Inside Scope
Say hello to Inside Scope — Lakeland Regional Health’s podcast, where our experts share insights on today’s popular health topics, hosted by our own Dr. Daniel Haight.
Inside Scope
Is Plastic Surgery Right For You?
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After significant weight loss, many patients find that feeling better on the inside doesn’t always match what they see in the mirror. In this episode of Inside Scope, host Dr. Daniel Haight talks with LRH board-certified plastic surgeon Dr. David Straughan about the role plastic surgery can play after weight loss as well as other reconstructive and cosmetic concerns. From excess skin and body contouring to other procedures such as breast and facial surgery, Dr. Straughan explains how today’s patients are approaching the next phase of their health journey and why setting realistic expectations and understanding options are key to achieving results that feel right for each individual.
Losing weight is only half the journey. What comes next is also very important and involves often plastic surgery. Hello and welcome to the Inside Scope, a podcast from Lakeland Regional Health, where we share the expertise of local experts on various topics important to you and your family. The Inside Scope wants to cover topics inside and out. Most of our previous podcasts have focused on the inside things, such as the heart, the brain, bones, and the joints. But today we're talking about the outside, the exciting field of plastic surgery that focuses on repairing, rebuilding, or improving parts of the body, either because of injury, birth differences, diseases, or to change appearance. Dr. David Strawn is a board-certified plastic surgeon practicing at Lakeland Regional Medical Center and his clinic at the Hollis campus, located between the hospital and Interstate 4. Welcome, Dr. Strawn. And we got a lot of exciting things to talk about. But the first thing I want to mention is you've really had this unique position in the last 10 years to watch, I would say, a huge change in the patients that you're seeing. You're seeing patients that are really aggressively for their own health, reducing weight. And often it's that part you're involved with. Is it that the plastic surgery that may be needed after weight loss? What are you what are you seeing and what kind of changes have you seen?
SPEAKER_01Well, first of all, thank you for having me. This is really exciting. So I agree with you. My practice is um this is a great time to be in plastic surgery. Um weight loss has become pivotal. Um, and it used to be diet and exercise were kind of the avenues to do that, and then surgical weight loss options. And now with the different medications that you're seeing on TV all the time, Manjaro and Ozimpo.
SPEAKER_00Trevor Burrus, Jr. Well, we were seeing the the gastric surgeries, the the surgeries that would help people lose weight, and I was always impressed on how carefully it wasn't all about the surgery. It was getting to know what the patient wanted, it was looking at the effects of losing a large amount of weight that could affect the mind, the soul, the body, obviously. Folks were feeling great, but they also wanted to look as good as they were feeling. What's what are some of the common things you're seeing now? Because now with the medications, they're losing weight without the surgery. So it's been a combination of both. Trevor Burrus, Jr.
SPEAKER_01And losing a great deal of weight. Exactly what you're saying. So they're doing the weight loss to get healthy. Their diabetes is going to be better, their obstructive sleep apnea is going to be better. How about their joints? I mean, uh, that's a lot of weight to be putting on a joint. Everything's going to be better. But after they lose great deals of weight, like 100 pounds in a matter of six months, um, unfortunately, for most patients, when they lose that great amount of weight in that quick amount of time, they lose the adipose tissue, the fatty tissue, but the skin doesn't retract back.
SPEAKER_00So under the skin, before you get down to muscle and the inside organs, you've got the they got the skin and this adipose tissue, which you'll hear is that's the fat layer that that's being reduced for these medicines. So the skin used to be elastic when we were younger, because you know, with with pregnancy, there's stretching of the skin and then going back. But as you get older, the skin doesn't spring back.
SPEAKER_01The skin would stretch out to accommodate the extra girth from the fatty tissue that you were talking about. But after you lose it that quickly in the skin quality, like you said, as we age, it's not not exactly as elastic. It doesn't tend to come back like it would after a pregnancy.
SPEAKER_00Well, that's the amazing elasticity of the skin when you think of pregnancy, and and later we're going to discuss breast augmentation, where sometimes you expand the skin and you take advantage of the skin stretching. Exactly. But here, with weight loss, it doesn't necessarily go back back down. So how do patients sort of uh come to you know ask for the services? Because I think the focus right now has been a little too much on the weight loss part of it and not the bigger picture. And what I've seen with really good weight loss programs, they're talking about who were you, like diabetes and family history, what are we going to do? But then it's like after we're successful, we're not done yet. There's things that you may want as a patient that are important to you. So what's happening?
