After Losing 200+ Pounds, Cosmetic Surgery is More Than a “Vanity Thing”

Announcer (00:02):
You are listening to Alabama the Beautiful with cosmetic surgeon, Dr. James Koehler and Kirstin Jarvis.

Dr. Koehler (00:12):
Alright, well we've got an exciting podcast today. I've got a guest on my show. Rebekah is a patient of mine who has a really impressive story and I just thought it'd be worth sharing. I know there's other people out there that are dealing with similar issues and so we thought we would cover this. And thanks so much for coming on our podcast.

Rebekah (00:38):
Thank you so much for having me. I'm really excited.

Dr. Koehler (00:40):
Yeah, we're excited. So let's just start off with a little bit of background. You have struggled with weight for a lot of years. Why don't you tell us a little bit about that part?

Rebekah (00:54):
Yeah, so honestly I have struggled my weight since about 15 years old. I've been up and down, been every size possible. I could probably write a book on nutrition and working out, I even got certified as a personal trainer. I've taught bootcamp before. I've done every diet possible, every program, but just continue to work, struggle with it back and forth and just a lot of it was stress eating and things like that, but it's just definitely been a big part of my identity, sadly throughout my life since I was about 15. But about four years ago, I got in a situation to where my health was bad and all kind of things, and I know that we'll talk a little bit more about that really defining moment of what made me make those changes. But I got so sick and it was really funny, cuz I had always been against weight loss surgery and all the things because being in working out and stuff, I always thought it was a cop out. Because all the experience I'd had before, I'd seen so many people have gastro bypass, but they didn't do what they were supposed to do. They'd gain it back. And so I was just like, that's the easy way out. Until I got in that position. I actually had yesterday made four years ago that I had gastric bypass. And when I say it truly changed my life and helped save my life, it was a tool that seriously helped save my life.

Dr. Koehler (02:08):
Yeah, that's awesome. Weight loss has really complicated subject matter and I don't think there's not a one solution fits all. Unfortunately, we see a lot of people that come in and they're looking for a quick fix for weight loss and they go, oh, can you give me a tummy tuck? Can you give me liposuction? And it's just not for that. It's a contouring procedure and it's designed to help you get your contour where you want it once you're at a stable weight. In fact, one time, I'll never forget, I was doing a pre-op on one of my patients and between her consultation and her pre-op, she had put on 20 pounds. And so we sort of said something to like, well, hey, you've put on 20 pounds since your consult, can you tell us what's going on there? She goes, oh, well you're planning on taking all that off, so I just decided I would go ahead and have whatever. And I'm like, oh my God, so you've got the wrong idea of what our surgery is, but things like intermittent fasting and all the nutritional things that are out there, one diet doesn't work for every person. It's not always as simple as calories in calories out and all of these things. And it can be complicated, but if you can do it on your own, obviously that's fantastic because surgery is still always surgery. But like you said, there's a lot of people that have had gastric bypass surgery and they've put all their weight back on because they didn't follow through with all the rest of it. And that's really the key part.

Rebekah (03:49):
That was that tool. I had that surgery and I had to pay out of pocket for it. And so I had all these health problems, but I still had to pay out of pocket for it. And so I would pay for it over and over again. It truly changed my life and has helped save my life. But I have to put the work in Dr. Koehler like,

Dr. Koehler (04:02):
Oh, I know you told me.

Rebekah (04:04):
I bust my butt. I work out about five to six days a week and I have to eat healthy. I mean now if I go out to eat, I'm going to enjoy something. And I've had the conversation, actually, my boyfriend talks about this and has kind of helped me in this perspective of food, but he says food, it doesn't have a moral compass. And it really kind of clicked recently and I was like, oh, we put all this weight on food. This is good, this is bad. But he's like, no, it doesn't. it has different nutritional values that will maybe make you this way or that way, but take the moral compass away. So I'm going to, majority of the time, eat healthy, but I am going to have treats and stuff because if I don't, then I'm just going to want to eat it all.

Dr. Koehler (04:42):
Well, I think that's a really hard thing for people too, right? What's sustainable And you have to eat in a way that is smart. But if you want to have a piece of cake every now and again, you should have a piece of cake.

Rebekah (04:57):
Have a piece of cake, cuz then you're going to want to go eat the whole cake if you don't, and then it's just going to lead down a horrible spiral.

