Justin Perron: If anyone’s here, if they have any specific questions. Trish’s been really, really wonderful to organise questions and get everyone organised to see how … To see what sort of questions we have. So, I’ve got a whole host of questions ready to go. If there’s anything specific that you want to ask aside from what we actually talk about, have no worries about adding them to the side note. So, if there’s a specific comment you’d like to make or anything you wanted to ask just, obviously, add it to the comments and we’ll get to it in time.

We’ve probably got about 20 questions to go through tonight. Most of them are related to body work, body lifting, body direct procedures. We’ll eventually get to them. There’s a few things that I think, as I was talking to Trish earlier that the questions are actually really well thought out. It’s great because it tells me that patients are researching quite extensively, which I love to see. Because it means we get informed patients, patients who are prepared to have a good conversation about how their … You know, what’s happening with them and what’s happening with their body and the best way to address it.

So, I think it’s great to see that everyone’s so excited about it. Certainly, it’s something that is quite topical. I think a lot of the body lifting, body work stuff right now is really important. Only because the … Obviously, driving into that very health driven environment to not only get good diet, and all that non-smoking stuff. But, it’s also getting the weight down. I think the important thing with that is obviously it’s that journey. Part of what I do is actually quite a small part. I look at the … If you’re to break down exactly what happens with everyone’s weight loss journey, you know, the hard work has been done. By the time I see patients, I really, really want to see patients who are … You know, they’ve had their big work. They’ve had all their stuff done and they come to me to just tidy things up. You know, certainly in life getting to the point where you’ve got a lot of extra weight it’s tough to look at yourself and say, “I need to get rid of it.” That’s a big psychological barrier to come across. That takes time, it takes time to address why it’s happened and more importantly to look at yourself and say, “Okay, I’ve got to fix this.” I applaud everyone of my patients for coming in and losing this massive amount of weight. Going through all that hard, hard, hard work. So, I think it’s absolutely fabulous.

Hello to everyone who’s just joined. Obviously, just slowly leading into it and letting everybody catch up and everyone can log in to have a watch.

All right. So, I won’t … I’m not going to name any names in terms of whose asked questions. But, I’ll just go through the ones that we’ve asked. A lot of the questions that have been posted are actually already on the site. Some of them have been emailed through. So, what I’ll do is just go through the ones that I’ve got, as I say to everyone already, we will go through all the other questions if anyone has any.

Hi to Gina. Good to see her. Gina’s probably one of my favourite patients. She did absolutely fantastic. She’s had a huge journey as well.

Do liposuction procedures also tighten skin? Can it ever be an alternative for skin removal in some patients?

All right. So, we’ll start with the first one that I’ve got here. So, first question was, “Some liposuction procedures claim to also tighten the skin. Is it ever an alternative for skin removal surgery in some individuals?” Sadly the answer is, it’s sort of a mixed thing. So, part of it is yes and no. So, will liposuction tighten the skin? No. Unfortunately, that is determined by a lot of things. So, it’s determined by location on the body. It’s determined by your own genetics. How much damage you’ve had to the skin and underlying tissues before that.

The hardest part is actually trying to get those tissues to rebound. So, if they’ve been stretched or damaged through the process of weight gain, and then subsequent weight loss some stretch marks will actually rebound a bit better than others. I’ve had several patients who’ve had extensive stretch marks and they just don’t come back after surgery. Some people heal actually really, really well. A lot of it is just very qualitative. It’s like experience, when you actually feel the skin and get people in to have a little look you can usually tell if that’s gonna … If that skins gonna bounce back really, really well.

Unfortunately, liposuction doesn’t improve that. A lot of the non-surgical treatments, things like coolsculpting, there’s a whole host of other sort of fat shrinking things that people will help to … Or, they’ll try and sell and say it will actually shrink the skin, it actually doesn’t. The skin isn’t just an inherent quality. If you’ve got really good soft tissue there’s a lot of elastic tissues that it generally will happen. But, unfortunately liposuction won’t change that.

So, in some cases the issue is the more liposuction occurs than the more loose skin is produced. So, I’ve had a few patients that I’ve had to council and let them know that if we do liposuction in an area we may have to come back and cut that skin out. In certain areas a lot of people don’t want those scars. So, lower legs, you know, on the side of their chest, chest wall. That’s not really necessarily a great place to have liposuction and sometimes have loose skin. So, you have to have an honest conversation. For me, it’s always an honest conversation to let patients know that it’s … What’s not achievable and what will work.

How long should you be at your goal weight before having surgery?

Next question in that section was, “How long should you be at your maintenance weight before you have surgery?” So, this is a really common question that I love having with patients because I’m not a numbers person. So, I don’t look at it as a very specific thing in terms of absolute numbers. So, what I don’t like to see are patients who come in and say, “I’ve had my gastric sleeve, I’ve lost my 30, 40 kilogrammes. I’m ready for my surgery.” My whole thing about that is, if you’ve had gastric surgery, or gastric sleeve bypass or whatever it might be I guess the whole point of it is to get to the weight that you want to be at. I do tend to push my patients a little bit and tell them to lose as much weight as they can. Not everyone can be emaciated supermodels, and I don’t really like that look. But, at the same time realistically to get the best results, and I’m really a results driven kind of person, to get the absolutely best results really you want patients to get down to a good healthy weight. There are sort of minimums and things that I would say. So, anyone who’s got a BMI of 30 or higher really not a great candidate. We really want to see that BMI getting to 27, 26 even. Really get it into healthy weight range.

