Kate Comrie

Hello and good evening, everyone. Welcome to our webinar on tummy tuck surgery. My name is Kate, and I am the Clinical Nurse Specialist for Plastics and Cosmetic Surgery. I'm joined by a Consultant Plastic Surgeon, Mr Christopher Macdonald. This presentation will be followed by a question-and-answer session. If you do have a question you'd like to ask during or after the presentation, please use our Q&A icon, which is on the bottom of your screen. This can be done with or without giving your name, but please note that the session is being recorded, so if you do not want your name on there, please do not provide it. If you would like to book a consultation, we'll provide you with the contact details at the end of the session.

My name is Kate, I'm the Clinical Nurse Specialist, and I have a background in a diploma in higher education for adult nursing. I studied in Guildford at the University of Surrey. I also did my nursing mentorship, and I have practiced in aesthetics, anti-wrinkle, and filler treatments, including some masterclasses. My background is in the NHS. I worked in the surgical assessment unit at both Royal Surrey and Frimley Park Hospitals. I also worked in A&E and did some wards, and then I moved over to the private sector and started cosmetics about eight years ago. So that's been my life for the last eight years, and I support our plastic surgeons here.

I'll hand it over to you, Mr Macdonald.

Mr Christopher Macdonald

Thank you, Kate. Thank you for joining us, everybody. It's particularly hard, and a nice sunny evening like this. My name is Chris Macdonald. I'm one of the plastic surgeons based here in Brighton, so I work across the South East, in Kent and Sussex. I also work for the NHS, where I'm based in Brighton, and Queen Mary Hospital in East London, where I mostly do reconstructive work. I'm a full member of the British Association of Plastic, Reconstructive, and Aesthetic Surgeons. I'm a peer-nominated representative for the South East on their council, and I'm also a member of the British Association of Athletic Plastic Surgeons as well. During my training, I was very lucky, and actually, I worked all across the country: southeast London, Hertfordshire, the North, and the Far East, and I spent some time working as a Consultant in the West Midlands as well. I have done fellowships in skin cancer surgery and aesthetic surgery. I did some advanced training in North America as well, and I'm a fellow of the Royal College of Surgeons as well. That's sort of what qualifies me to talk to you about this this evening.

So we're talking about abdominoplasty and tummy tucks, so I presume most of you all know what that is, and that's why you've joined us today, but essentially, it's any operation to try and improve the anterior part of your abdomen, and it can be designed to try and deal with loose skin; it could be designed to deal with excess skin; it could be do with abdominal wall weakness which can be a result of either weight gain or pregnancy or previous surgery, it can be to deal with scars from previous surgery and there's because there's lots of different parts to what creates the problem that means people need a tummy tuck it also means there isn't a single solution to it so we'll talk about that in a little bit more detail later on but actually there's lots of different operations that can be suitable for you depending on what it is you're trying to correct and as well as they being lots of different types of tummy tuck it can be paired with other what we call adjuncts as well so you can combine with liposuction to the flanks or the back or the buttocks you can combine it with repairing a large muscle gap down the front of your tummy which give you much better core strength and you can combine it with things like breast surgery all in the same setting or in people who've lost lots of weight it can be quite easily paired with brachioplasty so that's removing skin from your arms as well so we'll come back to that later on one of the things that's sort of really important to understand is what makes someone a good candidate for tummy tuck operation and it really you need to understand the difference between fat that's underneath the skin which is what we call subcutaneous or external fat or fat that's deep around your organs which is called visceral fat. So, visceral fat is a really important part of your body; it has lots of important hormonal roles, but actually, when people gain fat, sometimes you can gain lots of fat around your organs, and the difficulty with that is that there isn't any way that you can reach that fat either with a tummy tuck operation or with light production, so the only way that you can deal with that is through weight loss through either exercise, diet control, or bariatric surgery, but there isn't any way that a plastic surgeon can help with that, so we're limited to only dealing with the subcutaneous fat.

