Back Fat Busted! Why Workouts Won’t Cut It & What Actually Works

Monique Ramsey (00:04):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your host, Monique Ramsey. As we age, we can sometimes develop a little pooch in the back. Ladies, I'm sure you know what I'm talking about. That sort of is maybe when you're wearing an open back dress or you don't really want to wear the open back dress because of that pooch behind your back or two piece bathing suits. It's just they kind of get in the way. So I have asked Dr. Luke Swistun to join us today to talk about back fat, which it's not the most exciting topic, but it kind of is. If you have that problem, if it is something that bothers you, let's talk about how it can be addressed so that then you can just wear all the fun clothes that you want to wear. So welcome Dr. Swistun.

Dr. Swistun (00:51):
Thank you again for having me, Monique.

Monique Ramsey (00:53):
Thanks. So first off, what causes that back fat and how common is it that people complain about it?

Dr. Swistun (01:00):
There are certain things that sort of change as we gain weight throughout our bodies, specifically towards the back, there are adherence zones. Basically there are areas in the back that your body naturally has a connection between the skin and the muscle, and that's what everybody thinks of as that roll that develops in the mid back area, the back posterior, outer posterior, mid-back area. And if you are very slim, you just don't see that because there's not fat above or below that, and that adherence zone is tight against the muscle, just like everything else around it, just like the skin around it. But if people gain weight, patients gain weight, then the fat kind of collects above that adherence zone and below that adherence zone and it really starts defining that adherence zone as a roll, as a tight spot with rolls above and below that. So that's sort of the ideology of it. Typically, it's not the only area patients complain about, but it's certainly one of those things that they hate. A lot of people don't know that it is addressable and it is to a certain extent.

Monique Ramsey (02:01):
Let's say if somebody said, okay, I'm going to lose weight and try to get rid of it with exercises, are there any exercises that can kind of target that or not so much because it's that adherent zone where it's sort of tacked down? Is that what you kind of mean? Is there a way to exercise it away?

Dr. Swistun (02:19):
So with regards to exercise and weight loss in general, the way to think about this is it's since generalization, but the way to think about it is that you're born with all the fat cells that you're ever going to have and when you gain weight, each one of the fat cells from head to toe gets just a little bit bigger, and then when you lose weight, each fat cell gets a little bit smaller, but it's a global weight loss. So even if you were to exercise your abs 24 hours, you will still lose weight from head to toe because of burning calories during exercise. So really the only way to target weight loss in a specific area is to do liposuction. Really, it's like the most effective way to do that.

Monique Ramsey (02:55):
Well, first of all, I brought it up as a woman and I've had weight issues my whole life and that's an area that bothers me. So I think about it from a women's perspective, but is this something that men also kind of have that same area?

Dr. Swistun (03:11):
Absolutely, yeah, and most people have very well defined adherence zones throughout their bodies. There are some patients that have more or less, and it is just anatomically specific, but some patients are born with a little bit more fibrous tissue in the back specifically that makes liposuction a little bit more challenging and makes contouring a little bit more challenging, and they have more adherence zones sometimes and they gain weight. They develop not just one, but two or three tight spots and then they have more rolls.

Monique Ramsey (03:37):
Liposuction is the best way to target that. Where's your incision going to be? Where do you put the cannula to go get the fat?

Dr. Swistun (03:46):
So the cannula spots kind of vary depending on where I can get the fat the most efficiently. I kind of have a rule where ultimately the scars will fade and they will become a tiny little spot. So I'm not going to compromise my scar location just to hide them to some extent because ultimately if you do bad liposuction, the patients will see that more. If the contour is not there after we heal six months later or a year later, then we haven't really accomplished what we wanted to do. The scars will fade and if they won't, they can be revised and then they'll fade. But to answer your question, typically when I do 360 lip in the context of a 360 liposuction, the scars will actually be kind of hidden right in the posterior crease of the arm. So if you were to bring your arm down, the arm has a shadow right there, and I try to place my scar right in that shadow along the length of that wrinkle so that when it heals, it's just a tiny little line within an existing skin fold already.

