Tummy Tucks, GLP-1s, and Why Your Husband Doesn't Get a Vote

Dr. G (00:00):
Although I was just in a consultation where the husband was asking for it and I was like, No.

Bri (00:06):
Yeah.

Dr. G (00:06):
"Well what else can you do at the same time?" I was like, what?

Bri (00:09):
Automatic divorce. You're done.

Dr. G (00:12):
You can step out of the room now, sir. No one asked you.

Bri (00:15):
Automatic divorce.

Dr. G (00:17):
You're listening to another episode of All the B's with me, Dr. G and my scrub tech, Bri. So our last tummy tuck episode was actually about recovery, which is important. But before that we had some tummy tuck questions that got buried inside an old mommy makeover episode. And that was like two years ago, if you can believe it.

Bri (00:38):
That's crazy.

Dr. G (00:39):
So today we're going to do a deep dive into what we should have done ages ago, which is who actually needs a tummy tuck, who can get away with lipo, what GLP-1 is doing to everything, what the fleur de lis technique is, and the insurance question everyone asks, nobody understands. And as you know, some important celebrity news for you. So Kylie Jenner reveals she wants more plastic surgery and it's right up your alley, Bri. Did you read it?

Bri (01:10):
No, I didn't. It was her nose?

Dr. G (01:12):
No.

Bri (01:13):
Boobs.

Dr. G (01:13):
Boobs. Bigger boobs.

Bri (01:16):
What? She has big boobs. She has perfect boobs.

Dr. G (01:19):
She has 445 CC implants and she's thinking she wants to go bigger.

Bri (01:24):
They're literally perfect.

Dr. G (01:27):
I mean, my sister would say they're too big, but they need to be bigger and more out there. I want my tits to walk in before I do.

Bri (01:35):
That's hilarious. My old plastic surgeon used to say that. Your nipples come through the door before you do.

Dr. G (01:43):
Oh my God. I mean, maybe she'll switch to above the muscle. That would be more interesting than anything else. But yeah, she has moderate profile, half dual plane. But if she had bigger- Bigger implants? Why would you want to go above the muscle? Yeah. I don't know. Well, anyway, she's got her two kids. She's still dating Timothee.

Bri (02:08):
Timothee is like, "I just need bigger tits."

Dr. G (02:12):
I hope he's not influencing that. That's weird. Okay. And then let's talk about Dolly Parton rip. That's so sad. I know. She did had at least much like Kylie, an open approach to plastic surgery and didn't -

Bri (02:32):
You can't look like that and not have an open approach.

Dr. G (02:35):
Well, you can Martha Stewart it and pretend none of it happens, but I feel like she knows.

Bri (02:43):
Everyone knows. She looks fabulous. We love her, but there's no hiding anything on any part of her body.

Dr. G (02:50):
She said famously, "If I see something sagging, bagging or dragging, I'm going to have it nip, tucked or sucked."

Bri (02:58):
Damn. Those are wise words to live by. I feel like that needs to be tattooed somewhere.

Dr. G (03:05):
She wanted to look her best no matter what. So props.

Bri (03:09):
Wow. I'm going to -

Dr. G (03:10):
We're going to miss her.

Bri (03:11):
Yeah.

Dr. G (03:12):
Also, because she was such a sweet person and just genuinely good vibes all the way around. All right. And then Ozempic and I hate the cadaver derived injectables, but let's talk about Alloclae, which I feel like the media can't stop talking about because it's from dead people fat.

Bri (03:39):
Oh, are they dead?

Dr. G (03:41):
Yeah.

Bri (03:43):
I didn't know that.

Dr. G (03:43):
What are you talking about?

Bri (03:44):
Alloclae?

Dr. G (03:46):
Where do you think we get the fat from?

Bri (03:48):
Just people that donate it.

Dr. G (03:49):
Oh, no. No.

Bri (03:51):
I didn't realize these were all dead people.

Dr. G (03:53):
You can't get it from alive people. Props out to Elle to actually mentioning Lipoderma, which is another injectable fat. They left out Renuva, but Alloclae is stealing all the limelight because it comes in such big quantities. But Lipoderma is coming in at 10 ccs and a lot of it's been speculation based on the fact that the though is that Alex Earl and maybe Kaya Gerber used it because those girls are too skinny to have their own fat injected elsewhere, but it's basically harvested from human donors donating their organs to science.