I'll come to some photos later on hopefully explain why that's important the other thing that makes you possibly a good candidate or not a good candidate can be which I've already talked about is abdominal wall weakness so it's very normal that in between your six-pack muscles your rectus abdominus muscles you've got a thick layer of fascia which is a dense collagen that holds everything together but dur during the hormonal changes people go through during pregnancy the same thing that allows your pelvis to open up to allow you to give birth normally also weakens that same line down there and if you combine that weakness with all of the pressure of having a growing foetus inside you it actually stretches things beyond control it's a really common problem and there are some people who managed to deal with it through core strengthening exercises and Pilates and things like that but actually the vast majority of people can never get it under control and that's sort of way it might not be a problem for you and you might be lucky but there are lots of people where the loss of contact between those muscles allows everything to fall laterally and you end up with significant muscle weakness and a significant bulge down the front in its in its mildest form it's a cosmetic problem and it can cause a little a little bulge below your belly button but as it gets bigger and bigger it could be more of a problem and actually can interfere with your core muscles working and some people can find it difficult to sit up from lying down some you can find it causes problems with back pain and the best way of dealing with that is to put it all back together surgically so testing whether you're suitable for abdominoplasty one of the easiest things is actually to lie flat on your back and if you lie flat on your back and you find that the main problem is that everything falls down the sides of you then actually it may be that you're a good candidate for a tummy tuck and that's quite an easy thing to deal with if you find you lie on your back and you still have a big round belly then actually the problem is most likely due to all the fat around your organs and so having a tummy tuck is unlikely to be the solution for you or it's unlikely to give you what you're really after and actually what you probably should do is work on weight loss first of all and then and then once you've got further down your journey come into your plastic surgeon to discuss what could be done about the skin and fact that's on the outside that's just testing suitability.

Then, as I said before, there's lots of different options for what I know as abdominoplasty, so what we've got here is something called a mini abdominoplasty, and this is just a representation of the skin that would be removed. So, in a mini abdominoplasty, it just takes away a small ellipse of skin across the lower parts of your abdomen, usually an area that could be covered by underwear or bikini bottoms. It's a very limited operation; it's usually good for dealing with things like problem caesarean scars or, if you like, in this photo, if you’ve just got a small amount of excess skin or stretch marks that's all restricted to the area below the belly button, then actually a mini tummy tuck could be a good option for you, but it literally only deals with that small area, and actually it won't deal with any problems above the belly button; it won't control your flanks or anything like that, and through that small incision, it's often impossible for you to do a muscle repair.