(04:38):
So it's very subtle and that's one of my favorite areas to hide that scar. The other one would be sort of if I need to go in the mid back area, kind of like in the bra line, I can do one or two right across that area. And the third one, and this is typically when they do 360 liposuction, I will actually put one incision right in that crease that I was talking about right in that adherence zone because that really defines it and that allows me to target the fat above and below it from multiple directions.

Monique Ramsey (05:05):
You're trying to get around the problem the easiest way, but like you said, the scar isn't nearly as problematic as a bad result.

Dr. Swistun (05:15):
Exactly. Doing this for a couple of years now, more than a couple of years, I found that patients are not really upset if they find a scar in a eye sightly spot, especially if it fades over time, but they are definitely not satisfied if we didn't target the fat that they wanted to target. So ultimately compromising on where the incision is doesn't really make sense in the long term.

Monique Ramsey (05:34):
Now if somebody is, you were talking about where that incision might be kind in the back of their arm, but kind of behind their armpit. Speaking of arms, so if a patient has heavy arms, can you kind of do that at the same time?

Dr. Swistun (05:47):
Absolutely. So that's the same incision that I use for the arms for liposuction of the arms. I use that exact incision that I just mentioned, and in addition to that, I will put another incision sort of in the elbow skin, the loose skin of the elbow, which basically nobody ever sees once that heals because sort of naturally wrinkles in that area anyway, but that allows me to target the upper arm from two different directions and really focus on getting it even.

Monique Ramsey (06:10):
Let's say after surgery they go home with some sort of binder or compression garment or I am sure it depends a little bit on which areas you're doing the lipo from.

Dr. Swistun (06:21):
Correct. Yeah, yeah, so typically the back is a pretty forgiving area for the most part because it has thick skin, it has pretty extensive fascial tissues or connective tissues underneath, and it's not in a dependent area as in if you just stand up, gravity will take swelling down. So in general, yes, we do need a little bit of compression. I recommend three weeks of compression, 24/7 minus when you're showering for the first three weeks and after three weeks we switch to just compression when you're active and after six weeks we're pretty much done, although patients sometimes like to wear compression even longer just because they feel more comfortable in it.

Monique Ramsey (06:53):
If you were going to take it out of our back or our arms is this fat that we could move and put somewhere else. And where typically do people want to move that fat?

Dr. Swistun (07:05):
Yeah, we could. It's probably not the best fat to move around and use for fat grafting, although it can be used. Typically my go-to preferred fat is the sort of softer fat that's a little bit more pliable, which is typically front abdomen or the flanks. The lower the love handle area or the medial or inner thighs, that's sort of the best fat. Once we get into the upper back, that fat tends to be in some patients a little bit more fibrous, which is to say there's a little bit more scar tissue in there or just kind of fibrous tissue and then less of a supple fat, but that's not always the case. Sometimes patients have great fat there too.

Monique Ramsey (07:41):
Now I talked to one of your patients a while back on the podcast and you helped her make her arms much slimmer. I want to think that she might've had big weight loss and her incision extended back to the back. Do you sometimes do that and what do you call that?

Dr. Swistun (08:00):
I think what you're describing is a brachioplasty, which is basically removing extra skin from the arm in addition to the fat. So yeah, that takes the conversation back to any given patient, and what's the problem with the extra folds that they have in the back? Massive weight loss patients typically run into a slightly different problem. It's not just the fat that is the problem. A lot of times they've actually lost the fat. It's the extra skin that has grown in response to the fat that they used to have, and now when the fat goes away, that skin does not necessarily shrink back to the same extent. And now we just have extra skin that is sort of folding over. And to some extent, the extra skin is always a little bit the challenge and the determining factor of what we can do and how we can help the patient and what incisions we have to place.

