Dr Matthew Peters on Body Contouring Surgery

Trish

Hey, listeners, it’s Trish Hammmond here again from the Transforming Bodies podcast. And today I’m joined by Dr. Matthew Peters, who’s a Specialist Plastic Surgeon, based in Brisbane at Valley Plastic Surgery and he does lots of body contouring surgery. So we’re going to talk about the different types of body contouring surgeries that they are, and a little bit about fat transfer as well. So welcome, Dr. Peters.

 

Dr Peters

Thanks for having me.

 

Trish

Thanks so much for joining me, especially after a busy day on the tools. Yeah, so tell me you’re doing a lot of body contouring surgery lately, aren’t you?

 

Dr Peters

Yes, that’s pretty much all I’ve been doing all year, it’s been a very busy year, lots of patients needing lower body lifts, upper body lifts, breast rejuvenation, size, necks, faces- everything. So it’s been a very big year.

 

Trish

So what is an upper body lift, because that’s like a lower body lift is the 360s circumferential body, what’s the upper body lift?

 

Dr Peters

So for me, I guess it just comes down to the combinations that are taught people through because a lot of the patients they lose weight, and they don’t just lose it from their tummy, they lose it from lots of different signs and so I’ve just finished a consultation, where the story for this particular patient, for example, lots of skin access and needing to split it up into addressing the arms, the breast, the armpit area, and the back in her first procedure. And then for the second procedure, she wants to then have her lower body lift on to address obviously, the abdominal skin folds, the mum’s area, the lateral thighs, the anterior thighs, and the buttocks so it’s just nomenclature for me. And upper body lift is a correction of all of the stuff that’s been affected through massive weight loss for the upper body. So yep, the back of the pet, the side sort of thorax area, the breasts in female maybes, chest skin access and nipple positions for the males, and then their arms if necessary, as well, because for me it all sort of interconnects.

 

Trish

Of course. And would you do any of that as a combination procedure? Like say, for example, an upper body lifting the arms? Or is one enough without the other? Or I guess it depends on the patient, or?

 

Dr Peters

It does depend on the patient and the extent of their concerns. And that’s my approach, or the sort of body contouring stuff, because everyone sort of wants to try and there’s multiple procedures for some people, and some people we can get away with one procedure, others need to, some of them need three. So yeah, normally for the upper body lift, if the arms are a concern, I will do it with the breasts and the background lift. If necessary, if their hands are fine, then we just focus on the breasts, or the chest and the back area. So yeah, but essentially, it’s a 360 of the upper body plus or minus arms.

 

Trish

Okay, so you know, when you mentioned the bra lift? So yeah, so what’s that, because I know that myself, I’ve lost, like 50 kilos, but, and I haven’t had that much sort of skin to remove. But I guess as you put on weight and lose weight, you do start to notice the skin flopping around. And so you know, when you get those rolls a few because you’re probably nice and slim but when you get those rolls at the back, and you lose fat from those rolls, kind of say so that’s kind of the bra lift is that.

 

Dr Peters

So the bra lift essentially references where the scar is going to sit so we aim to sort of have the scar transition to the fall that sits at the front on the side of the breast, and then sort of extends around the back in that zone. If that’s able to be hidden in a bra side, then that’s great. But sometimes it’s not possible depending on where all the excess is. But yeah, the procedure itself is to address all that loose skin that’s draping from the upper body and it’s hiding the narrowness of the waist, it’s sort of giving a bit of a fuller version to that whole zone. So we lose the hourglass frame, just because we’ve got loose skin with rolls that just obscures the area. It gets rid of all the tissue that’s in the sides of the chest wall that people sort of find difficult to manage with bra straps and all that sort of stuff and then all of that extra bolt that sort of heads up towards the base. So I take that all out with the back bra lift and then transition how far it goes around the front. If we’re doing the breast at the same time then it sort of sits within the inframammary fold and I’ll do a mastopexy sometimes if people don’t need a mastopexy or a breast reduction then and I’ve got upper abdominal skin access at the front, between sort of the belly button and the breasts or chest area that I’ll extend being presents around to the centre of the chest at the front there to sort of do an upper abdominal lift as well at the same time. So, yeah, it’s all that whole zone gets managed by a background of depending on where the access lies.

