Dr. Gallus (00:02):
You are listening to another episode of All the B's with me, Dr. G and my scrub tech Bri. Hey, I'm Dr. Kat Gallus and you're listening to All the B's, the unfiltered plastic surgery podcast with me, Dr. Gallus, Dr. G, and my sidekick slash amazing scrub tech. Bri. Hey, Bri.

Bri (00:23):
Emphasis on the amazing. Keep going.

Dr. Gallus (00:27):
Yeah. So on this podcast we like to talk about plastic surgery topics, but also we get to share our love of celebrity gossip and Daily Mail fines. Also, for today's podcast, we're going to be talking about mommy makeovers. You're a mom, right Bri?

Bri (00:44):
Yep. I'm a mom. You're a mom. Only moms in the office.

Dr. Gallus (00:50):
Yeah. A lot of our patients are mothers, but we're outnumbered in our office, even though we're in an all female office, we're outnumbered by dog owners, which we also are. We're overachievers, honestly. Right?

Bri (01:01):
We do it all. Dogs, kids. That's why everyone else looks so well rested. They don't have kids.

Dr. Gallus (01:07):
But anyway, so we'll get to the mommy makeovers first. You found this interesting headline about this gymnast. You want to read it for us?

Bri (01:18):
I saw this last night and I was like, what an odd reward. So I believe he's from the Philippines. Carlos Yulo, I hope I pronounce that right, wins gold and got a condo, colonoscopies for life and free ramen.

Dr. Gallus (01:38):
Yeah. You kind of can't just make that up. Those are the offers he got. I mean, congratulations on being the first man from the Philippines to win a gold medal. But I don't know. I don't love ramen that much. I mean, I like it, but I don't know what I would do with a year supply. I would

Bri (01:56):
You might need a lot of colonoscopies if you have a year supply free ramen.

Dr. Gallus (02:01):
If your diet consists only of ramen, only ramen.

Bri (02:06):
I just how many colonoscopies are you actually supposed to have? Do you think he's going to go in and be like, oh, I want one every six months because they're free.

Dr. Gallus (02:14):
Yeah. I feel like maybe teeth cleaning or something would've been more appropriate. Not that his, his teeth are great. I'm just saying if you wanted something free, I don't know that colonoscopies would be where it's at for so many reasons.

Bri (02:31):
I know, I was so surprised. And then it segued into me going down this rabbit hole of what all the winners from different countries got, and I was so feel like I could talk about that forever. And then I was so amazed that US athletes only gold medal, what, like Simone Browns got 30 grand in winnings. Don't why that surprised me.

Dr. Gallus (02:51):
Yes. We did have a conversation today about the whole amateur athlete, which we're not going to do a deep dive into because we can't speak to it, but yes, it is a little shocking. They make slightly more than maybe the Dallas Cowboy cheerleaders.

Bri (03:07):
Oh God, don't even get me started. That's for a whole other episode because didn't they say she makes what a Chick-fil-A worker makes.

Dr. Gallus (03:15):
Yes. And then the owner said that the women that are cheerleaders are just so grateful for the privilege. The privilege.

Bri (03:26):
Yeah, they're privileged for what? Their billion dollar enterprise?

Dr. Gallus (03:31):
Yes. Privileged to work for practically free, which I thought was rich. Okay, well, I mean beyond that and Ben Affleck's new look, I don't think we have any more pressing issues.

Bri (03:45):
I don't know what is happening with Ben.

Dr. Gallus (03:48):
Maybe he needs a mommy makeover.

Bri (03:50):
I think and a colonoscopy. In his last picture, I'm not loving the midlife crisis. Look. No, we need to go back to J-Lo because

Dr. Gallus (04:02):
Yes. I don't know why he shaved his head. We were talking earlier again today in the OR about how it's like his Britney Spears moment.

Bri (04:10):
He's having Britney moment. He looks like he's straight out of Sons of Anarchy. Oh no.

Dr. Gallus (04:17):
How divorced is Ben Allen's haircut? Divorced from reality?

Bri (04:23):
Yeah. It is that that was not the move, Ben.

Dr. Gallus (04:27):
I know, like you're an adult, don't have a

Bri (04:30):
When he gets a fox hawk, having the most intense divorce

Dr. Gallus (04:35):
Did you say fox?

Bri (04:35):
Wait.

Dr. Gallus (04:35):
It's faux. Oh, I like that one.

Bri (04:41):
Oh faux hawk.

Dr. Gallus (04:42):
Fox, I was wait is there a new kind of faux mohawk I'm unaware of?

Bri (04:46):
No, let me drink my diet Coke and hope it makes me smarter.

Dr. Gallus (04:52):
Oh.

Bri (04:53):
Most intense divorce of his life.

Dr. Gallus (04:56):
I can't.

Bri (04:57):
And he's riding a blue electric motorcycle that makes it worse. Okay, Ben.

Dr. Gallus (05:04):
Okay. All right. So maybe what he needs is an actual makeover and not whatever happened to him. So let's talk about mommy makeovers. We have a story headline from Dear Jane. My husband told me I should get a mommy makeover surgery because he is not attracted to me after I gave birth to two kids.

Bri (05:25):
So first off, what a jackass. But she just carried your two children for nine months. She made two lives.

Dr. Gallus (05:34):
Yeah. I feel like this underscores everything, at least our office is not about. It's not about having surgery to please somebody else. Full stop.

Bri (05:44):
No.

Dr. Gallus (05:46):
Period, full stop.

Bri (05:49):
Period, period. That's insane. I would leave him after that.

Dr. Gallus (05:53):
Yes.

Bri (05:54):
In case you're listening Jane.

Dr. Gallus (05:57):
Let him pay for the mommy makeover and then get back out there.

Bri (06:03):
Yeah, there definitely could have been a different way of going about that. Like, hey, let's get in shape together while we raise our children that we just created. Also, how soon after did he want his wife to have a mommy makeover?

Dr. Gallus (06:17):
Right. I know.