(08:45):
For someone who hasn't gained a lot of weight and they just have a little bit of volume, we can liposuction that out and the skin will shrink back. For some patients who gained a little bit more, we have to use some skin tightening techniques in order to try to compensate for that initial weight gain. So Renuvion is my go-to for that. Typically after liposuction I would tighten up the back skin with Renuvion, which is basically kind of heats up the collagen from the inside and really tightens up the entire patch of skin in the back and really allows the skin to re-drape more favorably and mask that fold that we were talking about. And the fold pretty much disappears if you have good patient selection. If unfortunately somebody was 250 or 300 pounds at one point in their lives and then they have massive weight loss with bariatric surgery or with ozempic nowadays and they go down to 250 to 130, 140, that's a patient that will not have a lot of fat on them, but they will have a lot of extra skin that will not respond to skin tightening like Renuvion.

(09:49):
At that point, that patient needs to have that skin just resected or surgically removed. And so we basically trade that for a scar and that goes back to your question, where do those scars go? It really depends on where the skin is. There's lots of ways to do it. The classic technique for the back would be a thoracoplasty, which is basically an incision right across the bra line. That's sort of the classic way of doing that. I have a way that I prefer a little bit more that masks that incision a little bit better, which is called a crescent thoracoplasty on both sides. So instead of having an incision across the entire back, I put the incision between the arm and the front of the breast and it's kind of a curve so it hides in the upper side of your chest, sort of under the arm, and it allows all that back skin to be pulled up and then removed. So we avoid an incision, a horizontal incision across the back and it's a little bit more mass. It's a little bit more work because we have to flip the patient twice in order to do that surgery, but I think it's a nicer result.

Monique Ramsey (10:47):
That's really interesting. I love that idea of how you pull it from a different spot and then, because it's like you want to look great, but you also have to function and move and you think about how much our bodies move and stretch and bend, and that's part of your calculation too is

Dr. Swistun (11:05):
Correct.

Monique Ramsey (11:05):
How are we going to get you to the goal of removing that excess skin but also raise your arm above your head or something?

Dr. Swistun (11:13):
Scar placement is always a little bit of a challenge. I mean, I like it to keep it as simple as possible. Ultimately, whenever we have a patient who is a massive weight loss patient, they just have skin that they end up trading for seams, as in scars, but if you have enough skin removal procedures, then they have seams. And then some patients stage this, so they have a seam here and then a seam there and then another seam that doesn't really fit. Basically the crescent thoracoplasty is kind of appealing in the sense that it is one continuous incision and it's pretty interesting. I have a couple of patients that have undergone this and they love the result, but the incision is very long. If you think about it actually, because these are patients had massive weight loss, so we ended up doing a breast lift, so they have an incision that starts at the meat and center of the breast that goes all the way out here.

(12:01):
Then we continued that into that crescent thoracoplasty like I mentioned. So that incision then continues to the bottom of the arm and then they had a brachioplasty, which is the arm surgery as well. So that incision continues on the bottom of the arm and something's through the elbow and over here. So I have one long incision from here going all the way down to here and then under the breast, but it is still like a clean look because it's one incision, it's one continuous thing, but it allows to address the breast the entire back and the entire arm in one swoop. That's kind of the most elegant way to take care of a lot of these areas all at once.

Monique Ramsey (12:35):
And what would you call that if we talked about that full thing? If it's a breast lift with crescent.

Dr. Swistun (12:39):
Yeah, I mean that would be an extended brachioplasty with a crescent thoracoplasty with a wise pattern mastopexy.

Monique Ramsey (12:48):
But that's so neat.

Dr. Swistun (12:49):
It's a long day.

Monique Ramsey (12:50):
Yeah, I bet it is a long day, but for patients who are trying to deal with that extra skin because losing the weight makes you feel so good, but then if you're also then trying to disguise certain bulges and lumps, it's like, okay, how can we take care of it? And it's nice to know that there is a way, it might be liposuction, it might be some skin excision, it might be a little bit of both, and it's nice to know that you can accommodate that at the same time.

Dr. Swistun (13:17):
Ultimately it has to do with how much weight the patient has gained, what was their peak weight at any given time because that's going to determine how much skin they have grown in response to that peak weight. For somebody who was just 20, 30, 40 pounds overweight, a lot of times liposuction is the only thing they need. Once they get into 40, 50, 60 pounds, we typically want to combine that with Renuvion for the best result and that'll work to some extent. Beyond that, I think we have to look at removing the skin surgically and trading that for scars.