So muscle repair traditionally has to be done with a full abdominoplasty which is what this is demonstrating so you can see the scar is the amount of skin that's removed is much larger it normally starts from the top of the pubic hair all the way up to above the belly button and it comes all the way across to in front of your hips and that is a much more powerful operation for removing skin and fat and like I said allows you to tighten up those muscles as well and it can be really easily combined with liposuction to take away the sort of love handle fullness or around the planks and allow everything including the waist to be cinched in really nicely if you've got even more skin then actually this is what we call a fleur de lys and you can see the hashed area that's coloured in red has the characteristic fleur type shape which is where it gets its name from and it allows you to pull the skin downwards but also allows you to deal with any excess skin at the top as well so this is traditionally for people who've undergone a significant amount of weight loss and it's not normally just pregnancy related changes often people have had bariatric surgery where actually you can grab skin not only in in what we call the vertical Direction where you can pull it up and down but actually in the horizontal so you can grab skin and pull it away from your belly in the area between your belly button and your rib cage so most those patients are best suited by a fleur de lys and we'll come back to the drawbacks that in a second or finally this is called a circumferential abdominoplasty or a belt lipectomy or a 360 tummy tuck there's lots of different names for it and essentially it's removing skin and fat all the way around the body so what I trying to demonstrate there is there's a whole wedge taken all the way across the front but actually that carries on all the way around the back as well and that's for people who've undergone even more weight loss it's a really good operation it really significantly improves people's quality of life but it's a bigger undertaking any of the other operations and you can see here representation of where those scars would sit so your mini abdominoplasty just sits really low down it be very easy to hide your standard abdominoplasty gives you a longer scar but again it's usually designed to sit very low. Low enough that could be hidden by bikinis or by underwear the addition to this is you have a small scar around your belly button so usually the scar around the belly button is very easy to hide and actually after about six months it tends to disappear to being very inconspicuous anyway and we'll have photos about that later on so this is the scar that's left by a fleur so this is this is what puts people off unfortunately because it's a very good operation but it does leave you with a scar that runs all the way up and down and it's no longer something you can easily hide by a two-piece swimsuit but it does allow you to really tighten everything up completely and give you a much better silhouette and then the one that you have from a 360 goes all the way around like you'd expect so this is a representation of what's standard abdominoplasty so you can see in the first picture the skin markings of what I've been talking about so the dotted line down the middle is just where put a mark so we know exactly where the middle will be and then we normally make an incision across the bottom dotted line and you can see in the second one that's what's happened so that the surgeon has split all the way across the bottom is now lifting the skin and the fat off the fascia that's the layer that goes across the muscles of your anterior abdomen. Then everything gets lifted up here; they've split it into two, which sometimes people do to make the operation easier and allow you to see exactly what's going on, and that's all been lifted up, and then underneath the skin, actually, that skin gets lifted all the way off up to the top of the rib cage.

So as you can see in picture four, you get a really good view of the whole of the anterior abdomen, and then you can see where the gap is in between the muscles, and it's very easy to repair that very well and very strongly, and then once you've got everything free, you can pull it down and then find out exactly how much loose skin you're dealing with and mark it with your definitive skin marking, and then remove all of that loose skin and loose fat, and then stitch everything back together.

The only thing I've sort of glanced over is that if you go back to number one you can see the dotted line that goes around the belly button so the belly button is freed up from the skin and is left coming up out of your out of your body and then when the skin is pulled down over the top a little hole is made and then your natural belly button is delivered back through it so after tummy tuck you don't have a new belly button you've got your old belly button but slightly reshaped and improved and then you can see the lateral views so the side views in these pictures here are showing you not necessarily the removal of the skin and the fat but actually this powerful change is normally due to the tightening of the abdominal wall to try and get that dome that bold to go back inside and now we're going to go through a few representation photos.

So we've got patient number one who you can tell by the background was treated here at Benenden so this is a woman who was really bothered by just the skin the excess skin that she had on the front of her tummy and you can see how sort of loose it is it's hanging over her bottoms there the shape of her belly button is what people call so it's got that sort of overhanging skin it's very horizontal and you can see the excess skin is not only below the belly button but it's above the belly button so like I've already said she wouldn't be satisfied if we gave her a mini tummy tongue so she needed a full tummy tongue and so that's what she had and then here are her results afterwards and this was combined with liposuction so she had some liposuction too even though she's already very slim I'm going to keep flicking backwards and forwards I'm sorry about that so she's already very slim but the small amount of fat around her love handles and sides of rib cage were taken out but actually the main use of the liposuction was in contouring the skin and fat that she's got on the front so as well as just sort of tightening the put skin by pulling it down actually can take away some of the fat that's underneath it and try and accentuate her normal musculature and that's what's been done here so you can see she doesn't have any loose skin she's not got one of those wrinkles the skin changes that you can see is she's still in the early phases of recovery where she's still wearing a binder so it's compression garment goes on really tight and that's what's leaving her with a little skin dimpling there that she's removed for the photo her belly button has gone from a sort of horizontal sad looking one to a vertical athletic one and like I was saying a few minutes ago actually the belly button scar is very easy to hide if it's done it's done well so she's got this hip to hip scar running all the way across which you can only see because she's pulled her under away down for the for the sake of photographs but actually if she pulled that back up that would instantly be covered and nobody would know so I think she's got an excellent result.