Bri (06:18):
I'm hoping this isn't right away because

Dr. Gallus (06:21):
That is a great point. So I think eight months.

Bri (06:25):
She's like I'm two days out and he told me.

Dr. Gallus (06:30):
Well, okay, so talking about weird, bizarre things I've seen as a resident, I helped an attending who shall not be named at the time of c-section. We did a tummy tuck, which is as terrible of an idea as you would think it is for so many reasons. So for me, at the time I didn't have kids and I just thought, shouldn't you be focused on your child and not on a tummy tuck at the time of your delivery? But I know that's a little judgy, but still. Then there is the actual surgery. So in a tummy tuck procedure, we're excising that lower half of your abdomen, that abdominal skin that's loose and wrinkly. And when you just finish having a child, it isn't loose and wrinkly, it's swollen.

Bri (07:18):
It still looks like you're pregnant.

Dr. Gallus (07:20):
Yeah. You just had a kid. And one of the reasons that you are still looking like you're pregnant is that your uterus is still huge. It doesn't bounce back to the size of a ping pong ball in the seconds after you deliver. So now we have this giant uterus that the OB-GYNs are putting back into the abdomen and closing and then we're supposed to tighten the abdomen over the, abdominal skin over that. It was just so just unsatisfying aesthetically and in general. So that would be worst case is at the time of delivery to do an adominoplasty. It looks like in this article, the woman is being asked by her husband at eight months, which I feel like you spend 40 weeks, which is 10 months pregnant. You should at least give yourself that much time to get back to baseline if not longer. And I usually tell people having any kind of surgery, if you're still losing baby weight or you're still breastfeeding, is hitting a moving target also, who is taking care of your children when you're recovering from that mommy makeover. So sometimes it's not a great idea to do it when your youngest kid is eight months old because they're very much going to need their mom and you're going to be trying to recover from surgery so.

Bri (08:41):
Do you recommend then that women get to their goal weight before they have the surgery or lose as much as possible?

Dr. Gallus (08:49):
Yes, I do. I say you should get to your goal weight, whether or not it is you just had kids or didn't just have kids, you should just be at a stable weight. Because if you do the procedure and then lose another 15, 20 pounds, it's going to change your appearance. And now you might have a recurrence of loose skin again. It's not a weight loss procedure doing a tummy tuck or liposuction. So really you need to be where you think you're going to be at. Now if you've had three kids and your pre-pregnancy weight was 115 pounds and you're living at 125 and it's eight years later and you don't think you can get back to 115, then that's fine. Stay at your 1 25 or whatever and then have the surgery. But if you're actively losing weight, then yeah, wait until you're at a stable weight for reels. And usually that's about a year out from having a kid at least.

Bri (09:44):
The audacity eight months out. Also side note, the recovery from a C-section, I mean I personally have had two C-sections is pretty brutal. So adding a tummy tuck on that.

Dr. Gallus (09:56):
I know. Yeah, the thing about a C-section is at least you're distracted by the fact that you have a baby. So when I see patients who are like, well, I've had a C-section, the tummy tuck will be the same. It is and it isn't. I'm not cutting through the abdominal wall, so it should be less painful, but you don't have the distraction of a baby and it is a pretty tight closure of that separation of your muscle. So the diastasis recti closure I think is what hurts the most and it just feels different than a C-section. So it's still pretty uncomfortable. And you are in clinic with me when patients come back in. Most of our patients the next day roll up in a wheelchair and then we see them maybe a week later to take drains out, and then at two weeks most of our patients are walking in. But we have a handful that are like, please send the wheelchair down.

Bri (10:53):
Yeah. Pretty fair, it's most tummy tucks that are like, yeah, no. There was one girl who just strolled in though and I was like, didn't we just have surgery on you yesterday?

Dr. Gallus (11:04):
Yes. I mean there's always the outliers. My favorite post mommy makeover story is about a patient who had a mommy makeover and she was a little bit slow, on the slower recovery process and I think it was before you worked at the office. Anyway, her surgery was in October, so at Halloween she went as an old lady. So she wore a little gray wig and a moo-moo and had a walker.

Bri (11:32):
That's great.

Dr. Gallus (11:33):
And then was able to take her kids trick or treating with the aid of a walker, but it looked like it was part of the costume. It was amazing.

Bri (11:40):
Did she have her drains out?

Dr. Gallus (11:42):
No, she didn't have drains, yes.

Bri (11:45):
I've actually seen somebody and they dressed up, they had just had surgery, dressed up for Halloween and had the faja and the drains and it worked out really well.

Dr. Gallus (11:54):
Where you go as a cosmetic patient? Yeah.

Bri (11:56):
Yeah. And you're like, oh, this happens to be,

Dr. Gallus (11:59):
Yeah, you just add a little tape to your nose, make it look like you got everything done.

Bri (12:03):
It's fine.

Dr. Gallus (12:06):
Yeah, it was a good camouflage for her for sure.

Bri (12:09):
That's really smart. I love that.

Dr. Gallus (12:10):
Alright, well let's talk about something more positive, I guess. There's an article about 90, oh my gosh, I can't speak.

Bri (12:19):
See we're on the same speaking level, my faux hawk, fox hawk.

Dr. Gallus (12:22):
I need more Diet Coke. Why don't you read the headline?

Bri (12:25):
Diet Coke sponsor us. 90 day fiance, Loren B talks undergoing seven hour surgery for complete mommy makeover after the birth of third child.

Dr. Gallus (12:37):
Again to,

Bri (12:39):
Is that picture before or after, I assume that's after.

Dr. Gallus (12:43):
I don't know. I think that's after. She looks pretty good there.

Bri (12:46):
She does look good.

Dr. Gallus (12:48):
I think seven hours is on brand for a mommy makeover, honestly. Right? We're usually in the six to eight hour range.

Bri (12:57):
Yeah.

