Allowing Time for Healing

            Far too often, patients come to see me in May or June to discuss surgery so they can look good on the beach that summer. I very politely explain that their timing is a bit off and if I did the surgery within the next few weeks, they will look terrific for the following summer. As a rule of thumb, you should allow between three and six months to achieve the optimal result after surgery. The surgical procedure sets the stage, but the healing gives the finished look. Let's look at some procedures and see how healing proceeds.

            The body's initial response to liposuction is that of responding to inflammation similar to a minor burn. Fluid leaves the circulation and swells to suctioned areas. If you weighed yourself the day after surgery, you would actually weigh more than the day before. Over the next week, the fluid leaves the tissues and goes back into the circulation. The body is beginning the healing response and you now go into what the textbooks call the "stage of disappointment." It doesn't look like much of anything is happening. Your clothes fit the same way, or may even be a little snug. The areas of surgery and the skin now begin to shrink. The skin varies in thickness as you move around the body- the skin of the sides is thicker than that of the abdomen; the back is thicker still. The abdominal skin will show definition in about six to eight weeks.  The sides usually take about 12-14 weeks to shrink in, and the lat sweep into the lower back can take as long as six months until shrinkage of the skin is complete.

            With gynecomastia correction, there's concern with both skin shrinkage and the softening and fading of the scar tissue. The surgery is usually a combination of liposuction to the chest and removal of glandular tissue. The liposuctionned areas respond similarly to the abdomen, but there is the additional remodeling of the deep scar tissue and the fading of the skin scar that has to be taken into consideration. The greater the amount of glandular tissue removed, the longer the remodeling will take. You have to view scar formation as two basic processes. The first is the accumulation of the building blocks. The second is the reorganization of these building blocks based on the stresses and directions of stress that are placed on the healing area.

This second process is called the maturing of the scar. The speed of the maturation depends on genetic factors and the amount of stress, and the different vectors of stress, that act on an area. In the immature state, the scar is firm and red. The redness is caused by the increased blood supply seen with early healing. As the maturing of the scar proceeds, the area softens and the redness fades. This does not occur in a linear slope, but rather in a series of peaks and valleys. The area will soften and then become firm again, with the firm periods getting further apart and then ceasing. Massage will speed the process, but it will still take three to six months in most people.

            Pectoral and calf implants also have a period of healing until they achieve an optimum look. The overlying muscles are swollen. In the leg, gravity will swell the ankles, as well. The insertion scars also require time to fade and not be noticeable.

            In all of these procedures, elastic garments are worn to either control the shrinkage of the skin or stabilize the implants during the first few weeks of healing. While these garments will keep you warm in the cool weather, they can be somewhat uncomfortable in the summer heat. This should also be taken into consideration in the timing of the surgery.

            Finally, there is an interruption in training and working out during the healing phase. This can be from two to six weeks, depending on the type of surgery done. You want to consider this as well, when planning for the best summer look. It's important to take all these factors into consideration when planning your surgery, in order to give your body adequate time for healing and recuperation. That will assure you of getting those admiring glances on the beach come summer.