Dr. Koehler (05:03):
Yeah. Well, I know you shared a picture with me. We were actually, I didn't see it until after we'd done your contouring surgery, but you shared a picture with me and I guess that was kind of near at your peak weight. Is that about where you were at your peak?

Rebekah (05:19):
358 pounds.

Dr. Koehler (05:21):
358. When you sent me that picture, I was like, this is not even the same person. Yeah, it is pretty wild. I mean, you said you had some health issues, whatever, but what was your defining moment for you? What was the thing that flipped the switch for you that you're like, I got to do something?

Rebekah (05:40):
Okay, so it was actually around COVID. It was several years ago. It was a little over four years ago. I just had my surgery, it was yesterday, maybe four years ago. But one of my best friends got COVID. She had had COVID for about two weeks, and then all of a sudden, she was 33 years old. She had three strokes. She went into cardiac arrest and stopped breathing for 19 minutes. It is a miracle from the Lord that she's still here. She is 100% a miracle. She should not have made it, but she ended up being on a ventilator and it was definitely touch and go for a while, but thankfully she ended up turning around. But the thing was she stayed in the hospital on a ventilator for so long, but they needed to transport her to the Shepherd Center in Atlanta.

(06:24):
Well, they're like, we have to fly. Her family, they were too nervous to fly. And so I was visiting in the hospital and I was like, well, I fly, I'll fly. I love flying. I'll fly with her. So that was the plan. So they called me, I think it was on a Sunday afternoon, they called me and they were getting everything ready for the flight the next day. And so they went through everything. I was like, I'm good. And they said, oh, well, we do need to mention one thing. There is a weight restriction in order for you to fly with her. And I was like, okay, this shouldn't be a big deal. I was 20 pounds opverweight. 20 pounds, and so I could not fly with her. And so in that moment, to say I was devastated is an understatement because in that one time that I really needed to truly be there for my best friend, I couldn't because of my weight. And I was like, it is another thing that my weight is keeping me from.

(07:12):
And so I cried and cried for hours that night. I was like, oh my gosh, I couldn't be there. And so that is the day, I had a pity party. I'm not going to lie, had a pity party in the bed that afternoon crying. But then I was like, you know what? You can't continue to do this. You have done this for way too long, and so are you going to let this define you and define the rest of your life, or are you going to make a change and not let your weight hold you back? And so I decided that day, I was like, I refuse to let my weight hold me back from being able to be there for the people I love and do the things that I need and want to do.

Dr. Koehler (07:40):
Yeah. Well, that's really awesome. So you made the choice to have the surgery, and how long did it take you? Typically with gastric bypass, it's about a year and a half. I don't know. How long did it take for you to get the majority of your weight off?

Rebekah (07:52):
So I ended up losing about 205 pounds. It took about two years to lose a total of 205 pounds. Now I've kept 190 off, like I said, but about a good two years. And then that's when I really started hitting it heavy in the gym, but give or take, and I tried to not really compare my journey with other people that have had gastric bypass, but it's hard to do sometimes. I'd say a good solid two years.

Dr. Koehler (08:22):
And I mean your energy level, stuff like that, really, when that weight came off, did you notice a change in your just general energy and

Rebekah (08:32):
Oh, yeah. I mean, I feel like a different person. Before I couldn't even walk to the mailbox to go get the mail. And then now I'm like, oh my gosh, what is this life? Is this what normal feels like? Is this what other people have always felt like? And so I have so much more energy, I feel better. I came off, I was on over 13 medicines a day, and now I take one medicine a day.

Dr. Koehler (08:53):
You know what? So this brings up an interesting subject. Also, there's certain people that I've treated over the years that just sort of stick out. But I remember this lady, this was probably more 15 or more years ago, but she'd lost a similar type of weight, 200 pounds, and she had a gastric bypass. And I just remember seeing her in the office and we were talking, we're doing a consultation, and I made the comment, I said, oh, I said, well, you must be so glad that you had this surgery done. I said, you're off all these medicines and it sounds like you're feeling so much better. I said, I mean, I guess you're really glad that you had this done. And she paused for just a second and she said, all that's true, and I do feel so much better. She goes, but I wasn't mentally prepared for what I was going to be left with with my body after all this weight loss. Now she was older than you and she didn't have the greatest skin elasticity, but she'd lost a lot and had a lot of excess skin, and that was the thing that she struggled with. And fortunately, once we got her through her journey, I remember talking again and she's like, oh my God, I'm so glad I did all of this. But I think for her, she didn't know what to expect at the end of her weight loss.