Bri (04:32):
Oh.

Dr. G (04:33):
Yeah. You can't donate your own fat.

Bri (04:35):
I didn't realize. I guess now that I think about it, I just go, "Oh, I'm going to have lipo. Who can I donate this to? Can you save my fat?" It makes more sense now that I've thought about it.

Dr. G (04:46):
Well, the thing is, I get that because a lot of people go through that, but then you would have people selling their fat. The only place that's ever worked is plasma for some reason, but you can't sell your blood or I don't know. It would create a whole ethical problem. So these are patients that are people who have donated their stuff to science, I guess, their organ donation. And so they're already donating maybe skin and other things.

Bri (05:18):
This is going to be a new question at the DMV. Would you like to donate your fat to Alloclae?

Dr. G (05:23):
I mean, you're not using it.

Bri (05:24):
Yes.

Dr. G (05:25):
Are they making profit off of it? Sure. That's a little squirrely, but where else are we going to get it from?

Bri (05:32):
I guess I didn't think that deeply into it.

Dr. G (05:35):
The thing is that some of the. So the cadaver fat does have reconstructive purposes. So just like nobody gets upset about using tendon or rib or fake skin because you're using it for your ACL repair or your achilles repair or. I mean, even in rhinoplasty, if they're doing a really intense reconstruction, but sometimes it's cosmetic, you can use rib graft, which is donated. So I think this is just exposing that and because it's maybe on a little bit bigger scale, people are now raising their hand and asking, "Well, what are the ethics of that?" But it's been going on, it's just not at this level. So how should you choose between your cadaver derived injectable? I mean, you don't really have a lot of choices.

(06:33):
You have Renuva, you have Lipoderma, and you have Alloclae, but if you're looking for anything substantial, Alloclae is the way to go because the other two don't come in large enough quantities to make it worth your while. It would be too expensive. But Lipoderma actually has a reconstructive indication. So it's been used in foot stuff or foot ulcers.

Bri (06:57):
Oh, interesting.

Dr. G (06:59):
So that's where they started. And Renuva has been used for some other things and can be used above. Both of those can be used above the neck. Alloclae cannot be used above the neck. So it's for body only. And I think the most common places are hip dips, buttocks and breasts. And it's a nice option for people who do not have any fat.

Bri (07:21):
Alloclae is much thicker. Yeah, it's great. It's really hard to get in your face.

Dr. G (07:26):
Well, we could have a whole thing about Alloclae, so we're just going to move along and then discuss Lady Gaga's fiance or whatever.

Bri (07:36):
I didn't even know she was in. I feel like I'm not keeping up with everyone's relationship status.

Dr. G (07:42):
Her fiance is Michael Polanski and I feel like. Oh wait, so he's also doing something with donated skin.

Bri (07:53):
Ooh, very Ed Gein. You know he watched that and he was like, "Oh, great business idea. Yeah. Why stop at your organs? Get the skin and fat too." I mean,

Dr. G (08:05):
That's also been around for a while.

Bri (08:09):
I'm going to auction off my body when I die.

Dr. G (08:13):
She's been engaged since 2024, just FYI.

Bri (08:17):
Love that.

Dr. G (08:17):
But I feel like he's just using donated human skin to run tests on skincare products and different chemicals and stuff to look at how skincare penetrates, which makes sense. I mean -

Bri (08:29):
Better than the rats and puppies.

Dr. G (08:30):
Right? I was like, "Do we want to be using bunny rabbits, live bunny rabbits? No." So I think it's fair to use.

Bri (08:38):
Yeah. All right. I support that. We like that.

Dr. G (08:40):
Yeah. It's not skin crawling. It's just sparing the bunnies.

Bri (08:44):
Yeah.

Dr. G (08:45):
And then I'll have to say, I did not read about the puppy soda founder getting plastic surgery after dramatic weight loss, but good for her. I mean, once you have dramatic weight loss, you have a bunch of extra skin and so it makes sense that you're going to deal with it.

Bri (09:03):
Does it say what weight loss surgery she got?

Dr. G (09:06):
I think she probably just used GLP-1s.

Bri (09:09):
Like what surgery? She probably had a tummy tuck or.

