Speaker 1 (00:07):
You are listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey. And today on the podcast my guest is Nicole. She's our director of nursing here at the center. But today she's actually gonna be talking about her experience having surgery with La Jolla Cosmetic and Dr. Brahme. So welcome Nicole. How are you doing?

Nicole (00:39):
Good. Good. Thank you for having me.

Monique Ramsey (00:41):
Yeah, thanks for coming. So tell me a little bit about how long you've been thinking about a mommy makeover and you know, what made you finally, this is the time

Nicole (00:53):
Oh gosh. So probably I've been thinking about it for over 18 years. I have my oldest child and she is getting ready to turn 18 and I've probably thought about it since I was pregnant with her

Monique Ramsey (01:05):
Oh my gosh.

Nicole (01:07):
Right. I went from having an, you know, normal feminine body to being a huge blimp I felt like. And I just knew that it was inevitable that I was gonna have to do this one day.

Monique Ramsey (01:21):
So you have an 18 year old and then do you have any other children?

Nicole (01:25):
I do. I have a 16 year old, a six-year-old, and a three-year-old.

Monique Ramsey (01:28):
Oh my goodness.

Nicole (01:29):
So four <laugh>

Monique Ramsey (01:30):
Four. You're brave. That's, 

Nicole (01:33):
And busy. Yes.

Monique Ramsey (01:33):
And busy. And you look so young, so I'm, I'm not sure what you're doing there, <laugh>, but it's working.

Nicole (01:38):
Well, you know, I work at this fabulous place called La Jolla Cosmetic. So <laugh>.

Monique Ramsey (01:42):
Exactly. It doesn't hurt. That's right. 

Nicole (01:44):
It doesn't hurt. 

Monique Ramsey (01:45):
So four kids. Oh my gosh, that's a lot. So for people who are kind of maybe thinking about what is a mommy makeover, how would you best describe how you went about deciding what procedures to include?

Nicole (02:01):
Right. Like you said, a mommy makeover can include so many different procedures and every woman's idea I think is different as to what they want their body to be back to. So when it came to my decision, one of the biggest things that ends up being left over from having children is loose skin in the abdomen and stretch marks. And wearing a bikini after that is kind of non-existent for some women. Other women are pretty lucky, but I wasn't one of those lucky women. And then, you know, the hardest places to lose weight are your, your, your flanks in the back. So like the lower back fat <laugh> if you will. So, you know, I've really worked hard about trying to lose it and exercise and healthy diet and it was just nothing was helping. So that was definitely on my priority list was getting rid of that extra skin and the back fat mass if you will.  So with that they did the extended tummy tuck. So the incision actually goes around to the back along with some liposuction to kind of bring down the volume to give me a nice waist, which is what I was looking for. And of course Dr. Brahme nailed it, <laugh>. And then the breasts are the other thing that you notice with moms. They've breastfed, especially after breastfeeding four kids, they were kind of just sad. They were not perky and happy anymore. <laugh>,

Monique Ramsey (03:26):
They were all used up <laugh>.

Nicole (03:27):
I was exactly <laugh>. So the breasts were my other area of concern. And so I wanted them lifted up to look more youthful and have a better shape. And then I asked him to put in a small implant just to gimme some volume in the top. That way I didn't have just the top sloped breasts. They were nice and lifted and now I have the nice volume in the top and they look phenomenal. Oh and then the other thing was that to accentuate the waste i in the liposuction, I didn't wanna waste the fat. Of course it's good fat, why waste it <laugh>. So I asked him to put it in my buttocks so that I could have a little bit of extra curvature there and it really just came out a really great hourglass shape.

Monique Ramsey (04:19):
Oh, that's so nice. I mean especially like, I feel like, you know, moms have earned the right to, to try to recapture their body from prior to kids. I don't think any of us would change our minds about having kids, even if, if it does kind of wreck your body. But it's nice to know that there are some procedures, depending on what you need that can get you sort of restored and back to yourself. And I think you deserve it and I'm glad that you know, Dr. Brahme was able to get you back to what you want. Now let me ask you, when was your surgery?

Nicole (04:55):
So it was on the 10th of March, so I'm a month out now. 

Monique Ramsey (04:59):
It's a month. Wow. Wow. Like I would've thought maybe like six months. I mean you look great. Like how are you feeling? You feeling good?

Nicole (05:07):
I am feeling fantastic. I actually came back to work after a week, kind of limited duty, well pretty limited duty. Uh, and I did short days and it was like, I knew that it was gonna be difficult and I thought it was gonna be a lot more difficult. But I was actually surprised and kind of surprised my peers as well that I was actually able to come back to work after a week.

Monique Ramsey (05:30):
Yeah, that's, that's pretty short <laugh>. I dunno, I don't know if the, I know I wasn't in that space after my mommy makeover.

Nicole (05:37):
Most people aren't and that's completely fine. Everybody heals differently.  And it just really depends on pain tolerance and how you heal and your body.

Monique Ramsey (05:46):
And not overdoing it. I think it was smart if you're, you know, not running around the office, you're sitting down and you're doing a shorter days and that's, that makes it. And plus you have the doctors right there to help you <laugh>. 