Now, the problem there is that, that brings in that question of but what about the skin and weight I’m about to lose? That’s kind of, you know, that’s the icing on the cake. So, if you lose a lot of weight you’re sort of making this cake, right. So, it’s a really weird analogy but it’s … If you get all the ingredients together to make a cake, which is the gastric banding and the gastric bypasses and lap band all the rest of it. You make your cake, you go through that hard work, you put it in the oven and then when you bring it out you want to make it look pretty. That’s my job. So, I’m really just the icing doc. So I am there to make that cake look good. Trim a little bit off here, add a little bit there, whatever it might be.

So, anything that comes off from what I do is just a nice added bonus. But it’s the hard work and all the guts of it really should be done as a result of the gastric sleeve exercise, diet and all that and that sort of thing. So, I really … I’m really a true believer that numbers are important, but they’re not the only thing. Really you want to get to your good healthy weight before doing, or considering any sort of major, major gastric sleeve surgery. Or, sorry, any weight loss surgery.

Can you book a consultation before you’ve reached your goal weight?

Last question in that section was, “Can you book a consultation before you’ve reached your goal weight?” Absolutely, I have no problem having that conversation with everybody. I love making, you know talking to patients about that kind of stuff. A lot of times I think patients feel they get a little bit of extra motivation because it’s really important to have that conversation. Some patients they’re not, maybe not psychologically ready for some of those things and it’s really important to be able to go through and do that kind of stuff. So, yeah, absolutely. I’m more than happy to talk to anybody at anytime.

When can you start exercising after plastic surgery?

All right. Next series here. So, the next one has to do with exercise. So, question was, “Can you start to do Pilates again-” or, “When can you start doing Pilates after a tummy tuck?” So, question is, “If I wait six weeks for exercise can I start Pilates if all is going well in week seven?” So, my personal philosophy on this is certainly if you want to start exercising after surgery, inclined walking or inclined if you want to get on a treadmill and do a little bit of work is perfect. Keeps your cardiovascular fitness up, keeps your muscles moving and it keeps you healthy. Anything where you have to start lifting weights, putting a lot of strain is where we start running into troubles. That’s where we start seeing wound breakdowns, because the surgery that I do … Post operatively pain is the guide to what you should and shouldn’t be doing. It’s not that the pain is a thing you need to overcome.

So, that’s obviously if you go to a gym, you’ve got that lactic acid barrier where you need to overcome … PT wills always try and push you through the pain. Push through the pain, push through the pain, push through the pain. In surgery, it’s the exact opposite. You really need to let pain be your guide. So, if you get to the gym and it’s a bit sore you have to really sort of pull back and listen to your body. I find that the longer you wait to get back into the gym to do anything very heavy lifting, or do any major stretching is probably the safest.

Now, at week six, anywhere between week four to week six that’s the time when collagen that your body’s producing is almost it is usually at its weakest. So, physiologically … It’s kind of getting very scientific, but physiologically the way your body goes through the healing phase there’s two types of collagen that your body uses. The first type of collagen is just sort of a mess of collagen that sort of hold things together. Then at that, sort of, week four, week sick mark all that collagen starts to remodel. That’s the remodelling phase. Most physiology textbooks, and pathology textbooks will show these graphs of one type of collagen going down, the other type of collagen going up. The collagen that goes up after that week four, week six mark is the strength collagen. That’s the collagen you really want.

So, at week six that’s kind of where it’s at the lowest point, and that’s where we would see problems starting to happen. That’s when you can really pop open wounds if you start doing many major stretches. So, I’ve had one girl I did a body lift on, she went to see Kinky Boots. Sat in one of those very, very angled chairs to go watch it. Popped open a wound on her back and we had to resuture it a few days later. That was, it was week six. So, I tend to be very conservative with my patients in terms of how to do it. It just means that we don’t run into those kind of problems, which for me is the most important because that patients really don’t want to have a complicated post operative journey. So, as I say, I tend to be very conservative. Other people might say something else. But that’s just sort of my opinion.

All right. Next section. “Can you combine an inner thigh, or groin to knee?” So, that’s gonna be a thigh lift with a face lift, which incorporates a neck lift. “If so, how many hours would the surgery be?” So, definitely you can do two surgeries at once, not a problem. Thigh lifts, they would be … Depends on how significant the thigh is. Or, how much we’re going to take off. Usually a thigh will take about, on average about an hour per side. Anywhere from 45 minutes to an hour, sometimes a little bit longer sometimes a bit less. But, on average about 45 minutes to an hour. So, it’d be about an hour per side, so that’s two hours. Face and neck, that’ll be probably another five hours. So, it’s gonna be, what, seven hour operation.

I guess my issue with doing faces and all the body work at the same time is that post operatively the way I manage a lot of my body lifts is I’m pretty generous with things like Heparin and some of the blood thinners. The reason for that is that the risk of DVT and PE is real. So, the conferences I go to and some of the ones I was at in May in San Diego. Which is a great one to do for plastic surgeons because you get up to date with all the current techniques, see what everyone’s doing overseas.