Dr. G (09:12):
Yeah. So most people go with the tummy tuck first, which we're going to talk about in depth today. Although we currently have a patient coming up that is opting to go with her arms and breasts first. So it's really oftentimes when you lose a lot of weight, you have excess skin in multiple places, upper arms, breasts, upper back, abdomen, and thighs. Those are all the main areas. And then people sort of decide what is bothering them the most and then start addressing it because it definitely happens in stages. You cannot tackle all of it in one surgery. It's too much surgery at one time.

Bri (09:49):
Don't do yourself dirty like that.

Dr. G (09:50):
Yeah. I mean, people do go down to Mexico and get it all done at once, but I don't recommend.

Bri (09:59):
It's a lot of surgery.

Dr. G (10:01):
You're stressing your body out for its healing potential, and I just think your risk of complications is dramatically increased when you push the limits of what can be accomplished in one surgery. And you only have to listen to the cautionary tales every once in a while when someone dies and they're like, "They were having this, this, this, this, and this done." And you're like, "Yeah, that's probably the problem."

Bri (10:26):
Healing wise, yes. But think about your caretaker. Don't do them dirty like that. They're probably like. If you can't use your arms and your legs, can't use your core, your boobs hurt, that's a lot of surgery. They're doing everything. They're getting you up.

Dr. G (10:41):
Yeah. You're essentially immobilized.

Bri (10:44):
Yeah. It's a lot. They're like a board.

Dr. G (10:47):
Cute PJs in this picture.

Bri (10:49):
I know. They are cute, but yeah, all around. Pick top or bottom.

Dr. G (10:55):
Yes. One of my steadfast rules, unless, unless you're very tiny and we're doing tiny surgery, is no thighs and arms at the same time. I really think those should be separated.

Bri (11:07):
I did lipo on my legs and my arms at the same time, and that's much smaller than having a big thigh lift.

Dr. G (11:14):
Excisional surgery.

Bri (11:15):
Yeah. Yeah. And I literally could not move. I was like a board. I was stiff as a board. It was so uncomfortable.

Dr. G (11:23):
It definitely makes you feel very Frankenstein.

Bri (11:25):
Yes.

Dr. G (11:26):
Like you're like arms straight out, legs straight out. Everything's swollen. I mean, one of the tenets of recovery is to elevate above the heart. So how in God's name are you going to elevate your arms and your legs?

Bri (11:39):
Yes.

Dr. G (11:39):
So you're going to have to pick one, so something's inevitably going to get swollen.

Bri (11:43):
Yeah.

Dr. G (11:44):
I love that this girl got her journey of plastic surgery posted and in detail. That's awesome. I also like the Poppi soda.

Bri (11:54):
Yeah.

Dr. G (11:55):
My kids drink it.

Bri (11:56):
So do my kids.

Dr. G (11:57):
All right. So let's do tummy tuck versus lipo. Which one and why they're not interchangeable? So if you call to make a consultation, a lot of times people will be like, "Oh, I just need abdominal liposuction." And at least at our office, Ava will know enough to ask a bunch of questions and let you know that not everybody's a candidate for abdominal liposuction and that sometimes people would benefit more from a tummy tuck. Have I done liposuction on people who would definitely benefit from a tummy tuck? Sure. But you have to have pretty solid understanding of what the results are going to look like, what the trade-offs are, and some rationale about doing one versus the other. Generally speaking, liposuction to the abdomen is going to be a shorter recovery than a tummy tuck, but it doesn't address loose skin. So if your skin quality is not.

Bri (12:55):
If your skin's already loose, doing lipo, this is going to make it even more loose.

Dr. G (13:01):
Yes, it gets more loose. So you end up with more lax skin. So I've done it before for, for example, a patient who wanted some abdominal liposuction, knew that she was going to have some lower belly skin excess afterwards, but had a wedding coming up, hadn't had kids, didn't want to do a tummy tuck, and then have to go through it all again if you're pretty young. So that's the harder part are the younger patients who haven't had kids yet and have this loose extra skin. Do you go through a tummy tuck or do you try to get away with liposuction? It just depends. If kids are in your immediate future, I would say wait. And if they're not, then sure, you could do it because you don't know.

Bri (13:41):
So you can get a tummy tuck and have kids?

Dr. G (13:43):
You can.

Bri (13:44):
Just ruins that.