Dr. Gallus (12:58):
I don't know. I mean I guess it does seem like a long time for some people, but for the patient, you're asleep, so you wake up and it's all over

Bri (13:08):
Like that was two minutes. I was just say, can we zoom in on her belly button? I feel like that's always the way I tell. I just look at their belly buttons. So what happens with the belly button in a tummy tuck?

Dr. Gallus (13:19):
So what we do is

Bri (13:21):
Can't tell.

Dr. Gallus (13:22):
Yeah, that looks done. So what we generally do is make an incision around the belly button. Oh, there's some more. Why does she have something on her head?

Bri (13:35):
It's like that story of that one chick who just said she got something small done like a bleph and she did a whole facelift.

Dr. Gallus (13:41):
Right.

Bri (13:43):
It's like mommy makeover plus facelift, bleph and chin lipo.

Dr. Gallus (13:48):
Well then now we're taking, seven hours is going fast. So she did have a tummy tuck, also known as adominoplasty, and then Lipo 360. So that is kind of internet slang or plastic surgery slang for doing liposuction on the abdomen, on the flanks and on your back. So around your abdomen.

Bri (14:13):
Do you do lipo with every tummy tuck or is that just if the patient requests it?

Dr. Gallus (14:18):
No, I would say most patients are a good candidate for liposuction with a tummy tuck because they have a little bit of extra sub-q maybe on their lower back or on their flanks. And it really does enhance the result of the tummy tuck. There are a few patients who just don't have any fat, they're just extra skin, and those patients obviously don't need liposuction at the time of the tummy tuck, but most people benefit from it to be honest.

Bri (14:44):
And then it also says that a portion of the fat was transferred to her breast. Is that normally in a mommy makeover? Is that like an extra procedure?

Dr. Gallus (14:56):
So generally speaking, mommy makeover is referring to abdominal procedure, usually a tummy tuck and some sort of breast enhancement. And then like you mentioned, I mean you can make a facelift part of your mommy makeover if you want. There's no CPT code associated with mommy makeover. It's just a term, which there's people who lose weight that have these combined procedures. Some people call it mommy restoration. I've done breast reduction with a tummy tuck, breast implant removal with the tummy tuck, augmentation. And then you can enhance your breast with fat transfer, especially if you're already doing liposuction, right? You're going to throw that fat away, should put it somewhere. You can do a tummy tuck and then take that fat and use it in your booty. So you can do a Brazilian butt lift or a fat transfer to the buttocks too. That's also super popular. So anytime I used to do that procedure and tummy tuck with liposuction at this other place we used to operate out of, they would make fun of me if I didn't put it in the patient's butt.

Bri (16:02):
It was so disappointing having to see that fat get thrown away. It's like that could be in her booty, her boobs, all the places, you can stick it in your face. I mean, don't waste your fat guys. Let me just tell you that.

Dr. Gallus (16:15):
Yeah, I can put it in your hands.

Bri (16:16):
That is stuff is gold. It truly is.

Dr. Gallus (16:20):
Yeah. So don't just dismiss the fat. But people don't necessarily want it in their booty or their face or whatever. It's fine, but you definitely should consider that. So it sounds like this woman had the tummy tuck and then instead of getting implants, she also had liposuction and then used that as a fat transfer to her breasts, which is awesome. So what happens with these patients is that you do get a diastasis and there's no restoring that abdominal wall tightness without surgery. That's unfortunately there's no, you can't do sit-ups to make that go away. If you have a big separation between your rectus muscles, the only way to fix that is to pull it together with sutures down the midline. And I think that's what she's talking about because she had three kids back to back and that image is perfect example. So sometimes that space can come together a little bit with some muscle strengthening, but that middle area, that linear alba or fascia, that's what we sew together during the tummy tuck that really helps bring the waist back in.

Bri (17:34):
Are mommy makeovers, then, actually only for women that have had children.

Dr. Gallus (17:39):
No. So you can have a diastasis for other reasons or you can have loose skin and a little localized adiposity, a little extra cushion, and benefit from a tummy tuck, if you maybe lost weight. But I would say the most common is women who've had kids.

Bri (17:57):
And then does everybody get a diastasis repair in their tummy tuck?

Dr. Gallus (18:01):
So it's interesting. We define at our office differently. I say there's three components to a standard adominoplasty, a removal of the extra skin, transposition of the belly button, so we moved past the belly button thing, but we'll talk about it. That means we're going to cut around the belly button, pull that extra skin down and bring the belly button out through new incision. So that's part two. So you've got removal of the excess skin, keeping the belly button, but you're bringing it out through a new incision, and then the diastasis recti repair. So those are the three components. And I tell patients a mini adominoplasty, just like mommy makeover is defined by the surgeon. There's no agreed upon term. So a lot of times they'll call it a mini if you're just taking out that lower piece of skin. And then you can only do that up to so much because if you take too much, you're just pulling on the belly button and you're going to yank it down.

(18:58):
So then you have to either disconnect the belly button from the abdominal wall and it's called a float, float the belly button down. But as you can imagine, you only want to do that about a centimeter or so. And it really then if you start looking at patients, where is their belly button in relation to their torso and you don't want to create a look, that looks weird. I mean, some people have a little bit of a weird torso anyway, and their belly buttons, nots, it's not actually centered in between their ribs and their pelvic bone, but it's usually two thirds down. But there's a little variability. So you can maybe take a little bit more skin and float the belly button, but if you get too aggressive, you don't want to take the belly button down to their lower abdomen. It looks insane.

Bri (19:45):
So you never actually remove the belly button. I do feel like I get a lot of this question from patients after their procedure and they're like, oh, do they just take it off and relocate it?