So patient two is a similar build and a similar problem but actually she's had surgery unfortunately it's covered up by the skin markings she's had surgery and that has left her with a scar running up and down the middle of her lower abdomen from her belly button downwards and you can kind of see that in those photos because you can see the skin is sort of puckering into it and if she leans forwards ever so slightly actually she gets up with a deep crevice in between the two sides and she ends up with what looks like a bottom on the front of her belly so that was her main complaint she really wanted that scar to be revised and wanted something that would give her a flat lower abdomen so this is we're starting with a couple of spray slim patients and that was her problem it was the scar and the contour problems rather than her having too much fat or skin but you can see even though her problem isn't excess skin we're actually removing a really large amount of skin from her abdomen all of that stuff from below where her pubic hair is all the way up above her belly button and so if we take that to how she looks a little bit later and that's her now so she's had the scar taken away all of that excess skin taken away she's got a nice belly button here it's still fairly early stages so the skin the scar around the belly button is a little bit dark that'll disappear and you can see with her pants sitting in a normal place there's no way of you being able to see the scar that runs all the way from hip to hip and again she had a small amount of liposuctions try and accentuate her natural athletic form and accentuate the musculature and narrowing in her waist as well so  yeah a good a good result for that lady too.

So this is patient three so she has it's true functional problems from having a gap in her muscles actually so she gets a lot of back pain lower back pain she's had problems with urinary incontinence she's had difficulty sitting up or carrying her baby and a lot of the skin changes you can see are not from weight gain and weight loss but they result of a couple of pregnancies you can see that she's got a low caesarean scar I actually I don't know if that's going to project well onto your screen but just above just above where you can see her the skin at the bottom she's got a scar running all the way across and that's a slightly tethered caesarean scar and then she's also bothered about her breasts which is why I've included her in this so as well as us treating her abdomen we also did some breast surgery and it's just to demonstrate how easy it is to combine those two things so she was bothered by her breasts being quite low and quite flat and empty because of pregnancy and child birth her nipples had got significantly larger and she just felt that even when she had on a bikini or bra all of the breast fullness was very low she doesn't have any cleavage which is which is a really common problem so we're dealing with all of those things all together at the same time so she was having this skin taking away some liposuction as well and then those markings around her breast were to demonstrate where you're moving your nipple from it up to the disc that's marked out and she had some small implants put in at the same time to give her some extra volume because the difficulty with lifting a breast I know this is a tummy tuck talk but difficulty with lifting breasts is it's really difficult to get volume high up without these fin implants that's what she wanted actually this is demonstrating her c-section scar overhang a little bit better so in that lateral view the two views can see that her skin is overhanging at the very bottom and then this is her afterwards so she is this is quite early in her recovery phase so her scars are still a little bit pink and a little bit red her implants are still sitting a little bit high which is exactly what you expect and over about three to six months they droop down a little more naturally but it's just combining that with taking care of all of her extra skin and all the wrinkles that she disliked as well as dealing with the doming of her abdomen as well so that's all been tightened up really nicely so she's very happy and then.

So we're moving on to some slightly heavier patients so this is a patient who has struggled with her weight she's has gone up and down over the years she's had bariatric surgery as well and has lost a lot of weight and now she's left with an ex excess amount of skin and fat and you can see that her belly button is sitting very low and belly button is actually in front of her hips now and if you asked her to lift her abdomen actually her mons that is extremely bulky and problematic for her and again she was bothered by the size and shape of her breasts and she's had a very mild degree of what we call tubous breast deformity as well so the breasts are sort of falling very laterally so we combine this with the breast lift and implants at the same time as well as dealing with her abdomen and so she had very similar things to her to her chest and then we lifted you can see just the picture of her looking straight ahead you can see that how low we went down onto her vs to try and lift everything up and she had some liposuction as well to clear out her flanks and the area above her buttocks all in the same go and so this is her super early in her recovery so she's still got the tape on covering her scars up but you can see that those breasts that were sort of low have been lifted much higher she's got extra volume in there and her mons has been lifted up significantly so she doesn't have all the problems that she was having with self-hygiene and things like that. Because it's so early, she's still got a little bit of swelling in that area, and actually, over the following six months, that'll come out and should be left very nice and flat, but it's just demonstrating again that even people who are starting from a very different place, like the patients I've already been talking about, can actually get a good result at the end of it, and again, if you look at her belly button, there's no way that once we're a little bit further down the line and she's got the tape off, you'd never know that she's had surgery at all.