The really important thing there is the DVT prophylaxis. One of the things they talk about specifically at that conference was that. I’ll never forget it because the guys who were there they were talking about … Everyone was sort of talking about what they do. The guy who was moderating the section said, “Has anybody ever had any patients who’ve died post body lift?” There were a bunch of people who put their hands up in the room. It was frightening to know that potentially the risk, you know DVT is causing pulmonary emboli and potentially can be fatal. It’s a big deal.

So, we talked about the best way to manage preventing that thing from happening. One of the things that I do is I actually give patients Heparin intra operatively. So, what that means is while that same drug that we use for DVTs postoperatively during when the patients are having surgery, I actually give that to them while they’re asleep. Then post operatively I give them another drug as well called Xarelto. Xarelto is a blood thinner and its got very good evidence to suggest that it’s better than Clexane and Heparin to prevent DVTs. So, that’s what I use. Great drug Heparin, knock on wood, but haven’t had any issues with it yet. More importantly I haven’t had anybody have any P’s or DVTs, which is the most important. Post operatively, two weeks for that.

So, in theory yes you could combine a face lift and neck lift, but I would probably council that it’s probably not a great idea. Only because, you know, when we look at someone who’s on for a significant period of time we would have to provide you with blood thinning tablets. Certainly with face lifts doesn’t really go very well. So, hematomas and bleeds in the face can be pretty devastating. Whereas in the body it’s equally as bad and it’s something we need to go to theatre for quite urgently. But at the same time we really need to just be careful, particularly in faces and necks when it comes to airways and breathing, that sort of thing.

All right. Next section. “Who determines goal weight, and does that include the weight of the excess skin?” So, the goal weight … So, the whole thing with the excess skin … So, we’ve talked baking the cake and how much skin comes off. As I say, anything I do is really just the icing on the cake. So, we don’t really include that in … The goal weight is certainly something to discuss between yourself and your bariatric surgeon. Some people do better than others, and that’s just, you know, damn those people who do well but that’s a whole lot of genetics. In some cases just the way it is. Some people do better. I do tend to find that people who have gastric sleeves when their a bit younger tend to do very, very well. People who have it when they’re somewhat a bit older they do sometimes struggle with weight.

I think the most important thing with goal weight is really to be realistic about it. But it’s also important to remember that the time you lose the weight. You have one year essentially to get rid of that weight. So that’s the time you really want to smash it out. You really want to hit the gym, you know, really be very, very, very strict on food and diet and all that kind of thing. It’s very, very, very important in that first year. First year is absolutely the time when you want to do it. So, for me goal weight, well we’ve talked about BMI. Goal weight from that point of view should be something, you know a good solid discussion with your bariatric surgeon.

Multiple procedures at once

From the list, this other one we’ve got, “What would stop being able to perform several procedures in one surgery? So, things like belt lipectomies, breast lift, thyroid action and arm lifts.” So, I’ve got a philosophy on this and I think it’s my strategy. Knowing that a lot of people will have different areas of the body done at different times, I would usually say try and break it up into two surgeries. So, we do the big surgery first, which is the abdomen and circumferential usually plus thighs. So, try and do two in one. Then, we come back and do other parts. So, breast and arms, or upper back, whatever it might be.

Reason for that is anytime we do the lower half, anytime we do thighs and circumferential it’s not uncommon to have to come back to just do a little tidy up. That might be a little bit of excess fat that’s somewhere, or I don’t like this part, or this scar kind of annoys me. Whatever it might be. It’s great as a strategy to say, “We’re gonna do it twice. So, we do the lower body, upper body.”

Again, in terms of doing that as aesthetic procedure some people don’t like doing it. I don’t know why, but I haven’t had any issues with it. But, a few anaesthetists that I work with who we have our routine down quite pat and it works very, very well. So, for circumferential we start patients prone do what we need on that side. We turn patients over do the abdomen and then the other area that they want done. So, for some people they’ve had a huge weight loss and they’ve got a lot of arm excess. They’ll come in and say, “I don’t like my tummy and I don’t like my arms.” So, all right, we’ll do those one first and then we can come back and do … If you want breast and thighs, or whatever it might be.

So, for me I’m always willing to see which areas you want to do first. But, as a general sort of rule I would do circumferential because that’s the big operation. That’s the one that takes longest to recover from, and then everything after that is actually not too bad. So, thighs are pretty straight forward to recover from. Arms are pretty straight forward to recover from. Most breast work is also, you can sort of sail through that. So, doing multiple procedures I have no problem with it. But I’d always say if you want to do it plan for two. Then if we want to do facial work, facelifts, neck lifts that sort of thing we can always do that one potentially as an add on to the other ones. But just, you know, we talked about before you have to be really careful with some of those.

So, can these all be done in one surgery? I try and avoid it, one because it’s pretty stressful and your body will be asleep for a really long period of time. I have done in the past and I won’t do it again. Not because I’ve had any problems, but because it’s just, you know takes a long patients to recover from it. So, I’ve learned from those things and I won’t do them again. So I generally would just say two, about seven hours of sleep is enough for a patient. That’s kind of enough for me. I do lose focus a little bit sometimes and that’s why I have an assistant to help me out with those ones.

Can any plastic surgery procedures impact on lymphedema or lipedema?

