Think You Need a Tummy Tuck? You Might Need More

Announcer (00:02):
You're listening to Alabama the Beautiful.

Kirstin (00:05):
I'm Kirstin Jarvis and I'm here with Alabama Cosmetic Surgeons, Dr. James Koehler and Dr. Vincent Gardner. Hey, Dr. Koehler and Dr. Gardner.

Dr. Gardner (00:13):
Hey, Kirsten.

Dr. Koehler (00:14):
Hey, Kirsten.

Kirstin (00:15):
Hey. Today we're helping people interested in post weight loss body contouring. Understand the difference between a tummy tuck and a lower body lift.

Dr. Koehler (00:26):
Perfect.

Kirstin (00:28):
Dr. Gardner, since you love post weight loss surgeries, that's your passion. Why don't you give us just a little quick snippet of the difference between the two?

Dr. Gardner (00:38):
So when we traditionally think about a tummy tuck, we think about female who's given birth to a couple of kids and has stretched out her abdominal wall muscles and unfortunately has not been able to regain her musculature and her flat tummy despite doing a million crunches in the gym and working out and doing all those things. So it's traditional tummy tuck, and that's not everybody, but that's when somebody thinks about a tummy tuck, they think after kids you go to "get your belly back." But we do tummy tucks for all sorts of reasons. Some people, just depending on how they're born, their fat distribution, they may opt for a tummy tuck even if they've never had kids. So don't think that you have to have had kids to quote, get a tummy tuck. If you're unhappy with your abdomen and you've exercised and you just can't get rid of some stubborn fat or you have some laxity or some skin excess, then you can be a candidate for a tummy tuck.

(01:45):
Now, as far as were we talking about the difference between that and a body lift. Okay. So a body lift is typically we think of those after massive weight loss. When people have lost, and it doesn't have to be a hundred pounds or 200 pounds, I mean, I see people that have lost 50 pounds and they would benefit from a body lift. So a body lift is basically a tummy tuck plus a buttock lift. And that buttock lift could be with or without what we call an auto augmentation, meaning we're taking some of your own tissue and we're essentially placing that in the buttocks to give it more fullness. Now that's not a BBL. It's different than a BBL. We're not injecting fat. We're actually creating a flap of tissue. So instead of just cutting that tissue out and getting rid of it, we're going to keep that flap and we're going to create a pocket and we're going to tuck it in and pull the skin up over it.

(02:45):
And that's going to give you some of that mid and upper buttock fullness. And so essentially one treats the front, which is the tummy tuck, and the buttock lift treats the back. And when we do them together, we call it a body lift.

Kirstin (03:01):
Okay. Why do so many people feel stuck after weight loss? They did all the work, but their body still doesn't match how they feel.

Dr. Gardner (03:09):
Gosh, that can be for lots of different reasons. I immediately think of hormone issues. Obviously, as people age, we lose our hormones and menopause can be a problem in this situation. And so I always recommend make sure you get your hormones checked, make sure that you're optimized, meaning that everything is addressed, testosterone, progesterone, and estradiol. And we obviously are champions of bioidentical hormones, not synthetic. But anyway, that would be one thing that could cause somebody to not be able to meet their goals. They exercise, they do everything right, they're eating clean, and they just can't seem to get where they want to. So we like to optimize hormones. The other thing is, is really look at what you're eating, your diet. Everybody thinks they're eating great, but really, unless you're tracking your food choices and your calories and how much sugar is in, what's processed, what's not.

(04:13):
Right now, there's a war on sugar and processed foods, and it's because they're terrible for our bodies, seed oils, all these different things. And so again, maybe it's your diet. And when we talk about weight loss, it's not exercise. 80% of weight loss is your diet. It's what you put in. Remember, food is medicine. And if you're not eating clean and eating the right things, then you could be shooting yourself in the foot. And that could be causing you to stall, so to speak.

Kirstin (04:43):
Do most people think that a simple tummy tuck will address everything, or are they usually aware of when they need further intervention?