Then patient five so this is another patient who's had bariatric surgery and she's got you probably can just about make out the little keyhole scars around her tummy and that's all from her laparoscopic bariatric surgery to for a gastric band and she lost a lot of weight so she has I believe she had BMI of 33 so there's lots of surgeons who still have a very strict cut off for BMI and that's why every includes I think it's a useful thing to talk about so there are lots of surgeons who won't operate on a patient with a BMI of over 30 and the reason for that is once you get over 30 you know that your risk of complications from wound healing and small amounts of infection and things like that can go up and so it so patients have to be aware that actually they're more likely to end up with problems with wound healing the heavier they are and actually they're slightly less likely to get a good cosmetic result but there are some patients that with all the will in the world will never get a BMI below 33 and so you have to have a very sensible conversation about what's in their best interests and so she's got a lot of skin and fat on the outside but she's still had some visceral fat on the inside as well and so what we wanted to do was take that away and make her life better she's a very keen horse rider and actually found all this bulk on the front was really interfering with her competing and so we wanted to take all that away so that she gets on and then ride properly and so that's what we did so we took away all that extra skin and fat on the front, shed some liposuction to bring in her flanks, a little bit of contouring liposuction as well to try and improve the front again her belly button is tucked in really nicely so nobody would ever know about it but like I said because her BMI I was higher to start with you were never going to get her down to being you know a tiny little waist but she's got fantastic result she's got everything she wanted out to it because she's returned to riding and is very happy.

Then the last one is a similar sort of point to this one so this is a patient who's undergone natural weight loss without any surgery so far she didn't think she'd ever get her weight any lower and her BMI was ever so slightly higher and you can see you can understand why this patient would want her surgery because she's got that overhang and actually it's quite common when you get overhang that you can get skin irritation you get infections you can have problems with personal hygiene in that area as well so it's not it's not purely a sort of cosmetic type operation these things it can really make a massive difference to people's quality of life as well by taking that away and so we all mutually agreed that should have her surgery understanding that we' never get her to be tiny but that's what we did and so she had surgery to take all away that access skin because her BMI was higher she was a little bit slower to heal and actually this photo is probably nearly a month down the line and you can see she's got a tiny little scab there still which is one of the things you expect when your BMI is ever so slightly higher but actually that overhang has gone she's been nicely contoured she's got a waist now which she didn't have before and again that tell me that belly button is tucked in really nicely those scars will be low and be hidden and they are at this stage you know that over the coming months they'll disappear and fade away into a really faint pale line as well so she's incredibly happy got an excellent result and I think it's just important that everybody has a realistic goal and understand what can be given that's it I think that's all of my patients actually.

Kate Comrie

Yeah, there we go. Thank you very much for the really interesting photos there. It's nice to hear that it changes people's lives and improves their quality.

Perfect, so we'll now take some questions. So, would scarring be worse for older skin?

Mr Christopher Macdonald

No, so you've added that you're 58 so I don't think 58 is old at all no and actually we tend to find that people who are older actually tend to scar better so in much younger patients they tend to have a much stronger immune reactions the whole process and they can become redder and angrier and they can even become what we call hypertrophic where they become quite thick and occasion that can need treating with massaging and moisturizing or silicon tape and things like that but actually in patients over the age of 50 I have never seen that problem, it's incredibly rare and so actually I think the opposite so in someone who's 58 I think you're more likely to end up with a really nice scar than in someone who is younger.