So, “Can these surgeries impact on lymphedema or lipedema?” So, lymphedema is slightly different from lipedema. Lymphedema is usually excess swelling in the legs. Or lymphatic swelling in the legs or arms as a result of damage to the lymphatics. So, I would typically see those in patients, for example, who’ve had breast surgery and they’ve had some of the lymph nodes taken out of their arms. So, as a result of that the arm swells and that’s something that’s called lymphedema. So, the lymph nodes are damaged here, the limb structures are damaged here and there’s sort of that back up of fluid that happens at the arms. Same thing can happen in the legs as a result of all kinds of things. Again, can have surgery where we’ve taken lymph nodes out of the groyne and in some people who have been very, very, very … They’ve carried a lot of weight, sometimes their lymph structures can be damaged due to their excess weight. Repeated bouts of cellulitis, all those sort of things can damage those lymphatics. As a result they get that sort of lymphedema that can occur.

So, in what I do, depending on where that is we can certainly modify some of the techniques and use certain different techniques to address that. I can’t fix the lymphedema. So, that’s probably the hardest part. Can I fix it? I can’t really create new lymphatics. But what I can do is get rid of some of the excess tissue that might be causing all of them. That can be on the inner thighs, that can be in the arms. A lot of it is really just to address that excess. So, again it’s that contouring.

Lipedema is something different. Lipedema is a term that’s used for abnormal deposit of fat in certain areas. So, it’s interesting talking to a few patients who’ve come through talking about lipedema. The treatment for lipedema’s essentially just getting rid of it. So, liposuction, direct incision, all that sort of thing. So, there’s no, sort of, magical thing. It’s just a descriptive term. Typically I would see that women will get it abnormally in their thighs. So it depends on your body makeup. Some people they just carry weight in a slightly different spot. Might be their tummy, might be in the thighs, might be in the legs, might be the bum. That’s different for everybody. I find that depending on your body type, and women generally will hold in on the lateral part of their thighs. They hold it just with that lovely term saddle bags. That’s typically where they hold it. Especially after pregnancy, or during pregnancy. The other place is usually around backside. For men it tends to be in their flanks, in their abdomen.

So, lipedema would be after big weight loss. Some areas just don’t lose that weight. That’s understandable. There can be a lot of reasons for that. Sometimes the underlying tissues are damaged and as a result that fat sort of just folds off and doesn’t actually get fixed. It sure doesn’t get lost, and it’s really hard for that fat to sometimes get lost. But again, it’s fixable, it’s one of those things that we just hit it pretty hard with the liposuction and sometimes direct incision if that doesn’t help. But I would typically say, yes it is certainly … It can impact. All those surgeries can impact on the lymphedema lipedema.

Brazillian Butt Lift

Next one. Interesting question. “Why are Australian doctors not producing the same look as Mexico, Dominican Republic, and America when it comes to Brazilian Butt Lift?” Good question. I think most surgeons don’t really want to be too controversial and create really big butts. I think it’s probably a little bit of a cultural phenomenon. Certainly in the United States and Mexico and other places there is a bit of a trend. It’s one of those trendy things, and it might be great and trendy this year, five years from now. But it might not be so trendy after that. The question is what do you do with it then? You’ve got this huge buttocks with these huge areas where you’ve put fat in. How the heck you gonna get it out? That can be a bit hard, because we know that putting fat wrapped in, which essentially is what the Brazilian Butt Lift is. Putting that in is the easy part, but scars and it tends to be very difficult to get rid of down the track.

So, it’s an issue that no one’s really 100 percent resolved just yet. I think as a general rule Australian plastic surgeons probably just a bit conservative. You don’t want to be too controversial, you don’t want to appear like some cowboy whose doing some crazy stuff. That being said, certainly for circumferential body lifts I’ve increased the amount of volume that I’ve started back into patients. For circumferentials I tend to use a lot of the patients fats. So I do something called auto-augmentation. I’m happy to do a completely separate thing about that. But, it’s essentially preserving the tissue in the buttock, lifting the current buttock skin over top of that. So, it actually keeps that volume there. Then doing liposuction in various places, thighs, lower back. Then processing that, and then re-injecting. That’s the fat grafting part.

As I say, I’ve increased the volumes that I’ve been doing that over the past couple of years. I know I started initially 150, 200 cc’s seems to be okay. Now I’m getting up into the four and 500s, which again seems to be perfectly fine. I think the Brazilian Butt Lift is a guy in Boston and New York. His name’s Dan del Vecchio and he does some pretty big butt lifts. Sometimes he’ll do up to a litre and a half per side, which is a lot. I don’t know if I’d necessarily be comfortable doing that only because that’s a result that that, you know, your name is attached to it. That’s exactly what it would be for me as well. So, I think a lot of plastic surgeons would look at that at the same time as well and say, “I really never want to be known as the butt guy.” I don’t mind doing a little bit of fat grafting, but I think a lot of people will, you know plaster’s might get a little uncomfortable with it. That’s probably why they don’t push the limits a little bit too much.

Last question is, “Someone whose lost 56 kilogrammes, think it’s 65 kilogrammes, is a Brazilian Butt Lift advised to be done before a body lift or after for best results?” As I say, I do the same time. So, I use a technique called buttock auto augmentation. What that does, it preserves the volume you’ve already got there. We just lift that bit of tissue over top. Then also re-inject at the same time. Some patients don’t like it, they do feel like a bit of a bubble butt afterwards. That doesn’t bother me, ’cause I know that eventually some of that does drop down. It does go down to but I … But it’s also personal. I’m not here to judge associates. Certainly if someone came in and said, like I want that and we talk and see can we do it? That’s probably the most important thing. As I say I’m not here to say it just looks silly. It’s certainly something we talk about, and we go through photos and see what works best for you.

