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Dr. Houssock (00:04):
You are listening to another episode of Perfectly Imperfect.

Val (00:08):
Hi, Dr. Houssock.

Dr. Houssock (00:09):
Hey Val.

Val (00:10):
How are you?

Dr. Houssock (00:12):
I'm really afraid that we're going to have rough time keeping this limited today.

Val (00:17):
Has anybody got a timer on this?

Dr. Houssock (00:19):
Someone timing us? So Val and I are exceedingly excited and passionate about this topic. Not that we aren't excited about all of our topics, but this one is very near and dear this hits home. And so we are going to focus on not the only population that we have, but a big population of who we see in our practice, and that is our patients who we see after pregnancy. Obviously there's so much to be said about this patient population, but I think for Val and I, it's so fascinating because before we ourselves were mothers, we of course took care of moms, of patients who had babies. And if we had did this podcast before that we would have a lot to say and we loved that patient and we had all these options and we would be going through all the options.

(01:19):
But since Val and I have now gone through pregnancy ourself and have gone through having babies and the changes that come with that, I would argue that our whole take just, it just elevates. It elevates to a very personal emotional level. So while as a plastic surgeon and a aesthetic nurse, we understand the concept of the mommy makeover, there's just nothing like us experiencing the same things that our patients come in and talk to us about.

Val (01:55):
One hundred percent.

Dr. Houssock (01:56):
So this is very emotional and I will be honest, it's emotional to the point of feeling a little bit tearful about it because, in all the good ways, but also all of the just very being a mom ways. So excuse us if we get emotional today. Right Val?

Val (02:14):
Let's go.

Dr. Houssock (02:16):
So let's just start here. Let's just say the first thing is that I think when you say mommy makeover, I think that in some ways it can be very triggering. And I can't tell you that I personally feel this way, but I will tell you that I have had moms comment to me, especially on social media when I use the words mommy makeover, their explanation to me is, why do you have to make it sound like it's like it's a bad thing? What's wrong with the mommy bod? What's wrong with it? Why does it even need a makeover? And I do really try to personally understand that idea or the concept of that. And I think the reason it can be triggering is because we want women to be so exceedingly proud of what their bodies can do. And we never want that to disconnect from what you can also then achieve afterwards if you choose to for your own self and your own body.

(03:23):
And I think that's the point. There isn't a this or that, it isn't a, well, I either have to be proud and accept what's happened, or I can go ahead and alter myself afterwards and that means I'm not proud or I'm maybe ashamed even of what I've been through. And it's just not true. It's just not true. And I think that's the most important things I want to talk about today is being, having a mommy makeover does not mean that we aren't proud of what our bodies have achieved. It actually means that we, oh my gosh, I almost, I revere at the altar a mother now having experienced it myself. Right, Val?

Val (04:08):
Oh, well absolutely there are my favorite patient populations to take care of because I feel like we get to be their cheerleaders during this experience and it's just so rewarding to see go through for the beginning and then they come back and you can even see the way they walk down that hallway to the follow-up rooms and they're just standing up more proud and just have that glow to them. And it's so rewarding to be able to do life giving things like this because now that we both have been through it, we're just like, we deserve it. And it's just such a rewarding thing to be able to go through that with them.

Dr. Houssock (04:51):
Absolutely. And obviously our moms have been through pregnancy and delivery, and so they also are freaking tough as nails.

Val (05:02):
Oh yeah.

Dr. Houssock (05:03):
They're the toughest nails.

Val (05:04):
Heck yeah. You can get through childbirth, you can get through anything.

Dr. Houssock (05:07):
Yeah, it's the truth. It's a patient population that's easy to work with in that sense. Once you've done that, go ahead bring it on. But I would say one of the things that we do deal with is giving ourselves that time, meaning that, okay, you've given your body to creating a human. And then now this, no one will understand this, but this odd crazy mom guilt that occurs pretty much the minute you're pregnant until probably the rest of your life where you have always this guilt of you should be providing for your humans.

Val (05:45):
Constantly.

Dr. Houssock (05:47):
Constant. And if it's not for them, then why are you doing it? It's mental. It is just very real. And obviously we all learn to acclimate, but for the most part, if you're not doing something directly for your human, you're always just trying to justify it in your mind as to whether or not it's something you should be doing. Right?

