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‘Mummy Makeover’ with Consultant Plastic Surgeon Dr. Mohan Rangaswamy – Welcare Hospital

Please can you tell us a little more about the Mummy Makeover?

This is a catch phrase that describes the set of procedures that are done on a woman to correct undesirable changes to her body that are brought about by pregnancy. Many women seem to shed the excess weight easily and don’t even have stretch marks! They remain in the minority though. Many of them suffer ‘weighty issues’ for which proper diet and exercise in combination should help. But a significant percentage of them struggle with several issues that seem to be impossible to correct; it is here that mummy makeovers could help.

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Women differ in their bodily response to pregnancy and also in how successful they are in getting back to their pre-pregnancy form. Some women get extreme changes that are permanent. For example, loosening of the abdominal tissues and breasts as well as resistant fat deposits on the hips, flanks and thighs are some common problems. Some women develop excessive loosening or shrinking of the tissues in and around the vagina after natural birth. Then again there could be issues with the C-section scars or with improperly healed episiotomy scars. These problems cannot be corrected without surgery; unfortunately they do not respond to the diet-exercise combination.

Women suffer silently with these problems and consider these to be unavoidable after pregnancy. Secretly, they would like to do something about it if at all possible. The good news is that with a judicious combination of modern plastic surgery techniques, much of this can be set right. In combination with sincere efforts by the woman towards diet and exercise, such mummy makeovers can help her become a ‘yummy mummy’.

Who qualifies for the makeover?

Any woman who finds it difficult to lose unwanted fat from certain areas, or finds her abdomen very soft and wobbly, or finds that her breasts have sagged or deflated very significantly, qualifies for such treatment. It is all to do with the degree and severity of changes and whether or not the woman has made honest attempts with dieting and exercise to lose the excess weight accumulated in pregnancy. Issues of post delivery dissatisfaction with the genital appearance or function also can qualify a woman to consider such makeovers.

A simple test will tell you if the abdomen can be improved by exercise alone or if surgery should be considered. Try to get up from a lying down position without using the arms [as in abdominal crunch] and look at the upper and mid abdomen. If it bulges out, there is a gap in the muscles and you might have muscle separation which needs surgery. Again, loose pouchy skin and tissues that one can grab with two hands is not going away with exercise.

What exactly is done in such makeovers?

First we listen to her problems and then analyse her body to decide whether the issues can be resolved by modifying her lifestyle/diet/exercise. Only when it is deemed that the problems cannot be solved by diet and exercise do I offer surgery. In fact, surgery and exercise are complementary and not a substitute for each other.

A combination of surgeries such as a full or partial tummy tuck, liposuction, breast refilling by fat grafting or augmentation by implants, vaginal tightening and fat grafting or body contouring-type liposculpture are the techniques used to do the makeovers

Are there any procedures that are done for the face as well?

Facial procedures are rarely needed and are not a regular part of the mummy makeover, but women do benefit from lasers/peels, advice on pigment lightening and sometimes facial fat graft/fillers. Some women notice that during their attempts to lose their pregnancy weight gains, their face became smaller and deflated. This paradoxical fat loss happens to some women and thus acts as a dampener on their efforts to lose excess body fat.

Many women have told me that when their face started looking haggard, they abandoned their efforts to lose weight and regained the fat around their hips but their face did not improve! Strangely, in some women, if the facial fat is lost, it does not come back so easily. Such women benefit from fat grafting to face. In this procedure, fat is harvested form hips or thighs and given to the face by using very thin needle-like blunt cannulas. There are no cuts or marks on the face.

Does fat graft stay? We hear that it is only temporary and lasts 6 to 12 months.

This is incorrect. Fat grafted by older techniques used to be erratic in its survival. But the modern micro-grafting method is gentler on the fat and leads to a long lasting and, I believe, permanent enhancement; I have not had to repeat it in the majority of my patients. The method is being continuously improved.

How long will the patient need to stay in hospital? And can they have all the procedures done at the same time?

Patients typically stay overnight if abdominal procedures are included. If it is only breast or genital or limited liposuction, they may leave the hospital on the same day. Sometimes, if numerous procedures are needed, we may split them into two sessions about one month apart.

Do they require any follow-up surgeries or is this a one-stop makeover?

Usually it is best to do this makeover after a woman has finished having children, as obviously a future pregnancy can undo some of the gains. It is of course very important to follow a healthy lifestyle and maintain a stable weight. A minority of cases may require some touch-ups later on.

Are any other doctors / specialist involved?

These are procedures usually performed by plastic surgeons experienced in each of the individual operations and who are able to combine these with low complication rates. But depending on local practice, a gynaecologist may be included in the team to carry out certain procedures in the genital area. Many plastic surgeons carry out the vaginal procedures themselves.

A dermatologist may be consulted for facial pigmentation issues. Of course an important external team member is a good physical trainer who can advise the right training regimes for the woman.

How is the vagina procedure in the mummy makeover different from muscle repair done after an episiotomy?

There are some differences. An episiotomy repair is simply a repair of the cut made to widen the birth passage, it may also involve repair of the cut muscles. This should, in theory, restore everything properly. However it is not uncommon to see that the repair has failed. This may be due to the fact that the cut muscles retract and may not be well visualised and so missed during repair. Or it may fail due to minor infection or stiches cutting out. At the time of delivery, conditions may not be ideal for a good repair, also the focus at that time is on several other aspects of the childbirth process.

However, in later repairs as performed in the makeover, the tissues are better and focused attention can thus be give to a proper muscle repair. Other ancillary procedures may also performed in a mummy makeover, such as reduction of over stretched labia, fat grafting or trimming of excess mucosa as well as mons lift. Many of these procedures also try to address any local issues that may impact on sexual satisfaction. Thus the genital procedures done as part of the mummy makeover go far beyond a simple episiotomy repair. A plastic surgeon is able to marshall several principles of his/her art and science to rejuvenate this area as well. This is a new frontier in aesthetic surgery for the 21st century.

Finally, what can women do during her pregnancy to prevent such extreme changes?

We do not have all the answers yet. For instance, it is a mystery why some women get horrible stretch marks while some escape them even after a twin pregnancy. It may be to do with the end-organ response of the individual person’s skin to the pregnancy hormones, in some the skin stretches and recoils back while in the less fortunate, it splits, leading to stretch mark scars: such skin does not recoil back after delivery.

Speaking in general terms, she must maintain the correct weight gain by being careful with healthy eating and regular exercises, use moisturiser and gentle stretching massages for the abdominal skin from the first trimester and wear good breast supports. Some believe that cocoa butter and vitamin E can prevent the stretch marks, the evidence is not strong though. Early treatment of red stretch marks by IPL light treatment may help.

To book your appointment with Dr. Mohan Rangaswamy, contact Welcare Hospital on 04 2827788


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