But a patient hears … Or, another question here. So, ladies having a lower body lift. Yeah, a lower body and thigh lift. “I was wondering what cream or ointment to use on my scars?” So, silicone. Silicone’s probably the best thing. In my opinion there is … So, whenever we look at what’s best for scars I generally would look at burns data. So, of course anyone who’s had a bad burn they produce a lot of scar. So, a lot of the scar treatments, regimens that we get in plastic we’ve actually used in burn surgery because for that reason they get a lot of scars.

There’s three publications, off the top of my head, that have been published that are randomised control trials. Randomised control trials are obviously the most powerful way of determining which way the … to give you the best data. Those randomised control trials looked at using pressure, using silicon, and Vitamin E. So, Vitamin E is a classic one. Of those three it showed that … All three showed that silicon and pressure were the most important. Two showed Vitamin E provided no improvement in scar quality and one even showed Vitamin E even made the scars worse.

So, the best thing that works is silicon. Silicon ointment or silicon sheets. So, Cica-Care is a good one, and there’s a whole host of other ones that you can get a hold of. Those are the ones I that I would generally use in clinic.

So, I just had a quick question there. SSD. So, SSD is a thing that we use for burns itself. So, that’s something that we actually use for open wounds and it’s a bit of an old school ointment, but it’s still used. But it’s not really great for scars it’s just used for open wounds.

In that same one it’s a couple questions here about ointments. So, certainly zinc supplements. Someone was asked to increase their zinc supplements after their surgery. So, we go back to that collagen question that we talked about earlier in terms of how collagen works to … How it changes from one type to the other. So, there’s a lot of co-factors in that collagen production. The two most important ones are zinc and Vitamin C. The good thing about zinc and Vitamin C is that they’re both water soluble. So, you can have quite a lot of it and you don’t really have to worry about any major side effects.

Zinc in particular, I know there’s a lot of controversy in terms of does zinc cause all these, sort of, problems with the bodies and is it causing all of these issues inside? The answer is no. There’s no real issue with it. It’s a little bit of an anti-vaxxer kind of thing. Again, controversial and I probably shouldn’t say that, but I’m saying it anyway.

With Vitamin C there was a famous physicist, his name was Linus Pauling, he lived to the ripe old age of, like, 97. He was a huge fan of Vitamin C. He would take four grammes a day, if not more just because he thought it was a great antioxidant and it is. He lived old, he was a smart guy. But yeah, you can take a lot of it and it’s not really gonna harm you. Probably the most important thing is protein. So, protein, probably increase your carbs a little bit. Zinc and Vitamin C are also very, very important. So, there’s no real risk in doing it. In fact, I would tell most patients to increase their supplements anyway.

When having a thigh lift do you have liposuction on the calves as well?

One last question. “When doing the thigh lift do I do liposuction on the calves too?” Generally lower limb liposuction does have its problems for a few reasons. Nerves, sensory nerves can be very superficial and they can get damaged. That’s something we have to have a very, very honest conversation with patients with. There are a few people around Australia who’ve done lower leg, or lower limb liposuction and had some very, very, very significant problems with that. One doctor had a patient who ended up with neck ties and fasciitis, which is bad. That was just from liposuction alone. So, it’s not a great place to be doing liposuction regularly. Routinely I do it, but you just have to have, again, a very honest conversation and not be very aggressive with it. Certain parts of the body we can be a little more aggressive with it. The lower limb is not one of those places. So, you have to be very judicious with the use of liposuction.

Reverse abdominoplasty

Next question. So, reverse abdominoplasty. So, whether or not it’s a procedure that I do, or willing to discuss with a breast lift and an arm lift. So, certainly happy to talk about it. Reverse abdominoplasty’s are pretty uncommon. I would say that it’s not a procedure that I do regularly. Only because we can usually … You know, if we don’t have to do it, I don’t particularly like the scar. I don’t particularly like the look. Instead, as I say, there are circumstances where you need to do it but I wouldn’t routinely do it. What I do at the same time as a breast lift and arm lift absolutely no problem. But it just depends on what, you know, whose post operative photos you’ve seen and some people will really try and promote that one.

There’s a lot of reasons why people like to promote those types of procedures. It’s usually because … Particularly in the United States, they do them in their office. So, they’re not actually doing them at a big hospital, they’re doing them in the office because it’s all the new weird American health regulations and insurance issues that they’ve got. People, you know, have to pay a lot of money to get these kind of procedures done in a hospital. As a result, a lot of this is done in office space stuff in the US.

Tummy Tucks

Next question. So, “Looking for information on a tummy tuck. I reached a stable weight, feel awfully confused where to start.” So this patient’s specifically saying they’ve got an apron and they want it removed. So, “Has anyone had this done in Canberra.” So, Canberra is … there are certainly some fantastic surgeons down there that certainly can do that. When it comes to the severity of the apron it really depends on how much weight you’ve lost, and starting weight, finishing weight all that kind of thing. Certainly, apronectomies. So, for patients who starting within 200 plus kilos and they lost, you know they’re down to 100 kilogrammes those are the patients that I would see who actually have proper aprons. These are ones that are down to mid-thigh. Those are, you know, doing an apronectomy is a completely different type of procedure than doing an abdominoplasty.