Val (06:11):
Right. And a lot of these patients, they come to us after they've given so much of their life and their time to their families and they just come and they're like, I just want to do something for myself because I feel like if I get to do something for myself, then I'm going to be a better partner, a better mom, a better friend. I'm just going to be overall better person. And that's really our goal here is for them just to look at themselves and be like, I'm proud of my skin. I'm proud of who I am. And that's why I love mommy makeovers because we're not just making it over physically, but it's emotionally, psychologically, all of that.

Dr. Houssock (06:51):
Absolutely. Absolutely.

Val (06:54):
That's the one thing, you have to be good to yourself in order for you to be a good mom.

Dr. Houssock (07:00):
And being good to yourself, meaning means being very realistic too. Gosh, there's so much out there. The idea of the bounce back, I mean, I'm going to tell you we see it all, and again, saw this before my own experience, but definitely have much more to share on it now that I've experienced it. And you see women and they talk about the bounce back and gynecology or your OB will clear you at six weeks and then everyone just assumes you're just going to start working out and then your body's just going to come back. And then some will say, well, it's nine months in, nine months out. Okay, so that means now you have nine months to get back to where you were before or else you're behind. Or they'll say, well, technically you're not done until you're done breastfeeding because all the hormones are running through you.

(07:45):
And so, alright, we'll give you a couple of years. You were breastfeeding afterwards, it's not nine months. Maybe we'll give you a year and a half to get back. And so it's always this thought in a mother's mind of when should I be back? And I read something recently and God did I need it, I needed it. The woman said it was like, she was a sociologist or something and she said that all of us who have had babies are trying to chase the Noli Paris or the nonpregnant of ourselves.

Val (08:19):
That's so true.

Dr. Houssock (08:19):
Meaning we're always trying to chase the person we were before we had a baby. However, you can't be that person because you had a baby.

Val (08:31):
Not that person anymore.

Dr. Houssock (08:34):
You made a human inside your organs that was created from two tiny cells and grew to a full human. And then that baby sat in there for nine months and then you delivered it. You cannot be who you were before you did that ever. No matter what, no matter what surgeries you have done, no matter how lucky you are at your bounce back, you will never be the same. And everybody's journey looks different with that. And I would argue yes, you cannot compare yourself to somebody else I know and they know who they are if they're listening. We have a few patients who have had multiple children and you would never know it unless you ask them because they bounced back like that. I don't want to call 'em lucky. Nobody's lucky in this world. You have your own, everyone has their challenges. Those particular patients didn't have the challenge of the body having to bounce back.

(09:28):
And they were fortunate that way. I just think that story is different for everybody. So we need to be nice to ourselves because not everybody can bounce back. And then there are other things that are really positive. I can tell you that before I had a baby, I was very, very fit my whole life since I was like eight, I had a six pack, I looked more athletic build. So I always was petite, but I had more of an athletic body. I didn't really have curves or anything. My son gave me for the first time in my life, a woman's body. I almost went through puberty. I feel like after having him now all of a sudden I finally look like a woman.

Val (10:05):
We have love in all the right places.

Dr. Houssock (10:08):
Yes, I have hips and I mean literally my bone structure has spread, my hips, my bones are wider. I just look like a female, like a real woman now. And so there are pluses, there are pluses to it all. Val, what would you say you noticed are the big changes for you going through it all?

Val (10:30):
Oh gosh. The biggest change was my strength. That has definitely changed quite a bit for sure. Obviously physically, I definitely have more curves than I had before, but I'm okay with it just because I feel like I can now wear different clothes that enhance that.

Dr. Houssock (10:48):
Yes.

Val (10:50):
You know what I mean? And so that's also super fun for sure. And I noticed that my posture's actually a little bit better since that too because I had to really learn to sit up better when I was pregnant, so for sure

Dr. Houssock (11:03):
For support, for support.