(10:08):
So anyhow, you got down to your weight. And I guess yes, you had a similar issue in the sense that you had some skin laxity that you wanted to take care of.

Rebekah (10:18):
Absolutely. And so I'd actually followed so many people on social media too, just kind of seeing their transformation stories. So I knew ahead of time, you're going to lose a lot of weight. And so it's pretty much inevitable that you're going to have to have some skin removal surgery. But it is hard, that mental part because you've worked so hard for so long to get to that weight, and so you are proud of that. But then it's like, oh, I have a whole nother set of problems now all this skin. And a lot of people think it's a vanity thing, but it's really even not. It causes medical problems, rashes, pain, all the things. And so it's just a whole new set of problems. And so it can be really discouraging. Thankfully, like I said, I was looking ahead and thinking, I know this is going to be an issue, but until it really hits and you're like, oh my gosh, I have all this skin, you don't really realize the impact that it does have on you mentally and emotionally.

Dr. Koehler (11:08):
Yeah, and I've had patients that say they're doing the similar thing. They're working out, maybe it's three days a week or five days a week or whatever they're doing, but they've got to the point where the skin interferes with their ability to actually do their workouts. Now it's like annoying. They're like, I'm like, oh my God, I can't do this. So anyhow, you made the choice to, okay, well, we're going to get rid of some of this excess skin. So I guess first of all, how did you find out about us, I guess?

Rebekah (11:35):
So I found out about y'all. I kept seeing ads all over social media of Dr. Koehler, Dr. Koehler, and I was like, oh, he's close. Like I said, I had seen all these things on social media. I was like, I'm going to go out of state. I'm going to do all this. Well, first of all, that costs a lot of money instead of all that was unrealistic. But I was like, there's no one close around here that I'm going to find. And I kept seeing your ad and I was like, I looked at yourself a little bit, but then one of my close friends had used another surgeon, and I was like, I'm a creature of habit and I don't like change. So I was like, oh, she's used him. I'm going to go. And I went and I mean, they were great. They were super sweet, but I didn't really get to meet a surgeon.

(12:08):
And they were like, which surgeon do you want? And I was like, well, I don't know, I haven't met them. So anyways, I was like, I just didn't have a really good peace about that. I just wanted to meet the surgeon. I want to know who's going to operate on me. Then I went to a second consultation and they actually had it to where insurance was possibly going to approve to do part of my stomach. But I went and looked at the results and I just didn't see the results that I was really wanting. And I was a little nervous that, Hey, he hasn't done many of these procedures. I don't want to have to pay to get this fixed. So I was very tempted to take the cheaper route if insurance was going to pay for part of it.

(12:45):
But then I kept coming back to your stuff, and it was so funny. I was actually with a physical therapist. I had broken my leg, Dr. Koehler, and I was sitting there and she had a consultation with you, and she's like, I'm going with him, because I had so many friends that have used him. And I was like, you know what? I'm going to give him a shot. So I went to your website and I looked at all your pictures and I was like, oh my gosh, he's legit. Because when I say I probably look like a creeper, if someone took my phone, they would see all these progress photos from all these different surgeons, cuz I'm stalking all these photos to see who is good. But when I looked at your website.

Dr. Koehler (13:15):
FBI might be coming after you.

Rebekah (13:16):
Yes, they're definitely coming after me. They're going to think things. But I saw your pictures and I was like, okay, you know what? He's right in my backyard. Why did I not look into this sooner? His pics are legit. He knows what's up. And so I was like, you know what? So I called and I was like, let's do this. Let's just go for this consultation.

Dr. Koehler (13:35):
Yeah. So what was your, I mean as far as the surgery part goes, did you have any, I mean obviously you wanted a good result, we know that and it was part of it, but did you have any other sort of, I dunno, major concerns going into consultation and having this done?

Rebekah (13:55):
I think I was just nervous because I just had not had the best results, the best experience on those first two consultations. I honestly got discouraged and I was like, what if I don't find someone I'm comfortable with? But I was also nervous, I'm a little OCD in certain areas that I don't need to be, but I was like, I'm not going to be happy with my results. There's going to be something that's out of place and I'm just not going to like it. And it was funny because when you were marking me up before the operating room, you were like, I'm super OCD and a perfectionist, so I'm going to try and get this. And I was like, yes, I just had an extra confirmation. I knew I picked the right one. But I think the biggest thing is I was nervous that I wasn't going to have the results I needed and wanted and that I was going to have wasted all this money and not really be happy. And I think also just worried that even if I got good results, I still wasn't going to be happy on the inside.