So, abdominoplasty is one where we actually address the abdominal wall laxity. That’s where we tighten the muscles and do a lot of work along the abdominal wall. Whereas just getting rid of the apron is a slightly different one. That’s just getting rid of that excess skin that’s hanging down. That did wonders for people who have those big aprons that hang down because they’re major issues on the back. Afterwards they actually get somewhere to put their hands. They’re not putting it on this big thing that’s hanging down. It’s actually, you know they get their lap back basically.

So, it’s a slightly different type of procedure, slightly different area. This one sort of goes on to say that they’ve got private health care but no spare cash. So, will it be covered by Medicare? So, certainly those procedures are covered by private health. So, that’s something that does care an item number with it. So, the important thing there is that if its got an item number most private health funds will cover it. That means they cover the cost of the hospital stay, they cover the cost of the anaesthetic, you know, ICU if needed. But probably the hard part to say is what’s the gap. The gap is something that, obviously, you need to have a discussion with your surgeon about.

Those are the sort of procedures that can be covered also if you want to get your money from your super. That’s absolutely within the same limits of that and you can do that. I’ve had a lot of patients that come in to do that as well. It’s great, it’s an easy thing to do. Not really much of an issue. The best place to start is definitely with your GP. If you have a surgeon you specifically want to see just mention that to your GP and they can refer you straight through.

Does Medicare cover skin removal, tummy tuck or thigh lift without any skin conditions?

Next question. Kind of related to that one. “Has anyone been approved by Medicare for skin removal, tummy tuck, thigh lift after 40 kilogramme weight loss but no skin conditions?” So, you may not find you’ve got as severe a skin condition as everyone else, but in the Medicare book … So, the regulations surrounding that, there’s a few things that you need to tick. So, you’ve had a big weight loss so that’s tick number one. Tick number two is you’ve got a lot of excess skin that’s causing troubles with day-to-day activity, so that’s another one. You’re weights been stable, so that’s tick number three. And, for me the ADLs/Skin rash is not too far from me from themselves. The skin rash, the reason why they put that skin rash in … So, they’re saying that is the skin redundancy so bad that it’s actually, you know, potentially gonna cause an issue with skin integrity.

Well, I think it’s … Potentially if you leave it there for long enough absolutely it will. Why leave it to cause a problem, which we know it ultimately will. Why not just fix it up before it causes that problem, and so for me I’m happy to put it through to the health funds. Because once we do all they see is they see that you’ve had stable weight loss, you’re having problems from day-to-day, and it’s … You sort of hit those marks in terms of Medicare numbers and it works really, really well. So, I have no problem going through with those ones. Particularly if you hit those marks.

The last one for the one that we’ve got here is along those Medicare battle lines. So, “Has anyone had brachioplasty and been refused because it was done at the same time as abdominoplasty?” I’ve never had that issue. In fact, it’s always cheaper for the health funds to do it at the same time. So, if they have any issue two options. One, try again depends on the … Sometimes at the health funds it depends on the time of day, the phase of the moon. If you talk to Bill, or John, or Nancy behind the phone. Some people will say yes, some people say no. Certain health funds aren’t as good as the other ones. I’m not gonna name any but there are a few that are really, really difficult that I deal with. There’s a few health funds that I don’t deal with because they are very, very bad. NID is probably the one that I refuse to do any work with because they are just absolute bastards. They really, really, really are. They have patients that come in and they’ve actually refused care even though we’ve actually done an operation. It’s very frustrating. But, they’re just saying in Medicare. Apparently there’s a Medicare rule is that they won’t pay the 30171, which is a lipectomy or under arms and they won’t do it at the same time as surgery 30177. I do it quite regularly and never had any issues with it.

And, “Have I ever heard of anything so stupid?” Yes. All the time. I can at least … Health funds are just absolute pain in the you know what. It’s just annoying.

So, we’ll go through just a couple questions here. A couple people have asked some things as I’ve sort of chattered on here. Thanks everyone for all the questions and the thumbs up and the happys. I feel really good.

What is the time frame for getting back into weight lifting post op?

So, Mandy’s just wondering she loves weight lifting, planning on doing a belt lipectomy, brachioplasty June this year. What time frame looking back getting into full weight lifting post op? So, with the belt lipectomy, so that’s obviously the one that’s gonna go all the way around. For me, again, I would wait a full three months with all that work that’s being done. One of the things you don’t want to do is get back into the gym, you start doing weights, anything high impact, high activity and you start ending up with problems or issues.

The gym will always be there, but you really want to put that hard work into keeping the work that’s been done and you don’t want to put it into … To risk it and getting a bad result. So, personally I would say wait three months. That’s just me, you can certainly head back into the gym and enjoy the smells of the gym by getting on the treadmill. But, entirely up to you. But, as I say, I would normally tell most people to say to wait three months.

Freezing the fat in the double chin, is it practical?

There’s a few options now for that double chin area. It really depends on how bad it is. So, certainly Kybella in the United States, and it’s Belkyra in Australia that certainly does help to get rid of double chin. I know I’ve got my little early double chin that’s starting to start. But, that does work.

For the big, big double chins certainly coolsculpting can help.

But, it has its limits. Again, we talked about that. If we get rid of that volume does that mean we don’t have to get rid of the skin? So, is that also gonna tighten skin? That’s kind of something we’d have to look at, have a discussion. It can help, but I do find that things like coolsculpting is actually a lot of money. So, if you’re doing two, three, four rounds of coolsculpting it’s almost the same cost as having liposuction. It certainly, from a financial economic point of view certainly worth thinking about. And certainly if you’re having surgery you can sometimes get some of those little tidy up things at the same time.