Val (11:04):
Oh absolutely. But that's the biggest thing is just like you said, going back to getting curves in the right places and just, I dunno, there's sometimes I'm like, oh, I actually kind of feel sexier than I did prior to having babies. And thankfully I have a husband that's really great about telling me that because we are women and why are we so hard on ourselves, and we overanalyze everything. I also think social media has a big thing to do with it. We see other people and they're like, why do I not look like that after?

Dr. Houssock (11:37):
The thing is they probably don't even look like that. That's the problem with social media is that they'll portray whatever they want online and we all think that they look like that. And it is hard. Like what the hell? I went the same thing they did. Like why, why? And you just do that. You have to realize that your story is different and that it's just not the same no matter what. Some people are tall, some people are short, some people get through pregnancy and some people you can't tell and some people you can't. And it's just reality. And we have to be nice to ourselves. We just have to. And you are.

Val (12:12):
Yeah, absolutely. Do I miss my CrossFit days where I had intense muscle mass and I know I was the strongest I've ever been in my life. I mean, I lifted up all the way up until I had her and it was great. And I felt honestly the moment the week I had her was the best I've ever felt.

Dr. Houssock (12:31):
Isn't that wild?

Val (12:32):
Seriously, I was in such great shape and I was like, well, because I was trading myself for labor pretty much making sure that I was, and now that I had her, yes, I want to go back to feeling strong, but my biggest thing is I just want to be healthy for my daughter.

Dr. Houssock (12:48):
Mm-hmm.

Val (12:50):
And just to teach her just to live a healthy lifestyle. And that doesn't mean diet all the time, but just manage things better.

Dr. Houssock (12:59):
Yes, yes. There's a difference, right? There's a difference for sure. And it is difficult. We live in an aesthetic world. I mean it's our profession and so obviously we're aware of those things, but I think being aware of them and because we experienced them through patients, even for us as patients, it was kind of a soothing thing to go through because we know so many women who have been here. I mean, we see so many patients who become family here, and so we've experienced their pregnancies and what they've gone through. And so you're not alone. You're just not alone. No matter what it shows on social media, every single woman goes through it and everyone's journey is different. And I'll tell you, it took me forever when I really, I'm really finally starting to get myself back and I actively tried to get back from the beginning.

(13:52):
I mean, once I was cleared, I tried my hardest to, because it's always been important to me. Fitness has been important to you, diet all that's been important to me. But I never couldn't really achieve it for years. I mean, my son is coming up on over, he's two and a half now, and so we're talking over three years worth since I started my pregnancy. And I'm just starting to finally see peaks of my old self. But I'll tell you, I will never be my old self. I am sure of it and I just know it just based on the permanent changes that have happened.

Val (14:24):
Absolutely.

Dr. Houssock (14:26):
And that's kind of the point. There's going to be things that don't show me a picture of you when you were 18 before you were pregnant. You're not getting that back. It's never going to happen. And that's okay. Please understand, it's okay.

Val (14:41):
Oh yeah. And also we're learning how to eat and exercise with this new body. I'm sorry, I'm not going to snatch over a hundred pounds over my head right now.

Dr. Houssock (14:53):
Me neither.

Val (14:54):
It's not going to happen. Sorry, my back can't do that anymore. But now I'm doing less impact now because my joints are happier and I just don't want to hurt. You know what I mean? And then with eating with this new body, I, I need to eat more protein. I don't know, just after you have a baby, you just realize, oh, I can't eat how I did back.

Dr. Houssock (15:18):
I think that's the point though, is it's not just a physical. So when we feel bad about ourselves and we feel bad about what our bodies have been through and when it gets to the point where you come visit us, I think there's this misconception that it's all physical and it's not like once the baby's gone, your body just should just bounce back. You had so many hormonal changes that do alter and sometimes absolutely permanently. That is true. Metabolism, whether it becomes that, your development of where your fat sits and lies. Hormones are

Val (15:49):
You skin is different. Your skin is so different.

Dr. Houssock (15:51):
Absolutely. Absolutely. And we'll get into, even when it comes to hair and all of that, because your body goes through it all, you can't anticipate that it's just going to all go back. So we feel very kind of passionate about the fact that yes, we have options when it comes to moms and their changing bodies. But please understand nobody, no matter who they are, can ever really take you back to the day when you were never pregnant. It's just not going to happen. And mentally, everyone has to kind of know that. And it's okay too. I genuinely feel like it can be okay, but there's no such thing as the bounce back.