Dr. G (13:46):
It just usually doesn't work out well for the tummy tuck. When I was a brand new intern, so brand new baby doctor, one of the first cases I did was a tummy tuck because I started on plastic surgery randomly as an intern. The patient was getting a tummy tuck and she had had two kids and she was married and blah, blah, worked out great. She loved it. And then she was a doctor and so I circled back around later, I don't know, like 10 years later. I was still a resident probably. She worked at the hospital and she'd gotten divorced, remarried and had a kid with a new husband. And so then probably needed a tummy tuck again. But she got years out of the tummy tuck, so what are you going to do?

Bri (14:33):
That's crazy.

Dr. G (14:35):
Then I've also had the patient who's had a tummy tuck and then is ordering donuts to the hospital.

Bri (14:40):
Oh yeah. I feel like people do think once you have lipo and tummy tuck, you can just let go of your eating and that is not the case. Don't go eat a Snickers. That's not going to, have some protein, eat a salad.

Dr. G (14:53):
It's not a common misconception and I feel like our current patient population's educated and isn't that type, but there have definitely been people in the past that have approached this as like, "I'm going to get liposuction, eat whatever I want and then do liposuction again." I don't know. It just doesn't make any sense.

Bri (15:11):
They're like, well, the fat doesn't come back in the area you got lipoed.

Dr. G (15:15):
Yeah. So it's not. Just invest in your body if you're going to invest in your body.

Bri (15:19):
Right.

Dr. G (15:20):
So if you're going with liposuction and you have some loose skin, sometimes you can get away with doing Renuvion or Body Tight. We have Renuvion. Both of them are radiofrequency energy devices that help tighten the skin. And a lot of times, if you accept that it's not the same as skin excision, you can get away without doing a tummy tuck. Or if you just don't have enough loose skin. Some people are sort of on that in between where they just don't have enough loose skin. And if you get liposuction and you actually need skin removal, you can come back and get the tummy tuck. So I have had patients who did lipo, did Renuvion, and then a couple years later like, "Okay, I still don't like the skin laxity. Just do a mini tummy tuck or a reverse tummy tuck or something to get rid of the skin." So you have the option. Let's talk about GLP-1s. We love those. People are coming in with significant weight loss on them and then asking for a tummy tuck. And the reason we ask is because you do have to come off of it for your surgery. And most people are on a maintenance dose and are fine, but some people are really still on it to maintain their weight and it creates a little bit of panic. People are worried that if they come off of it, they're going to gain weight.

Bri (16:54):
Yeah. But definitely be at your goal weight, the weight you want to be at. If you want to keep losing another 30 pounds, don't get the tummy tuck yet. Be at your goal weight and then slowly taper off GLP-1s and yeah. You have to be off of them for how long? Two weeks prior?

Dr. G (17:13):
Yeah. And that's my personal opinion. Some plastic surgeons, I know this came up at a conference I attended, make people get off of it for six weeks, which is wild. Two weeks was the original recommendation from an anesthesia standpoint. Now we know we could probably do a little less from an anesthesia standpoint, but two weeks is that balance where you're getting your nutrition up to speed before surgery and it's a safe anesthetic outcome. The anesthesia reason to be off of it is because it delays your gastric emptying. So when we say nothing to eat or drink after midnight, for somebody who's on a GLP-1, that's actually not enough because you'll still have food in your stomach. And when we put you under for anesthesia, we don't want to see any of that food come back up.

Bri (18:04):
No, we do not.

Dr. G (18:05):
So it's best if you're off of it for two weeks for that reason. And then I used to say two weeks afterwards, you can go back on your GLP-1, but now I just say probably can go back on, but depending on the extent of your surgery, it might be longer. And so I will let you know when you can restart it. Because there are studies coming out now showing that it does impact your nutritional status and your wound healing capabilities. And I've seen it in real life where people went back on it too soon and then started having wound healing problems or their wound healing issue was not getting better.

Bri (18:43):
Yeah. You stop eating, you're not getting enough protein.

Dr. G (18:46):
Yeah. You think you're eating enough, but you really aren't and the protein stores are getting tapped because you're also healing. So you do need extra nutrition around the time of a tummy tuck. And then being at a stable weight, I guess it depends. If you're someone who lost 15 or 20 pounds, I mean, you're ready to go. But if you lost 100 or 200 pounds, generally you need to be at that weight for at least six months. Back when gastric bypass was the way to go, they wanted people to be at a stable weight for at least six to 12 months. And that generally meant you were outside of your surgery by 18 months because it took you six to 12 months to lose the weight and then another six months to stabilize. So most insurance companies would not cover a panniculectomy, for example, unless you were 18 months out post bariatric surgery.