Dr. Gallus (19:56):
So for a traditional abdominoplasty, no, we cut around the belly button, it stays attached to the abdominal wall, and then I'm pulling down a window shade the skin over it and then bringing the same, your actual belly button out through a new incision. And how that incision is made is kind of one of the nuances of doing a tummy tuck. So the way I like to do it, and I think plastic surgeons who do a really good job with tummy tucks, are you're creating a little bit of an upside down U and then you're tucking the belly button in so that the bottom part of the incision ends up tucking in. So it's not a little incision all the way around. I think traditionally we used to go all the way around and it look, see, so her belly button is pulled up and gives that kind of nice natural look. And the bottom of that incision, even though it goes all the way around, is tucked in. So sad belly button, happy belly button.

Bri (20:57):
I've seen a couple pictures where the belly button, I don't even know how this happens, but it's up high in very off center and it's like, how.

Dr. Gallus (21:07):
Yeah, I mean it's where they make that other incision. So there is a famous surgeon in Columbia who has at least he was advocating, Dr. Alfredo Hoyas, I saw him do a presentation where he decided after studying women's torsos where the belly button should be put in an ideal setting in an ideal aesthetic. And so he just takes away your belly button when he does the surgery and leaves you with no belly button. I am not making this up.

Bri (21:39):
It's like Kyle XY or what was that show? He thought he was an alien because he had no belly button.

Dr. Gallus (21:45):
And then seven days post-op he decides where your belly button should go and makes you a new one, which seems very

Bri (21:54):
Interesting.

Dr. Gallus (21:55):
God complexy in my opinion. Just keep your belly button.

Bri (22:00):
But the belly button is still attached. He doesn't take it off, correct?

Dr. Gallus (22:04):
I don't. He does. He just throws it away.

Bri (22:06):
He stays. Oh. I was like, how does that stay alive?

Dr. Gallus (22:10):
He makes a new one. It doesn't stay alive. Honest to God thinks he can make you a better belly button than the one you have. So he creates it completely new from flaps.

Bri (22:23):
Oh, interesting.

Dr. Gallus (22:24):
Yeah. And that way he could decide exactly where he wants it.

Bri (22:29):
Through a whole another little procedure awake.

Dr. Gallus (22:32):
Yeah, whatever. I don't know how long he'll do that. He presented it at a meeting and I thought, okay, I'll just going to

Bri (22:37):
How interesting.

Dr. Gallus (22:38):
See if next time you present, you're still doing that.

Bri (22:42):
I've changed my method after careful consideration.

Dr. Gallus (22:47):
Women do not being told where their belly button is going to be. Right? I mean, come on. Anyway. Okay, so she talked about her seven hour surgery. I do think it can take quite a while to do a mommy makeover if you're doing tummy liposuction and breast. Yes, for sure, that's probably six hours. And this comes up all the time and it just depends on how much liposuction we're doing. Patients often will be like, well, can you do a little outer thigh liposuction? You start to go down that rabbit hole of I'm already awake or asleep rather, I'm awake. Right? I'm awake.

Bri (23:24):
I hope so.

Dr. Gallus (23:26):
You go down that rabbit hole of I'm already asleep, I'm already having surgery. What can I add on? Which as we mentioned earlier, put the fat somewhere. That'd be a great idea. But also they're like, can you lipo my arms? Can I do a labiaplasty?

Bri (23:43):
Labiaplasty. Very popular.

Dr. Gallus (23:45):
There are some small things you can do. You do not want to do too many things. First of all, I cut my OR cuts off at eight hours and that's being pretty generous, cuz some people will say no to six. I think it has to do with the component of what's the safest amount of time I feel like I can operate and also how accurate your times are. So when I say something's going to take six hours, you know me, most of the time it's going to take six hours. It's going to take six hours and it really takes seven and a half. That's kind of the trend among surgeons is to under guess. So if I'm saying eight, I'm not saying it's going to be 10, I'm saying it's gonna be 8.

Bri (24:26):
That's how you make a really angry scrub tech.

Dr. Gallus (24:29):
And anesthesiologist. If the case is always three hours

Bri (24:34):
He's like, I have to keep sitting in my chair for that much longer. What movies should I watch? I've been watching too many memes on Instagram.

Dr. Gallus (24:44):
Oh, about anesthesiologists? I mean, we love our anesthesiologist.

Bri (24:49):
He's awesome.

Dr. Gallus (24:50):
But we also love making fun of him.

Bri (24:52):
It's even better. He's the only man in an all girl office. Poor guy. It's just too good.

Dr. Gallus (24:59):
Yes, we're having an influence on him for sure.

Bri (25:04):
All of our Daily Mail topics in the OR, he's like, I go home and I tell my wife, I learned all these things, and I feel like she thinks I'm so cool, and I feel like the cool Dad. Like, we got you. Don't you worry. We'll keep you all up to date about J-Lo and Ben and his Fox hawk and everything else under this. I can't stop saying it.

Dr. Gallus (25:25):
It's so good. So it looks like Jenny Mollen did have liposuction under her chin, which explains that photo of that thing of wrapped around, which is a procedure you can add on. Right. That's like 30 minutes and it's not the biggest, it just adds about 30 minutes to your case and it's not going to

Bri (25:43):
It looks like very mean girls. Like the nipple cut out.

Dr. Gallus (25:47):
Why does she have a pink? It's fine. Anyway.

Bri (25:51):
It's fine.

Dr. Gallus (25:51):
What I was going to say, a common ask is arm liposuction. And honest to God, you do not want to do that while you're doing a mommy makeover because your abdomen's going to hurt and you kind of need your arms to help you get up and down. And so adding arm liposuction, I usually try to talk people out of doing that and have them do it at a later date.

Bri (26:14):
I'm just going to say from my own personal experience here, I have done lipo on my arms and legs at the same time. Worst idea ever. I could not move, I was like a stick, like a little board.

Dr. Gallus (26:28):
Yes.

Bri (26:29):
I can't move my legs, can't move my arms.

Dr. Gallus (26:32):
Yeah. I think it's just the problem is that, again, you're going with a theory, I'm already asleep. And the other theory that it's just liposuction, no one should ever say it's just liposuction.

Bri (26:44):
What does Dave say? This is the best. I say this to patients.