SPEAKER_01So feeling better on the inside. Um, however, when looking in the mirror, not necessarily feeling better. And I've actually had some patients tell me they regret losing the weight because of the amount of excess skin they have. And the excess skin, we all think about the areas like the breast and the abdomen, but that excess skin is literally from the head down to the legs. People have extra skin around their face. The the breast, the arms, the abdomen, the thighs, it it's not just to one area. So these areas are really bothering people when they're seeing themselves in the mirror because they a lot of them are asking, why did I even go through it if I'm going to end up looking like this?
SPEAKER_00Aaron Powell So they see that there are answers to this, but it is part of the bigger story in their in their weight loss journey. Trevor Burrus, Jr. Precisely. Some of the things that you have to offer are would you how would you characterize them as are they trying to be gradual changes? Because I I think when I look in a mirror, I don't think anybody wants to see sudden changes unless you're ready for them. Yes. But if it if it is sort of I know what to expect, how gradual is it? Because surgery can be a wide spectrum, you know.
SPEAKER_01So losing the weight tends to be a little too sudden as far as their change, and I think that is part of the problem. Yeah. Um and then surgery, um, that is a very quick fix, honestly.
SPEAKER_00So the plastic surgery.
SPEAKER_01Precisely. I'm sorry, I'm talking about the plastic surgery, the skin removal surgery. Whether it's of the breast, you know, skin tightening procedure of the breast, we can literally take someone to surgery in a two-hour surgery and have them wake up with breasts that are completely different and in my opinion, in the patient's opinion, better.
SPEAKER_00Right. And that was well understood. I think some of the tools you have in both uh imagery uh predictive before and after photos, that's gone a long way for patients to know what exactly is going to happen. Because as we'll discuss later, you know, the board-certified plastic surgeon and those who are really understanding their patients well, like you're getting to know them, you're asking what's most important to them.
SPEAKER_01Exactly.
SPEAKER_00You're really helping with the technology you have predict this is the expectation, and that is our goal. That's the that's the beauty of plastic surgery. Whether you're correcting a uh something that had happened at birth or due to a disease or due to a desire of the patient. You're really trying to get the the the outcomes that the patient wants.
SPEAKER_011000%. So the pre-op conversation that I have before surgery, I should say, the conversation I have with my patients, I think is almost the most important conversation, even compared to those after. Because the first thing that we're gonna do is I'm gonna sit down with the patient, I'm gonna say, what's bringing you in today? And they're gonna tell me I'm interested in having breast surgery. And then I specifically ask them direct questions like, what is it about your breast that you want to see different? Because it may be something that I'm not even thinking about. And the most important thing is not what I think, what their husband thinks, what their brother thinks, it's what they think and what they want.
SPEAKER_00Have you ever had a patient say to you, I hadn't even asked myself that question? All the time.
SPEAKER_01They just say, I want to be different. And I say, Well, there's a lot of different things. And that's when the nuances come out. We say, are you considering more volume? Are you considering tightening of the skin to have a more lift? Because are you considering smaller volume? And those time of pointed questions, and then we can kind of start going down that road and figuring out exactly where we need to go.
SPEAKER_00Aaron Powell, I I think the the satisfaction of what the patient feels is so much increased by getting a good start. And I noticed that a lot of the surgeons we've talked to, and you're saying the same thing. It's not all about come to the appointment and have the surgery. You're getting to know the patient, but you're also saying sometimes surgery is not the immediate issue. It may be more questions or think about it, sleep on it.
SPEAKER_01Yes.
SPEAKER_00I I bet you have a lot of patients that have done the opposite. They've researched it. They they know exactly they're the they're probably the some of the most best educated patients, and they you get that comfortable feeling. I whenever I work with a patient, is like, okay, you've done your homework, you've come in with the right questions, you've looked for the board-certified surgeon, and you've also uh had realistic expectations. Exactly. Not just what's going to happen two hours after surgery, but what what's gonna look like uh two years after surgery, three years. Interesting. Um and I and I think that that that that's a huge help. You know, it sounds like you want to have your patients in the in in the best condition to have the surgery. So they've had weight loss. You want to, I guess, make sure nutritionally they've done well. Do you often connect back with their primary care doctor about how is their sugars doing, their diabetes, if they have that? Exactly.
SPEAKER_01So we definitely want to do a whole medical review of the patient. You know, we want sugars to be well controlled as far as their diabetes. We want um, you know, other issues that may be their heart or something like that, um, something that would preclude undergoing general anesthesia. And I find my and I always tell patients I am a plastic surgeon. I don't pretend and I don't even play a heart doctor on TV. So if you have something like, oh, you had a heart attack two years ago, we're gonna get on board with their PCP, we're gonna get on board with their cardiologist, because I always tell the patients they know you better than I do. I'm meeting you right now. So I need someone that's been following you for the last two years or three years that can tell me, is so-and-so ready for this surgery? Is their heart ready for this surgery?
SPEAKER_00Is there some optimization that we can do? I we were talking about a patient earlier today in a in a class I was teaching about uh 40 years ago, the patient had open heart surgery as a child. And you know, it it didn't come up in conversation. Have you had any surgeries? And the patient said no. Yeah. But there's a big scar in your chest. Exactly. So that helped them get ready for surgery. I I like how you mentioned the diabetes because that gets into the healing of the surgical process. High sugars, slow healing, increase risk. Getting the fine-tuning, I love that. You know, if if you're a diabetic, do you know what your hemoglobin A1C is? That lets you know how your diabetes is. I'm glad you're connecting with the doctors and you got that my chart.
SPEAKER_01Exactly.
SPEAKER_00How how do how do patients uh access you after the clinic visit? Is there a way they can connect with you?
SPEAKER_01So I always tell people after they see me, there's three ways they can contact me. They can come see me in my clinic a thousand times. I'm happy to see them. Um but if that's inconvenient, they can either call my office and talk to my staff or me directly, okay, or they can use the my chart function to write messages back and forth. All three are acceptable and all three work really well. It's whatever the patient's comfortable with.
SPEAKER_00Yeah, and I think with technology is evolving, you'll find that sweet spot on what on what you're you know, what you're finding out best. But I think that idea of patients are you know feeling good inside, they want to feel good 100% and and do that. Are there any myths or common questions you want to get folks thinking about now as they're heading down this journey or they're thinking of a plastic surgery or this? Well, what are some common like uh I'm always answering that question.
SPEAKER_01Yeah. So one of the things that I um discuss with patients is my job as a plastic surgeon, regardless of what we're doing or what we're discussing, is to not turn you into someone else.
SPEAKER_00So I'll have You're you're still you, yeah.
SPEAKER_01No matter what I do, I wish I had magic wands, but I don't. I just have my two hands. But I always tell people, because they'll come in and show me a picture of the local celebrity, Kim Kardashian, like I want this. And I say, Well, we're we're gonna make you a better version of you, like you want to be, but I'm not turning you into Kim Kardashian. That's not my goal. Um so we need to you know talk about those pre-op considerations as well. Um, that is one of the myths that I can turn someone into someone else.
SPEAKER_00Yeah, I get that. That's I think a key issue. Now, with uh breast implant technology and reconstruction, breast implant reconstruction, I can imagine there's a number of questions like is this a one-time procedure? Is this you've already mentioned there's a variety of different requests. Uh there's also, is it a two-step procedure? What's some of the common things about that?
SPEAKER_01Yeah. So breast reconstruction is a large part of my practice. Um when you say breast reconstruction, it could be a lot of different things, but generally speaking, it's women that have had breast cancer or surgery for removal of all or part of the breast for whatever reason. And one of the ways we do reconstruct is with breast implants, which everyone knows about. To answer your question, there are different ways to do it. The most common way to do breast reconstruction in America, which is also my most common way, is a two-stage approach, meaning multiple surgeries. The first stage at the time of the mastectomy, we put tissue expanders in. Tissue expanders, what are those? They're deflated breast implants that allow us to slowly and safely expand the skin over the next few weeks as opposed to trying to stretch the skin right after a mastectomy.
SPEAKER_00Aaron Ross Powell, Jr. So they're they're put in place in this in a smaller size, but by themselves with well, with your help, they can get larger without having to take them out. What makes them larger if they're already under the skin? Aaron Ross Powell, so you put them under the skin and they're deflated.
SPEAKER_01And the implant itself, the expander, has a port, just like some women have ports or some patients have ports with cancer. Trevor Burrus, Jr.
SPEAKER_00Yeah, for it to get medicine into the veins, but this is a port into the implant.
SPEAKER_01And you can access that port via the skin through the skin with a very small needle.
SPEAKER_00So it heals over.
SPEAKER_01Oh, exactly. And you can add air safely to that expander to stretch the skin.
SPEAKER_00Aaron Powell So it gets bigger and it gently stretches the skin. And then when it's at the right size, you can put the more which is the second procedure is the more permanent breast implant that everyone knows about. Oh, excellent. Is there any particular advice or common questions you have about those?
SPEAKER_01Aaron Powell Yes. A lot of women ask specifically about saline versus silicone breast implants.
SPEAKER_00Yeah, what's on the inside of the implant?
SPEAKER_01All implants have a shell. It's what's filled, is either with saline or silicone. That's the substances that we use. I will say back in the 90s, there were so many stories about women having vague systemic symptoms from their breast implants, like I'm having joint pain, I'm having hair loss, I'm having fatigue, and it must be because I have silicone breast implants. There were so many issues with them in the media that they actually took them off of the market to do rigorous studies. So they being the FDA. They did these rigorous studies and saw no correlation with these symptoms in the silicone breast implants.
SPEAKER_00Trevor Burrus, Jr. Separate to the issues of a rupture, the implant rupture, which you know those are avoidable or preventable now that that's taken care of. Trevor Burrus, Jr.
SPEAKER_01Yes. But they actually put them back on the market because they were deemed to be safe. So we had this conversation with our patients that silicone has been deemed safe. You can go on the internet and read women or whomever saying, oh, my breast implants caused me this, my breast implants caused me that. But there's been no real uh cause and effects type studies showing that. Trevor Burrus, Jr.
SPEAKER_00Well, I think another key issue, and this is true for anybody seeking medical advice, your local physician who's here, you trust them, they're the expert, you have that conversation. Exactly. And and don't be afraid to ask. Be assertive and have your homework, but asking that question, because I need to hear the answers, is what the patient should say. Not what I've read, but I will take that into account. Definitely. I I'm really happy that you're helping people through their decisions. And at the end of the day, it's their their decision. But interesting. And then I think the uh I think it boils down to a common question is will my augmentation appear that it has occurred, or would it not like you know, could a person tell?
SPEAKER_01So again, a lot of this is the discussion you have with the patient. I always tell women, my goal, regardless of if we're operating on your breast, your face, is I don't want it to be obvious that you had surgery. I want it to be a natural result that I want your friend to come up to you if you had a facelift, for example. I don't want your friend to say, Did you have a facelift? I want them to say, There's something different about you. Did you get your hair cut? You're just looking really good and vibrant. I don't know what it is. That's my goal.
SPEAKER_00I'm not going to play you in tennis because you're looking at good shape or something else. Like it's those subtle changes we see. But it's also the selection of doing your homework, but it's also the point about being with a board certified surgeon, but also a board certified plastic surgeon. Definitely. I see a lot uh of choices out there in the community, and I'm glad you're right here in Lakeland. But what what's the what do you go through to get a board certification as a plastic surgeon?
SPEAKER_01Aaron Powell So it's a rigorous process, and I think that it's needed if you really want to be um a safe and competent plastic surgeon. There really aren't shortcuts to becoming that. And that was my goal.
SPEAKER_00Aaron Powell It's yeah years of training. Years of training.
SPEAKER_01So I did general surgery residency first, so I am a board certified general surgeon as well. And then after that, you do three extra years of fellowship training for plastics.
SPEAKER_00Three extra years, yeah.
SPEAKER_01Yeah. So and again, my goal was to be a safe and competent plastic surgeon. And I thought that the only way to do that would be to do this training. Trevor Burrus, Jr.
SPEAKER_00Yeah, and to have that service available, and also to be approachable. Uh, you know, even before, and it's not all about the surgery, it's about getting to know the patient. We've talked in the past about what matters most to the patient, and you're getting to that information because that's what everyone should ask of their doctor. The I should be asked what's most important to me. Sometimes it gets forgotten in the discomfort or the mission or I want to get this done. You know, part of it is when you're when you're getting to know your patient so well, um, your patients are not only getting to know you, they're getting to know your team. And over at the the Hollis campus, your team at the clinic and your team in the surgical suite, they're top-notch. Uh what do you what so tell me a little bit about your team.
SPEAKER_01I am the luckiest person in the world when it comes to my team. Um they take care of me, and more importantly, they take care of my patients.
SPEAKER_00Uh, they're looking out for the patients, yes.
SPEAKER_01It's all about the patients. They are answering a phone, they are going the extra step by filling out any sort of paperwork. They are doing whatever needs to be done to help the patient, and I can't thank them enough for all that they do.
SPEAKER_00Aaron Powell Oh, we really appreciate it. Legment Regional Health is blessed to have both our promises that all of us make to help the patients be ambassadors. It's just an amazing organization. That is great.
SPEAKER_01Yeah.
SPEAKER_00Well, I'm glad you're here in the community. I'm glad you're helping us out explain these topics. Um, you'll be around maybe for some future conversations. So great. Well, thank you very much. I appreciate everything that you're doing. You're welcome.