 

Trish

Yeah, right. And like with that, because I know that abdominoplasty has just come back onto Medicare, which is amazing but are there any entitlements to patients that are massive weight loss patients when it comes to other skin removal surgery?

Dr Peters

Yeah, because in these areas, there are a lot of lipectomy item numbers to remove these tissues so they’re the non abdominal lipectomy areas and they are a concern to patients. But I’ve seen patients with rashes and chafing, and all sorts of areas within the folds, that cutting those areas out actually addresses. So yeah, there are benefits that do attract Medicare rebate and then certain levels of health cover can be applied to reduce out of pockets as well.

 

Trish

Yeah, of course. And with those ones, like even though someone’s lost a heap of weight, do you find that you might need to still liposuction some areas? Like I’m thinking like, the under arms or you know, like?

 

Dr Peters

Yeah, look, we had a recent talk in ASAPS about this in a few sessions and there’s a lot of people who do liposuction, and some people don’t, I do like to do liposuction, if I feel it’s necessary in combination and safe as well. In combination with the arms, especially if I find that there’s where I place my scars for my brachioplasty is in the groove between the bicep muscle and tricep muscles. So on the inner aspect of the arm, I don’t want my scar necessarily at the back of the arm, where some other techniques advise you to do so. So I like to live outside the back area, the arm to deflate that and to tighten up that area and bring it all forward to hide the scar inside where the arm sits against the body so liposuction is pretty routine for me with my arms. And then when it comes to the back, if I’m going to do any liposuction, it tends to be in the areas that are above where I’m cutting out the background and stuff or below, just to sort of debug that. But a lot of the time, the back, the skin is just really thick, and the muscles are really thick. And what we feel is extra tissue or fat is actually just really thick rolls of skin so it’s not as common for me to do liposuction in the back area as it is for the arms or the thighs or for the tummy in those areas.

 

Trish

Yep, yep. And I was wondering, like, are they like day procedures? Or like, do you keep clients overnight? Because I know that well, I think that the object nowadays is to get people out of hospitals as quickly as they can, as quickly as you can. Is that right? Or is that just my imagination?

 

Dr Peters

I think it’s your imagination.

 

Trish

Some keep people in and some people don’t. I kind of can’t work out when people stay in and when they don’t.

 

Dr Peters

Yeah, I tend to sort of focus on things like the procedures themselves a lot of the time and they’re pretty big operations and sometimes doing them as day surgical things. Certainly, I do some things as a surgical procedure but it really comes down to how long the operation. How long is the exposure to general anaesthetic? How much pain relief they might require? Is it going to be over level that means that they should really have a nurse keeping an eye on them to make sure that they’re okay? Are there other things that are beneficial by staying in a hospital in terms of bed positioning and pillows and support and people that are able to help out with doing all the other things like making a meal and taking a tray away? And there’s all those little niceties that, you know, if you sort of get a procedure and then suddenly get home to two, four year old twins who need dinner, you know, like there’s just bits and pieces there which can really impact on recovery. So the procedure depends, like if it’s a breast reduction or breast lift, or a small set of arms or a small set of tires, sometimes we’ll do that. If it’s anything bigger than that, I don’t tend to do a case of abdominoplasty as I find that a lot of my patients are women that have had children and once more spend a bit of time in the hospital to recover and go through it that way and the bra lifts and things like that they long operations and their variable and their pain relief requirements and often just keeping them in the hospital to make sure they’re comfortable, at least overnight is is really well accepted by patients and I certainly don’t hear from people that they wish that they go home earlier.

 

Trish

Yeah, I mean, I’m more wanting to stay in the hospital and I just, sometimes people come home on the same day, I’m like, what, it just freaks me out a little bit because I agree with you like, because you can’t go home to a normal life and expect to not do anything, usually, because you do have the, just by being at home, I think you’ll really want to do stuff probably quicker than what you should.

 

Dr Peters

That exactly and that’s what I learned from people is that if they find themselves back in the home environment, they have a personal, they almost flip back to what their usual level of involvement engagement with the family is, and often that is something that they don’t recognize is actually pushing themselves too hard until the day after, it’s like going to the gym for the first time in ages. And you’re sort of going yeah, I’m doing okay, and I’m gonna push this, push this and you sort of pay for it the next day. So I tend to find that if you’re in a supportive environment, like a hospital, and you’ve got staff there to remind you, and to sort of take away some of those things that you otherwise would push your body through, if you had to support young children or had to clean the house or prepare meals or whatever it might be, then you are able to just focus on recovery and do it in a step manner, versus pushing yourself through things.