Dr. Gallus (26:49):
Yeah. So my husband's a surgeon, a general surgeon, and I was telling him about another doctor that I operated on.

Bri (26:57):
Everyone thinks lipo is the most painless surgery.

Dr. Gallus (27:01):
And he was so surprised, the patient was so surprised how uncomfortable and painful it was afterwards. And I was telling my husband about it, saying, Hey, there is this doctor and he's like, oh my God, this hurts. And he's like, well, you're taking a steel tube and ramming it in and out of their subcutaneous tissue. What wouldn't hurt about that? And I was like, oh, okay. I mean, there's some finesse in there, but yes, I see what you're saying. It's sounds so barbaric.

Bri (27:30):
I know, but it's a good way to explain it to people who are like, I didn't think this would hurt at all.

Dr. Gallus (27:37):
Yeah, it's definitely you're going to be sore. You're going to feel like you went a couple rounds with a boxer and you were on the losing end of that.

(27:47):
And then you're swollen and uncomfortable. So I think if you're mentally prepared that liposuction is not going to be zero pain, then you're fine. But if you think this is going to be no big deal, that's when I think people get in trouble. So it's just managing your expectations.

Bri (28:04):
Yes. Wow that pic has such a vibe.

Dr. Gallus (28:07):
Oh, and her mom went under a face procedure including a lip lift, as well as hand filling.

Bri (28:13):
Mom and daughter goals.

Dr. Gallus (28:15):
Those two. Good for them.

Bri (28:17):
I love that.

Dr. Gallus (28:19):
Oh, Dr. Oren Tepper. He's a good surgeon. Okay. Okay, so we've covered kind of what you can do with your mommy makeover. All the variations in a safe with a board certified plastic surgeon. Dr. Tepper is well-known, but then we have another story that's not amazing, which I feel like it's actually not this one. It's the one about the LA woman who dies. This lady touches on it a little bit. But yeah, this sad story happens unfortunately more often than we like to admit. And people go across the border, especially in San Diego, we're right above Tijuana and get what they consider a great deal, i.e. cheap plastic surgery and then pay the price either with horrible complications that they end up in the hospital for a long time and an unfavorable result, or the worst case scenario die, which is just awful, awful.

Bri (29:20):
I feel like I have so many side notes here, but when I first met Dr. Gallus, I had gone down to Mexico to get lip filler. I'm going to try and find a picture of this. It was so good. And I came in and she was like, oh my God, do you need a prescription? I don't know what you said, but you're like, what happened? They were, they put so much in, they were rock solid, swollen. They had, I think I got dog hair, I'm allergic to dogs. And they had blister, oh, it was terrible. She was like, you can never go to Mexico again. I was like, I know. I learned my lesson.

Dr. Gallus (29:57):
The problem is if you go down there, are there board certified plastic surgeons in Mexico? Yes. Mexico has certification process for doctors. Some of those guys are internationally recognized, they're just leaders in aesthetics. But when you go down to Mexico, you don't speak the language. You don't even know if you're getting a doctor, to be honest. If you're not vetting that surgeon. It's also the same in Miami. People go down there and they have these horrible complications and a lot of times it's not a plastic surgeon, it's OB GYN, who's pretending to be a plastic surgeon. And honestly, in Miami and Mexico, it's so crazy that a lot of times it's not even a physician. You're like, what?

Bri (30:45):
Does anyone really check? Is there accountability down there?

Dr. Gallus (30:48):
There is, so the leadership of Mexico in the plastic surgery field have made it illegal to advertise, because it was, I mean, you would imagine we have people going across the border having this and then coming back across and treating the complications. But for Mexican citizens, they're also seeking treatment and having these horrible complications that the legitimate plastic surgeons in Mexico are then having to deal with and clean up. And so they have done a lot of advocacy on their side to advocate for proper certification, proper education, and actually making it a criminal offense to falsely advertise as a surgeon when you're not one. So they've made some ground in that, but it's still an ongoing problem.

Bri (31:35):
And I feel like your post-op care is just as important as having the actual surgery.

Dr. Gallus (31:41):
Yes. I would agree. Surviving your surgery is just as important as having the surgery. So I mean, I think the $25,000 is just reflecting the standards that are generally enforced. Again, there's always loopholes in the states as well. You need to do your research, but generally, there's standards that most of us either adhere to because we have to or voluntarily adhere to because it's good practice. And so our or is fully accredited, you want to make sure you're going to an accredited facility. In my case, that means I have a board certified anesthesiologist. We have a crash cart, we're ready for any unexpected outcomes. We have a transfer agreement with a major hospital that is literally down the street. We have protocols in place for that. We have sterility protocols. We're adhering to all these standards. And even just being part of that accreditation process, guess what people, it costs money.

(32:44):
It costs money to maintain your licensure for having a quad A accredited facility. It means we can get inspected anytime we have inspections every three years. All of that is frankly expensive, making sure that we're not using counterfeit medications, that we have all the tools we need, all of that costs money. And so 4,000 to $25,000. I mean, yes, if I did it in my garage, I could probably do it for $4,000. I don't know. That's just crazy. You're also paying for training and for the fact that you're getting an actual doctor. So it's a problem that happens with plastic surgery. It happens with vet care, veterinary care.

Bri (33:25):
Oh, interesting.

Dr. Gallus (33:26):
People go down, we were talking about it today, people go down to Mexico for bypass surgery, which is also fraught with problems if you aren't going where you're supposed to. So I would call it a big hard pass. Just go with someone that is accredited.

Bri (33:44):
Pay that extra money.

Dr. Gallus (33:45):
Yeah, it's worth it, definitely worth it. Because these outcomes are so much more expensive than you can imagine. Okay, so do we want to talk about some more mommy makeover stuff?

Bri (34:00):
Sure. So just a few more questions so we don't miss anything. So I know we talked a little bit about this. I know you're going to start curing it in office, the GLP-1s. Do you recommend that patients do that prior? I know it's a very popular topic prior to doing this. Do you think that would help prior to this procedure?

