Women are increasingly seeking plastic surgery in the hopes of reclaiming pre-baby figures; but what should we tell our little protégées?
When Kirsten Lester shyly called her closest friends to reveal news about her stint under the knife for a “mommy makeover,” their reaction took her off guard. Instead of shock or reproach, one by one, several came clean about the work they also had done. Plastic surgery, especially among the done-having-kids mommy set, is not only the purview of celebrities—it’s just not bandied about during lunch with the ladies at Fearing’s.
Despite a floundering economy, Americans spent almost $10.5 billion on cosmetic procedures last year, according to the American Society of Plastic Surgery (ASPS). The top five surgeries sought by women included: breast augmentation, liposuction, eyelid surgery, abdominoplasty (tummy tuck) and breast reduction.
Lester, a Frisco mom of five, considered all but one of these enhancements two years ago when she decided to shake-up her post-pregnancy figure. At the time, she found her family complete with a preteen and two preschoolers, as well as two stepchildren with husband Kyle. After her first pregnancy in her early 20s, she failed to shed all of the pounds, and before her thirtieth birthday, she had two more children within a year of each other. She also breastfed all three kids. The aftermath of it all left her feeling top heavy and overweight.
She decided her first plan of action would be to lose weight—which she did to the tune of 40 pounds.
But she still struggled with large, floppy breasts (that made it difficult and painful for her to exercise) and stubborn fat in areas she simply couldn’t target, such as her chin.
At age 34, “I wanted my pre-mommy versus post-mommy body,” reflects Lester.
And she’s not alone. Dallas-Fort Worth-area plastic surgeons have noticed an uptick in mothers seeking body-contouring procedures to regain what they have lost after one or more pregnancies.
This is a younger, affluent clientele and they don’t want to settle for droopy breasts and a pooch in their lower abdomen, reports Dr. Robert Wilcox, board-certified plastic surgeon of Plastic & Cosmetic Surgery Center of Texas.
Cosmetic surgery isn’t cheap (or covered by insurance). For instance, the range for a mommy makeover is $5,900 to $14,600 (all inclusive) at North Texas Plastic Surgery in Southlake, founded by Dr. Sacha Obaid, a board-certified plastic surgeon.
But most practices offer financing options (including zero percent-interest loans) to qualified applicants, putting cosmetic procedures within reach to approximately 10 million Americans last year.
You simply can’t exercise or diet away lower abdominal stretch marks, loose skin and abdominal wall weakness, Obaid claims.
During pregnancy, many women experience a separation of their stomach muscles (called the rectus abdominus). “You can lose all of the weight, but still have the appearance of a three-months-pregnant belly because the rectus remains split apart,” explains Obaid. “Also, the skin stretches out, but often doesn’t snap back.”
And, though it has been documented recently in a first-of-its-kind ASPS study that breastfeeding does not lead to sagging breasts, pregnancy can trigger what Dr. Michael Thornton, board-certified cosmetic surgeon of Mansfield Cosmetic Surgery Center, describes as “postpartum deflation.”
“While the breasts shrink down, the skin does not,” notes Obaid. “A woman might be left with an A or B cup, but now she has D cup skin.”
So, plastic surgeons are now combining surgeries to address the anatomical changes wrought by childbearing in what’s been dubbed the “mommy makeover.”
What’s Right for You
These procedures are not a one-size-fits-all plan, however.
According to Dr. Michael A. Bogdan, a board-certified plastic surgeon who specializes in mommy makeovers at The Gunter Center in Dallas and Aesthetic Solutions in Southlake, “A common combination is a tummy tuck, flank liposuction and breast implants.”
But, each woman’s body is different depending on muscle tone, body fat, skin elasticity and genetic factors (which is also why some women "bounce back" to their pre-pregnancy bodies while others do not), states Thornton.
For instance, some women might only want one of the procedures, because the breasts or abdomen are not as affected by pregnancy and weight gain. Also, if there is minimal laxity in the abdomen, a minituck might be an option, just as slight breast deflation can be improved with implants only.
In some cases, a full tummy tuck (including liposuction) to eliminate extra skin and fat, as well as permanently tighten muscles, coupled with a breast reduction, lift and/or implants, may be necessary to achieve the desired look. For major revitalization, Thornton often suggests that the patient break up the surgery into two sessions. However, the goal of the mommy makeover is to target both the breasts and tummy during one surgery to minimize downtime, offers Obaid.
