Episode 27 - Dr. Susan Kaweski, The Guru for Mommy Makeovers

Transcript

Teri Hausman: I’m Teri Hausman, host of “Beauty Now.” We get the facts from experts on lasers, lipo, lifts, lashes, breast augs, tummy tucks, cellulite, hormones and today we have Dr. Susan Kaweski, a woman plastic surgeon, specializing in mommy makeovers.

Usually after childbirth, the breasts deflate and then they sag after breastfeeding and there may be even visible stretch marks. So some women might chose to have an implant placed in order to restore volume, possibly a life to restore the breast really to their anatomic location. There have been a lot of things discussed about stretch marks from laser to creams and ointments and really nothing has helped stretch marks. The only thing that I know is really surgery. And for example, when you have a large stretched abdomen after having multiple children, those stretch marks have to be surgically excised.

Things that I can do is really evaluate the patient on an on going basis and when the scars stay red and ropey, then I can go ahead and inject some steroid into the area, or even apply some silicon gel sheeting in order to calm them down.

Teri: Welcome Dr. Kaweski.

Dr. Kaweski: Thank you Teri. It’s very nice to be here.

Teri: Well, I’m really happy that you are here because there are so many women across American that don’t feel great about themselves after they have a child. You have written a book and it’s a “Mommy Makeover?”

Dr. Susan Kaweski: Yes, a mom’s guide to beauty after childbirth.

TERI: a mom’s guide to beauty after childbirth, which many, many women need. How does a woman actually know that they need a makeover? I know how when I need one, but how does the average woman say, this is what I could use, because they are feeling kind of blah?

DR. SUSAN KAWESKI: Yeah, and that’s basically what happens after having children. You know, having children is just a blessing but really the process takes a toll on the physical appearance. Often distorting the breasts and abdomen and sometimes causing that abnormal fat deposition on the flanks and the thighs. And also, hormonal changes can also affect the skin.

So women basically wan to feel confident about their appearance. They want to go back to shape that they had before childbirth. Many women really have careers and certainly physical appearance plays very, an important role into how they are perceived by their peers. And if they have gained weight or they feel undesirable, unmotivated, maybe even frustrated, a mommy makeover may be right for them.

So my book will really take every mom through the steps necessary to achieve a successful mommy makeover.

TERI: And how does a woman start? So they read your book and they say, hmm, this could be me. So they call your office and they go…could you walk us through a consultation?

DR. SUSAN KAWESKI: Well, yes, I can. First, I would tell you that I feel that the Internet is a great source of information. A lot of women go to there first, but I would caution them, because there are many charlatans out there who just kind of want to make money. So, it’s really important to chose a very reputable plastic surgeon and we want to make sure that that plastic surgeon is board certified in plastic surgery and also has the necessary experience to perform the type of surgery in which the patient is interested.

So, going back to the start, that’s where I would begin in choosing a reputable plastic surgeon. Once that patient comes into my office for consultation, we’ll go over exactly what the patient is interested in and then determine what surgical procedure or non-surgical procedure would be right for them. And go from there.

In choosing a board certified plastic surgeon which we stress on the show almost every show, especially with what’s happened lately in Kanye West’s mother, who passed on due to heart disease, just because you know, somebody didn’t actually do a thorough check up. I’m not blaming the doctor, but I’m just saying that you need a thorough check up. So that’s actually really, really good advise. I really love that advise. How does a person find a board certified plastic surgeon to start with?

DR. SUSAN KAWESKI: Well, that’s what my book discusses. It really tells a patient how to recognize certain qualities and then how to chose the surgeon that is going to be right for her. But there are ways to do that and my book will go over all those ways in which the patient can look for a qualified board certified plastic surgeon. And we have a little logo that recognizes our board certification form the American Society of Plastic Surgeons. So that’s one way to do it, but there are other means to really determine whether the surgeon is right for you. And that’s what my book will discuss.