Val (16:35):
And it's hard at first to accept that. But then once you do, you're like, alright, this is the new me.

Dr. Houssock (16:40):
Yes it is. And it really can be. But it has to be a mindset and it's not the, you'll notice that neither of us said, well, it's for my baby and I love, I would do it. Yes, of course it is. You've created a human. We will never want to change that. But you still are a human on your own and you still are your own self and you still deserve to be happy in your own skin. You don't have to feel like a martyr for the rest of your life. You can love your child and do everything for your child and also want to be happy personally. It's okay. It's okay Moms. Do you hear me out there? It's okay to love yourself too separately from that beautiful being.

Val (17:24):
You all are so beautiful, so beautiful.

Dr. Houssock (17:26):
Yes, you deserve, you've been through it. No, you will never be that pre-baby person, but you deserve to be happy in your own skin. And that can look different for everyone. So when we see mommy, what is a mommy makeover? So a mommy makeover can mean all kinds of things. Let's just very quickly go through the changes that we see in women from having babies and what we have in our back pocket for that. So literally head to toe, you're going to see significant changes in your hair. Every woman does. Here's how you have to look at it when it comes to hair and it comes to pregnancy, you, gosh, I don't even know the percentage, but you double the amount of blood in your body. It's like double. It's like huge amount during pregnancy that is flowing through you during all those huge happy meals that I was starving for.

(18:23):
Not only are you making a human, but you are also increasing your blood supply. Not only to of course feed your baby and circulate through your baby, but also during delivery so that you have enough blood during that placenta leaving your body that you don't just drop. So you build blood supply. So that means that you have an increased blood supply running all over your body. Well a medication like Rogan, all Rogan does or Minoxidil is, increases the blood supply to the scalp. And in so doing, it keeps your hair in the growth phase. It provides nutrition to the hair while that increased blood supply that you have during pregnancy is doing the exact same thing. And you are getting that beautiful, gorgeous hair. It's thick, it's full. It just stays in the growth phase. It doesn't shed, it just has so much blood supply. You're getting hair everywhere else too. I gave up down below eventually. I couldn't believe.

Val (19:17):
It's wild. Absolutely wild.

Dr. Houssock (19:19):
There's so much growth everywhere. But in the good way, you get this beautiful thick hair and your hormones are flaring. And so you get all of that and you have all this hair, and then you go through your delivery and whether it's after your delivery or after you stopped breastfeeding, at some point everything just starts to drop. And all that hair that was staying in your head sheds and everyone thinks they're losing their hair, but you're not technically losing your hair. You're technically losing all the hair that you would've lost during those nine months and you were hanging onto it. But it's traumatizing, scary and traumatizing.

Val (19:57):
It really is. That's a big part of our identity is our hair.

Dr. Houssock (20:01):
Where did you notice that? Did you notice that Val?

Val (20:03):
Oh, right, right here in the front area. And then my crown for sure that was, and I already have pretty thin hair to begin with. I have a lot of hair, but it's very thin. And obviously I wasn't doing my PRP injections with Lindsay or taking neutrophil or anything like that. And I was just like, oh my gosh, it's insane. Absolutely insane.

Dr. Houssock (20:26):
Yeah. And it can be really scary, but it is transient and it isn't permanent. And if you find that you're losing more hair than the typical meaning, you're really starting to see thin spots. The things that we suggest typically speaking are supplementation. Like she's describing some of the healthy vitamins, whether you use Neutrophil or the Viscal is another company, biotin in general. And then sometimes PRP injections, platelet rich plasma will help their growth factors. You can inject them into the scalp. And again, because it is a type of telogen effluvium or a transient loss of hair, it is transient and it is not permanent, but it can be very scary.

Val (21:02):
I will say once I was done pumping the neutrophil postpartum was a game changer for sure. So I incorporated that with my other vitamins and I definitely noticed a difference as far as it coming back.

Dr. Houssock (21:17):
And you start taking them as soon as you're done with, did you start taking 'em as soon as you were done breastfeeding?