Monique Ramsey (13:46):
And could somebody start with the liposuction and Renuvion if they're maybe on the border and then see, let's see how that works.

Dr. Swistun (13:55):
Absolutely. Ultimately, it's a cosmetic result in the eyes of a beholder and for some people the skin may be after liposuction and a little bit Renuvion, a lot of patients will say like, well, it's a little bit loose, but it looks really good. I'm comfortable with that. I certainly don't want to trade that for a big scar and they're done. And some patients say like, no, the level of exercise that I do, I'm very active. I jog now or I run or I do marathons, and that skin being loose really interferes with that. Let's just go ahead and cut it out.

Monique Ramsey (14:25):
I would think that as you gain and lose weight, the fat cells that are there just getting bigger or smaller, once you take those fat cells out of that area, they're gone forever. Would you say that the result is permanent or is it not quite that cut and dry?

Dr. Swistun (14:43):
No, it is. It's very close to that. Whenever we do liposuction and whenever we do fat grafting, we're basically changing the proportions of where your natural fat cells live. So when you lose or gain weight in the future, then your proportions change that much more favorably. So if we were to remove a lot of fat from the flank area, which is a lot of patient's problem area or the abdomen and just maybe get their waist, they're very thin, get their back very thin. If they were to gain weight, they would not gain as much in those areas because a lot their fat cells are already removed. If we do fat transfer, let's say to areas where patients want volume, let's say the breasts or the buttocks, if they were to gain weight, they would gain a lot less from in the areas where we removed it and a lot more where we placed it. So basically weight gain in a patient after a procedure like this basically results in slightly larger breasts and buttocks area, which is kind of what they wanted, and much less expansion of the waist, so more favorable contours overall down the line.

Monique Ramsey (15:41):
Okay. Now if somebody is just having liposuction to that back area that we're talking about, what is the recovery for just that versus maybe that if you added a little bit more, if it was more of a 360 lipo, what are the two recoveries look like?

Dr. Swistun (15:57):
You go to the two extremes. I think the big differentiator would be drains. Typically whenever I do 360 liposuction, then we're addressing the entire back, upper back, mid back, lower back. We're also addressing the flanks, the sacrum, which is that sacral triangle right above the buttocks. We also turn the patient and do liposuction in the front, so at that point we're opening up so much surface area with this liposuction that that skin needs a little bit of time to adhere back down to the muscles. We need to place drains in those critical areas, the gravity dependent areas in order to help get that fluid out of the picture so that everything heals better. For areas that are a lot more localized, let's say if we just liposuction the upper back or midback only, typically we can just get away with a garment without having to do drains. As far as the recovery of the entire thing, the timeline is about the same, but obviously the patient is going to be a lot more sore if we are addressing a larger surface area and a lot less sore, a little bit more sore if we're addressing a smaller area.

Monique Ramsey (16:56):
Now, do you have any other specific post-op instructions for them?

Dr. Swistun (17:00):
It's always depends on what they do for work. There's patients who are on Zoom that don't, which doesn't really require a lot of activity on their part, so they go back to work like day three, day four, day five, as soon as they feel comfortable enough to have a conversation like this. There are patients who are very active physically. There are nurses who move patients around that also are patients of mine where basically they just need to take a solid four to six weeks off. I think four weeks typically patients are pretty much there, pretty functional. Early on obviously we just want to make the patient comfortable and avoid major activity. Once the drains are removed for patients with larger liposuction, then we want to continue, there are low level of activity for at least a week or two after the drains are removed to make sure that they don't accumulate too much fluid. Basically the more active you are, the more fluid you'll accumulate. So we need to keep the activity, the levels low and keep them in a compression garment until that skin seals back down throughout the entire area that we treated.

Monique Ramsey (17:52):
I would think they'd start to see results pretty fast, but when would you say is their final result that they could expect to see and all the swelling's gone?