Dr. Gallus (34:23):
I think so. I think if you're struggling to lose some weight and that's your goal weight to have this surgery, then it's a great tool to use to help you lose weight. I just tell patients, you want this, you're investing in yourself. So if your goal is to lose 25 pounds or 50 pounds or whatever it is, then let's make sure that you're going to keep it off. The worst thing I want to do is someone have crash, lose 50 pounds, have surgery, and then immediately go back to old lifestyle habits and then gain that weight back. It's going to mar your result. But we've seen a lot of patients that have successfully lost weight with the GLP-1s and are keeping it off and it's changed their life, but now they have all this loose skin because one of the things about Ozempic, Mounjaro, semaglutide, however you want to call these GLP-1 agonists, the weight often comes off quickly. So you're losing weight pretty quickly and your skin's not retracting, so you end up with some laxity afterwards. So the faster you lose the weight, the more likely you're going to have that happen.

Bri (35:25):
So are there different variations for a tummy tuck such as a mini tummy tuck, extended circumferential?

Dr. Gallus (35:33):
Yeah, I think mini tummy tuck usually means you're just either removing that lower pole of skin, you're maybe floating the belly button, you're not doing a diastasis recti repair or you're not cutting around the belly button. You're not doing a couple of the components that we generally think of with the tummy tuck. So that's a mini tummy tuck. And that also usually lends itself to a faster recovery. The extended tummy tuck just means that the incision's going much farther out laterally than normal. So sometimes wraps around towards the back. And that a circumferential body lift is kind of a big undertaking. So you're addressing the lower back and buttock area, the hips and the abdomen all at one time and it's a big surgery. And I would not recommend combining that with too many other things because the recovery is significant.

Bri (36:23):
So if you have a C-section scar, what happens to that scar when you get a tummy tuck?

Dr. Gallus (36:29):
With a C-section scar, even though they're pretty low, my incision for the tummy tuck is also low. So I go below that and the C-section scar gets thrown away, which is we love that.

Bri (36:39):
Great.

Dr. Gallus (36:39):
Because those are usually not ideal.

Bri (36:42):
Not great. And the stretch marks, what happens to the stretch marks? Do you get rid of all of 'em? Do you still have some? I know it's location based.

Dr. Gallus (36:51):
Yes. So the stretch marks, if they're below the belly button, those are going to get removed, so they'll be gone. Any stretch marks you might have above the belly button are going to end up below the belly button. So at least for your upper torso, you shouldn't have any stretch marks. And if you don't have anything above the belly button, then yeah, you're going to get rid of your stretch marks.

Bri (37:09):
Good to go.

Dr. Gallus (37:10):
Which is great, a win-win for everyone.

Bri (37:13):
So tell me about the recovery for a tummy tuck or mommy makeover.

Dr. Gallus (37:18):
Yeah, so the recovery is you need at least two weeks of taking it easy. And most people are not chomping at the bit to do anything during those two weeks. So some of the procedures I do, people still need to take it easy for two weeks, but maybe after a week they're like, I want to go to a concert or whatever, do something that I've already told them they can't do because they feel so good. So I want true story, your heart rate to stay low for two weeks. But for our mommy makeover patients, they're usually not trying to misbehave because you're still bent over a little bit. You're still stooped, you're sore, you're not interested in lifting anything heavy. It's definitely a longer recovery than most of the procedures we do. Then after about two weeks you turn a corner, so somewhere around three or four weeks you start to feel pretty good and at six weeks you're usually in great shape.

Bri (38:12):
Do you use drains in this procedure?

Dr. Gallus (38:15):
Yeah, I mostly use drains in a tummy tuck, not for the breast surgery. You can do drainless. abdominoplasty. It can be a good option I think. I don't know, I feel like the drains are in for five to seven days and are not too bothersome. Whereas the alternative to a drain list tummy tuck is suturing internally, which if the patient's thin enough, you can sometimes see some puckering and if they get a fluid collection, then you need to drain it. So it just has to be the right patient for a drain list, tummy tuck, and honestly, I just use in those patients I'll often just, they're really thin and we can get away with one drain and it comes out at five days and it's no big deal.

Bri (38:56):
And what kind of garments are worn after the procedure? Garments are the worst part. Garments suck.

Dr. Gallus (39:05):
They do, I think we saw in one of those photos she was wearing a abdominal binder. We tend to have our patients wear what looks like Spanx, so it's shorts and then that comes up your torso all the way up. And I think it just does a better job of providing compression in stability than having that little panel binder that's a corset because that thing tends to either slide up or slide down and is never putting even pressure on where we want it. So I like compression in those little kind of shorts with, I don't know what you would call it. It almost looks like an old school girdle.

Bri (39:41):
I wish we could do a video of us trying to put on the garment at the end of the surgery.

Dr. Gallus (39:46):
Yeah, that's right. You wake up in your garment,

Bri (39:48):
It's so special.

Dr. Gallus (39:50):
That's when the magic happens.

Bri (39:52):
It is.

Dr. Gallus (39:53):
Let me just assure you, after seven hours of surgery, the one thing we want to do is wrestle a completely asleep patient in a garment.

Bri (40:01):
Yeah. I think one time Megan had popped in because she heard us cheering because we had got the bra and all five hooks at one time and she's like, what is happening in here? And we're like, we're doing big things.

Dr. Gallus (40:14):
That's right. Yes. That's a win. So a lot of times the patient will be wearing a bra and then it has a front closure because you don't want to be doing this after breast surgery. And so when we put it on one person's holding the hooks and the other person's holding the other end, and so we try to get all five down.

Bri (40:31):
It's only happened a couple times.

Dr. Gallus (40:34):
Yeah, it's really

Bri (40:34):
Hard to do a couple times. It's not easy.