Wilcox recommends that women wait at least three months after delivery before getting a tummy tuck and at least six weeks after weaning baby for augmentation. And, while a woman might not need to have implants replaced following pregnancy, doctors prefer for women to hold off until they are done having children before undergoing a tummy tuck (because the skin will stretch out again).
As with any major surgery, plastic surgeons readily acknowledge that there are certain risks associated with cosmetic procedures. According to Bogdan, simple risks include bleeding, infections and visible scars. More catastrophic risks range from blood clots and pulmonary emboli to heart attacks and strokes. “For healthy moms undergoing makeover procedures, catastrophic risks are very rare.” Bogdan emphasizes. “The simple risks occur somewhere in the 1 to 3 percent range.”
And, certainly, there are horror stories of procedures being performed at the hands of unqualified doctors.
Wilcox recalls a patient who recently came to him for a redo on her tummy tuck. She underwent her first procedure at a med spa and spent almost seven hours on the operating table with only local anesthesia (the average tummy tuck operation lasts three to four hours and is done under general anesthesia). “It’s vital to seek out board-certified plastic surgeons in a state-licensed facility,” urges Wilcox, past president of the Dallas Society of Plastic Surgeons (DSPS).
“Many physicians are attracted to aesthetic surgery for financial reasons and call themselves cosmetic surgeons,” warns Bogdan. “These doctors do not have the training or experience of true plastic surgeons and may make bad decisions due to lack of experience or take unnecessary risks. As these combination procedures take more time to perform, surgeons who frequently perform the individual operations or specific combinations are more likely to deliver good results in a safe manner.”
Obaid stresses that experienced and qualified plastic surgeons will prescreen candidates to determine that they are physically and mentally healthy to undergo surgery. “If a woman is in good health, she can safely have this done without complications,” he affirms.
Lester consulted with two board-certified plastic surgeons before making a decision. The surgeon she chose did not push her into a certain procedure, but instead tailored a plan that met her body type and goals.
Although she wanted a tummy tuck, her surgeon advised against it until she gets down to her ideal weight (she says she still has another 30 pounds to go). Bogdan says, “Surgery is best reserved for women who have reached a stable plateau with a maintainable diet and exercise regime that fits in their lifestyle.”
Lester did, however, undergo a breast reduction and lift followed by implants, as well as liposuction on nine areas of her body.
The working mom remembers emerging from surgery and finding the transformation “amazing.” “I saw myself in a way I hadn't seen myself since my freshman college year,” describes Lester. “It wasn't about fitting into a size, as much as feeling beautiful and attractive.”
She recalls the shock of seeing a picture of herself after surgery and thinking she looked 10 years younger. “I looked my age again,” she declares. “My health changed, too, in that I did not hurt in my lower back and knees anymore once I was healed. By removing some extra weight in my back, knees and stomach, as well as the breast part of the surgery, I didn't get sore or pained.
“I felt renewed in a way … back to my old self.”Doctors say some women, especially with breast augmentation, can see results very quickly. “It’s instant gratification. They wake up a different person,” offers Thornton. In fact, research shows that the five-year satisfaction rate for breast augmentation is 94 percent, reports Wilcox (80 percent of the implants he places are silicone-gel, which was approved again by the Federal Drug Administration in November 2006).
Bogdan also dispels a common misconception that implants need to be replaced every 10 years. “Implants are not perfect, and there are some issues that can occur with time, but if the breasts look good and feel soft, there is no reason to undergo implant exchange surgery,” he stresses.
What is recovery like? Without complications (as Lester experienced with a pre-existing infection that caused a rupture in her incision that took three months to heal—a rare occurrence), breast augmentation patients can usually resume normal activities within days. A tummy tuck, on the other hand, while not as taxing as a C-section or hysterectomy, requires a woman to take two weeks off of work. “It’s often four weeks before she starts to feel like herself again,” informs Wilcox.
Can moms opt to combine a tummy tuck with a C-section? Bogdan says this is known as a “c-tuck” and presents an unnecessary risk. He, along with the other plastic surgeons interviewed, advises women to hold off until they recover from childbirth and their weight returns to normal.
Doing It For The Right Reasons?
Lester says her husband supported her decision, although family members questioned it.
But, to Lester, this was a matter of restoration versus cosmetic enhancement. Also, she says she did it for herself—not to impress someone else.
“It’s easier to take care of others if you take care of yourself first,” affirms Lester.
Dr. Jackie Keish, a Southlake-based licensed professional counselor, advocates that women contemplating plastic surgery should check their motives at the OR door.