Dr. Gardner (04:51):
Gosh, I think our patients are pretty smart. I think that most of the time, by the time they get to us, they've really done their research and they know what a tummy tuck is. They've looked at before and afters. Having said that, yeah, occasionally we're going to have somebody that comes in and thinks that a tummy tuck is going to just fix everything. So yeah, of course, we're going to have all comers, but no, a tummy tuck doesn't address everything, especially if you're in that category of massive weight loss and you've lost 80, 100, 120, 150. We've seen patients that have lost 250 pounds. So clearly those are patients that we're going to end up staging their procedures. They're going to need lots of stuff done, but we like to start, depending on what they bring to the table, we'll make some recommendations about where to start.

Kirstin (05:42):
Is there a certain common misunderstanding that people have about tummy tucks versus body lifts?

Dr. Gardner (05:49):
So there's a couple of different kinds of body lifts. And again, when we say body lift, upper versus lower, what is an upper body lift? Well, that would be a backlift and potentially bringing that all the way around and doing what we call a reverse tummy tuck where we take skin on the upper abdomen and pull it up. We do do those, but they're less common. When somebody has massive weight loss, we may do a combination of things, but as far as the body lift, a lower body lift, there's what we call a belt lipectomy, and then there's what we call a lower body lift. And that's a weird distinction, but they're just slightly different. One of them, the incision is a little bit higher to where it literally looks like when you put your pants on where your belt would lie. So it tends to be a little bit higher.

(06:37):
A true lower body lift is the incision tends to sit a little bit lower and it could be that somebody likes to wear French cut underwear and they want that incision a little bit higher in the front. And so we try to match that to what they want and certain people are going to be better candidates for one versus the other. As far as like what I like to do as an auto augmentation, because I think a lot of patients that get these type procedures, if we just pull the skin up, sometimes it can leave them a little bit flat. And so having that option of being able to do an auto augmentation is really nice.

Kirstin (07:15):
If you got it, you might as well use it.

Dr. Gardner (07:17):
Hey, that's right. Don't throw it away.

Kirstin (07:21):
All right. So why do you guys sometimes recommend going all the way around instead of just fixing the front or just fixing the back? Is it easier to do a belt lipectomy together than like if somebody were to do a tummy tuck and come back and do a back lift? Or are there certain instances where one set of surgery is easier or better for the patient than the other?

Dr. Gardner (07:46):
I always have my preferences, but I'm here to make you happy. And so if a patient has particular desires, then I'm going to aim to try to make them happy. Now, I have plenty of people that need a buttock lift or a lower body lift, meaning the tummy tuck plus the buttock lift, and they don't care. They're like, "I don't see my butt. It doesn't bother me at all. " And so if that's the case and they just want a tummy tuck, then we just do a tummy tuck. I mean, again, we're here to help somebody meet their goals. And I see plenty of people that say, "Gosh, I didn't know you could do anything for my butt." And so then we have that conversation. We look at before and afters and we may have turned a tummy tuck into a body lift because they just didn't even know it was a thing.

(08:29):
But yeah, like I said, back to, I think we have really smart patients, so most of them kind of know what they want coming in. Dr. Kohler, what do you think about that?

Dr. Koehler (08:38):
I always tell people, if your main concern is just the laxity in the very front, tummy tuck will take care of it. But if you don't like the laxity along your sides or your buttock is drooping, well, tummy tuck's not fixing any of that. So like you said, some people, they'll be totally satisfied if they just get their anterior laxity fixed and they don't care about the rest, or maybe it could be a cost thing and they may decide to stage it and do it later. But to answer your question that you asked about, is it easier to do it at this ... I think it's easier to do a complete belt lipectomy as one operation than to do the front and then the back. I mean, I just like to do it all at once. I've done it the other way, but again, it's a patient preference. We're just trying to achieve their goals, whatever it takes to do that.

Kirstin (09:28):
Is there a certain type of weight loss journey that leads to a tummy tuck versus a body lift, especially now that GLP-1s are so popular among literally everyone?