So, is it there? It is. Certainly it’s something you’d have to definitely talk to someone who does a lot of coolsculpting to see what they can do. There are limitations to it, but it just depends on how severe it is and all those sort of things.

Do you need a belly button?

No, you don’t. Belly button’s actually just a scar. It’s a scar remnant from the umbilical cord. So, if you look at babies their umbilical cord actually sticks out and then as it scars it contracts and moves in as everything kind of grows inside. But you don’t actually need one. There’s no functional consequence from it. I try and preserve the belly buttons that I use only because they look the same and they still have a bit of sensation. So, they feel the same. I think from an aesthetic point of view it does certainly … While it doesn’t frame the abdomen it’s certainly a feature that we’re so used to if it’s not there it looks really weird. It also provides some definition to the abdomen to a certain degree.

Best products to help reduce scars?

So, it depends on the stage of the scar. So, if it’s a late … If it’s something that’s been around for a long period of time that’s something may need Adjuvant therapy. So, either steroids or something else. But, generally if you’re looking at preventing scars or it’s just starting to get a bit hypertrophic anything with silicone in it is the best thing to use.

Do I weight the skin that gets taken off in surgery?

I absolutely do. If so, what’s an average usually comes off with a full lower body, tummy and thigh? So, depends on the person, depends on the weight loss. I think the biggest amount I’ve ever taken off was in a apronectomy, just an apronectomy alone and I think that was 15 kilogrammes. That was because it was down to the persons knees and she couldn’t function from day-to-day. So, taking off that amount is a massive, massive improvement for her. So that was number one. Then two we also did a little bit of work on her thighs, used a couple kilogrammes on both sides. So that was a huge amount. But, generally average would be anywhere from usually two to about four kilogrammes. I do try and do a lot of liposuction. As I was saying before, liposuction and actually re-inject that back into the bottom just to help get that shape back at the same time. But on average it’s, again, anywhere from about two to four kilogrammes per operation.

Abdominoplasty, before or after kids?

Definitely after. If you want to do one before there’s nothing wrong, but it’s just all that work kind of goes for naught. It’s best to really consider it afterwards. Ideally after kids. Doesn’t do a lot of damage, kids. Guess which way you look, physically and fundamentally, psychologically, philosophically sometimes they do. I’m just kidding. I think the abdominoplasty, you know, they can kind of ruin the effects of the abdominoplasty. Certainly if you’re prone to stretch marks or something along those sort of lines. Then yes, they can potentially cause them to come back again.

Thanks for all that stuff. Thanks for your comments. What else, what else?

Should you stop taking multivitamins a few weeks before surgery?

So, the important thing about multivitamins are the ones that have oils in them. So, Vitamin A, Vitamin E those are the ones that you really want to stay away from. Fish oil, krill oil those are the ones that actually act like asprin. They thin your blood. So, people who are on those I would get them to stop at least two weeks before. The risk of bleeding and that sort of thing is a major issue. But, water soluble medications are totally fine. Arnica I definitely, if you want to do the Arnica go after but not before. The important thing about supplements is you want to maintain the rate at which you’re doing it. You don’t want to start chomping and changing before or after because you’ll really throw your bodies physiology out before hand. So, if you wanted to do it before give yourself enough time. A couple months to sort of build up a very, very slow rate. If you want to do it afterwards same thing again. Just build it up at a slow rate let your body adjust to that new thing.

What is the difference between a Fleur de Lis and a regular tummy tuck?

So, the difference with the Fleur de Lis is that the Fleur de Lis is the one that comes up the middle. A standard tummy tuck is one that just sits on the bottom. So that’s where you get that one incision that goes from hip to hip. Benefits, so I would usually refer a Fleur de Lis for people who’ve lost a lot of weight and this bit in the middle just able the abdomen hasn’t actually come off. So, there’s still a lot of loose skin in the midline. That’s where Fleur de Lis’ very powerful. It also deals with some of the contours on the side. I think in people who’ve lost huge amounts of weight, so we’re talking 70, 80, 90 kilograms and this bit in the middle just hasn’t come back then Fluer de Lis seven days a week that certainly makes sense.

Some people in the US in particular, they really … that’s the only thing they’ll do. That’s because they feel that in terms of contour it’s a superior type procedure. And in some people it is. I try and avoid it only because I just don’t like the midline scar. That’s kinda just one of those things. But, you can get excellent, excellent results from them. In terms of contouring they can be superior absolutely to a standard, or a routine, abdominoplasty. Inside everything is the exact same, so we do the same kind of suturing for the abdominal wall, do all that kind of stuff. But, some people don’t like that midline excess that sits just above the umbelica. So the belly button, sometimes that little bit there and there’s no other way to get it. Liposuction, all the rest of it just doesn’t quite address it 100 percent. So, Fleur de Lis is important. Benefits of both, again the contour it can be superior for if you’ve got that little bit of excess.

How long does numbness last after a lower body lift?