 

Trish

Yeah. Have you ever had a patient because we had a patient come through last week who had lost a heap of weight, but her stomach was still quite solid? Like, it’s almost like she didn’t lose any weight in the stomach. So she was after a tummy tuck, but her stomach was quite solid, if that makes sense. So she would, you know, she was looking at the back lift and lower body lift but she wasn’t sure about the stomach, because the doctor had said that it might have been a bit too hard. This is just on a zoom consult, it might have been a bit too hard to stomach. Is that a thing? Or can you? Because I guess you can liposuction a bit? Or can you remove fat because I know you can remove that with liposuction. But can you remove that when you’re having the surgery?

 

Dr Peters

You can but like, everyone has different body shapes, as you know, and sometimes that sort of fullness in the abdominal area is a genetic thing, or a hormonal thing. You see that pattern occasionally and post menopause. See that pattern in some people that have underlying things like big chest walls and all sorts of things like that. There’s obviously the need to assess what the problem is and think about just the mechanics of the procedure? And is it like fat that’s just sitting on top of the muscles, is it potentially fat that’s around the organs is a potentially a really large liver? Is it that sort of thing where there’s things that we can do, we can take away the skin, but perhaps we can’t or we know we can’t actually take away the fat that’s deep around the organs and the liver and stuff like that. So sometimes patients do come along, thinking that we can make everything really flat and neat and all of that, but there are limitations to what we can do in that picture and it’s often a gentle sort of just a redirection to sort of get them to revisit diet exercise, speak with GP Bariatric Surgeon and think about further weight loss or scans to look at size of livers and other things that may be contributing to that arrangement. That’s all taking into account proper assessment where you’re looking at muscles, and you know, is there significant muscle separation, and everything’s sort of pushing forward? And is it just that that needs to be repaired so yeah, to have the patient that just has a really tight abdomen, potentially with some some extra sort of weight around their organs to see that and refer them on to try and address the weight so that we can collectively get the result that they want and it can be something where they lose three, four or five kilos. And that’s enough to sort of deflate in an area and then allow us to actually cut the skin and repair muscles and get that physique that they’re actually wanting.

 

Trish

And so for example, if someone’s lost a whole heap of weight, and they want to do the whole thing, like they’re going to do it in stages, but say we’ll use a lot of body lifting examples like that. Like I know that those procedures take a lot of hours and I was gonna ask you what’s the longest that you would actually do an operation on someone for? or what has been the longest?

 

Dr Peters

I’ve done really long operations, which have been mainly big cancer reconstructions in the past, with this sort of stuff where it’s, you know, I’m talking about previous times where during my training and afterwards where we cut out cancers from the head and neck area, and then have to reconstruct someone’s whole door, and you’ve got to put it all back together, otherwise they can’t swallow or there’s an infection risk in the light. So some of those operations can take 12, 14, 18 hours but the reason for putting a patient for that is a bit of a night through that and the risk attached to that with blood clots and pressure areas and all sorts of things. It’s sort of taken into account versus a cancel infection or issues. In this stuff, it’s all really elective and we’ve got to think about the safety profile, we got to think about the post operative recovery, how things might compete against each other. When it comes to wounds and certain directions, we need to think about the wound load in terms of ability to heal, and matching that with nutrition requirements or nutritional deficits with some of the bariatric procedures just need extra supplementation for there’s all these things to take into account, when I’m looking at how long someone can have, how much operating time someone can tolerate. It’s a collective decision about how big is the patient? How many areas are there? How many of them will compete against each other in terms of, as I said, we’re intention, what’s the patient’s sort of appetite for having a procedure, as many down in one versus splitting them up? I made lots of people who are self employed in businesses have children need to think about how they try and put a few combinations together to limit how many operations they may have in one year, two years, multiple recovery periods so those things are considered. But ultimately, if we’re looking at combinations that just start to get up to the six and a half, seven and a half, eight and a half, nine and a half hour type category, you sort of start to get a little bit into the into the ballpark of wanting to split things up a bit.