(19:39):
They don't have stringent requirements now, except for maybe six months at a stable weight. They like to see that for doing something like a panniculectomy. And that's an insurance based procedure where we're just removing the lower apron of skin from your lower abdomen. And that's a part of the tummy tuck that could potentially get covered. Again, insurance companies have very strict guidelines. The overhanging skin has to hang below your pubic bone. You have to demonstrate that there's a rash underneath your skin in that kind of folded area, and it has to either demonstrate that you have a rash or that you've been managing the rash with conservative measures. Maybe you saw a derm, maybe you've used creams, maybe you've treated it for an infection, something specific regarding that has to have a failure of conservative management for at least three months. And they're kind of sticklers about that and then the stable weight.

Bri (20:41):
Interesting. Is there ever a way that they'll cover a tummy tuck?

Dr. G (20:47):
Not generally. Sometimes the surgeon will do it at the kindness of their heart, but no, because that upper abdomen is not generally causing a functional problem. So from an insurance standpoint, it needs to be functional and that lower panus is generally what's considered a functional problem. So sometimes the surgeons who take insurance will do the panniculectomy in combination with the liposuction, abdominoplasty, and you just pay out of pocket for the rest of it. Unfortunately, sometimes insurance sees liposuction as part of the procedure and then immediately just kicks it back. So it just varies from insurance company to insurance company.

Bri (21:30):
I wish I worked at an insurance company. I would just approve everyone. You're approved, you're approved, you're approved. Lipo for you, tummy tuck for you.

Dr. G (21:38):
Oh my God. If the word gets out, then it just gets flooded and it's crazy.

Bri (21:42):
Yeah. Everyone gets what they want. That's what insurance is for. Pay an arm and a leg for it. Might as well.

Dr. G (21:49):
Yeah. Might as well get your money's worth. That's not their business model, unfortunately.

Bri (21:54):
Damn it. Guess I won't get hired.

Dr. G (21:56):
Their business model is to fight everything to the death.

Bri (22:01):
I have some choice words, but I won't say that on here.

Dr. G (22:05):
What is a fleur de lis tummy tuck? How's the scar different? I don't generally do these, again, because it's reserved for massive, massive weight loss patients. Usually people are losing 200 pounds or so, but it's when you both have that low horizontal incision across the hip bones, from hip bone to hip bone and a long vertical incision. So from where your xiphoid process below your rib cage, all the way down to that lower incision. It's called a fleur de lis.

(22:37):
If you have that excess in both the vertical and horizontal dimension, we don't see it as often anymore. I feel like a lot of it can be taken out from the horizontal and then sculpted with liposuction. I've seen a variation of that where they just do horizontal and then what's considered an H, so an incision on either side instead of straight down the middle. I think fleur de lis was more popular when the means of weight loss was gastric bypass surgery and it was an open bypass. So now most gastric bypass surgery, if it's being done, is being done laparoscopically. So you have little tiny incisions. Before it was an upper midline incision, so doing the fleur de lis didn't really add too much. You're just extending that incision and meeting the lower one. But now that people don't have that, now you're saying, "Oh, okay. Well, we'll take all this extra fat out, but we're also going to leave you with a vertical incision down your midline."

Bri (23:42):
I mean, I'd rather have that than all the extra fat.

Dr. G (23:44):
Sure.

Bri (23:45):
I've seen that incision one time and it was pretty gnarly.

Dr. G (23:48):
It's a lot, but I think those are larger patients and we don't see that in our practice. I think it's a little bit regional too. We just don't see patients that large here who have lost that much weight or they're getting some of it done through insurance, honestly.

Bri (24:07):
I would assume that is a harder recovery than a standard tummy tuck.

Dr. G (24:11):
Again, a lot of incision to heal. And so that T breakdown is often pretty complicated. So where the vertical hits the horizontal, that little area is prone to problems. Usually means you're going to lose your belly button, not always, but a lot of times we'll take your belly button out and then just make you a new one along that vertical incision.

Bri (24:34):
Do you do that at the same time that you do the procedure or do you do it after?

Dr. G (24:37):
Yeah, you can.

Bri (24:38):
Interesting. Do you still do a diastasis repair for that one?

