LEAP.

We are grateful for this opportunity, and want to thank you in advance for your support!

Sincerely,
Dr. Richard Zeff’s Team

The practice is very excited to introduce our latest acquisition, the Quadralase Laser from Candela! Now the search for excellent results with far less down time is here. This fractional laser is based on the principle of resurfacing the skin in an almost pixel-like fashion rather than the entire skin surface. This allows the skin to heal much more quickly with a shorter recovery. Significant improvement can be seen with wrinkles, fine lines, problems with pigment, and scarring. Depending on both the patient and the areas of the face being lasered, this procedure can be done under local,topical, or general anesthesia. We’re very excited about how much easier this is on our patients, and the results have been impressive.

1.  How do I choose the right breast implant size?

I’ve found that the absolute best way to select implant size is to try on sizers in the office.  Sizers reproduce the exact shape and feel and when worn under clothing will accurately reflect post op size making size selection very easy.

2.   Breast Implants and Breast Lift after pregnancy? How long after pregnancy should I wait before I can get breast implants and undergo breast lift?

When you are no longer nursing and your breasts stop changing, you can consider breast lift and/or augmentation.

3.    Which breast implant placement gives a more natural appearance? When getting breast implants, what gives a more natural appearance, going under or over the muscle?

I prefer using smooth round implants. My philosophy is that all women already have an inherent breast shape, and they simply want to enhance that shape with larger breasts. Therefore, I don’t use anatomic or shaped implants for cosmetic enlargement.  Because the pectoralis muscle serves as an internal bra, placement under the muscle provides addtional support giving the breasts a perky, but natural look.

4.    Breast implants – How long do they last? When should you replace them?

No one really knows how long they will last. Every patient should expect that they will need to be replaced.  The companies warranty the implants for life. I see no reason to replace the implants at a predetermined time unless there is an issue or problem.

5.    Should I get breast implants if I plan on getting pregnant later? Is it recommended to have breast implants before having a child? How will the breast look after breast feeding?

Getting breast implants prior to pregnancy or breast feeding simply gives a larger starting point.  Whatever pregnancy and breast feeding will do is essentially unaffected except that you will still have the implants when it’s over.

What are the best alternatives to a face lift?

Generally, there are no equal substitutes.  Every alternative does something different. A facelift tightens the skin of the face and neck as you might do with your fingers by gently pulling back towards your ears. This takes away excess skin and most wrinkles but doesn’t alter the actual texture of the skin. Injectable fillers can fill out indentations or creases but can’t compete with facelift with regard to tightening or restoring more youthful lines. BOTOX® Cosmetic simply stops the undesirable creases associated with some facial expressions.

What is the best treatment for under eye wrinkles?

When very subtle, these lines might respond to topical creams. For more severe lines especially when associated with bulging and excess skin, surgical options include blepharoplasty and laser skin resurfacing.

What’s the difference between popular wrinkle fillers? There are so may “wrinkle fillers” like Restylane, Juvederm, etc.  How can I pick the right one?

Restylane and JUVÉDERM™ are very similar products manufactured by two different companies. It’s generally a question of personal preference. Fillers can differ in how long they last and how effective they are for different areas.  What’s effective for lip enlargement might not be best for a crease.

1. What should I ask my doctor during a liposuction consultation?

• Is there a safe limit to how much can be removed?
• How well will my skin respond to the procedure?
• What are reasonable expectations?

2. Is traditional liposuction outdated? With all of the new lipo procedures out there – tumescent, laser-assisted, ultrasound-assisted, and even fat-dissolving injections – is there still a place for traditional liposuction?

Traditional liposuction is still the gold standard.  Most of the newer techniques  are a variation of or an adjunct to traditional liposuction.  Tumescent simply refers to the amount of numbing fluid that is injected prior to the actual liposuction.  Laser and ultrasonic are enhancements that in most cases don’t alter the final result to any significant degree.  Your choice of surgeon is definitely more important than your choice of technique. His or her results should speak for themselves.

3.  Does liposuction in one body area make another get fatter?The Mayo clinic posted the statement that “It’s possible that if you remove fat cells from one area with liposuction, you may gain less weight in that area, but you’ll gain more in another area of your body.” Have you seen this with your patients? Please explain!!

Fat cells don’t move around.  They simply get larger or smaller with your body’s fluctuations.  The distribution or number of fat cells in different areas of your body give you your shape.  By removing fat (cells) from specific areas, we are deliberately altering your shape.  Weight gain following liposuction means that fat cells enlarge according to this new (hopefully better) distribution.

1. Is there a recommended target weight for a tummy tuck?

The most important issue is minimizing complications. What is removed during abdominoplasty is less important than what remains.  The less fat remaining, the lower the complication rate.  There is no precise target weight, as everyone’s different. Visit our Tummy Tuck surgery page to learn more  or visit our gallery of before and after photographs.

2. How long should I wait to get a tummy tuck after pregnancy?

First, it’s important that this is most likely your final pregnancy.  Once the condition of your abdomen has stabilized (or is no longer changing noticeably), tummy tuck can be considered.

3.  Who should consider a tummy tuck?  How do I know if this is a good option for me?  Should l consider liposuction instead?

Some people need tummy tuck because the problem is purely excess skin.  Others need both tummy tuck and liposuction, because they have both excess skin in the lower abdomen and fat in the upper abdomen and the hips.  Still others have good skin tone and really only need liposuction.  Only a full evaluation can give the right answer.

4. What procedures can help with excess skin after baby and weight loss?

The most common corrective operations are tummy tuck and breast lift, which address the excess skin remaining following pregnancy and/or  significant weight.