Val (21:21):
Yep. And I started taking 'em, and that was definitely helpful. Super helpful. Yeah.

Dr. Houssock (21:27):
I mean, that's almost universal. We talk about the hair and hair loss, but it's just a shedding of all that hair.

Val (21:35):
What got me through it was just talking to other people like you who were going through it too. And we're like, yes, I'm going through it, but it's definitely not forever. So thankfully I had people around me that were going through it and they could tell me, it's okay.

Dr. Houssock (21:49):
A hundred percent. And I still know where those hairs are. They're still flyaway. They're finally getting long enough. They used to be more flying and now they're really, they're there.

Val (22:00):
It's not forever guys.

Dr. Houssock (22:01):
No.

Val (22:02):
Definitely comes back.

Dr. Houssock (22:02):
No. So that's hair. I mean skin, absolutely different for everybody. And some people really do struggle with their skin during pregnancy and then afterwards and some don't. And it's personal. And so there are plenty of skincare products that are safe during pregnancy and during breastfeeding that we can help you with. There are limitations obviously to that because some things are just not tested on pregnant women. I think it's a poor excuse. I think we should know more than we do right now, but we don't. And so instead we just say no. But that being said, skin changes are common. And depending on what your issue is, we definitely have answers for them. Some of the things can be permanent, can be hormonal. Val had some pigmentation issues during her pregnancy.

Val (22:51):
Good old melasma.

Dr. Houssock (22:52):
Yeah, man. And it's tough because that is tough to treat during, so we unfortunately kind of have to wait. And luckily we do have treatments that can help you after, but it's not the easiest thing to treat during. Some people have typical acne breakouts and that, again, it just depends on where you are in the mix if you're breastfeeding or not, whether we can use certain things. But we've got answers. And so we just always say, bring it up. Don't think that because you're pregnant or breastfeeding, you have no options. It's not true. There are plenty of things that are safe.

Val (23:22):
There's a lot out there for sure. Absolutely. And I will say during pregnancy, when I couldn't use the stuff to help with my melasma, Alastin products were really great.

Dr. Houssock (23:33):
Yes, Alastin across the board, Alastin products are safe for pregnancy, ZEO and SkinMedica and a lot of the other medical grades do have things that are safe, but not across the board. So you always want to ask your practitioner or your provider to see what's safe for you. But in general, there's a lot options. So it's not like, oh, sorry, they're not, the old days are. Yeah, and it's not, no, there's nothing to do. Those days are over, but the skin eventually does settle out and it does. I would say generally speaking, my skin got back to its typical self afterwards, but it did take a little bit of time for it to go through some things for sure.

Val (24:14):
Just once the hormones calmed down, I feel like it regulated, for sure.

Dr. Houssock (24:18):
Yeah. And remember, the hormone regulation doesn't happen right after delivery. It happens really, I mean, if you're breastfeeding, if you're a breastfeeding mother, you're going through your breastfeeding, if you're doing that for a year, whatever time you're doing that for, and then it takes time after that. So your time zero really, when it comes to hormones and all that is really when you stop lactating. I mean, and even then it's going to take who knows how long for your body to regulate. And surgically, we usually tell you to wait a few months to even think about doing something to your body after breastfeeding because that breastfeeding time, your hormones are still ramped up. They are ramped up.

Val (25:00):
Definitely want to wait for that to calm down.

Dr. Houssock (25:02):
Yeah, for sure. So I do think that the concept of the mommy maker, I just want to touch on it and then we're going to do a part two on this to really dive in. But a mommy makeover really is whatever the mother needs. And the typical changes that can happen in a mother through pregnancy and breastfeeding have to do typically with the breast and of course the body or the core, the trunk. And typically for women, whether or not they breastfeed during their pregnancy, they will engorge due to hormones. Doesn't necessarily mean that they are lactating, but the glands themselves will develop, they will engorge, they will stretch the skin, you will feel fuller. And then once you deliver, you will originally and eventually start producing milk. And then it will be up to you whether you decide to perpetuate that concept. But even in the woman who has not breastfed, her breasts have changed significantly through that process. And so it is not just as simple as whether or not someone breastfed, whether or not their breasts will change.