Dr. G (24:42):
It depends on the patient. I mean, a woman is going to need a diastasis repair almost always, unless they're older and they never had kids, I guess. Speaking of things that can impact your ability to have a tummy tuck, this has come up recently and it comes up every few years or so. Older women who are presenting, maybe have lost some weight and then have that abdominal bulge and are candidates for tummy tucks, but also have fibroids. So those are benign tumors on your uterus, but they can get really large and make your uterus a lot bigger. And so it gives the impression that they're pregnant because the tumors are so big. Those should be removed before having a tummy tuck, because otherwise we're taking all that skin and we're trying to tighten up your rectus muscles and then you still have this mass inside your abdomen that's pushing out.

(25:37):
So when I do an exam, I have the patient lay flat and I'm feeling for their diastasis, but I recently had someone who had. You could feel the fibroids. They're right there. They're pretty large. And she already knew that she had some and I was like, "Yeah, it's silly to do the tummy tuck first, get that handled. Get that removed, and then we can make you tighten right, But not with those in the..."

Bri (25:58):
Did she know she had them.

Dr. G (26:01):
She had just found it out before and she was seeing GYN for it.

Bri (26:05):
You can fit like three fingers in my diastasis. You could probably put your fist in it.

Dr. G (26:11):
That sounds gnarly. Yeah. I have a pretty bad diastasis too. You just have to tighten up your core, but I think if you're going to have the tummy tuck, you should fix that.

Bri (26:20):
Get your EmSculpt on.

Dr. G (26:23):
Speaking of, so that is one thing it doesn't fix, right? We always worry about visceral fat, so that's fat that's inside your abdomen. Generally men, when they put on weight in their belly, it goes into their visceral fat. So they'll have that hard belly look because they don't have much sub-Q, but it's just all intraabdominal fat. Women sometimes are more apples than pears and they tend to put their weight on intra-abdominally. If that's the case, then me taking the little bit of skin and fat that's outside isn't going to change that contour. You're going to have that kind of apple look afterwards. So making sure that if you're at your goal weight, but you still hold onto fat intra-abdominally, we're not fixing that. So that's one consideration. And then it does take out any stretch marks that are below the belly button, which is nice, but anything that's above the belly button, which isn't that common, is going to get pulled down below the belly button, but you're still going to have them.

Bri (27:26):
Yeah. I feel like the most common question I get is what happens to my belly button since we're speaking of belly buttons.

Dr. G (27:33):
Yeah. So your belly button is -

Bri (27:36):
Just turn you into Kyle XY. No belly button.

Dr. G (27:41):
We can do that, but most people want to hold onto their belly button. So we usually leave it where it is. So I'm going to make an incision around it and then I'm going to take all that tissue above it and pull it down. And then where your belly button's still sitting on your abdominal wall, I'm going to mark that and make a little upside down U. And then we bring your belly button out through that incision and the upside down U actually tucks into the lower part of your belly button so that it tucks in. But your belly button's still kind of swollen and looks a little wild for a while until the swelling goes down and then it settles out. And ideally the little upside down U flap tucks into the lower part looking like a more natural belly button. At least that's how I close it.

(28:25):
You can do like just a incision and close all the way around, feel like that tends to look more fake. And then it depends on honestly how deep your diastasis is. When we put your diastasis repair back together, it brings your belly button in a little bit. And then if you think about it, your belly button stock grows with you. So if you had a lot of weight gain and then your belly button stock will be long and then we sometimes need to shorten it. I don't know. The belly buttons are funny.

Bri (28:55):
Interesting. I never thought about that.

Dr. G (28:57):
Think about it. It grows with you so that it's still at the surface. So if you're this wide versus skinny, your belly button, the umbilical stock is long.

Bri (29:09):
Yeah.

Dr. G (29:09):
Yeah.

Bri (29:10):
Interesting.

Dr. G (29:11):
And then if you have a pretty big hernia there, that can impact how your belly button heals. That's what we worry about because I am disconnecting it from the surrounding tissue. So all the blood supply is coming through the stock and it's relying on that to live. And so I'm less aggressive about fixing little teeny tiny umbilical hernias there now because to do that, I have to disrupt the stock and now I'm really messing with the blood supply and it doesn't like it. It's just not worth it. If you have a cute little hernia, just leave it.

Bri (29:41):
Yeah.

Dr. G (29:43):
Don't mess with it. And then I've seen more and more patients with tattoos. Most of them have lower abdominal tattoos, which they're just going to get thrown away, but I did recently see somebody who had -

Bri (29:58):
Most people are okay with that.