 

Trish

Yeah, yep. So it’s not all done in one session, maybe if it’s too long, because I would think, I’ve just presumed that if someone has lost a lot of weight, let’s say if they’ve had bariatric surgery, they’re obviously not getting as much nutrition as someone who perhaps didn’t have a gastric sleeve or something like that so they would take longer to heal and recover, I would imagine.

 

Dr Peters

I think they can, but it’s part of the original assessment and talking to them about where their nutrition is at if they’ve had bariatric surgery are the bariatric team happy with their nutritional status. And a lot of the bariatric surgeons I work with, they’ve got in house dieticians, they’ve got all of these extra psychology support areas to make sure that the weight loss is stable, and it’s healthy and the patient can tolerate an operation where they they are going to be putting their body through stress and their body is going to need to have the resources and take the resources like extra protein, vitamins and things to actually heal. So yeah, they are big things to factor in and you do see differences between people that have lost weight through diet and exercise, people that have lost it through some of the medications that are available. Now some of the people that have lost it through a gastric sleeve versus a gastric bypass and the different procedures are essentially can affect iron supplementation requirements, they can affect protein supplementation requirements, and that can be enough to sway me into saying to someone, hey, thing, given you’ve had a bypass procedure, and we’ve got some protein absorption issues, let’s split this up. Let’s give the body a chance to recover from smaller bites compared to bigger bites, and sort of try to move things through in that way so it’s just done safely on the heal and it’s not a negative experience.

 

Trish

Now, I totally hear that because it’s so true. It depends. There’s no cookie cutter approach and it depends on the actual patient. Yeah. So someone asked that question, it’s like how you need to speak to your Plastic Surgeon and actually have that conversation with them once they’ve done a consultation and had a look at you and worked out.

 

Dr Peters

Yeah, it’s really and it is an interesting thing that comes up sometimes where I recently had a patient who sort of set up and reading online that there’s this lady that says that you’re going to do a double circumferential and arms and yet with me you just want to focus on a breast and a tummy but I want to get my arms and my back down as well and what’s the difference? And it was about the size, like the person that could have everything done had really small areas of skin access, it was just that they’re in multiple zones and so her operating time was going to be four and a half, five hours for all of those areas and she’d done it through diet and exercise and all that sort of stuff. So I didn’t have as much protein deficit issue to think about and so they’re a different picture compared to the patient in front of me who just had a bigger amount of skin to remove and was taller and and was broader, and their shoulders and just wound lengths and everything were different so it really is a consultation and a personalised approach to just see what is safe.

 

Trish

Yeah, of course and so for example, if someone was having like multiple procedures at the sorry, someone’s having the one procedure, do you find that it’s very often that turns into a two step procedure, like, what I mean, is a classic example is one of the ladies in our forum, she’d had a breast reduction, but her boobs were like, absolutely massive, but they were full, like, they were really full. They weren’t just loose skin, they just had never, you know, uh, she put on weight, it just got bigger, and she’d lost weight, but she never lost any weight, no boobs, they’re like solid, and she was in her mid 50s but she had a breast reduction and then I don’t know if it was didn’t go far but it needed to be a two step procedure, because there was all these little dog ears, I think hanging off the side, I think that’s what they call them. This, I guess you wouldn’t, because if someone’s lying down, you’re not really going to know what they like when they sit up. In a way, I guess.

 