Kate Comrie

Perfect, thank you. Can a tummy tuck be done during the same surgery as an arm lift?

Mr Christopher Macdonald

Yes, yeah. So, I said so; I did say that earlier on, and actually there's a few different things it can be combined with, so like I said, it's really commonly combined with breast surgery but actually can easily be combined with arm surgery. The recovery is a little bit more involved because you have to have someone who can help you out with a few extra bits, but actually it really makes sense, and if you're someone who's interested in trying to reduce the amount of what we call downtime recovery time and you are bothered by your arm and you're bothered by your arms, then actually combining those operations so you just have one period of recovery is probably the smartest thing to do. You only end up with a single general anaesthetic; rather, you make two general anaesthetics. There's usually some sort of financial benefit because you're only paying for a single time in the hospital, and actually, there's normally a small reduction in the fee when you combine these sorts of things, so combining surgeries, particularly tummy tucks and arms, is a really good combo. One lot of downtime at work, and that's it.

Kate Comrie

We focused very much on women; are there any significant differences for men?

Mr Christopher Macdonald

No actually so that's a really good question I apologize so generally not so they are for men and sort of what I have to consider when I'm doing the operation but in terms of everything else it's very much the same so we tend to not really see quite as much of a muscle separation when operating in men as we have on women but you definitely can so in some so in a man who's carried on a lot of weight then you can still see the same problem where the weight itself has separated those muscles even without hormonal changes and things like that that's the same this the options for minis or a standard or a fleur de lys or a belt they're all exactly the same and in fact I've done all of those on men as well. Men also benefit from liposuction as well. The only difference, like what I was trying to say, is that for me, it needs to be tailored for, you know, an aesthetically pleasing male shape rather than a female shape, so actually, whereas some of the liposuction contouring that I do is designed around trying to accentuate a waist or accentuate a buttocks or something like that, you don't want that in a male, so the liposuction sculpture is tailored slightly differently, but the actual surgery is the same, the recovery, and all the other options are identical; it's just that the technicalities of the surgery are slightly different.

Kate Comrie

How long does surgery take for a normal tummy tuck? Someone who's worried about being under general anaesthesia.

Mr Christopher Macdonald

So, it really depends on how much skin and fat are being taken away, depending on whether you're combining them with anything else. So, a normal tummy tuck will probably mean you're asleep for about 2 hours, which is very straightforward. I mean, most of my patients stay in hospitals over night, but patients can actually go home the same day. If it's the general anaesthetic that you're concerned about, then actually, general anaesthetics these days are incredibly safe, and the likelihood of you having a problem with your anaesthetic is far less than you having a problem in the car driving to the hospital in the first place. Which is why I often say to patients that if you've made it safely to the consultation, then that was a much more dangerous thing for you to have done in the first place than having a general anaesthetic.

Kate Comrie

What happens with an existing mesh hernia repair that is 10 years old?

Mr Christopher Macdonald

So that's a really good question, actually, so it depends on where the mesh is. There's lots of different kinds of hernia that could have been repaired with the mesh, so it depends on whether it's one around your belly button or around the area above your belly button called an umbilical, whether it's repairing a hernia result of surgery from four, or whether it's repairing the hernias in the groin. You have inguinal hernia, so there's lots of different options. If it's one of the groyne ones, then it's completely nowhere near where we go, and it has no impact at all. If it's any of the other options, I'd need to know a little bit more about what kind of mesh it is or where it is. Most of the time, when these meshes are put in, they're put underneath the muscle, which isn't somewhere that we go near, so it wouldn't make a difference at all. If it was one that was put on top of the muscle, then it might involve a little bit more thought about how to deal with it, but it's not. It's not a problem.

Kate Comrie

I'm 65 and have what I would call a menopause belly. My belly does stay around when I lie down. Does this mean visceral fat? My BMI is currently 28. I am interested in tummy tucks and liposuction around the flank and back.