Dr. Koehler (14:50):
Well, you make

Rebekah (14:51):
Change things.

Dr. Koehler (14:51):
Yeah, you make a good point there actually. I think that's a really awesome and insightful thing to actually even think about because one of the things that I think is tough in my world is I'll meet people and I'll find out what's bothering them and get their concerns, and I try to get a good idea of the motivations for why people are wanting to get something done. I think it's important. We want to be doing things for the right reasons. That's important.

Rebekah (15:17):
Absolutely.

Dr. Koehler (15:18):
But then sometimes you can't step inside their head and sometimes people have broken parts of them that a surgery is just not going to fix. And to me, when people are okay with themselves and we're just fixing something outside that bothers them, I know we're going to be good, but there are some broken people and like you said that they're like, well, the fact that you even had that sort of mental exercise tells me you were fine. But the thought that, am I going to feel good enough about myself despite whatever result I get, even if it's a good result? And I think that's important because as a surgeon, we are always trying to meet the expectations of our patients. We want them to be happy. And I know I really try to paint as realistic a picture as I can. We want to give people excitement about what they're choosing to do because they should be excited because they've gone through this whole journey. But at the same time, we want to try to manage that with the appropriate, I guess, expectations. So you felt pretty good expectations wise going into it and when I'm doing my markings. So you were okay with that?

Rebekah (16:33):
Yes, I did. What's funny is though I did cheat a little because I've been a licensed marriage and family therapist in the state for the past 13 years.

Dr. Koehler (16:39):
Oh I didn't know that.

Rebekah (16:40):
So I have the therapy background, so that may be why, just thinking about the,

Dr. Koehler (16:44):
Okay, can I get some therapy after we're done here? I might need some,

Rebekah (16:46):
Hey, we might need some after this. But what's funny is I actually see my own therapist too, because in grad school they taught us every therapist needs a therapist. But I did have conversations with my therapist too. And I think what it really boiled down to is having honest conversations with myself and saying, okay, what's realistic ?

(17:05):
And what are you going to be happy with? I mean, I've seen women go try to, and I mean I'm guilty. I've tried to change my hair color to feel better about myself or want, or people in general, I want to go buy this car, it's going to make me feel better about myself, whatever it may be. But it's really what is the root thing and are you genuinely going to be happy with the changes? But even not talking about, like you said, those realistic expectations, I had to say, Rebekah, what is realistic? You're not going to be some size 2. I'm just a taller, bigger girl. I'm not going to be some size 2, but that's okay. That's not who I am. That's not my body type. And I think that's a lot of it too, because I told you I had lost 205 pounds where I got to my lowest, but I'm staying at 190 loss because I found out that that's my realistic weight, that's attainable. So I made sure for the first two years after losing the weight that I could stay at that weight and it was attainable because I didn't want to get all this surgery and then ruin my results by gaining all this weight back if I wasn't at a realistic weight. So I think a lot of it is reality and really coming to grips with what you're okay with, but also checking internally and saying, Hey, are you at a good place for this?

Dr. Koehler (18:19):
When you got to your lowest weight, and then how long of a period of time did you wait before? So you maybe put a little bit back on you found out where your weight, where you were comfortable, what kind of timeframe did you give yourself there? Was this a year after you hit your low?

Rebekah (18:36):
It was a year. Yeah. I came to you for my first consultation a year ago this month.

Dr. Koehler (18:40):
Okay, so

Rebekah (18:41):
It was a year.

Dr. Koehler (18:42):
Yeah. So I mean, one of the things, for instance, if somebody's losing weight on their own, let's say they haven't had gastric bypass and then maybe they have a lesser amount of weight to lose, sometimes people go, well, what weight do I have to be at to have my procedure? My answer for those patients is typically like, well, if you're within about 20, 25 pounds of your ideal weight, you're probably fine. It's probably not going to affect your result. But ideally, I really want people to be at their weight, the weight that they are going to be at and going to manage because it's going to give me the best opportunity to give them the best result. And like you said, it's like you had to basically prove to yourself or not prove to yourself, but okay, I'm stable and I know that when I do this, it's going to give me a lasting result versus spending money and then it goes and then you put it back on or something.