Dr Peters

We do when we’re trying to work out what someone needs, sort of factoring, what as things fall together, how long the scars might be, and it’s pretty normal to be able to say to someone while they’re standing there and you’re examining them and you’ve got a mirror, you can sort of point out this is where I’ll be making my like, I’ll put my drawing here, I would expect that the length of the scar is going to be to here, so that I’ve got an impression of how things are going to turn out because some of the general public they don’t, they might know what we do and they might think that they have an idea of what what applies to them and it can be very different to the reality of it. And you see that with tummy tucks pretty frequently where people will think that it’s just going to be this little low scar just in the front hip to hip and quite frequently to get the contour that they need, we have to go up into the sides and sometimes a little bit further round into the back and so you have to point the length of the incision out. And that’s the same with the breasts and with the breast reduction, examining the sides and seeing where they’re creases and highlighting to them how far around and sometimes if it is really gonna be far around, that’s where it might need a position change, you might need to operate on the back and then turn them over to the tummy to finish or split it up into two procedures and see if we’re able to get away with with less than more in terms of the length of the scar into the back. Some people do sort of heal well, despite there being a bit of performance left behind. So yeah, sometimes it’s usually a good assessment at the start and decision that’s made about how far things you know will go. Sometimes, especially with the press, you have to tell people that address it properly, they do need their back operated on with a back bra lift, and sometimes they don’t want to do that sometimes they sound really like my back and if I don’t need to then limit the scar to the side and there’s a bit of excess there that I can hide in the bra. Right? So there’s that sort of negotiation.

 

 

Trish

Yep. Yeah, it’s funny I always liken it to it’s like being a dressmaker but were you using the skin instead of the fabric. The skin is the patient’s fabric and you kind of like fixing the wall up so that it just looks neat.

 

Dr Peters

Yeah, that’s where I actually started, which is not what some people know. Yeah, soldering clothing years ago during that school, so it’s sort of a relief. It is an extension. Yeah.

 

Trish

Can you sew? Do you know how to sew? I always get really impressed when doctors can do those, when you do the stitches and you do the knots, it’s like wow, that’s like real dressmaking skills.

 

Dr Peters

That’s cool. And it’s very similar stuff.

 

Trish

You’re right. So you know, you mentioned before about when people lose weight, the fact that sometimes the neck is getting really saggy so what do you do for that?

 

Dr Peters

A neck lift and it just depends on, like what, where the concern is and so the standard neck lift, where we make incisions to suddenly the chin and you tighten that muscle or to evoke fat, and then sort of make incisions around that here and into the back of her hairline sort of area behind the ear and then resuspend the skin, resuspend the muscles, there’s different things there. Sometimes we tighten up the lower part of the face as well to sort of shift the gel position up there things like that. Sometimes it’s a facelift and necklift. Otherwise, it can look a little bit disproportionate. So yeah, there are things there that can be quite extensive. The occasional patient that I see when I explain to them what’s involved in that space will want something that’s less invasive, and doing just a local skin resection underneath the chin, in the neck area there. Especially since some of the males prefer that because they’ll grow up, they usually wear a beard and so I’m able to just cut that skin away and then stitch it out without giving them scars around the ears and into the back of the hairline so that’s another way that it can be done that’s a little bit less involved a little bit simpler, and sort of limits the scars to the front, which again, with males can be helpful when they grow a beard.

 

Trish

Yeah, of course, yeah, they’ve always they’ve always got a bit of an ask the guys, it’s always much easier for them.

 

Dr Peters

Yes, and no in facelift. And sometimes those were the scars behind those ears, they sort of have to modify their haircuts a little bit and it changes where when you do a facelift, it can just change where the hair sort of ear, the beard line and the ears sort of sets and there are some changes, which, for me, like walking on the street, I can tell if someone’s had something done. The general public, probably not as much because they don’t see facelifts all the time. But the men, I feel women get away really pretty well with face lifts and neck lifts compared to some men. Yes. Yeah. And all that sort of stuff so there’s just some differences there.

 

Trish

Yeah, I was gonna ask as well, moving straight from the neck down to the thighs, with a thigh lift, because I know that that’s becoming really popular. I have people asking about it all the time. Is there a couple of different ways to do the thighs isn’t there? Because there’s some people that actually do, like where there’s a T cut with a cut down the thigh and into the groin area as well so it ends up like a T and then there’s the one where you just do this, that just the long line down the thigh and just remove skin in there is is that like, is that just the only two procedures for the thigh? Or is there something different? Or when would you choose one over the other?