TERI: Right because it is important to have a good rapport with your surgeon. Number one. Let’s get right to the breasts. Droopy, dragging breasts after childbirth, what can you do to help?

DR. SUSAN KAWESKI: Yes, you know, usually after childbirth the breast deflate and then they sag after breastfeeding. And there may be even visible stretch marks. So some women might chose to have an implant placed in order to restore volume. Possible a lift to restore the breasts really to their anatomic location.

So, the breast is one way of just kind of enhancing their contour. The abdomen is another location that can get stretched both internally and externally. Sometimes there is lose skin and that’s often difficult to hide in pants and skirts. And the abdominal muscles may be stretched apart and the waistline is then increased. So, a tummy tuck will solve both of these problems by removal of the excess skin and then tightening of the abdominal muscles.

And then some women can have some abnormal fat deposition on their flanks and thighs and that can be taken care of with liposuction.

Now, some of these procedures can be combined. And that’s why I talk about breasts with abdomen, because that’s a very common mommy makeover. And it’s very easily tolerated by a very healthy individual.

TERI: So you are able to do the breast and the abdomen in the same day?

DR. SUSAN KAWESKI: Yes. If the patient is healthy enough to do that.

TERI: And you determine this by a physical examination and getting their history.

DR. SUSAN KAWESKI: Absolutely. By physical examination. If they are over 40 they get an EKG and I often send in blood work just to check out to make sure there’s no evidence of any thyroid problems or anemia or anything like that, prior to surgery.

TERI: Well, that’s exciting. What’s the recovery like?

DR. SUSAN KAWESKI: Recovery varies for each procedure, but I would say that most likely it’s about four weeks. And most women will feel pretty well after breast surgery within a week or two. But that doesn’t mean that they can go back to doing strenuous activity or any physical activity involving aerobic activity, because they really need to allow the body to heal properly and it takes about four to six weeks.

TERI: What about lifting their children afterwards? They are going to need to get help correct?

DR. SUSAN KAWESKI: Oh, that’s a very good point, because again, I don’t allow them to lift anything heavier than 10 pounds. So I usually advise that they hire somebody to help them or bring in a friend or relative to help them with their small infants and children. Yes.

TERI: What about…what can women do for their skin? Often it’s tired from sleepless nights and things like that. What would be a non-invasive way helping their skin?

DR. SUSAN KAWESKI: Well, it depends what exactly we are looking at. Because hormones you know affect your skin, whether you are menstruating, you’re taking birth control pills, you are menopausal and sometimes what can happen is that acne can actually appear, all of a sudden.

You’re forty years old and you have acne. And so there are a lot of little skin pearls in my book that go over discussing some of the products currently on the market for acne. But you know, just routine good skin care is a necessity and that doesn’t mean washing your face with soap and water. That means using a gentle cleanser, and a toner to bring your skin back up to it’s natural pH, and then further defining the skin with either a hydroquinone, which is a bleaching agent, or a glycolic acid, which is an exfoliating agent. Or even Retin-A for blackheads or white heads. So there are a lot of things to do that are non-invasive for the skin.

 

TERI: But basically you would need a consultation just because everybody is different.

DR. SUSAN KAWESKI: Exactly.

TERI: So I hear so many women complaining about stretch marks. Is there anything truly that gets rid of stretch marks?

DR. SUSAN KAWESKI: Oh, I wish I could give you an answer for that. There have been a lot of things discussed about stretch marks from laser to creams and ointments and really nothing has helped stretch marks. The only thing that I know is really surgery. And for example, when you have a large stretched out abdomen, after having multiple children, those stretch marks have to be surgically excised.

So, that lessens the amount of stretch marks but it certainly doesn’t take them away. We just don’t have that magic formula for them yet.

TERI: So you are able to cut away a good portion of the stretch marks for a tummy tuck, is that what you are saying?

DR. SUSAN KAWESKI: Yes. Yes.
TERI: And so then there is actually nothing. What about Retin-A on stretch marks?