Dr. Gardner (09:40):
Yeah. I think my opinion on that is it doesn't really, to me, matter how you lost the weight. There are certain people that believe that if you lose it really slowly, that your skin is just going to miraculously retract back. But I mean, again, it depends. If you weighed 500 pounds and now you're 250, you've lost a tremendous amount of weight. You've really stretched out that skin. Whether you lost that quickly with a sleeve and GLP-1s versus you did it the hard way and you exercised and ate right and lost it over a long period of time, I think it's irrelevant. The skin has been stretched out and for most people, it's not going to necessarily snap back. There are situations where somebody comes in and they said, "I lost 110 pounds," and I look at their body, I'm like, "Wow, your skin really did snap back." But those are few and far between. Most people unfortunately have stretch marks, stretched out skin, and they just need a lot of skin removed.

Dr. Koehler (10:43):
I think there's two things that I think there is a difference depending ... If you get a true full-on gastric bypass where you're basically pushing your body into a nutritionally depleted state and you're not absorbing certain nutrients, micronutrients, and other things properly, to me, I notice a difference in the quality of the skin when I do surgery. It's a thinner dermis, the skin just doesn't have the same kind of quality compared to the other methods of weight loss, whether it's GLP-1s, a gastric sleeve or whatever. But calorie restriction versus complete malabsorption or issues with it malabsorption, it changes the game to me a little bit. But again, in the end, it probably doesn't make a huge difference as far as what we do. It's just, I notice the difference in the quality of the skin. And then I think it's the amount of weight. People lose 200 pounds.

(11:38):
And one of the things that I've always been frustrated with as a surgeon, and I'm curious to hear your thoughts on this, Vince, but I'll get somebody as tight as I can get them on the table. I know that there's not a centimeter more of skin that I could take, and they are tight, tight, tight. In fact, sometimes we're having to use towel clamps and other things to kind of hold things to take tension off as we're closing it. But anyhow, I'll see these patients back three months later and when they stand up, it is totally flat. But when they go to sit down, you'll see all this laxity and it's because their skin doesn't have the elasticity and we can't fix that. So early on in my career, I'd be kind of personally frustrated with my surgical results going, "Man, I should have done this, or maybe I could have done something different." Now that I've been doing this for such a long period of time, well, maybe I'm just talking myself into the fact that I can't do any better than that.

(12:31):
But no, it is what it is. I mean, I hear this from other surgeons, weight loss patients are, they can be really tough, especially when you're talking 150, 200 pounds weight loss.

Dr. Gardner (12:43):
No, I completely agree. I think that's spot on. We pull them tight and you just, yeah, you get frustrated because you're like, "I know I pulled it. " I mean, I was sweating it. We pulled it so tight. And unfortunately, you're right, it's just the quality of the skin and there's not a whole lot that can be done.

Dr. Koehler (13:02):
Still a huge improvement, but there's a difference in their skin for sure.

Dr. Gardner (13:06):
Oh, absolutely. I've never had somebody say, "Gosh, I wish I hadn't done that because I got this little bit of laxity."

Kirstin (13:11):
Well, my next question is about recovery and whether people online really hype up the recovery for these two procedures. But it kind of made me think of a story of when I worked in the nursery, I worked with a nurse that, this was like years ago, she worked on women's and children's and she told me one time we're randomly talking about Dr. Koehler and she was like, "Oh my gosh, yeah, I love Dr. Koehler, but he does these surgeries that it's called a belt." And I was like, "What is a belt?" And she was like, "He does a tummy tuck, but it's the whole body. He just takes..." And it sounded so traumatizing. And so that kind of being said, people online are like, "Oh my gosh, a lower body lift. The recovery is horrible. The recovery's so long. It's painful, da, da, da, da, da." But as compared to a tummy tuck, is it really that different or it's just those people haven't experienced a tummy tuck and they both kind of are not super fun for the first three or four days?