Mr Christopher Macdonald

So yeah so unfortunately I mean so you probably could still have a tummy tuck with all of the sort of caveats that I've been saying it what you really need is someone to have a have a look at you so what I would suggest is if you lie on your back and you have a round belly then it usually is due to visceral fat and it's not normally due to abdominal wall weakness so it might mean that you won't get a result as good a result as you would do if you lost some weight even though your BMI is 28 and actually that's a really that's a really difficult conversation sometimes to have with patients because everybody based on your hormones like you've said because of the menopause based on your hormones everybody puts weight on very differently you know and sometimes we see patients who've got a lot of a lot of weight all around their organs and they've got skinny legs and skinny arms and skinny everything else but it's just all around there and then you see a patient who's got the exactly same weight but that weight is spread off across the whole body as a whole and they will end up with very different surgical results so I I'll be very happy to see you and discuss it but it might mean that if the if the weight is around your organs then you probably will be better where even though you even though you be 28 be better to try and get your weight down lower.

Kate Comrie

Thank you. We've got a gentleman who is 78 with a BMI of 29 and has a flap of skin with a low belly button. Would I be a good candidate for surgery?

Mr Christopher Macdonald

Yes, so I would say yeah. So if you've got a big flap of skin, that's what I was saying, and it depends if that's what your problem is, then actually removing that overhanging skin is one of the most satisfying results you can get from this sort of surgery, and having a low belly button isn't a problem at all because, like I said, if we move that belly button higher up, it would just mean that if you had a standard abdominoplasty, I'd expect to get a good result.

Kate Comrie

Yeah, I guess. Does a 360-degree option have any risks to nerves like back surgery does?

Mr Christopher Macdonald

No, so no, it doesn't—that's a really good question, actually. So it so all of the stuff that I'm talking about removing is all above the deep fascia so the fascia the stuff that goes around all your muscles all around your body and all of the important nerves are deeper than that so we don't go near any of the important nerves that are responsible for the function of your lower legs or anything like that the only nerves that run through the area we do operate on are some of the nerves that supply the skin in that area so it's quite normal for you to end up with numbness around where we're actually operating so numbness around the scar and around very tops of your buttocks or around the very tops of your thighs most of the time that's a short lasting problem but actually they you go through a little phase with a little pins and needles a little bit funny and then they come back to come back to life. It's normal that, very occasionally, you can find that you're left with a bit of permanent numbness, but that's the same with any sort of surgery; it's just limited to where we're operating, but it doesn't have any of the risks to your spinal nerves, the really important nerves, so could we go nowhere near that at all?

Kate Comrie

Thank you. I have significant diastasis recti. How long would the recovery be following a repair? How long do women usually wait for surgery? i.e., if you've done regular exercise for two or more years, is it still likely to improve?

Mr Christopher Macdonald

I'll tackle this one. how long is the recovery so it depends so most people have returned to all their normal activities by six weeks and I'd expect you if you are someone who's undergoing heavy exercise or weight training I expect to be back to normal without eight weeks so that's the sort that's that that part of it I mean to talk about general recovery because I know we haven't really talked about that have we so it might be a good time just to drop that in so you spend you know normally you spend a night in hospital for the first week you're quite dependent on having someone around to help you around the house you be up and you ping around I don't really want you to be completely bed rested so you lose some of your weight and strength and things like that so I want you to be up and around but not doing too much and then after a fortnight that's when I expect you to be able to do things like work from home be going for short walks and things like that so that's from week two and then by week four I expect to be back to work as long as it's not a heavy manual job and you'll be back driving and doing things like that and then by six weeks that's when I'd be happy to start doing basic cardio or some exercise and things like that and then eight weeks is when you do heavy lifting and really strain that repair so that's what I would say about the recovery point. How long do we usually wait for surgery so there's no real rule so if it's after things like pregnancy then we normally say nine months to a year as a minimum and that's to allow your body to generally recover from all of the other changes you have to go through during labour and then child birth and it depends on whether you're breastfeeding and things like that but really the other thing is I want your weight to be stable and it's quite common for ladies weights to fluctuate in that early phase and it's also me the other the other reason we delay it is just and I don't want it to sound patronizing but there's just lots of stuff going on you know when you've got little children at home and trying to take six to eight weeks off to recover is just not a practical thing so I think once you've got two years that's a really reasonable time I would be amazed if your diastasis recovered at this stage I think it's very unlikely what some people can find is that by doing really focused core work or palates work which is normally something we have to get a proper physiotherapist or someone involved to really that by strengthening the other accessory muscles of you can sometimes help take away some of the symptoms of having a diastasis but at this stage it will never actually repair itself those muscles will never actually come back together and knit themselves back together properly so if you want to avoid surgery it definitely worth exploring some palates or seeing a proper trained physiotherapist who works in this area and they might be able to help with some of those symptoms but it will never recover to how it was before and those muscles will never really go back together.