DR. SUSAN KAWESKI: Well, I don’t think Retin-A really affects stretch marks to that extent. And I wouldn’t advise it.

TERI: You wouldn’t advise Retin-A on stretch marks?

DR. SUSAN KAWESKI: No.

TERI: So there’s actually nothing that we can do? What about the lasers?

DR. SUSAN KAWESKI: No. And the lasers really they have shown that they don’t help either.

TERI: Well, that’s at least honest. They could actually lesson though, may be.

DR. SUSAN KAWESKI: Well, I really haven’t seen that to be honest with you. I mean, I know that patients try these things and they ultimately end up coming back for surgical excision if they are really, really bad.

TERI: That’s what I hear too. But I keep looking for the cure for stretch marks. That’s what we need to find.

DR. SUSAN KAWESKI: We do. We do need to find that cure.

TERI: We do need to find that cure. All right so what about the patient that has lost a ton of weight and they are beyond the tummy tuck, the lower body lift?

DR. SUSAN KAWESKI: Um-hmm. Well, with those patients, they have multiple problems and what they have to do is they have to be realistic. So they have to decide where exactly they want to start. Most women will find that they just can’t fit in their clothes properly and they have all this loads of excess skin on the lower body.

So a lower body lift is kind of a good place to start. And that is one procedure. You can’t do a lower body lift and do a breast lift and arms and everything at the same time. That’s not a safe way to go. Because you’re asking for a lot of surgery and you know with a lot of surgery you run the risk of increased complications. That’s including blood clots, stroke, even death. And that should be foremost in everybody’s mind with Kanye West’s mother recently succumbing to plastic surgery.

But usually women will start with a lower body lift and that gives them a real boost, because it improves their waistline and it allows them to wear a pair of pants and they feel good about themselves. Now, once they undergo the lower body lift, they may find that, oh, my thighs are really kind of saggy and I need something done about that. And so, the excess skin of the medial thighs can be excised and tightened up and then all of a sudden, they can really wear those tight jeans.

TERI: Which is a nice reward and I want to talk more about this. We have so many more questions for you can you join us back in a minute? We have to take a commercial break.

DR. SUSAN KAWESKI: No problem.

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[Music]

This is Teri with “Beauty Now.” We have been talking to Dr. Susan Kaweski and we have been talking about mommy makeovers. Welcome back.

DR. SUSAN KAWESKI: Thank you.

TERI: Well, we were just talking about the lower body lift and what a serious procedure this is because actually you can only do one procedure in a day for safety reasons. 

Tell us a little bit about the scars. That’s the trade off isn’t it?

DR. SUSAN KAWESKI: It sure is but I’ll tell you most patients will trade those scars for all that excess hanging, loose skin.

TERI: I agree.

DR. SUSAN KAWESKI: I’ve seen it. I’ve seen it and I’ve seen their reactions. And you know it also tightens that up that butt and so they don’t like those droopy butts and saddlebags, so a lower body lift will do that also. So I think they like the scars much better than that, the sagging butt.

TERI: Absolutely. So tell about the scar for the saggy butt.

DR. SUSAN KAWESKI: well, basically for the lower body lift, the scar is like a tummy tuck but it goes all the way to the back. And it goes from the buttocks crease and then it goes laterally and joins the tummy tuck scar in the front.

TERI: So when you say the buttocks crease, you are talking about above the butt?

DR. SUSAN KAWESKI: Slightly above the butt.

TERI: So, slightly above the butt. How thick is this scar?

DR. SUSAN KAWESKI: Well, scars vary in some individuals scars can be those nice thin flat scars and in other people, they can be very ropy and red and angry looking. And my job as a plastic surgeon is really to try to minimize those scars so the best things that I can do is really evaluate the patient on an ongoing basis and when the scars stay red and ropy then I can go ahead and inject some steroid into the area, or even apply some silicone gel sheeting in order to calm then down.