Dr. G (29:59):
Her whole abdomen. Is a giant tattoo. Anytime I try to do something to fix, preserve the tattoo, a lot of times it doesn't work out. So I just told her, "Listen, we're going to do the tummy tuck and get the skin and ignore the tattoo and then-"

Bri (30:19):
It's better to just come to terms with your tattoo from your belly button below is going to go at least.

Dr. G (30:25):
Yeah. Sometimes people have those lateral hip tattoos and I've tried to scooch around it. I always end up having to revise it.

Bri (30:33):
Yeah. Just let them go.

Dr. G (30:35):
You're never planning those around a tummy tuck incision. Just sucks.

Bri (30:41):
Yeah. Find a way after to fix that tattoo.

Dr. G (30:44):
And then another common question while we're on belly buttons is if you have a belly button piercing, that's going to get tossed when we do the tummy tuck. But if you just want to address that little loose skin or the belly button piercing, there is no good surgery for that, unfortunately. No one's figured that. There's just such a weird area that you can't just. You would think you could make a little crescent excision and take it out and it just never looks right.

Bri (31:12):
Never looks right.

Dr. G (31:13):
Just leave it. Everybody has that belly button piercing at this point.

Bri (31:17):
I'm about to get my belly button pierced. If Kylie Jenner can, I might too.

Dr. G (31:21):
Don't do it. Let's see. If you have other abdominal surgery or scars, I can usually work around it. So it's not a contraindication if you had an open coli or. I would say a liver transplant might be more than I can bite off, but most surgeries, if you've already had some abdominal surgery, it's not a no to having an actual tummy tuck. It won't keep us from doing it.

Bri (31:50):
Is there anyone that's not a good candidate for having a tummy tuck?

Dr. G (31:54):
I think if most of your weight is intra-abdominal, if you are not at your goal weight, if you're immediately planning to have kids, get pregnant and have kids, those would all be reasons. And I know we talk about recovery all the time. If you don't have a game plan for recovery, because this is not a surgery where you can just gut it out the next day. You really need some help and you need to give yourself enough time to heal from it.

Bri (32:21):
Yeah. Now if you have a whole bunch of skin like I do, just mainly on the top, you reverse tubby tuck it?

Dr. G (32:28):
Yeah, you can reverse tummy tuck it. It's a good option if everything's above the belly button. So we just did that recently for somebody who was doing a breast dog at the same time. And so the incision is just underneath your breasts. Sometimes can come up to a point just in the midline. I try to avoid doing that, but that's the option. And it's a much faster recovery. We're not messing with your diastasis, but if you don't have one or you don't care, then it's a good way to get rid of that little extra skin up there. It's nice. It's a nice option.

Bri (32:57):
We like that. Obviously, but can you do tummy tucks with other surgeries? Or what surgeries would you recommend not doing a tummy tuck with?

Dr. G (33:06):
So tummy tuck is the most common surgery we do with tummy tuck is some sort of breast surgery, right? That's our standard mommy makeover. So breast anything, implant exchange, augmentation, breast reduction, breast lift, breast fat transfer. Those are all options. You can do a BBL at the same time. It's a little awkward for recovery, but you can do it because we're already taking all that fat off your abdomen and your flanks because I almost always do 360 lipo with a tummy tuck and you can put that in your booty. You can do a tummy tuck with a thigh lift. I think that's a good combination and that's about it. Oh, you can do a tummy tuck with a labioplasty.

Bri (33:51):
Nice, nice.

Dr. G (33:53):
Although I was just in a consultation where the husband was asking for it and I was like, no. Well, what else can you do at the same time? I was like, what?

Bri (34:02):
Automatic divorce. You're done.

Dr. G (34:05):
You can step out of the room now, sir. No one asked you.

Bri (34:08):
Automatic divorce.

Dr. G (34:11):
It's just wild. Nobody asked for your two cents. If she's interested in a tummy tuck, let her get the tummy tuck.

Bri (34:16):
Yeah. Not like, oh yeah, can you also work on her labia too? I have some choice words, but.

Dr. G (34:27):
Yes, but you can do it at the same time. I mean, maybe he is just asking because she's too shy to ask and they had an agreement before that, but I doubt it. So any hoodles. Yeah. So there's a lot you can do with a tummy tuck. I think some of those are better combinations than others, but a lot of times when you do our most popular, which is tummy and breast, the breast surgery is easy breezy because the tummy tuck is going to be the distractor for all of that.