Rebekah (19:36):
And realistically, what's that comfortable weight to where when I want to go have a piece of cake, I can stay at that weight and I don't want to sit there and have to eat asparagus all day every day. I mean, I love asparagus, however, I want to also enjoy life too. So it has to be attainable. It has to be realistic. You can't just go in there and expect to be at your lowest weight and be as lean as possible all the time. So that's why you kind of have to pick that middle ground while being healthy as well.

Dr. Koehler (20:00):
Yeah. So we did your surgery at the hospital. Do you mind me talking a little bit about your surgery?

Rebekah (20:05):
Of course.

Dr. Koehler (20:06):
A lot of people who go undergo massive weight loss, a lot of the problems were in the trunk. And so you had circumferential skin laxity, so all the way around, not just in the front and the abdomen, but even in the low back area and the buttocks even kind of has descended a little bit. And then the breasts were deflated. And I imagine, and I hear this from people who were a lot heavier, it's like some of these women have had big breasts their whole life, and then when they lose all this weight, they've got nothing or they feel like they've.

Rebekah (20:37):
They give up on life. That's what I say. They give up on life.

Dr. Koehler (20:41):
So we did your surgery at Thomas Hospital and for what we ended up doing was a body lift or a belt lipectomy where we go all the way around to circumferentially, remove skin, tighten up the muscles, do some liposuction to contour, but it's a circumferential skin excision and then a breast lift with an implant to restore some volume in the upper part of the breast. And so we did that all as one procedure. Now because of the length of the surgery and just it's an involved surgery, that type of procedure I typically do in a hospital setting. If I have a smaller patient and we're maybe just doing one or the other procedures that could be potentially done as outpatient, but for this, it's typically an overnight stay. And so we did yours at the hospital. And how was your time at the hospital? You stayed overnight, right? We just let you go home the next day, right?

Rebekah (21:40):
Yeah, they spoiled me. They were great. I had a really great experience.

Dr. Koehler (21:44):
I was a little worried about that. I didn't know what they were going to say there, but no,

Rebekah (21:46):
No, no. I actually had a really good experience. I was like, you know what? I'm going to drive from Saraland to Fairhope if I need to go to the hospital again. They took good care of me. No, it was really good. And I was actually glad that we opted just because my history of a bunch of medical issues and stuff. It just made me feel a little bit safer going into it, knowing that we were doing it at the hospital. And it made me feel better knowing that I had the extra good meds on board for the first night because I was nervous. But no, it was really good, and it was a great experience being there.

Dr. Koehler (22:14):
Yeah, no, I was just kidding. I know the nurses there are good, and I think it is for those bigger procedures, especially if people have medical conditions and stuff like that, that definitely is the way to go. But after you left the hospital, tell us a little bit about your recovery. How was that first week?

Rebekah (22:34):
Week one I feel like was pretty good. Pain was very manageable. Week two, it kind started coming off the meds some, and I was like, oh, I'm starting to feel everything that's like, I feel like it's all waking up, but let me go ahead and preface this. I'm a wuss and I have no pain tolerance at all. So week two, I was like, oh, I'm feeling all the things. Just, I think it was mostly nerves and all that kind of stuff. But by the end of week two, I mean, which y'all were great, y'all helped me keep my pain managed and all the things your nurses always got right back with me. So we kept things under control really well. But about end of week two, I ended up being able to go back to work after two weeks and it started getting more and more manageable, and I was off meds by that point and just really kind of feeling a lot better at that point of everything.

Dr. Koehler (23:21):
I mean, our hope is I try to tell people my goal is for people to be back at work after two weeks. Two weeks, you should be back. And obviously it's different for everybody, but two weeks you're not a hundred percent, but if you don't have a job that requires heavy lifting or something like that, you should be able to go back.

Rebekah (23:36):
I was able to sit there on my computer,

Dr. Koehler (23:39):
And then of course, I don't let people go back to their exercise routine for six weeks, which is a long six weeks if you're working out five days a week. So you made it through that.

Rebekah (23:50):
I did. I called your office and I was like, can I just go walk on the treadmill? I'm tired of being stuck in the house, and so y'all let me of course walk on the treadmill after a good amount of weeks, just walk very slowly just to get in the atmosphere. I was going stir crazy being at home. But yeah, y'all released me at a certain point and I just started easing back into things and just took it lightly. Of course, I avoided core exercises and chest just, y'all had advised me to do that for a while, but just kind of easing back into it and get back in a steady routine because honestly, the working out helps my mental health as well. And so it was good to be able to get back into that.