TERI: You just brought up a really good subject that we haven’t really touched on is that scars are really made by the patient and so what do you do to actually fix scars when there are patients that keloid or do something like that, because I think people don’t really know that you make your own scars. Sometimes it’s not the surgeon.

DR. SUSAN KAWESKI: Right and they often think that plastic surgery occurs without having any scars. And I would dispel that myth because all surgery involved placing a scar. Now it just depends upon how the patient heals. If the scar usually stays red and raised for a period of three to six months after surgery, then I usually inject the scar with a little steroid. And that I do on an ongoing basis. Probably every month until the scar really settles down. Now, in some individuals where they actually keloid, and that’s where the scar outgrows the bounders of the scar. So it becomes a lot bigger than the scar normally would.

In those individuals actually removing the scar and then possibly giving them radiation therapy to decrease or diminish that scar is necessary. So, it just depends. And that’s what my job as plastic surgeon is to look at these scars and then determine how I can help the individual.

TERI: I think it’s so important for patients to realize about their scars, because I think oftentimes that is the most depressing thing but as we said, it is a great trade off when you have a big hanging skin. It’s more preferential to have the scar to have the hanging skin.

DR. SUSAN KAWESKI: That’s right. It’s an individual’s choice.

TERI: Yes, and you have to think about those things prior to going into surgery. Because if you think about surgery and you don’t think about scars then don’t have surgery.

DR. SUSAN KAWESKI: Right. Exactly.

TERI: Let’s talk about tired eyes.

DR. SUSAN KAWESKI: Umm. OK. Well, you know, those happen to a lot of mommies after having multiple pregnancies and a lot of women will say, gosh, you know, my job really depends on how I look and so a tired eye is not a good idea. I want to get rid of those.

And sometimes their eyelids just feel very heavy and saggy and removal of the saggy skin of the eyelids usually solves the problem for most individuals and that’s called a bletherplasty. Now if the upper eyelid skin kind of droops more laterally, that is more towards the ear, rather than the nose, then usually the eyebrow is the culprit. That’s the droopy area.

TERI: Oh, good to know.

DR. SUSAN KAWESKI: Yeah. And the eyebrow actually should be about 3/8 of a inch above the bony rim in females and when the brows fall, the eyelid skin also droops into the line of vision. So removing the skin will shorten the eyelid and in so doing, may pull that brow even further down, so the best treatment for the saggy brow is really a brow lift. And there are different types of brow lifts. There’s an endoscopic brow lift.

Where you use an endoscope, which is an instrument that allows the surgeon to go underneath the skin through very small incisions in the scalp line and then through the use of camera, we’re able to visualize the undersurface and then remove the frowning muscles and then life the brows up.

TERI: That sounds good.

DR. SUSAN KAWESKI: Yes, less incisions and usually most women can go out after a couple days with hardly any bruising. So it’s very, very nice approach. But some women have a very high forehead or may have had some hair loss in that area so a coronal brow lift might be the right choice for them and that’s a bigger incision, goes from one ear to the other ear and you can imagine that there is more of a chance for numbness of that scalp hairline.

But it actually can address some of the deep transverse lines of the forehead. But you have to realize that the hair-bearing scalp will be removed in the process.

TERI: So you’re talking about a scar in your hairline that you could maybe see?

DR. SUSAN KAWESKI: Possibly. If you have very thin hair right there. Yes.

TERI: So what would be the indication then for the endoscopic and the transverse?

DR. SUSAN KAWESKI: Well, usually, most women will choose the endoscopic approach. The coronal brow lift is basically just done if you have to address those really deep lines on the forehead, those transverse lines on your forehead. So, I can’t see those with the endoscopic approach, but with the coronal approach where it opens that all up, I’ll be able to take care of them and cut them out.

TERI: So many women would want to have the endoscopic because there is less scarring and then if you had to you would have the coronal approach and isn’t that the old approach? A lot of women have had that.