Dr. Gardner (14:03):
Think about it this way. We will often do combination surgeries, including a tummy tuck plus breast, a tummy tuck plus arms. So there's other areas that we operate on at the same time and people do really well. I mean, honestly, these patients are so happy just to get rid of this excess skin. It sounds terrible, but it really isn't. And it kind of reminds me of when Dr. Kohler's doing a facelift. I mean, he's doing face, brow, eyes, everything and you think, "Oh my gosh, that's terrible." Well, they look pretty rough. Well, they look pretty rough for a couple days. I never say that. But the patients are so happy. I mean, you see them in a week and they just look like a different person. And so again, I think most of these patients are so excited to get rid of this skin that yeah, maybe it is a little bit more difficult, but I don't think adding the buttock part to a tummy tuck is that much more.

Dr. Koehler (15:04):
I don't see any difference in the recovery. I have people who are tough and people aren't tough and they're going both categories, body lifts and tummy tucks. And so, I mean, I had one lady that I've talked about her, I'm sure, on here before, but she says, "Well, I've got a week for recovery for my body lift." I'm like, "To go back to work, I'm like, that's going to be kind of tight. I don't know that that's going to be enough. Oh, that's all I've got. That's what I'm going to do. " I saw her the night of surgery and she was sitting up at the hospital, sitting up in bed and she's like, "I don't know what all the fuss is about. I'm doing great." And I saw her one weekend, she was back at work. I mean, some people mentally are just like, they know they're going to be fine.

(15:42):
So I don't know. I think it's a highly variable and personal experience, but I don't see a huge difference in recovery between the two, not anything significant.

Kirstin (15:53):
My boss actually wouldn't let me have more than a week off work. I came back at seven days.

Dr. Koehler (15:58):
Yeah. This smart guy. Yeah.

Kirstin (16:00):
I'm just kidding.

Dr. Koehler (16:01):
Probably.

Kirstin (16:04):
Okay. Well, along that same kind of recovery line, I want to talk to you guys about scars because these are major surgeries and they come with big scars. So how do you-

Dr. Koehler (16:15):
Not my patients.

Kirstin (16:17):
Okay. Long, not big.

Dr. Koehler (16:19):
Okay.

Kirstin (16:20):
Okay. In your perception, how do patients feel about their scars?

Dr. Gardner (16:26):
Just like I mentioned a moment ago, getting rid of all that skin, most patients, they're willing to trade skin removal for a scar as long as the shape is what they want. So if you can give them a better shape, they're very accepting of scars. Now, I'm not saying anybody wants a scar, but when you can relieve them of having to wear two spanks to the gym for a scar, they don't care. They're going to be happy. And yeah, we do everything we can to minimize scars post-op. We use silicone, we tape, we use compression, and if somebody will follow the post-op routine, their scars usually aren't bad. So I would say, in my opinion, they'll trade it any day of the week to get rid of the skin.

Kirstin (17:14):
I agree. And we've got needles, we've got lasers, we've got creams, gels, we got all the things. How long do you feel like patients take in between surgery and really feeling like, okay, this was 100% worth it?

Dr. Gardner (17:31):
Some people the next day they feel fantastic in the sense that mentally they can see their future self after recovery. Other people, it takes time. And I've had some people initially say, "Gosh, I wish I hadn't done this. " And then two weeks later they're like, "Man, I was wrong and this is the greatest thing ever and I would do it again." So I think as long as you give them a little bit of time, and we're very encouraging. We follow our patients, we help them through the tough times. But I mean, for most people, they're going to do great. They're going to be happy, so I think they're going to be fine.

Kirstin (18:08):
Yeah. Okay. Especially Dr. Gardner, are you now seeing more post weight loss patients currently than you did just like a few years ago?

Dr. Gardner (18:18):
Yes. I mean, the GLP-1s have changed the landscape. We're seeing more and more people that have lost a dramatic amount of weight. They're healthier GLP-1s. Basically, we talked about this at our recent meeting. When you look at it, every little bit we're coming out with a new indication for a GLP-1. Well, now it's supposed to help with cardiac disease. It helps with renal failure or renal disease. It helps with everything. Why is that? Well, because it's helping us fight metabolic disease. And by losing the weight combined with clean eating, it's just improving everything. But we're seeing tons of patients that are coming in, pun intended, with extra skin, and they're just looking to improve the way they look because they feel better. But I can't tell you how many people who have lost weight still look in the mirror and they still tell me they see a big person.