So, in certain areas it can be quite permanent. Certainly from the belly button to the scar, just above the scar that goes around. That does … Sort of, it’s really quite intense initially. But it actually decreases as the months go by. The problem with nerves is they take a long time to regrow. Usually anywhere from three to about 12 months. Three months they usually start growing back, and then up to 12 months before you start seeing those effects come back. Again, the things that govern that, things like genetics, location, what sort of damage it was and certainly in an operative type damage that just takes awhile to come back. In some areas it’s kind of a complex play between your brain and the area. So, just, it does take a while to come back.

So, Stephanie was just asking about … You’ve lost 30 kilograms since having kids. Good work, fantastic. Breast surgery is covered by private health. Surgeon said tummy tuck won’t be. Yeah. So, I think that’s an interesting one. I think push them. Push them a little bit. Because you’ve lost weight, so technically you are in that range where you’ve had a large weight loss, it’s stable and if you’ve got issues with skin or rashes then you qualify for that. I don’t think that’s really too much of an issue. It really depends on the motivation behind getting that done. It doesn’t … You don’t necessarily have to have a weight loss surgery as long as you’ve lost weight. That’s probably the most important factor there. you’ve had a large weight loss, so more than 10% of your weight. More than 15% of your weight and that’s fine, 30 kilograms. Then, just have to push a little bit and ask.

What else, what else? All right. Over 80 kilograms weight loss. Wow, impressive. Very, very, very good work Iona. Lots of excess skin, so would the fat that’s been removed by lipo give a good result in the lifeless empty breasts, or would you recommend implants? Yeah, so implants definitely. So, one of the things about implants is not only do they provide a little bit of extra shape, but they do provide volume. At present we don’t people who are doing fat grafting to breasts. There’s a really complex reason for that. My insurance company won’t cover me if there’s any issues or any complications as a result of doing fat grafting to breasts.

So, if I, for example, do liposuction and do a little bit of fat graft somewhere you get a haematoma we gotta get you back to surgery. Not only am I not covered, but potentially you’re not covered either. So until that area gets resolved through the insurance companies with the various other things we don’t do it. So, large volume fat grafting to the breasts we just sort of stay away from it. The good thing about implants is that they’re predictable and pretty easy to discuss with.

Thanks everyone for having a little look. Just going to keep on going down. So, Steph’s just asking here she needs a full lower body lift, breast lift, and aug. But just can’t afford it right now, so that’s unfortunate. There are other avenues when it comes to finances. So, certainly one of the things that I’m legally not allowed to discuss are those other avenues. Certainly using your super is an option, and certainly there are some good people around who provide payment plans. I think Trish can probably point you in the right direction. But in my rooms I’m just legally bound by not being allowed to discuss that kind of stuff unfortunately.

I think it usually leaves a lot of patients sort of resorting to areas where they shouldn’t be. Sometimes not getting proper financial sort of discussions about that. So, I would normally say if you’re having the thoughts about where to go certainly ask around this forum, this group there’s a lot of people who’ve done things certain ways and it works very, very well. Super funds seems to be a good place to access because it doesn’t actually leave you with a big financial debt, which is probably the most important thing. But, certainly talk around and see what other people have done.

Sorry, just keep on going down there. Local who’s very uneasy about going about my tummy tuck. Yeah. It’s certainly one of those things that we can talk about. That’s certainly one of those discussions that’s certainly around the forums. As I say, Trish is a great resource. She’s absolutely fantastic and she can point you in the direction of a few people who could certainly help and give you some ideas.

Yeah. More than happy to see patients who’ve had work done elsewhere. Doesn’t bother me at all, just depends on what we’re trying to achieve and making sure we’re all on the same page. Probably most important.

Any time frame that you must wait between tummy tuck and breast aug. Three months for the tummy tuck is probably the best. Allows all those little issues, contour problems that you might want to get addressed as a result of getting breast done. Certainly, if you do the breast aug first same reason you’d want to wait three months. Let everything kind of drop and settle down before we’d actually really go in there and do something too crazy.

Health fund that I’d recommend? So, the … Let me get my phone. There’s a website you want to go to. That website is … I think it’s called the AHSA. So, I keep this on speed dial because I do get that. So, it’s theses guys. So, the AHSA. Australia Health Service Line’s they’ve got a whole list of what we call the good health funds. To be honest, some of the bigger guys are pretty good as well. Medibank, Bupa, they’re not too bad. Again, I shouldn’t say it but there’s a few that I don’t particularly like. The one that I refuse to deal with is NIB though, because they’ve burnt us in the past and they refused to pay on a lot of patients. It’s been not very, very kind on their part. So, certainly that’s where I’d go for those ones.

How long do I expect out of town patients to stay in town after surgery? Depends on the surgery. Should be minimum two weeks just to make sure that we’re … You’re up and around and able to walk. That would be kind of the time frame that I would be looking at. That’s for most surgeries.

Is it impossible to have lower body lift and arms at the same time? Not at all, I do it all the time. We’ve had a few of those questions and I’m happy if you want to go back and look at them. But, yeah, definitely certainly happy to do at the same time.

Certainly check with NIB PITA. Some days good, some days bad. Depends on the level of cover. But, they can … They just can be really difficult. As I’ve said, we’ve had some issues with them in the past.

All right. I think I’ve talked enough. Good to hear from you, Maria. Hope everyone has a great Australia Day weekend. Long weekend. Enjoy the sun, hopefully it’s sunny where everybody is. Don’t get up to anything too crazy and keep it safe.

Thanks everyone for coming. Thanks for all the questions. Loved doing it. Look forward to doing it again. Thank you.

Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.

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