DR. SUSAN KAWESKI: Yes. A lot of women have had that. The other thing about the endoscopic approach. Remember that no skin is removed so you don’t really have hair loss. And that’s really important.

TERI: If you can have that.

DR. SUSAN KAWESKI: Yes.

TERI: What about arms? What can we do for flabby arms?

DR. SUSAN KAWESKI: Oh, the old bat wings. Yes.

TERI: That woman are getting, besides pushups.

DR. SUSAN KAWESKI: Very common and if you look in the mirror with your arms like at a 90 degree angle from your body and you see some extra skin or extra skin and fat, or maybe even just plumpness, you probably got some bat wings, that have to be taken care of. And the ultimate result if really to remove them with the smallest scar possible. But a lot of women, you know, they want to wear sleeveless dress or top and it’s really hard to hide scars in that area.

So first you have to judge whether or not that area is just fat or if it’s fat and skin. And usually if it’s fat, you can just liposuction that area. Now, if the skin is not elastic it will not tighten up so you will have to have skin removal and that means a larger incision. So the incision for that will usually go from the elbow up into the axilla or armpit area.

TERI: And how’s the recovery on that?

DR. SUSAN KAWESKI: Recovery is about four weeks. Again, the biggest complaint is swelling, even swelling down in the fingertips, because you are removing lymphatics, which are necessary for drainage of all that tissue and so the biggest complaint really is swelling. But again, it’s surgery. So we have to be patient and that means no heavy lifting, greater than 10 pounds and no strenuous type of activity to further that swelling and make it worse. Because if you can get rid of the swelling at a fast rate initially, then you don’t have to deal with it later on.

TERI: right, so you really need to take care of yourself and get some good help, whether it be a family member or a professional to come in and help you. Do you often recommend that your patients if they have had more than one procedure go to a surgery center overnight care or do you think that they could recover at home?

DR. SUSAN KAWESKI: It just depends upon the family situation. If they have a very supportive family member or friend that’s going to be with them, oftentimes I will just send them home. But if I feel that they have really no support, then we’ll plan for a stay in an overnight facility. Where they can be looked at and taken care of and it really just depends upon their situation. Everybody is different.

TERI: Well, I want to ask you one last question. I think we are running out of time. This is so interesting. We’re going to have to have you back. Leg veins.

DR. SUSAN KAWESKI: I’m sorry. I didn’t hear what you said.

TERI: The leg veins.

DR. SUSAN KAWESKI: Leg veins. Oh, leg veins. Well, leg veins, there are two types actually. There are those small little spidery veins, less than a millimeter. They are very tiny. They are oftentimes like blue. You may see them through the skin. And those can be usually lasered, but when you get one with a little bit of a wider vein where it actually can result like in a rope, you may need to have sclerotherapy performed on that vein, or sometimes that vein may even need to be stripped. And it really depends.

I assess the patient laying down and then standing up, because I want to see exactly where the veins are filling and if I feel that the veins aren’t involving a certain group of veins where they are better stripped, I may send them to a vascular surgeon.

However, if they are just simply a cluster of veins, usually they are very amenable to scleratherapy and or laser. So, I use both in my practice.

TERI: Well, that’s so good. I think we have covered almost everything. I think we need to have another session so that we can cover a little bit more. I’m pretty sure that all the moms out there are going to be able to come in and get your book.

DR. SUSAN KAWESKI: If you go to personallifemedia.com, you can link up to Dr. Kaweski’s website and also get a copy of her book, “The Mommy Makeover: A Woman’s Guide to Beauty” and makeovers and we’re going to be able to link you so you can actually buy that book.

She’s located down in San Diego so we’ll also have her contact information and if you would like a transcript of today’s show just go to PersonalLifeMedia.com.

Thank you so much, Dr. Koweski for being with us today. We’ve learned so much and we are going to have you back soon.

DR. SUSAN KAWESKI: OK, Teri, thank you.

(Music at end of show)

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