(26:07):
It really has to do with pregnancy in general. The breast in general is one of the most significant organs to change during pregnancy. So that may then end up with all types of changes. Women will engorge and then stay engorged and will develop huge breasts that they'd never had before. They may engorge and then they stretch and then they lose it all after pregnancy and they end up with no volume and a ton of extra skin. They may engorge or they may not really engorge much and they may not have much change. And so that though it is a huge part of the mommy makeover, there's no one surgery that fits all when it comes to the breast. It really depends on what happened during and then afterwards, what you're hoping for, is what we include. Would you say that's about right?

Val (27:00):
Yeah, you definitely nailed it. Absolutely. And depending on what they come in with, then we have the option to do just a lift or just an implant or an implant and a lift. So that's why that consultation is super important that we discuss their goals and expectations so that way we can lead them in the right direction.

Dr. Houssock (27:21):
I always ask for my patients, the first thing I'll ask is if they've been through pregnancy, and then if they did, did they breastfeed? And if they didn't, the, do they know what their size was before pregnancy, during and after? Because that all just gives me an idea as to where their head's at in the sense that some people, they want that. I'll have women picture, they miss it. Yeah, they like, I love how my husband loved them. I love how they were during pregnancy. I want those. Or they'll be like, oh my God, they were the worst, they were awful. I never want them again. So everyone's perception is different, so I can't just assume what you're going to want.

(28:00):
So I ask all those questions. And then typically any surgery on the breast, I will tell you to wait a minimum of six months, but I'm not a stickler on that. If it's been at least three months and you're not currently able to express milk, I'm comfortable with you having a procedure on your breasts, meaning that we could do something. That being said, the reason we want to wait for that is milk in general is a, it can leak, generally speaking, if I cut into the breast. And if it does, it can create something called the Galacto seal. It's a fluid filled area filled with milk. And milk we know is the most nutritious liquid in the world.

Val (28:39):
And bacteria loves that.

Dr. Houssock (28:41):
Oh, baby. So it's not only a problem on its own, but it can create and perpetuate an infection. So we like to make sure that you are as dried up as possible. Now, do we sometimes, Val, find ourselves no matter what, even years later, cutting into breast and finding milk?

Val (28:58):
We do.

Dr. Houssock (28:59):
Yes, we do. We do. It looks like milk, baby.

Val (29:03):
Yeah, it does.

Dr. Houssock (29:04):
Yeah. So it's not like you're going to be completely dried up. And there are women who would never even know it. And I cut into their ducts during surgery and I find milk and they haven't breastfed for decades, but it happens. And so a little bit of milk is not a big deal. It's really when you have a lot of milk. And then just finally, just a quick touch, and again, we'll go dive into these surgeries more on part two, but the tummy is obviously the area that we all focus on when we think about a mommy makeover, and it's really three parts. What do you have as far as the excess skin? Do you have scars that have perpetuated how it looks aesthetically, meaning have you had a C-section? And then how did your muscle wall do?

(29:45):
Do you have the type of frame where your baby had tons of room and didn't have to expand outward very much, or did you have no room and the baby had expand a lot, and your muscle wall, your fascia has been stretched and permanently has that stretch to it where you have what's called a diastasis recti. And so I would say nearly 100% of every woman will have some type of diastasis recti. Whether or not it is at the level of needing a surgery is dependent on many factors. I think we're going to end it there. And on part two, we will come back and start off with diastasis recti and why there are ways for you to accommodate for those changes, but there is no way to actually repair it without an operation, and we'll go through all that.

Val (30:34):
Awesome.

Dr. Houssock (30:34):
Sound good, Val?

Val (30:35):
Sounds good. Carry on. Dr. Houssock.

Dr. Houssock (30:38):
Carry on Val. Perfectly Imperfect is the authentically human podcast navigating the realities of aesthetic medicine. JEV Plastic Surgery is located in Owings Mills, Maryland. To learn more about us, go to JEVplasticsurgery.com or follow us on Instagram at Dr. Care Houssock, spelled D-R-C-A-R-E-H-O-U-S-S-O-C-K, or just look in the show notes for links. If you enjoyed this episode, please share it and subscribe to Perfectly Imperfect on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.