Keish counsels many women who struggle with co-dependency and who are apt to try and fix their physical appearance to please their husbands/significant others or to fit a certain “Barbie Doll” stereotype that is prevalent in Dallas-Fort Worth. “It’s very damaging to say that I’m only good looking if I look good in someone else’s eyes,” she stresses.
Area plastic surgeons say there is a line to be drawn to establish when too much work is, well, too much work. Although they claim women seeking numerous procedures a la Heidi Montag are in the minority, they don’t have a problem saying no to outrageous or inappropriate requests.
“As with any cosmetic procedure, proper patient selection is important,” stresses Bogdan. “Patients who have unrealistic expectations or are medically unfit for a procedure are not good candidates and should not undergo surgery.”
In fact, Wilcox asserts that many of his clients specifically say they do not want their implants to resemble those of Pamela Anderson, but prefer them to be more natural and akin to the breasts of their youth. On average, most women will increase by two cup sizes following augmentation, he adds.
Thornton says he aims for natural and feminine results. And he will often recommend a woman seek out nonsurgical results first (especially in the case of skin rejuvenation). “There is nothing wrong with natural aging,” assures Thornton.
“Self esteem runs much deeper than a boob job or face lift,” adds Keish. Although she is not against nip and tuck for “corrective versus superficial” reasons, Keish advises women to get to a “place of acceptance, because it’s always going to be tempting to do this and that [to our bodies] as we age.”
This is important, says Phyllis Bisch, an area licensed professional counselor, ascosmetic surgery raises body image issues—especially for daughters. “We need to make sure kids don’t get the idea that their own body parts need ‘fixing’ too,” she urges. For boys, it’s important not to impart that future partners must meet an unattainable criteria of perfection. But, “a daughter is always watching her mom for cues,” says Bisch. “If a woman feels good about who she is and is balanced in her life, there is nothing wrong with seeking cosmetic surgery. It’s not that different from putting braces on her kids. But the results should please her—not determine her happiness.”
And it shouldn’t be something she feels compelled to hide, offers Keish.
Research suggests that plastic surgery is becoming more widely accepted. A study commissioned by the American Society for Aesthetic Plastic Surgery (ASAPS), revealed that out of 1000 respondents, 69 percent of teens and young adults ages 18 to 24 are in favor of cosmetic surgery. And, 78 percent of all women polled said they would not be embarrassed if others knew they had cosmetic surgery (although, as Lester learned, it’s still not playdate fodder … that is, not until one mom opens up).
So, should mothers tell their children that they’ve undergone plastic surgery? Yes. And no.
“Tell them what they ask—nothing more,” advises Bisch. For older children, who will obviously know you are recovering from surgery, the important thing to stress is that your body has changed over the years, and while you still love it, you want to do something to improve it.”
What moms don’t want to convey is that “I am not good enough as who I am,” she emphasizes.
Bisch says preteen and teen girls already face insecurities with the constant barrage of perfection depicted through unrealistic (read airbrushed) portrayals of women in the media. Teens are battling eating disorders at an alarming rate, she cautions, and they need to hear the message from moms that you should love yourself for who you are, take care of yourself and accept your normal body weight and type.
Keish doesn’t feel it is necessary to inform children when they get older that mom had work done when they were babies. “They are not likely to notice,” she counsels. But if they do ask, moms should be candid and open to discussion.
Lester’s oldest daughter was 12 years old at the time of her surgery—and going through her own body concerns and changes. Lester explained that the pregnancies and genetics contributed to weight gain and loose skin, and, while there is nothing wrong with that, Lester wanted to improve her body so that she would be stronger and healthier. “We also talked about how she can maintain a healthy lifestyle now, so she will be in better shape later,” explains Lester of her daughter.
Keish agrees that moms should share the wisdom of living with their daughters and tell them that when they have had their families some day, they will have their own decisions to make regarding their bodies.
Lester says she has no regrets.
The plastic surgeons interviewed contend that the feedback they receive from mothers post-surgery is likewise overwhelmingly upbeat. Wilcox reports that some of his patients haven’t undressed in front of their husbands with the lights on in years. “It gives them this huge boost of confidence that is life changing,” he shares.
“You don’t really need to do this, of course,” Wilcox stresses. “But it’s human nature to want to look our best.”
Obaid reveals that women often come to him frustrated after trying for two to five years to change their bodies on their own—to no avail.
“There’s no question,” says Obaid, “women love the results. They feel whole again.”
Keish asserts that what’s important is a mom who knows she is more than the sum of her parts; the family, and especially daughters, will pick up on mom’s positive energy.
Adds Lester: “I’m healthier for having had it done. It’s a great motivator to keep my body fit and healthy.”