(19:14):
And so getting that skin off can be very healing to the mind just so when they see themselves in the mirror that they, for some reason now, they don't see the big person anymore.

Kirstin (19:25):
I love it. Do either one of you have a post-weight loss or belt, body lift, tummy-tuck, superstar story that kind of sticks out in your mind?

Dr. Gardner (19:36):
Gosh, I got a ton of them. I will tell you one I have, and it's amazing. You'll have patients that'll cry on you when they see their results post-op day one, when you peel everything down and they'll literally cry on you. But I have one. And what's funny about it, it wasn't her that said anything to me. It was her husband. And we're seeing her. She stepped out to go to the bathroom and he said, "You would not believe how her life has transformed." She posts pictures all the time where she never would do that before. She's just generally, and this is coming from him and he kind of told me on the sly because she would probably be a little shy about it, but he just said it's completely transformed her life. And so it feels good when you hear those kind of stories that we are making a difference to help people.

Dr. Koehler (20:26):
Yeah. I mean, I think a story that stands out, and I may have shared it before, but it was a lady that I had saw on consult for weight, body contouring, and she had lost all this weight and her diabetes was gone and her hypertension was gone and all this stuff. And I said, "Oh, well, I guess you must be really happy that you had this surgery to lose the weight because her health was so much better." And she looked at me and she goes, "Honestly, I don't know. " She's like, "I didn't realize I was going to be left with all this loose skin and I just don't know. " And then we completed her journey, and of course she was very ecstatic at the end. But it's a difficult thing that ... There's a lot of stages that those patients go through. They lose the weight and then they're dealing with other struggles and then they get that back.

(21:13):
Anyhow, it takes years to really travel that whole journey, the weight loss plus then the body contouring, and we can't do it all at once. So usually it's multiple surgeries. So it's a long journey for them, but worthwhile in the end.

Kirstin (21:29):
For sure. All right. Do you guys have anything else you want to add?

Dr. Gardner (21:33):
Give us a call.

Kirstin (21:35):
Give us a call.

Dr. Koehler (21:37):
Tell us more about your boss. It sounds like he's awesome. It sounds like he told you to get up and work and so you'd recover quicker.

Kirstin (21:46):
Told me to just get out there, get after it. Seize the day Kirstin.

Dr. Gardner (21:49):
Quit whining, I think is what he said.

Kirstin (21:51):
That's actually also in line.

Dr. Koehler (21:53):
I like this guy. I don't like hearing whining either. I don't like that either whiners.

Kirstin (21:59):
They may cut this out, but my boss gave me these eyelids. He gave me this chin, these boobs, this butt, this stomache.

Dr. Koehler (22:07):
Hold on.

Kirstin (22:07):
These lips?

Dr. Koehler (22:10):
We got to do your ankles next.

Dr. Gardner (22:12):
That's right.

Kirstin (22:14):
You got to get rid of these. Is there a cankleostomy?

Dr. Koehler (22:17):
Oh, well, we can make one up. Yeah, no, I can do cankles. Yeah.

Kirstin (22:21):
Okay. All right. Do you have a burning question for Dr. Koehler or Dr. Gardner or me? You can leave us a voicemail on our podcast website at alabamathebeautifulpodcast.com. We'd love to hear from you. All right, doctors, go back to making Alabama beautiful.

Dr. Koehler (22:38):
All right. Have a good one. Goodnight.

Announcer (22:43):
Got a question? Leave us a voicemail at alabamathebeautifulpodcast.com. To learn more about 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 Podcasts, Spotify, or wherever you like to listen to podcasts. Follow us on Instagram @EasternShoreCosmeticSurgery. Alabama the Beautiful is a production of The Axis, T-H-E-A-X-I-S.io.