 

Dr Peters

So the majority of people that go through massive weight loss, there’s a fat pad that sits on the inner aspect of the upper thigh, which is really stubborn. It’s like the last sort of storage area that just wants to stay and there’s a lot of skin that then drapes in that area and it’s an assessment of where’s the skin access? Can you cut it out as a vertical sort of dialect, which is just the straight line running from the inner groin down to the knee, or is there going to be access that sitting sort of behind those areas or in front of those areas where the T junction bar left becomes beneficial. It’s one of those things where if I can do the vertical, I prefer to do the vertical, I do mind with a lot of liposuction as well so I tend to find that by doing liposuction of the area that I’m going to be taking skin away so that we preserve lymphatics and reduce the risk of lymphedema and swelling in the ankle and do lipo there but also liposuction the anterior thigh and life has sucked that area that’s their inner posterior upper thigh that might rub together after this sort of stuff then getting away with a vertical with the lipo can be really good and avoid the T junctions. In thighs, the wound itself can be a bit troublesome, it can break down, it can separate the scar that is the upper groin scar, it will usually come out of the groin crease even though we set it in there just gravity and the way that we see it and strip skin in that area. It can come a couple of centimetres out and down the thigh so the lift component of the T junction. Sometimes we lose the lift component with time so the benefit there during the T junction sometimes doesn’t apply. It’s one of those things. Again, if you’re doing combination procedures and you’re looking to do lower body lift with a thigh lift, it’s pretty safe to do the vertical thigh with the belt, versus doing the T junction and the scars being quite close to each other, they can just pull in different directions and sometimes sort of run into some wound healing problems as a result. So that can be something where we try with patients to sort of say, hey, let’s see if we get away with the vertical lipo and if it’s not enough, then we can add a crescent resection at the top of the groin to try and take away any extra skin or otherwise, that’s rubbing. So there’s things like that, that sometimes are a plus or minus that go from being just a vertical or just a T to being a vertical that then turns into a T as the months go on. Yep, yep. Some people do like a boomerang type style, that’s like an L shape that pulls the anterior skin and bulk backwards in like a groin crease that goes down to the middle of the thigh, and then heads down to the knee and the cut out looks like a boomerang. And then there’s other ones that occasionally I hear people talk about in terms of spar or sort of five lives and that’s a similar sort of thing where the scar is on a slight sort of spiral to think about vectors of pull and all that sort of stuff. But we’re at ASAPS recently, as you know, and LLA, who pretty much wrote the textbooks on all this sort of stuff, was talking about how successful his career has been just doing verticals most of the time and that’s sort of the experience for me is that if a vertical is possible, then it’s usually enough and it really helps. And the T junction, some people just need the T junction, if they’ve got access in certain areas, and some people try the vertical and don’t win and we have to think about how we just correct those other areas surrounding it. Not common to do just to present, but I am aware of some surgeons that will just try and cut out things up there and pull things up and they feel that it gives their patients that result they need so that’s another option that some people employ.

 

Trish

I really want to know, like, I don’t know what it is, but you see some belly buttons out there that you can tell her, you know, have had a tummy tuck. But I’ve yet to see one of your belly buttons, that’s not perfect. How do you get a good belly button? What is so different? Like I just don’t get it because, you know, like, it’s such a thing, that the ability to do things and some people can just do them. And some people maybe don’t do them as great or whatever. I don’t know, because like, I’m looking at a close up now of one of your before and after and even it just looks like a real belly button.

 

Dr Peters

Yeah. I spent a lot of time on the belly button and I think it’s important because it is one of those things where I can look at photos of people’s work and I can tell who’s my tummy and who’s not based on the belly button and it is something that people ask about. And I think it’s worth investing time and effort into doing it. The way that I’ve evolved into doing my belly buttons, surprisingly, comes from days spent doing paediatric general surgery. And so, and it will sound bizarre, but I was taught by a surgeon in his late 70s how to manage boys that had problems that needed circumcisions for medical reasons like that, you know, sometimes people have to have them it’s not just about aesthetics and and so I was taught how to do that during my general surgery training, and specifically my paediatric time and, and the techniques for that. You can modify it to make its belly button shorter and you can modify it to work out how to sort of get things to sort of sit a certain way. And so it sounds a bit gross, but that sort of applied a similar way to make things shorter and reduce the amount of skin and all that and then I think about how the belly button sort of is attached internally and how I need to get the skins and sort of contract down onto it and so there’s ways that I attach it in certain positions back onto the abdominal walls so that we create a bit of a hood in the upper part, but I like to sort of think of it as a funnel and so trying to get that scar from the cuts that are sitting down in and making the bellybutton shorter so it’s easier to clean. There’s all those things that sort of spend up to about 45 minutes on an average belly button trying to get it shaped correctly.