Dr. Koehler (24:29):
And I think that's something that's really important. Again, more so probably for my weight loss patients especially, they've got their routines, their habits and is huge. The big fear for whether you did it on your own or whether you had bariatric surgery and you're doing what you're doing and continuing that with all the diet and exercise, but the whole thing is slipping back and gaining it back. And so there's

Rebekah (24:54):
Fear every day.

Dr. Koehler (24:55):
Yeah, there's that anxiety about, Hey, I don't want to go back. I've worked so hard to get to where I'm at. But the reality of it is six weeks seems like forever, but really most people, they just jump right back into it. And of course it is hard to, certain exercises core and stuff like that. I imagine that took you a little bit longer to really get into doing any kind of core stuff.

Rebekah (25:17):
It did, and like I said, I just really started to ease into it. My biggest fear was like, I don't want to mess up the results. And so I was like, just do everything that they tell you. But I was focusing doing arms and other things like that, still doing legs, just making sure not to strain too much on certain things, and of course doing cardio, but still able to start back lifting. So that was a big deal for me.

Dr. Koehler (25:39):
And of course, we just took some pictures of you at your last visit, and I thought looked amazing. I mean, you just look so good. It's like the before and after. Sometimes you really just need to have the before and after side by side to really truly appreciate it. Because I was like, yeah, you look good. But then I was like, oh man, you can see all of these changes. And anyhow, I just thought you looked great, and I know you were excited about the results.

Rebekah (26:07):
No, I've been so excited. As my boyfriend says Dr. Koehler killed it, he tells everybody he freaking killed it. But no, I'm so proud.

Dr. Koehler (26:16):
I generally don't like to use those words talking about surgery.

Rebekah (26:20):
Okay, let's see. Let's rephrase. He nailed it. Is that better?

Dr. Koehler (26:24):
Yeah, that works good.

Rebekah (26:26):
But no, I mean, honestly, and I knew that I was hopeful that I was going to have good results. I wouldn't have went with you if I didn't see the results and feel all the comfort and stuff and just the confidence in knowing that you knew what you were doing. But when I saw those results, I was like, oh my gosh, I literally went home and cried that day because it makes me emotional now. But it is been such a long journey, and so to have y'all as part of that to help me get, I worked my butt off, but then there's only so much you can do. And I've been working out, working out, working out, but you couldn't see the results because of the skin. And so to have y'all be able to do that, it just kind of helps give me a sense of life back and give me a new identity in a way, but kind of becoming who I've always really meant to be and who I was underneath, if that makes sense. But really helping me just get to a point of being who I am.

Dr. Koehler (27:17):
Yeah, well, I remember I could see lateral definition of your abs and stuff. There's a lot of really awesome things there that were really good.

Rebekah (27:23):
I was like, is this what an ab looks like?

Dr. Koehler (27:25):
I look good. I know there's going to be people listening to this that maybe haven't started their journey or they're just really don't even know where to begin. But what would be your advice to somebody who's listening to this that they're dealing with a weight issue, maybe not have to do bariatric surgery or whatever, but I guess this whole journey, what would you tell someone?

Rebekah (27:54):
I think the biggest thing is find what works for you. And you may have to try a few things. Sometimes, like you said, bariatric surgery may not be your answer, whatever it may be. Just figure out what works for you and what's attainable. Don't try to do some quick fix as far as, and when I say quick fix, don't expect that you're going to lose all this weight overnight or try to do something so extreme that you can't keep it up to where you're trying to lose all this weight in four months because you need to do something that you can continue. Because if you do that quick fix and just try to do something so drastic that you can't keep up, then it's most likely going to come back. I've been there, done that a million times over the years, and so I've had to learn, it's about making little steps as well and doing things every day because those little habits that you create will build up over time and create just healthy things day by day that will get you eventually to the place that you want to. And not giving up too, give yourself grace. You're going to mess up. And I think one of the biggest thing too was I know if I was trying to eat healthy and I ate something I wasn't supposed to, I would be like, well, I've already screwed up. I'm just going to eat whatever I want the rest of the day. Do not do that.

(29:07):
It doesn't matter. It restarts every meal. It doesn't matter. Okay, you maybe ate something you shouldn't have. Just get back on track.

Dr. Koehler (29:14):
Yeah. Yeah. It reminds me of another story. There's a guy that I know, I run into him in his business every now and again, and I hadn't seen him in a while, and he'd lost actually a fair bit of weight. And I made the comment to him, I said, you look like you've lost some weight. He goes, yeah, and he's been working with his doctor and he's doing it on his own, and that's great. And I said, well, tell me about that. And he said, well, it's been a little frustrating because I go in monthly to get weighed by my doctor, and I get on the scale and it's like one or two pounds. And especially, he lost a lot of weight quick at first, and then it was harder for it to come off. And he said, well, I got a little frustrated and I said something to my doctor about, it's only a couple pounds.