Dr. Swistun (18:03):
Yeah, so the short answer is a final result, at least six months if not a year after. The answer becomes pretty complicated once we start getting into the nuances of what we did. For instance, if a patient started off with a lot of volume and we did large volume liposuction, they're going to see a big result right away. But then the cool thing is that that result continues to improve over time. I have plenty of patients who are like three weeks out and they're like, oh my God, I'm so happy. This is great. You can see my waist so much thinner. I'm like, oh, just wait. This is nowhere near the end because you're still, that's only 50% of swelling that's gone. Give it a little bit more time. So then they come back at six weeks like, oh my god, even better.

(18:41):
And then we're like two or three months out they're like, oh, this is great. This is even better. And then we're a year out and we're comparing photos and there's still an improvement between three months out and six months out or a year out. Whenever we do Renuvion, which is that skin tightening technique, the areas that we treat with Renuvion actually tend to swell a lot more and hold on to the swelling for a little bit longer just because it is additional sort of surgical trauma. We're actually heating up collagen from the inside and we're causing contraction of the collagen, but there's an inflammatory process associated with that. So whenever we do Renuvion, let's say to the inner thighs or the upper back, that area swells more for longer, so you don't see that result right away. But once that skin tightens in six months later, nine months later, then you really see a nice result and then that's a huge change in the before and after photos that we see.

Monique Ramsey (19:30):
Now is Renuvion something you can do in a lot of different places? How many things can we target with Renuvion?

Dr. Swistun (19:38):
It's really the only modality that I rely on that does not require an incision to tighten up the skin to some extent, but it's not a replacement for removing a lot of skin. If somebody has a lot of extra skin, the Renuvion is really not going to make a huge difference. But if somebody has just a little bit too much where it's just a little bit too loose or maybe just a shadow hanging over that little fold area we talked about, Renuvion is great for that because you address the entire back, you tighten up the entire back and they just kind of lift up just enough that shadow becomes a non-issue just is masked away. You can use it in lots of places. I mean I use it on the abdomen, I use it on the flanks, I use it in the upper and lower back for sure.

(20:17):
Pretty much anytime I do liposuction of the arms or the thighs, I recommend Renuvion because most patients are good candidates for that because of the fact that if they have enough fat to be concerned about removing, once we remove that fat, they're going to have a little bit of skin looseness. So it makes sense to go back there right away and at least compensate for the volume that we removed and tighten up that skin just a little bit or just enough so we're not creating another problem, another shadow. The classic blunder would be if somebody has a lot of fat and a lot of skin here and then they get liposuction only and then they wind up with loose skin that looks like a bat wing, which I've seen, and a small looseness can be corrected with Renuvion right on the spot.

Monique Ramsey (21:01):
It's almost like Renu helping the body bounce back more or retract that extra skin. Who knows, some people may get great retraction cuz they're 30 years old, and if you're in your fifties, it's not going to be the same. So I feel like Renuvion is a nice little addition if it's appropriate to help you get the best result.

Dr. Swistun (21:21):
Yeah, it's one more tool we have in the box. It's not always the best solution, but it's certainly a solution for a lot of patients if they're right candidate for it. But you kind of nailed it, Monique, in the sense that what do we look for with regards to how well the skin will shrink back? The two factors I actually look for is age of the patients, so the younger the patients are, the more collagen they have just inherently in their skin and therefore they will tighten up a little bit better. But in addition to that skin quality, so one telltale is stretch marks. So if a patient, let's say had a pregnancy and they developed lots and lots of stretch marks around the abdomen, that sort of speaks towards not the best skin quality. Whereas if you have a patient who had two or three pregnancies and they don't have a single stretch mark on their abdomen, that's really good skin quality. So that's a patient that will tighten up a lot more favorably. So that may be the patient that does not need an excision or skin resection that may be a good candidate to try the Renuvion and see if it gets us to where we need to be.

Monique Ramsey (22:16):
Interesting, and let's talk about what you talk to them about at the beginning in their consultation. So at their consultation, they're going to talk to you about what bothers them and then do you do an exam at that point, and then how do you show them what might be their potential result?