 

Trish

Yeah, right. So it does pay off because it’s some, like for me, that’s the standout of your tummies is the fact that the belly button looks so good.

 

 

Dr Peters

Yeah, I do. It’s worth the effort and I have some patients who are very public, through their jobs and I get to see their belly buttons on certain social media for things like social media things and advertising campaigns and it’s nice to see that they’re confident they’re happy with their belly button enough to have it in a paid advertising campaign. It’s just, I do think that there are things that we can do to make it look as natural as possible, as it’s worth the effort to do it.

 

Trish

Yeah, totally. I totally agree with you, because for me, it’s the first thing that I look at and yeah, I think it makes all the difference for sure. Yeah. No, that’s awesome. And before we go, can I just ask you about some scarring, like, because I know, everybody’s scars different, like, I’ve have a friend who recently had a breast reduction that I was talking about, and her scars after like three months, or less than mine, which after, you know, 10 years, you know, like, and I’m like, what? Why is that? Like, she’s not having any treatment or anything like that. But what do you guys do for scars?

 

Dr Peters

Well, scarring has two big parts to it, which is the technical elements of the surgical intervention and thinking about how much is cut out and how it’s stitched together and trying to remove tension from the wound edge and then how we continue that into the postoperative period to reduce tension and keep the outer aspect as thin as possible. Through taping and then introducing silicone gels and LED therapies and all sorts of things down the track. Steroid injections of people are starting to have thickening and those sorts of things, which, thankfully uncommon, but there’s also just genetics and then there’s also just time. And so coming back to your thing, where you’re saying, Hey, why is his so thin and need three months after surgery versus yours, that’s 10 years old, and the body does go through changes, scar tissue is only ever about as 85% bad as strong 85% of the strength with normal skin. So with time, the scar will stretch more so than the adjacent skin, because it’s just inherently weaker. So that’s where time can undo a really thin, nice scar in some people, and also its location depends. So underneath the breast, depending on the technique with breast reduction, sometimes the tissue can sort of just come down the chest wall and just stretch things out a little bit. And if this guy is going to fatigue anywhere, even if the skin is gonna stretch anywhere, it’s at the scar point. And some people around joints, scars can stretch because they’re under load, and they get stretched multiple times a day. So they’ll fatigue and that sort of area and widen in that spot. So there’s there’s elements that are body location dependent, genetics, how you heal as well, and how you scar, but then also the technical elements of where the cut is made, how the cuts are made, how it’s stitched together? What sort of post operative support? Are there complications in terms of bleeds, or infections or problems where the scar is irritated? There’s quite a lot attached to why someone’s scars a certain way.

 

Trish

Yeah. And I guess, in all honesty, when I’ve never ever looked after my scars, you know, sorry, years ago, when I didn’t know when I first had my breast reduction, I never looked at the scars because I’ve never, you know, I’ve never really cared about them. But then I’ve seen some people that are so anal with the way they look after the scars. I’m just like so impressed because they’re, you know, they care about the scars, whereas some, some people don’t care so much about the scars, I guess and we all have different skin.

 

Dr Peters

We do and there’s that genetic element, there’s medications that some people are on that affect the skin thickness. There’s also hormonal things where people can have really, really lovely skin and then go through menopause and things just can thin out a little bit. So there’s all these changes. There’s some damage attached to that which can really affect the elasticity and skin that’s smoking history which can do the same. So there’s a lot of factors attached to it. The only things that we can really control as plastic surgeons are all those technical elements how we do it. Is it too loose? Is it too tight how we support this guy? With hours the activity modifications that people need to think about postoperatively so things don’t get pulled stretch separate. Yeah, it’s monitoring how it all plays out and intervening along the way with certain different therapies if things aren’t going the way that we ideally want them to go.

 

Trish

So it all just comes down to what’s right for that. Oh, sorry, that patient that their the way they look after it the way their skin is their body, what they the whole lot. It’s an individual thing. Hey.

 

Dr Peters

Yeah, it is. Yeah, there’s all of that. I like to think I have a role in performing stitches. I think it plays a role. But yeah, there’s, there’s so much more to it. Definitely.