Dr. Gallus (40:37):
I will say that when my daughter, my eldest daughter did Nutcracker, it was a professional production and I had to volunteer backstage. I was the go-to for quick change because the ballerinas and ballet dancers would come off on the side stage and they have to get out of one outfit into another and it's all this hook class nonsense. And I'm like, I got this.

Bri (41:01):
She's like, this is my jam. Say less.

Dr. Gallus (41:04):
Yeah, you're sweaty. No problem. At least you're standing and able to help a little bit.

Bri (41:09):
Right? Yeah. Those sleep patients, there's nothing like it.

Dr. Gallus (41:13):
Yeah, nothing like it. Also, we're at the mercy of the nurses, so if they haven't set it up for us properly, you can add an extra level of pain. So I've done where we get the garment on and then we're going to clasp the sides

Bri (41:28):
With each side and it's inside out or backwards or I'm like,

Dr. Gallus (41:33):
So then we have to roll the patient, take it out, redo it, start again. So fun.

Bri (41:38):
Take a sip of diet Coke first and breathe.

Dr. Gallus (41:42):
So we complain about putting the garments on probably only second to the patient's complaining about the garments afterwards. Right?

Bri (41:50):
Right. They're not comfortable. I mean, I could have a whole podcast on the plastic surgery I've done, but I have worn one. It is not comfortable. It is itchy. It is tight. It hurts your ribs, but it's essential helps with swelling. There's so many good benefits for it.

Dr. Gallus (42:10):
Yeah, I think the compression garment is great.

Bri (42:12):
So after having a mommy makeover, do I need someone to take care of me? How long will I need help?

Dr. Gallus (42:20):
So implied in the mommy makeover, if you're a mom, usually it means you're doing all the things and so you definitely need a hand. So this is something, even if you can kind of manage your own postoperative recovery and you don't think you need too much help, if you have younger kids, I mean your job is probably just driving them around and getting them to school, pick up, drop off, getting them things. So making sure you have the support that you need so that people can take care of the other members in your family that need things and also be able to take care of you is super important. So I say that's not the time for your husband to be deployed or on

Bri (43:04):
A golf trip.

Dr. Gallus (43:06):
Yeah.

Bri (43:06):
Oh, he'll be gone on a golf tournament that weekend. I'm sorry.

Dr. Gallus (43:11):
That's not going to work. It generally doesn't work out. I mean, people have done it. It's just you need a very friendly neighbor or best friend or somebody to pitch in. You need help. Otherwise you're just adding stress to something that doesn't need to be stressful.

Bri (43:27):
Get that help.

Dr. Gallus (43:28):
Yeah. We just don't like asking for help.

Bri (43:29):
Find your husbands. So how do I prepare for recovery with little kids at home? Say, I know you want somebody to at least stay the first night or two with anesthesia in their system, but how would after that first couple nights say I had zero help? Could I still get a mommy makeover if I was helping my little kids?

Dr. Gallus (43:50):
I mean, it's been done, but I would rely heavily on friends and family to help you because who's taking care of little kids For patients that don't have kids, we know that based on their intake, what isn't on our intake is if you have pets, i.e. dogs and if you have very large dogs. So I know to ask for that because people fly under the radar. I don't have kids. And then you're like, oh, but I have the St. Bernard that I have to walk every day.

Bri (44:18):
That's dragging me the whole walk.

Dr. Gallus (44:21):
So I do ask or you have a job that you have to go back to that involves lifting things. Those are all things that you just need to think about ahead of time. And so we tell you what your limitations are. We've had multiple patients that live on farms and have livestock to take care of. Right. We've had patients come in

Bri (44:40):
With kids.

Dr. Gallus (44:42):
Yes. With kids. And then are like, oh, our goats had kids, goat babies the night before

Bri (44:52):
Our goats had kids.

Dr. Gallus (44:53):
So they were up all night helping deliver the goat. I'm like, okay, well sure, as long as that's out of the way before surgery, that's fantastic. But after surgery, I don't really want you post mommy makeover and going in the barn and milking cows, sorry.

Bri (45:07):
Delivering animals.

Dr. Gallus (45:09):
Yeah. Have somebody else do that.

Bri (45:10):
Hold my wheelchair, please. So when would you expect that I can go back to delivering goat kids?

Dr. Gallus (45:19):
I would say for that specific question, probably six weeks. Okay. Yes. Do not deliver farm animal babies for a solid six weeks.

Bri (45:29):
So I can start exercising as well at about six weeks.

Dr. Gallus (45:32):
Yes. At four weeks you could walk maybe or increase your activity. But going full court press, which a lot of people in Southern California love to do. You've got your CrossFitters, you've got your, I think it's called Renegade. There's so many gyms. There's Orange Theory. You do not want to be doing that until you're at six weeks.

Bri (45:51):
Okay.

Dr. Gallus (45:52):
It's just a safe move. Don't hurt yourself before you're fully recovered.

Bri (45:57):
Another common question I feel like I get asked a lot is how does what suture is used to keep the diastasis together? Like am I going to pop a suture after I know you do a pretty good suture that's all whipped up in place.

Dr. Gallus (46:14):
Yeah, that's a good question. So traditionally, most surgeons will double layer that closure. So that means putting one row of sutures, bringing those edges together, so tightening up that abdominal wall and then we will over sew it with another suture. So most of us do a two layer closure. There's some people who do one layer closure, it's just faster. And most of us will do a combination of permanent and dissolvable suture, long acting dissolvable. Some people will just do dissolvable. So I do a permanent row of sutures and then I overs sow it with a pretty long lasting suture because you really want the suture to stick around for six weeks. And once that's done and everything scars in, then you're not going to bust that repair open. It's sort of like a hernia repair unless something incredible happens, but you're not going to go do a workout and have that repair fail. But interestingly, they've done research papers on this and found that just closing it with one layer of absorbable sutures has the same effect at two months as any of the other techniques. So that's great. But if you have a big cough, you get covid or something in that for four to six weeks before everything heals in, then I would say I like having that double layer of suture to reinforce things. So it's a little bit of insurance and I haven't had anybody bust the repair open.