(29:54):
He goes, yeah, but you understand in a year that's a lot of weight because he doesn't need to lose that much. But the point is, you're right. You didn't put that weight on over a month and you're not going to lose it in a month. It's going to take some time. And I don't remember where I heard this. Maybe it was like an audio book or something I heard one time, but the whole sort of concept of if you're sailing a ship and you change your course one degree, well, if you only go 400 feet, your direction has not really changed a whole lot. But when you go 200 miles, your course where you started and where you would've ended up, where you do end up by a one degree change is very significant. So that little change can create a big result as long as you're sustaining it over time. And that's really the key there.

Rebekah (30:42):
And I think also taking shame away from the things too. For instance, you said he's going to the doctor and weighing and things like that. There's just so much, our society has put so much, and we put it on ourselves too, but so much pressure about, oh, losing this or that, trying to take the shame away too from it, just because overweight and I was guilty of this just because if you're overweight, that doesn't make you a bad person. That doesn't make you not worthy of walking in the same place as a majorly fit person does. You deserve, you're human just like everyone else.

(31:11):
You deserve to do good things for yourself, and you deserve the life that you want. And so if that's what you want is to get healthier and be here for your family longer and live an enjoyable life, whatever that may look like, if you're bigger, smaller, medium sized, whatever, just do those things for yourself and make that commitment to yourself about waking up every day and saying, you know what? I deserve this. Yeah, I may not get it right all day every day, but I'm still going to wake up and say, you know what? Let's just give it all we got today.

Dr. Koehler (31:39):
And then I guess from the surgery standpoint, what advice would you give to somebody about how to pick their surgeon or how to go about this whole process? What advice would you give there?

Rebekah (31:52):
Pick Dr. Koehler.

Dr. Koehler (31:54):
I paid you for that. That's good.

Rebekah (31:56):
Pick Dr. Koehler. No, absolutely, for real. Pick Dr. Koehler. But anyways, look at photos. Be the creeper like me. Go look at all the photos. No, no, for real. Do your research. Find surgeons in your area and look at their websites. Look at photos. And I know that sounds funny though, but photos was a big part for me. Read reviews. And also there's Facebook groups too, talking about plastic surgeons in the area and stuff like that. But I think the biggest thing, look at the photos, meet the surgeon. I would advise anybody to go, don't go to just one consultation if you're not comfortable in your first consultation. Now, if you come to Dr. Koehler, you're going to be comfortable in your first consultation. But anyways, no. Go see a couple surgeons, see who you're comfortable with, and ultimately go with your gut. If you're going, don't go for the cheapest option because that's not a good idea. Always go with somebody that you're going to be safe with. You're confident that they're going to take care of you and you're confident that they're going to do good work.

Dr. Koehler (32:58):
Well, I think there's a couple things that you said there that really stand out to me. One of them is getting more than one opinion. And I think for certain procedures, especially things that are maybe a little more complicated, getting a few opinions is a really a good idea because sometimes there's different ways to approach these things. It's not always a one, this is the only and one way to do it. So sometimes if you see three people, you might have two people that told you the similar thing and one person that told you something different. And that one that maybe told you something different. If you didn't have this great vibe there, maybe it confirms, okay, maybe the other two people, that's maybe the better direction for me to go. I mean, it's hard to say, but just getting other opinions can definitely help make you feel good about what the choices that you're going to make. So that's something that I think is important. And then, yes, looking at photos and stuff like that, I mean, I always tell people it's like you're buying a painting. I might be painting a different picture for you, but if you've seen some of my other work, then maybe you go, yeah, I kind of, in general, the work. The real reality, the big reality I guess, is that unfortunately all surgeons will have complications. That's unfortunately a part of surgery because biology and we're not perfect people and things don't always behave the way we want them to. But definitely people who do this type of thing often and do this kind of work regularly, I think that gives you the best chance of hopefully not having any issues and feel

Rebekah (34:31):
Don't fly of the country either. Don't go out of the country to do it.

Dr. Koehler (34:35):
That can be problematic for a lot of reasons. But alright, well, is there anything, now that you've had this surgery done, what stands out for you? Is it clothes that you can wear? Is it activity you can do? What is the biggest positive thing for you since you've had this?