Bri (34:53):
I think we need to do a whole podcast and husband etiquette.

Dr. G (34:57):
We could. Maybe don't bring them to the consult. No, sometimes they're very helpful and supportive.

Bri (35:03):
Some husbands are so great and some husbands I'm like,

Dr. G (35:07):
"No, be so removed." So for recovery, which I know we love to talk about, we do do a tap block for our patients, which is a nerve block that I do with ultrasound once the patient's asleep. So almost all my patients get liposuction. There's a few that are so skinny they don't need it, but almost everybody will benefit from some lower back flank, upper abdomen liposuction. And then we'll start with the back lipo and then when the patient's laying on their back, then we'll do the tap lock. And so we use the ultrasound that's not a one time use device. Recently had to replace it because it got thrown away.

Bri (35:49):
Got thrown away. It wasn't me.

Dr. G (35:51):
It was not you. Anyway, and then we inject local anesthetic and that is very helpful. It's awesome because it's done before we make any incisions. So it decreases the amount of narcotic you need intraoperatively and it provides pain relief afterwards in the immediate post-op period so that you can use less narcotics during your recovery and feel a little bit less groggy.

Bri (36:12):
Yeah. I feel like patients do so much better. I think I've only had one since we started doing it God knows how long ago that actually needed a wheelchair, but everyone else is just moving and grooving and they do so well with the tap block.

Dr. G (36:26):
Yeah. They come up here, maybe they need a walker. They're not running up here generally speaking. But before we used to have to go down and meet them with a wheelchair for the post-op day one situation.

Bri (36:37):
We also do put in a Foley. If a patient requests to have it taken out that day, they can. Otherwise we leave it in overnight and it helps you so you're not getting in and out of bed, go and pee all night.

Dr. G (36:47):
To go to pee, yeah.

Bri (36:47):
And then we take it out at your post-op day one appointment and that's pretty helpful too.

Dr. G (36:52):
Yep. And you're in a compression garment, that helps. And I think Journavx has also been helpful. That's a medication you take prior to surgery and then you take it twice a day afterwards and it's a sodium channel blocker non-narcotic pain reliever and that really helps take the edge off. So all of those things make it a little bit more tolerable, but just know that you need to plan on six weeks before your full court press again with your regular activities. But we do want you moving around immediately, which is why I have you come back in post-op day one. You can start raising your heart rate and blood pressure at about two weeks so you can start moving and grooving a little bit at two weeks, but four to six weeks before you're doing any heavy lifting or any intense core stuff.

Bri (37:42):
Yeah.

Dr. G (37:43):
All right. Should we do rapid fire?

Bri (37:45):
Yes. Okay. Rapid fire. Duh, duh, duh. Myth or reality? Insurance will cover your tummy tuck if you've lost a lot of weight.

Dr. G (37:54):
That is a myth.

Bri (37:56):
Lipo and tummy tuck do the same thing.

Dr. G (37:58):
Also a myth, but often done in combination.

Bri (38:01):
You can get a tummy tuck while still losing weight on a GLP-1.

Dr. G (38:05):
You could, but it would be dumb.

Bri (38:06):
Yeah, be at your goal weight. I know how you say this. Fleur de lis scar is always worse than a standard one.

Dr. G (38:14):
I mean, it's just more scar.

Bri (38:16):
Yeah, it's bigger.

Dr. G (38:17):
It's not worse. Yeah.

Bri (38:18):
A tummy tuck removes belly fat, not just skin.

Dr. G (38:22):
No. I don't know what you mean by belly fat, but it removes any subcutaneous fat, but anything intra-abdominal stays. If you have any questions, feel free to reach out, give us a call, comment.

Bri (38:37):
Eat your protein.

Dr. G (38:38):
Take your protein, prep for surgery.

Bri (38:41):
Or drink it.

Dr. G (38:41):
Yes. Or drink it. We like to drink it. And if you're listening today have questions, need info about scheduling, financing, want to look at reviews or photos, check us out. You can check the show notes for the links.

Bri (38:54):
Yay.

Dr. G (38:55):
We'll scrub in.

Bri (38:56):
Scrubbing out.

Dr. G (38:58):
Bye.

Bri (38:58):
Bye.

Dr. G (39:01):
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 podcasts.