Bri (47:44):
Yeah, I was going to say, I know the answer to that question, cuz I'm the one holding the tractor shaking while she's all the way up.

Dr. Gallus (47:52):
Yeah. Suturing.

Bri (47:54):
To the top.

Dr. Gallus (47:55):
Yeah, you can't skimp on that. You have to go all the way to the bottom of your sternum, which is called the xiphoid process, all the way down to your pubic bone. And if you leave the upper or the lower undone, that's going to bulge out. So it's going to look worse afterwards. So that's why you have to repair the whole diastasis. Even though someone, a lot of times your abdominal wall is stretched out depending on your anatomy, maybe it's more lower central, more upper, whatever, but you really have to repair the whole thing, otherwise it won't look good.

Bri (48:27):
We don't want that. I know, cuz I feel like a lot of people are like, oh, can you just do the bottom or do you just do the top?

Dr. Gallus (48:32):
No, we want

Bri (48:33):
Right and tight.

Dr. Gallus (48:35):
Yes. Right and tight. And we want Bri to get her workout.

Bri (48:37):
You're going to have to show you these muscles one podcast. This is just from holding retraction, I swear. So what do patients say to you after they're all done, when they're healed, come back for their post-op?

Dr. Gallus (48:49):
Most patients, I would say overwhelmingly love it. Love, love, love getting their body back. It's just huge. So yeah. So nice. They can wear a bikini again, they're active with their kids. They don't feel like they're, I mean, on average, people are just generally happy with this procedure. The people who are over the top happy are the ones that have such a stretched out abdominal wall that they still look pregnant. So I've had women in tears, like tears of joy, cry after having the surgery once they're on fully recovered, because it was so important for them to be able to walk around and not have people ask them when they're due, which is so bizarre to me.

Bri (49:30):
It's 2024. You can't be asking that though.

Dr. Gallus (49:34):
I know. Every time it happens, I'm like, wait, what year is this? Why are you asking a stranger when their kid is due?

Bri (49:41):
I'm going to be like, oh, I'm not pregnant.

Dr. Gallus (49:43):
No. Nope. You let the woman tell you.

Bri (49:46):
Right. I know, I don't know if I can say this on the podcast, but when I talk to patients, it's obviously a little bit different when they talk to the doctor, but they're like, when can I go back to having sex, cuz my husband is horny. He looks at me, she's like, it is looking good. I'm feeling confident.

Dr. Gallus (50:07):
Four to six weeks. If they ask it that way, if they ask it, when can I have sex again? I'm like, what do you want me to tell 'em? Yeah, I'll write down.

Bri (50:14):
Do you want me to tell the husband 10 weeks, 16 weeks?

Dr. Gallus (50:17):
Yeah. Six months. What do you want? Only foot massages.

Bri (50:20):
Only foot massages.

Dr. Gallus (50:21):
I know. We'll do whatever. We will tailor it to you. Let us know.

Bri (50:24):
Yes. You let us know what you want. I feel like most people are like, I'm looking good. And they feel so confident. It's huge that they're ready to go.

Dr. Gallus (50:36):
That's why we have Bri in the office so they can share all their real questions.

Bri (50:41):
I get all the deep, dark, real stuff.

Dr. Gallus (50:45):
Well, you do offer lymphatic massage, which we could have a discussion about. And so a lot of times patients are coming in after liposuction or a tummy tuck for lymphatic massage. And that's true confessions time as well.

Bri (50:56):
It is. It truly is. You lay down on that table and it is like

Dr. Gallus (51:01):
She's getting the lymph and all the tea, pushing tea.

Bri (51:06):
Literally pushing tea. Pushing tea.

Dr. Gallus (51:09):
That should be a new song for you.

Bri (51:12):
Yeah, no, it's true. We become besties.

Dr. Gallus (51:15):
Yeah. So you get, when can I have sex? I get, I'm in Hawaii. Can I go scuba diving? No. No. Not at five weeks. Please don't.

Bri (51:26):
No, no.

Dr. Gallus (51:27):
Maybe it's a metaphor for things. Maybe all these random requests are actually a metaphor for asking about sex, so just don't want to ask me directly.

Bri (51:33):
They don't want to know.

Dr. Gallus (51:35):
They ask if they can go scuba diving or repelling or paragliding, and I'm like, no, but what I should read is, can I have sex?

Bri (51:44):
No. I get the sex. Can I use vibrators? I'm ready to go. That's right.

Dr. Gallus (51:50):
Well, we like our patients to feel comfortable talking.

Bri (51:54):
Yes. And I like to think that I keep this office fun.

Dr. Gallus (51:57):
And on our toes.

Bri (51:59):
Yes, yes. Some say it's diarrhea of the mouth, but I'd like to say it's just being fun.

Dr. Gallus (52:08):
I think our patients then feel comfortable asking us anything. AMA, Ask me anything.

Bri (52:14):
I love that. It's better than the other AMA.

Dr. Gallus (52:18):
That's right. Which is what I usually think of if you're not on TikTok. Alright.

Bri (52:25):
Yeah.

Dr. Gallus (52:26):
I feel like we've covered a lot with Mommy Makeover. Certainly any of those procedures could be broken down into a complete podcast. And don't worry, we will.

Bri (52:35):
Oh, yeah.

Dr. Gallus (52:36):
But we can answer your questions as they come.

Bri (52:41):
Yeah. Any questions, concern, shoot us a DM on Instagram.

Dr. Gallus (52:46):
Go to our website.

Bri (52:48):
Yes.

Dr. Gallus (52:48):
Call the office. We can answer your questions. We're here for you.

Bri (52:52):
Yeah. If you have the good questions, ask for Bri though. Okay. We'll be back.

Dr. Gallus (53:01):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to RestoreSDPlasticSurgery.com or follow us on Instagram @RestoreSDPlasticSurgery. If you enjoyed this episode, please share it and subscribe to All the B's on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcast.