Ask a Plastic Surgeon with Dr.J

This week, Bree is taking all of your burning questions about plastic surgery and asking a plastic surgeon for you! This is not an episode to miss!

Payam Jarrah-Nejad, MD, a Beverly Hills plastic surgeon better known to patients and colleagues as Dr. J, has performed countless successful surgeries on thousands of patients from all over the world. Dr. J is known throughout the Los Angeles Area medical community as well as beyond it, for his record of outstanding outcomes and his engaging, patient-friendly personality. Dr. J has been certified by both the American Board of Plastic Surgery and the American Board of Surgery.

Find out more about Dr. J on his website https://www.drjplasticsurgery.com/

Learn more about Bree and her programs at www.bodybybree.com or follow her on Instagram https://www.instagram.com/bodybybreefitness/

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SPEAKER_01 0:01

Are you looking for a space where you learn straight out and screens? Another of three. Those who are ready to feel inspired and motivated to live a more purposeful life. Let's grow together.

SPEAKER_02 0:38

Hi everyone. Welcome to the Better Me podcast. Today we have a special guest with us. And I am so excited because he is pretty special. We have our very own plastic surgeon, Dr. J on the podcast. Welcome, Dr. J.

SPEAKER_00 0:54

Hi, Brie. Thank you so much for having me. Really appreciate it.

SPEAKER_02 0:58

Thank you for joining us. I absolutely love Dr. J and everything that he stands for. Not only was he awarded LA's best plastic surgeon, but he treats his patients with compassion and he takes the time to walk you through exactly what's happening and why. So I really love him for that. He educates you. He's also a double board certified surgeon and his practices in Beverly Hills, but he has people flying in from all over the world just to see him. He's rated in the top 10 plastic surgeons by the National Academy of Plastic Surgeons. He's been featured in Cosmopolitan Magazine. He's a celebrity plastic surgeon, and you would never know because he is the most down-to-earth doctor you'll ever meet, because he makes everyone feel important. We're so excited to have you. Are you ready?

SPEAKER_00 1:50

I'm so ready. I really appreciate the introduction. Um, and um I'm so delighted uh to be on your podcast, and I have so much respect for you because you're not just a uh personal trainer, which I know many. Um I love how you take a multidimensional approach uh to the body uh as a personal trainer. Uh you have a very open mind, and you're very open to all aspects of the body, not just plastic surgery, but I see how you take care of your clients uh as far as nutrition, diet, as far as their activities, daily living. And uh that's why I have so much respect for you as well. And I accepted uh to be on your podcast, and uh I really appreciate this meeting.

SPEAKER_02 2:39

Oh, thank you. You're the nicest.

SPEAKER_00 2:42

Yeah, absolutely.

SPEAKER_02 2:43

I appreciate that. Yeah, that just goes to show how sweet he is, he really is the best.

SPEAKER_00 2:50

Absolutely. It takes one to know one.

SPEAKER_02 2:53

All right. Well, when I asked my followers what questions they wanted to ask a plastic surgeon, a lot of them were centered around surgery after having kids. And we all know how hard that process can be for moms. And I never want women to feel like they have to get plastic surgery. But I also am not against a woman just wanting to feel her best and take care of things that have been stretched out and torn apart. So obviously, I'm a personal trainer and I believe that you can do a lot to improve your body with hard work and the right nutrition. But there are also some things that you cannot fix on your own. For example, loose skin, diysysis recti, umbilical hernias, or even like sagging breasts. So let's chat about a couple of these. And like the first one that I, the first question that I had from a from multiple clients was how do you know when you need to get surgery to repair your ab separation or when you can fix it on your own through exercise?

SPEAKER_00 4:00

Well, that's a really good question, uh, especially uh from me, because as you mentioned uh during your introduction, I'm a double or surgeon. So I can answer that not only as a board certified plastic surgeon, but also as a board certified general surgeon who did hernia surgeries, and I've done hundreds of hernia surgeries as a board certified general surgeon before becoming a board certified plastic surgeon and doing thousands of abdominal plastics, pendicolectomies, abdominal wall reconstructions for trauma, uh burns, and many other reconstructive reasons. So I'm very familiar with the abdominal wall, and um now I've dedicated my entire practice to uh aesthetics, and uh one of my uh most common uh surgeries is mommy makeovers, which basically is bringing back moms' bodies, and that's why it is called mommy makeover. So basically, we reverse all the changes moms go through during pregnancy. To clarify, there's rectus diastasis and there's hernias. Rectus diastasis is a normal phenomena that some abdominal walls will go through during pregnancy. During pregnancy, the hormones, estrogen, progesterone, will go up to loosen up the ligaments and some of the structures to prepare the abdomen to carry a child and eventually deliver the baby through the vagina. So obviously the vagina itself will get will be prepared to stretch out, and everything else will be prepared to stretch out. Now, after the delivery, the linea alba or the structure between the two rectus abdominis muscles may not contract back. So that separation between the two muscles will be called rectus diastasis, or in other words, very simply put, separation of the muscles. So that's the rectus diastasis. The difference with the hernia is that it does not have a sac, it does not have a distinct sac. So that is a difference. Some of my patients ask, like, is there a hernia? Do you feel a hernia? Do I need a hernia repair? And it's a very good question. Uh, and it may be accompanied with a hernia, which most comp most commonly would be a umbilical hernia or a belly button hernia, which is above or below the belly button, uh, which is going to be a very distinct um uh uh defect, and there's going to be a sac coming out, and you could actually feel it with your finger, and there's gonna be a sac coming out that'll be a hernia, which could happen during pregnancy as well. Um so now what to now what are we gonna do with uh rectasiastasis or the hernia? Hernia is a separate procedure. We have to do a hernia repair, we have to reduce the hernia, put the contents back into the belly and repair it. It'll depend on the types of the hernia. Sometimes we have to repair it with a mesh. If the defect is too large and we can't bring the two edges together with sutures, we have to place a mesh uh to reinforce it. Um it's a complete different surgery.

SPEAKER_02 8:23

And you can't do that, you cannot repair a hernia on your own, correct?

SPEAKER_00 8:28

No, no, there's no way repair a hernia on your own. No, right is a complete surgical procedure and uh it's medically necessary actually, and it's right, you know, and it's covered by insurance too. It's something that could become very dangerous because the abdominal contents, like the bowels, for instance, uh it could actually come into the hernia sac and it could get stuck. So um uh, you know, they they say it could get incarcerated, so to speak. And it could block off the blood supply, and uh, you know, it could get very dangerous. It could die for lack of a better way of saying it. It could get strangulated and uh it could lose blood supply and uh it could get very dangerous. So it's something that needs to be addressed and it needs to be repaired, and um obviously it's something medically necessary, so it'll be covered with it by insurance. So you simply look at your you know your insurance and you see, you know, the surgeon on your plan, on your network, and you go to that surgeon and you get repair, you have it repaired. It's completely something separate from rectus diastasis.

SPEAKER_02 9:47

Right.

SPEAKER_00 9:47

Rectost diastasis is not something medically necessary, it's more of an aesthetic issue. Now, when it comes to um aesthetic issue, um it's it's something that um you know it's not like necess medically necessary, but it becomes like do we really need to address it or do we not need to address it?

SPEAKER_02 10:12

Well, and sometimes when you're like when you have such a wide gap, it can really cause like back issues, right?

SPEAKER_00 10:21

Thank you. Exactly. See, that's why I know you you address things in a very uh open mind, uh in a multidimensional uh uh perspective. Exactly. So just like you said, when you have a loose abdominal wall, the loose abdominal wall itself may not be the issue, but it can contribute to other problems. And we do have referrals from neurologists that that uh the loose loosened abdominal wall is causing like back problems. So um we do repair it secondarily, and um what we need to do is uh we literally go back and and uh at the time of the tummy tuck, we repair the abdominal muscles and we bring the two abdominal muscles back together with sutures, and uh we literally bring the muscles together from the xiphoid with the from the little bone at the chest wall all the way down to the pubic area.

SPEAKER_02 11:27

So when you're um checking, when you're doing an exam, is there like, oh, if you have two fingers or greater, you need you need surgery to repair it, or is there any type of rule with that rule of thumb if people want to check on their own and see how big their gap is?

SPEAKER_00 11:46

No, there's no, I mean it's very tough uh to uh really know that uh you know you for you to tell uh really it's more symptomatic and it's a uh matter of like a choice.

SPEAKER_02 12:00

Yeah. And a lot of a lot of women it'll be like a pot belly, right? Like it'll help it'll make them kind of look like they have a pop belly because it's so stretched out.

SPEAKER_00 12:10

Right, right, right. And yeah, these are some it these are some of the things that uh best is to you know find an honest plastic surgeon, you know, and just have a like a nice thorough consultation and just review it with them. And like you said, you or like a uh personal trainer like yourself. Yeah, you look at each, you know, you look at the your client, you look at him, and you press on the tummy, and you can feel, I know you can. I know you can easily press on your tummy, look at the edges, and uh knowing you, you can easily feel the edges of the rectus diastasis and say, hey, listen, you know what? This is something that uh we need to address this, and we need to bring the edges together.

SPEAKER_02 12:58

Right. So can you repair diastysis recti without a tummy tuck?

SPEAKER_00 13:05

Uh no, no. There's there actually uh when it comes when we say repair, repair is only with a tummy tuck. You only bring in the when when you say repair, that itself says it has to be with a tummy tuck, and we have to correct it or repair it, and we have to fix it with a tummy tuck, and we have to like uh suture the two edges back together and uh strengthen the abdominal wall with uh uh through a tummy tuck, basically.

SPEAKER_02 13:42

Got it.

SPEAKER_00 13:42

Yeah.

SPEAKER_02 13:43

So sorry, go ahead. No, I'm sorry, you go.

SPEAKER_00 13:47

Uh, in fact, um, like crunches will make the uh rectus diastasis worse. Crunches, like any exercises that targets your rectus diastasis, or like these yoga exercises, like a down dog, up dog, or any of these exercises that focuses, targets your rectus uh uh abdominus muscles will make it worse. If any exercises, now you would know this better than me, but any exercises uh would be like the would uh would be before doing it would be good or after, if anything would be the external obliques or um anything that does not focus on the rectus diastasis, but anything that would be focused on it will actually may turn the rectus diastasis into a hernia.

SPEAKER_02 14:40

Yes, that's why I'm always stressing to have the correct education after you have a baby. You can't just go and start doing like a million crunches to try to bring the abs back together because it could pull them farther apart. Exactly. So I'm glad that you said that. So, how soon after you have kids can you have a tummy tuck or a mommy makeover? Is there a certain amount of time that you suggest waiting before you want to do that surgery?

SPEAKER_00 15:04

Very good question. So the best answer is you have to be at your stable weight. I can't give a timeline because um it differs from one person to another because it may take one person three months to get back to their stable weight. It may take one six months to get back to their stable weight. So, generally speaking, from what I've seen, um, I've had patients, they've been very anxious to uh have their bodies back. So we've had mommy makeovers three months after delivery, after their babies. And I've had patients uh uh back to their stable weight six months. Generally speaking, safest would be one year. A year after is where is like uh you know, you you know, it's like a good timeline. But we've had ambitious uh, you know, moms who really just they know this is going to be their last child, and they they already have their mindset to have their bodies back. So it's right after we've had we've had mommy makeovers, and they already were had their mindset not to do any breastfeeding, and um, you know, they've come and they've had their breast lifts, hogs, and their tummy tucks, everything uh all together.

SPEAKER_02 16:29

Awesome. Thank you. So I know let's talk about loose skin. I know that some women are really uncomfortable. I haven't ever had a C-section myself, but you know the flap of skin that hangs over a C-section scar. Yes. What would you do to help them? Would that be a tummy tuck, or is there a way to help with that loose skin that hangs over?

SPEAKER_00 16:52

Sure. So um when it comes to skin, it varies so much from one person to another. It's it's all over. So it all comes down to genetics and at the same time how you take care of your skin uh with nutrition, or simply put, um, just sun, avoiding sun and using moisturizers. Very easy. So uh it all comes down to skin elasticity, no matter what the ideology is and uh how um you come to it, it's skin elasticity. That's why you see some girls just after one baby, uh they would they may have a lot of stretch marks and they may have a lot of loose skin, or they may have like one weight fluctuation, like one uh you know, weight loss of 30 pounds, and then they may have a lot of stretch marks and like loose skin. And then you have you may have you may see moms with five babies and they're fit as like nothing happened, they have skin. So it all comes down to skin elasticity, and what determines skin elasticity is genetics, that's the most important one, and then we have other factors such as like nutrition and how you take care of yourself, uh, you know, avoiding sunlight and you know, all the other minor factors, but it's mostly genetics. Having said all of that, let's get back to the question the c-section scar and the skin flap over it. The c-section scar heals different, and that has two factors. One obviously is the patient and everything else we just said, but the other one um is how it's sutured. Sometimes, if it is sutures down to the fascia, which is the underlying layer, that will cause um the irregularity that you see, and that may um cause it to scar um uh in a way that the skin over it over it will kind of like uh form a little bit of um you know uh little flap for lack of a better way of saying it.

SPEAKER_02 19:15

Right.

SPEAKER_00 19:15

So um, so uh it's it's a few things. So it may heal in a way that the overlying skin may like scar down and attach to the underlying fascia over time, or it may be sutured to the underlying fascia, um, and the skin will like uh hang over uh the scar, or it may just be after pregnancy the skin will not retract back, and no matter how the scar heals, that skin will hang over the scar. So there are many reasons for it, but the solution's easy. That is uh that does not need like muscle repair or anything like that. Those uh we just remove that old scar and we remove that little bit of a skin, um, and the recovery is extremely easy. It's like two, three days of like uh just like um uh you know, babying the scar, so to speak, and uh that's all it takes. I mean, like you can have surgery. Yeah, that surgery is very easy. You can uh if you have especially if you have an office job, you can have that done on a Thursday or Friday and go back to work on Monday. Um very easy scar revision. We remove the scar, we remove that excess skin because there's no um muscle repair and there's no like uh excess uh you know uh skin removal. It's just uh you know, there's no muscle pull, there's uh no tension on the incision. We're just removing that excess hanging skin, which is already there. You know what I mean?

SPEAKER_02 20:48

Yes, yes, so helpful. Thank you.

SPEAKER_00 20:51

And at the same time, uh the patient can have a pubic lift because the pubic area uh could get stretched out during pregnancy, uh, or as a result of the same scar, uh, which may not be as noticeable, but the at the same principle that you see the abdominal skin hangs over when they lay down, the pubic skin actually will look kind of normal. Uh same principle we uh not only pull down the abdominal skin, same principle we pull up the pubic skin and we tighten up the pubic area. All can be done all at the same time.

SPEAKER_02 21:31

And uh that's super helpful.

SPEAKER_00 21:33

Yeah, two or three days, yeah. Very easy surgery.

SPEAKER_02 21:36

Awesome. That's good for my clients to hear because I know a lot of women really struggle with that. So that's really helpful to know that there's something they can do about it. They don't have to live with that. So let's talk about implants. I know a lot of women have implants, and one of the main questions that I get is can you work your chest after you get implants, or do you want to stay away from lifting your chest specifically?

SPEAKER_00 22:00

Very good question. So um so the answer is yes. The answer is yes, but there's two ways of um having your implants um over the muscle and under the muscle. Um overall, uh under the muscle is better than having it than over the muscle. Now, there's no such thing anymore, at least uh when it comes to a reputable plastic surgeon who's who does breast augmentation, there's no such thing as completely under the muscle anymore. Um that it's an it that's a very old-fashioned way of doing it, which is called submuscular or under the muscle. Um when it comes to placing the implants under the muscle, plastic surgeons, the board certified plastic surgeons, the teaching is to do it dual plane fashion, which means 90% of the implant is under the muscle, and then 10% of it kind of sneaks out at the bottom and forms the nice round shape at the bottom of the breast, which forms that round shape. So a good plastic surgeon will shape the bottom of the breast to make it nice and round, and then the implant will maintain the roundness of the bottom of the breast. No matter how if it's a tubular breast, because not all breasts are shaped round at the bottom, but a good plastic surgeon will shape the bottom of the breast round and then will have the implant maintain the roundness. So the implants are planned in a dual plane fashion, which is the same thing as saying the implants under the muscle as opposed to being over the muscle. Right? Right. Okay. Now, there's no question that the implant being under the muscle is better than being over the muscle. Uh the implant being over the muscle will show more. So let's let's go pros and cons. Let's do the easy one.

SPEAKER_02 24:13

Yeah, I love that. Okay.

SPEAKER_00 24:15

Yeah. All right. Let's go with the easy one, which which is which is more palpable. So the implant being over the muscle. All right. So when the implant's over the muscle, it's more palpable, right? Uh, you see it easier, especially if the patient doesn't have much breast tissue. The implant is in direct contact with your breast tissue, right? Um, the implant will sag more because obviously the only thing holding on the implant is the skin, right? Right. And uh the chances of the most common complication after a breast augmentation, which is capsular contracture, is much higher, right? Because uh the inflammatory process, which can be um uh caused around the implant, initiating the capsular contractor will have a higher chance when the implant is over the muscle. So for those reasons, um the implant being over the muscle is less preferred.

SPEAKER_02 25:21

Got it.

SPEAKER_00 25:22

Got it? Good. So now let's talk about the implant being under the muscle, right? Which is dual plane. Okay, so when it goes under the muscle, we have two types, completely under the muscle and dual plane, but like we just talked about, there's rarely surgeons do under the muscle, rarely. I mean, I don't know of any surgeon that does it completely under the muscle anymore. Um, so it's dual plane, at least in the hands of reputable surgeons, or most not all the surgeons that I know of, or they should be doing it.

SPEAKER_02 25:58

Okay, good.

SPEAKER_00 26:00

So when it comes under the muscle, there's one, so all the things are good. So there's much less chance of capsular contracture when it's under the muscle, right? Um and um the implant will well, the shape is much better, you're gonna have more chance of having the teardrop shape, the implant's going to be much less palpable, uh, it's gonna look much more natural, and um it's gonna be much more durable, and um the only one problem you're gonna have when the implant's under the muscle is uh what's called animation because uh the implants under the muscle. So if um you contract your pec muscles, uh the implant will move with the pec muscle. That's called animation. That's basically uh one of the uh only issues that we have with uh implants being under the muscle. So um uh when we have like uh patients who like do a lot of like um like sometimes when uh patients are like bodybuilders, for example, or patients are really like want to like build up the their pec muscles. So this is something that we really discuss with them, and we really have to make sure that uh they really understand the difference between under over muscle, the pros and cons, and uh the difference between the animation and non-animation, and and uh so they really know uh uh the differences and to make a well-informed decision. But um, aside from the animation, from all other aspects, still the dual plane is preferred over uh uh being completely under muscle or over muscle.

SPEAKER_02 27:54

So even if you get your implants under the muscle, do you need to be careful of lifting your chest so it doesn't pull the implants farther apart, or does it not matter at all?

SPEAKER_00 28:06

Yes, no, it does. So it does. So the when the implants are under the muscle, the more you work your muscles, um it'll pull them farther apart, right? It will pull apart, yes. Okay. Contraction, there's a chance that um, you know, it will pull apart and you know, go toward um, you know, pull away from your cleavage, so to speak.

SPEAKER_02 28:27

Got it. Okay, that's so helpful.

SPEAKER_00 28:29

Yeah.

SPEAKER_02 28:30

So um, okay, so what are your this is the biggest question, what are your thoughts about implant illness? I know that's a loaded question right now.

SPEAKER_00 28:41

Yeah, no, it's a good one. No, it's a good do we do we still have enough time because that's a whole nother subject.

SPEAKER_02 28:46

But uh Okay, how about we how about we skip implant illness and I'll just say, well, I'll just ask you like one more question about implants, and then that'll be the end.

SPEAKER_00 28:57

Um, however you like. Um however you like.

SPEAKER_02 29:01

No, it's okay because I like to try to keep them under 30 minutes, and so I think it'll be good, like just to answer, we'll sum up the implant section, and then I'll just say, you know, thank you so much for joining us. If you guys have more questions for Dr. J, let me know, and maybe he can come back or something. And then if we want to tackle that, we can another day.

SPEAKER_00 29:22

Whatever you like.

SPEAKER_02 29:24

Okay. Okay, so Dr. J, do you still have to replace your implants after 10 years?

SPEAKER_00 29:32

Very good question. Very good question. So um, very good question. So there's no such thing that you have to change your implants after 10 years. So it's not like uh you put on your calendar, like 10 years from now, I'm gonna go back to Dr. J and he has to remove and replace my implants just because 10 years. There's no such thing. However, you can't consider uh breast implants a lifetime device. So it's not like now that I have these implants and Dr. J told me that I don't have to change them every 10 years, I'm just gonna have these forever, and uh I don't have to do any other surgery. So you can't think of it that way either. So uh what let me expand on that. So the implants itself, you could have these forever. There's no such thing that at 10 years you have to change them just because. Um, but you have to have an open mind that you may uh want to change them, uh, or you may have capsular contracture, or you may have babies, you may need a lift, you may um um uh want to go larger, you want to go smaller, you may uh for any reason you may need another surgery, but there's and there but there's no expiration date on these implants, and there's no such thing that you have to change these implants every 10 years. Uh in fact, they do have uh, at least uh the ones I use, they have a lifetime warranty. If any time during your lifetime they rupture, they'll give you a free pair. And even if they rupture, the implants are all cohesive. Uh, what does that mean? That means that even if they rupture, um, they don't spread anywhere, they stay in one place. And after the third month, usually the body forms a very thin capsule around the implant, which is very different from a capsular contractor. It's a very normal capsule around the implant, which basically it's a little layer between the implant and the body. So um, even like let's say theoretically, theoretically, the the implant ruptures, um, although the contents will not go anywhere, that's why Centra gave them the name, give, gave the implants uh the name gummy bear, which is completely a uh marketing um uh term, um, which basically implies that they're cohesive, they don't spread anywhere, just like gummy bears, which you bite through it, it doesn't spread anywhere. Um uh uh which is still going to be inside that capsule. So there's no worry about the implants. Uh you can have them forever. Uh, you don't have to change them every 10 years. But when you have these implants, you have to have an open mind that you may need uh more surgeries, but you may not need them and you may not have them.

SPEAKER_02 32:37

Okay, awesome. That is helpful. Yeah, yeah, super helpful. Dr. J, thank you so much for helping us.

SPEAKER_00 32:46

You're welcome, Bri. Absolutely.

SPEAKER_02 32:48

You're so knowledgeable, and you're just so great at answering in depth so that we understand and educate. So thank you. I really appreciate your time.

SPEAKER_00 32:56

Anytime, Bri. Anytime. It was such a pleasure, and I love your questions, and it's always a pleasure talking to you. And I know when you and I start talking, even uh when we meet in person, it can go on and on.

SPEAKER_02 33:08

Yeah, I know.

SPEAKER_00 33:10

I can't believe it's already like uh it's more than 30 minutes. I can't wait. Time just flew by, and it was such a joy, seriously.

SPEAKER_02 33:17

Thank you. I really appreciate Dr. J.