Dr. Swistun (22:34):
Really based on experience and having done this a while, we have developed a library of patients who represent different body types and different ages, and we can sort of correlate a presenting patient to a result we already have. So that's I think the biggest part of the discussion right there. A lot of patients are considering different things that they may identify a single problem area and present with just that, and then when we examine them, we can certainly guide them and say like, sure, that's certainly an area we can address, but then other areas may suffer or you might see other areas that get unmasked. So instead of just liposuction in the back, why don't we target these other areas as well so that you're not chasing them later? Or sometimes there's just an obvious disproportion that patients are very unhappy about just this one area and they just want a subtle correction just to fit everything else, and that's another perfectly appropriate request that we can accommodate.

Monique Ramsey (23:24):
So when they come in for their post-op, see them at three weeks or when are you going to sign 'em off for exercise, maybe it's at six weeks. What is kind of the feedback that you get from people?

Dr. Swistun (23:36):
I think we have some podcasts on that. You can put links up on that, but there's a couple patients that stand that in my mind that were very surprised about how life transforming this was. One in particular, which I'm not going to say her name, but she's been very public about her result, but she reflects a lot of patients that we have is that there are dresses in her closet that she thought she'd never wear again. Six months after our surgery, she more than volunteered to bring those dresses to our photo rooms so that she can really express how she feels and this new result that she has.

Monique Ramsey (24:10):
That must make you feel so good. Because that's a lot of work, like you said, you're in the OR and slaving away, giving them the best results and then to see their faces or what they say to you at the post-op.

Dr. Swistun (24:22):
They'll say it's life changing. And I mean I always have tried to put that in the perspective because we didn't cure cancer or anything, but at the same time, this is a patient that feels so much more confident. She is rocking these dresses that she has rather than just wearing them. Huge difference. The way this manifest is she took a picture of herself like a selfie and a New Year's party basically titling it like, I thought I'd never wear this dress again, but here I am, and she just looks stunning and all the girlfriends around there was like, were not as good. So she's so happy. She was like the star of that photo.

Monique Ramsey (24:55):
I love that because we all want to feel like Cinderella sometimes and feel amazing. And so we do have her podcast and I'll put it up.

Dr. Swistun (25:04):
And especially when you hit that age, part of the conversation between me and her is like, well, it was like my early forties now, and I thought, I just never get this back. I was in the gym and nothing was just happening despite all these efforts. I thought I'd try this, but I didn't think that the result would be this stunning because all she needed, I mean she had a great body mass index to begin with. It's just the fat was just in the wrong places. And when we really sculpt her, I have the opportunity to target that intervention. Spending all this time in the gym will burn calories, will have her lose weight, but it will not change her proportions. Where that fat is, is where it's going to stay, and even if she loses a lot of it, the problem areas are going to remain, smaller problem areas, but nevertheless problem areas. But really the only way to rearrange them is to do this procedure.

Monique Ramsey (25:52):
I love the fact that her story started with a picture. They were in Mexico or something, girls' trip, and there was a picture of her and it shows the back of her, and she was like, oh my gosh. So it's neat that it kind of came full circle and it ended up where a picture, then she's rocking this dress and feeling so great. It's really nice. Last thing that everybody always wants to know about is cost. We talked about a lot of things today. All of our price ranges are on our website, but for something like this, maybe it's from 9,000 to more because it's hard to say. And so why we do a free consultation is we don't think that you should have to pay to talk to a doctor and find out what are the possibilities. And so if you live local, great, come in and Dr. Swistun can show you his library of photos and talk about really what are the key ways to address what's bothering you. We can figure out what the prices would be for. And sometimes there's different scenarios if you do these two things or if you don't, then the patient coordinators can work on that with you. We show different financing amounts because a lot of times people just don't have this hanging around in their bank account. So it's like, okay, like your car, you can pay for it over time. Starting that conversation I think is the best thing. And if you don't live locally, because a lot of our patients come from out of town, we can start with a Zoom consult. Dr. Swistun, anything we missed today that we want to make sure we discuss?