Rebekah (34:52):
So I can wear a bikini now, and so I'm really excited about that. I'm just like, okay, I feel comfortable enough to wear a swimsuit, a two piece a bikini. And I'm like, okay. So that would be as far as getting to wear and getting to wear the clothes that I want to. I'm not held back, so I get to really express myself how I've always wanted to. But then on the flip side of things, honestly, and this may be a little sappy, but I was sitting here thinking about this yesterday. I get to walk into a room with my head up. And I know that may seem silly and it does make me emotional, but I get to walk in a room with my head up because I feel like I deserve it now. And it makes me sad that it took me getting to this point to realize that because even when I was overweight, I still deserved it, but I didn't see it.

(35:39):
And so I feel like through this journey and getting to the point that I have and getting the skin removed, all the things, and you don't have to get to that point to have the realization that I did, but I think just realizing, you know what? I deserve to be here. I can walk in here confidently and be happy with myself and just live an enjoyable life and be who I am. And I don't have to be ashamed of that anymore, and I shouldn't have been ashamed of it before. But we all live and learn and we all have our journey.

Dr. Koehler (36:09):
Yeah. Well, and that's the thing about cosmetic surgery in general. It's like we can correct certain things and you have to, we just mentioned this earlier. I mean, you got to be okay on yourself on the inside, but there's no question I have heard from people who've had procedures done. They're like, you have no idea. This has changed my life. I feel so much more confident and whatever. And things like getting your hair done or getting your nails done or whatever. Those are all things that make people feel good. Yes, surgery is a definite big jump from getting your hair done, but the point is that if there's things that you've worked hard for this weight loss, you feel better. But now we want to look our best, and you've earned it. You worked hard for it, and you've got to this point. So obviously I do this for a living, so I see the benefits. I know some people are like, oh, you should just be happy with the way you are and the person you are inside. And yeah, no, you absolutely need to be, that's critical to the end result we talked about, but

Rebekah (37:09):
But be proud, and if you want to get it, get it. I have a lot of, especially a bunch of mom friends that have lost a bunch of weight, and I'm like, you should go just see. They've talked about, oh, I want to get that done, or I want to do this. And I'm like, go for the consultation. They're like, but it's selfish. And I'm like, it's not selfish. You worked your tail off. It's not selfish to want to become a person that's feeling better about themselves and you worked your butt off. So if that's what you want to go do, go do it. If that's going to make you feel better, there's nothing wrong with that.

Dr. Koehler (37:37):
Yeah, no. I think obviously we weigh out every situation. There's certain people that if they have health concerns and other stuff, we're not going to do something ridiculous. But that mommy makeover. Yeah, after having kids and taking care of kids and not doing anything for yourself, and you worked out and you still, you're not ever going to get that body back because you can't fix loose skin, you can't fix muscle separation, all that kind of stuff. And the sagging breasts aren't going to get perkier. So I really do see the benefits of that. And yeah, I think that's why I enjoy what I do. I mean, it's fun to see people have those transformations and feel good. And I mean, I think the one thing that is just, and I guess the reason that I asked you to even come on this podcast is like how much energy you bring when you come. I mean, you've got a smile on your face. You just got this energy and this attitude that you're taking life by the horns. And I was like, she'd be so great to talk to and hear her story. So

(38:36):
Thank you. No, you've given me confidence. It has given me confidence and just such a joy to live life every day. And I know that seems probably silly, but I really get to live life and be happy now and just walk around and be confident for the first time in my life.

(38:53):
Well, that's awesome. Well, I thank you so much for taking the time out to do this, and I know that it's going to benefit somebody out there and in their thought process and their journey, and hopefully in getting their expectations where they need to be. But thank you again and we'll hopefully see you again soon.

Rebekah (39:15):
No, thank you so much.

Announcer (39:18):
Got a question for Dr. Koehler? Leave us a voicemail at AlabamatheBeautifulpodcast.com. Dr. James Koehler is a cosmetic surgeon practicing in Fairhope, Alabama. To learn more about Dr. Koehler and Eastern Shore Cosmetic surgery, go to easternshorecosmeticsurgery.com. The commentary in this podcast represents opinion and does not present medical advice, but general information that does not necessarily relate to the specific conditions of any individual patient. If you enjoyed this episode, please share it and subscribe to Alabama the Beautiful on YouTube, apple Podcast, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, theaxis.io.