Kate Comrie

Thank you. I have long legs, but I'm really short-waisted, with no gap between my ribs and hips. Even when I was really slim, I had a curvy tummy and now have a C-section overhang from two pregnancies. Would I still be suitable for abdominal plastic surgery?

Mr Christopher Macdonald

Yes, and actually, I think one of the slides I presented is someone who is slimly built. The gap between her ribs, the bottom of her rib cage, and her hips is very small. Yeah, there's no reason why you can't have a tummy tuck. I mean, it just means that your scar ends up cosmetically looking higher. That's the only thing, because there's less of a gap between your rib cage and where your scar sits, but there's no reason why you can't have a tummy tuck built like that.

Kate Comrie

Thank you. I had weight-loss surgery 12 months ago under Mr Hamouda at Benenden. Is 69 years old, sorry, 68 years old, too risky to have Tommy Tuck surgery?

Mr Christopher Macdonald

I would say no, so actually, it's so well treated. I've been lucky enough to treat a lot of Mr Hamouda's patients, so they. So, Mr Hamouda, if you don't know, is a local bariatric surgeon who's helped a lot of people on their weight loss journey, and they often stick with Benenden and come and see me, and I've done a lot of tummy tucks for those patients over 68. So, 12 months is a good amount of time. What I would ask is whether your weight has plateaued. What we don't want is to do surgery on someone who's still on their weight-loss journey. So as long as your weight loss has plateaued and isn't continuing down, then I would think you are certainly ready now, and like I mentioned earlier in the presentations, 68 is not too risky. It would need to be considered in terms of your general health, so in terms of things like blood pressure and diabetes or whether you're a smoker, all those other bits, but actually, the age on its own is certainly not a reason not to have that.

Kate Comrie

Lovely, thank you, right? I think that's all of our questions for now. Sorry if we didn't get to answer all of your questions. If you've provided your name, we will answer it via email.

Okay, can we just move to the last slide, please? We are offering free mini consultations if you'd like to book online via the Private Patients team. They are offering 15-minute free consultations; our next one is on Monday, June 10. It's here at Benenden Hospital, and you can come and discuss any cosmetic treatment with us that Mr Macdonald currently offers, such as tummy tucks, breast surgery, enhancements, uplifts, reductions, blepharoplasty, arm lifts, labiaplasties, thigh lifts, and liposuction. You can always book a full consultation afterwards.

We'd be grateful if you could complete the survey at the end of this session to help us shape future events. If you would like to discuss or book a consultation, our Private Patients team can take your call until 6pm this evening; sorry, 8pm They're normally here till 6pm or between 8am and 6pm Monday through Friday, using the number that should be on the screen in just a moment. Our next webinars include knee surgery, breast surgery, and varicose veins, which you can sign up for via our website. So, on behalf of myself, Mr Macdonald, and the team at Benenden Hospital, we'd like to say thank you for joining us today. We hope to hear from you soon.

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