Dr. Swistun (27:21):
One thing that we didn't address that comes up a lot with regards to back fat specifically is that buffalo hump that patients come in with, which is definitely something that can be addressed at the same time. That's a very easy, most of the time it's a very easy liposuction to really just bring that area down. And that can be addressed certainly as an isolated single problem, which that's a classic area where patients say like, yeah, I just have this problem right here and yeah, maybe I'm overweight somewhere else, but this really stands out. Can we shave this down? And it just takes one small incision and some liposuction in that area just to really bring it down. It makes a big difference. It goes from obviously visible and stands out and bothers me and I'm self conscious about it to a complete non-issue. I think the take home point to allude to what you just said is that everybody's different and liposuction fact grafting, Renuvion skin tightening, skin removal, these are not surgeries that patients necessarily have to have.

(28:18):
The gamut of what they want or what they expect can be so broad that it just warrants a discussion of what the patient is looking for and their expectations and also the time they have to recover their finances and everything else. There's no right or wrong answer on any of this. It's basically like, this is my problem area. What can we do? And it can be as simple as like, oh yeah, let's just target this little area. We can do it in one position. It'll take an hour and it's not that expensive and the recovery is pretty minimal and it'll fix this area that you're really concerned about, that really stands out to you in front of the mirror. Some patients basically say, well, I just really want a huge transformation. And obviously that comes at a different commitment with regards to recovery and price and everything else.

(28:58):
But again, there's no right or wrong answer. The patient has to be comfortable with their decision, what they're going to do, their recovery and everything else, and we come to that decision together. We make a surgical plan based on what they tell me now, based on what I think, I'm not going to tell you this is what you need, this is what you have to have. I'm going to consider exactly what you're looking for and what your limitations are. I mean, there's plenty of patients with kids at home who basically, I cannot afford to be down for four weeks, but this really bothers me. Let's just address this. I'm like, perfect. This is definitely an option.

Monique Ramsey (29:32):
And you can have things in stages for sure if it has to do with work or with family, and how much time you can devote to really staying down. You need to follow the directions, as we know, the patients who don't, all it does is delay healing longer. So if you can say, okay, sure, I can commit a month to not picking up my kids or not doing this or that, throwing luggage in the overhead bin that depending on what you do for a living. So yeah, I think having different scenarios, a lot of people go, okay, what if I just do the minimal? What if I kind of do an intermediate or what if we do the whole thing? And what would be looking at in cost, in recovery?

Dr. Swistun (30:12):
Sometimes there's a scenario where patients basically say, I know that I have loose skin, I have extra skin. I know that I think the perfect thing may be excision of that skin, but you know what? I don't want that scar. I don't want that recovery. I just want to look better in clothes because when I put on my yoga pants or something, this area right here on the outer hip really bothers me and I just want it to look tighter in my clothes. I know that out of clothes, it may be a little bit looser, but I'm okay with that. And again, that's a decision that we make together and that's fine. The gamut of what patients prefer and their priorities is so broad that you really have to take the time to listen and make sure that you address their concerns first and foremost before committing to a plan.

Monique Ramsey (30:51):
And I like the fact that you, it's very collaborative. Like you said, I don't tell you, here's what you should do. Collaborations.

Dr. Swistun (30:58):
I will inform you of your options and I will give you the full gamut of what we can do. But that comes with different levels of recoveries, and ultimately you need to be the one picking what you're most comfortable with and the plan that we're going to do.

Monique Ramsey (31:09):
Well, thank you for this little topic turned into sort of a big topic, but I feel like a lot of people do have this issue with back fat and let's just get it out there and let's figure out how we can address it and the different ways that you can help people do that. So thank you Dr. Swistun.

Dr. Swistun (31:25):
Thank you again, Monique.

Monique Ramsey (31:26):
Thanks. And everybody will have things in the show notes because we talked about a lot of things today. We talked about a couple of the previous podcasts that we've done, about 360 lipo with some of our patients who've had that procedure, one of our arm lift patients. So we'll put all of that in the show notes and we will see you on the next one. Thanks for joining.

Dr. Swistun (31:46):
Thank you.

Announcer (31:47):
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