 

Trish

Yeah, totally. And I know I said that was the last question. But I just want to ask one more thing. If someone was to have skin removal surgery, like just say, a lower body lift or whatever, what would be the recovery time? Like, could they say, right, I can go back to work in two weeks if I’d sit at an office, and then I can start doing the exercise in three months, and like, what’s your general rule?

 

Dr Peters

So I always ask about what people do for hobbies and exercise, and I never inquire as to what someone does as a job. But I will inquire as to whether it’s a physical job, or if it’s more sedentary, or office based. So I’ll always sort of preface it with that, to get an idea of what sort of movements they need to consider so that we get them back to normal life in the safest way. If someone is having a low body lift, and they’re self employed, they can work from home. I’ve seen patients in hospital, even with their laptops out, contributing to the workplace with certain tasks and the like and I think people should focus on recovery and not be working whilst they’re in hospital. But the self employed business owner doing some of their things as long as they’re not on medications that are affecting their judgement, they can do that. For a sedentary job, if someone is an office based worker, I do highlight to them how long they’re going to be in hospital for the medications, how they’re going to feel slow, and and they’re going to be hanging on to fluid and they’re going to need to sort of be aware that they’re not going to be their usual cells for three to four weeks and as much as they may want to get back to the workplace within two weeks. Sometimes it can be a bit of a push when they think about, you know, how are they going to get to work? Are they going to be able to drive yet which a lot of people don’t feel safe doing for at least the first three weeks? What are they going to do at work in terms of all the incidental things so I do get them to sort of do a bit of a stocktake of their workplace. So think about their day, and how many times they’re getting up out of their chair and going to meetings and having to pick things up and carry things and all these different elements of their job that may exist that they haven’t realised that an office based job does actually entail. So yeah, I think two weeks is a bit of a push because of all of those incidental things. Three weeks is safer. The really physical jobs, the nurses, the tradies, all of that I do talk to them about how certain movements and twisting things can not only elicit pain, but can also result in bleeds and things just through shearing activities and so I sort of talk to them in the same way about activity restrictions for up to six weeks. And in terms of what they they might return to light duties before getting back into full, full active duties again, some people, I’ve had some some big players and all sorts of stuff, who will really think about being on light duties for anywhere up to 12 weeks with some of the muscle repair requirements for their lower body lifts.

 

Trish

And you know what, I guess when you think about it, like we spend all that money and all that time, like an extra two weeks in the big scheme of things like the recovery is not that big a deal. I think you have to take the time that your body needs to recover, hey, to get the recovery, really.

 

Dr Peters

You really do and it needs to be put out there right at the start. And thankfully, so many of my patients come to me like I’m in my rooms right now and they will come here having spoken to other people about their journeys, they’ve read about things on forums, that they’re educated, and they know that there’s a recovery consideration to factor into the outcome, and that it’s not something that’s really small back to work the next week. Everything’s going to be sweet. This is a small thing to think about. All of them come in saying I’m ready to do this. Now I know that I need to plan. I know what’s involved in the recovery and then let’s get this sorted out. So yeah, it is really important to educate people about the recovery stuff so they just get it done properly.

 

Trish

Yep, yep. No, that’s so true. I’m all for that. Because some people it’s up to, the patient needs to take over from there, as you guys know, do so much. But if they’re not looking after their food, and they’ve gone back to smoking or something like that, of course, you’re gonna have a different outcome to someone who has actually followed all the protocols given to them by you.

 

Dr Peters

Yeah, it is true. And those things happen and we manage them. We help them through things. Yeah, we do equally want things to be as smooth as we can happen.

 

 

Trish

Yep. Yep. That’s so true. Yeah. Well, thank you so much. That’s been so good. I always love doing a podcast because I learned so much and I always want to line up and come and have some surgery. Get rid of some of that skin. Thank you so much for taking the time to talk to us this evening.

 

Dr Peters

No worries, Trish.

 

Trish

Lovely listeners. Look, if you do want to get in touch with Dr. Matthew Peters, you can check out the Instagram which is @vaelleyplasticsurgery, or you can just Google them and give them a call. They’re really, really helpful and the staff are just amazing. So thank you so much for joining us today. Dr. Peters.

 

Dr Peters

No worries, good talking with you.

 

Trish

Thank you.

 

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