Nicole (05:57):
Exactly. <laugh> 

Monique Ramsey (05:57):
If you need it. 

Nicole (05:59):
And of course all the nurses are trying to pitch in and make sure I'm not overdoing it and 

Monique Ramsey (06:02):
Right, right. 

Nicole (06:03):
You know, everybody's like, oh do you need to sit down here, let me get you a chair. So it was very accommodating. It was nice.

Monique Ramsey (06:09):
Now as director of nursing are, in terms of what you do in the center and who you interact with, are you mostly in the clinic or in, in the operating room or a little bit of both.

Nicole (06:19):
So I kind of interact with everyone. So I have to make sure that the surgery schedule works out for the doctors, the nurses, the scrub techs, the anesthesiologists, putting it all together as a big puzzle. So I work in the clinic as well with Dr. Swistun primarily right now, just a couple of days a week. And I basically manage all of the nurses and nursing staff that would be all the medical staff, all of their schedules. I help with the coordinators with coordinating surgeries and adding them on to help patients get their optimal surgery time cuz we know that getting that date is the biggest thing for a lot of patients and making it work for them in their life is huge. So I work very closely with the coordinators as well to try to make those things happen for people.

Monique Ramsey (07:14):
So, you know all the secrets of the clinic and you knew all the secrets of the OR so <laugh>, was there anything at all surprising, I guess being a patient? Cuz you've seen it all from the employee point of view, but then sort of going through the process d was there anything that kind of surprised you or that you weren't expecting?

Nicole (07:34):
Yes, so I, working in the environment and being hands-on, I guess with the patients before, during, after surgery, you would think that for me to have surgery would be pretty simple. But I actually was very surprised about how squeamish I was to my own recovery. So <laugh> I was actually very squeamish. I it was, it was uh, almost embarrassing <laugh> at that point. 

Monique Ramsey (08:06):
Okay. We'll get into that in a minute. So I wanna get, thinking about bringing yourself back to, let's say five weeks ago when your surgery was still coming up, you know, was there anything that you were worried about or concerned about or that you wanted to make sure was addressed? Like at that pre-op appointment or during your consultation with Dr. Brahme? Like how did you all work together and how, what, what did that look like?

Nicole (08:33):
Well, <laugh>, knowing as much as I know I, you know, trying to choose the implants that I wanted and the sizes and all of that, I, you know, I thought, oh well I know Dr. Brahme, he'll do a great job no matter what. He'll get me on the table and he'll choose all of this. But then I was like, wait a minute, but what about if this, like what about I get this implant? And I decided, and that's not really what I wanted. And kind of going back and forth with everything. I actually talked to him multiple times about sizing and shape and all of that. But really feeling like I was heard and everybody was pitching in with their opinion about what I should shoot for or not shoot for if I chose this type of implant or that type of implant. And just finding out after surgery, he absolutely listened to me and nailed it. I mean that was fantastic.

Monique Ramsey (09:30):
So did you do the implant sizing or try on some different sizes or shapes or profiles? I know some of them are more round and some are more high profile and teardrop and all these, and then we also have the Vectra imaging system that for 3d. So what, what tools helped you get to that size that you were trying to aim for?

Nicole (09:53):
I think the biggest thing was trying the implant sizers with the bra and actually seeing what it would look like on my body was huge. I thought I wanted a 350 cc implant and when I put that on I looked like Dolly Parton. <laugh> They were, they were just way too big. And so, you know, Dr. Brahme's like, no, I think this is my, my thought, you know, probably between a two and a 300 cc implant. And so I tried those on and sure enough, like I found a good size range and you know, he was like, yeah, we'll try 'em and see what looks better. And then that's what we did.

Monique Ramsey (10:33):
That's good. That's good. Uh, yeah, I would think having a, a variety of tools to help you. Cuz some people might find that that 3D imaging and seeing that is more helpful. Other people would be like, yeah, I need to see it on me. You know, uh, and look in the mirror and have other people look. So you ended up with what size at the end?

Nicole (10:52):
Um, I did 230.

Monique Ramsey (10:54):
Oh, 230. Okay. And see that's

Nicole (10:55):
And a high profile.

Monique Ramsey (10:57):
Oh and a high profile. Oh that's nice. So that kind of gave you that more, that cleavage that you were looking for.

Nicole (11:01):
Uhhuh, <affirmative>, the upper pole fullness. Yeah. 

Monique Ramsey (11:04):
Nice. Nice, nice. Now let's go into maybe the day of surgery. What was that like for you? And especially cuz you've been again on that other side as a nurse, and you know what's gonna happen because you've been there. So it's not like a scary thing, like I have no idea what's gonna happen to me.  <laugh> You're prepped from your pre-op and then you're prepped from also because you work here. But that morning, what was that like for you?

Nicole (11:32):
You know, I, I kind of got brought in by my husband, went into the check-in room, got changed. It was kind of surreal cuz I was like, you know, I'm so used to being on the other end and I was actually trying to help a lot with getting myself ready <laugh> and everybody was telling me, okay, just sit down like we're gonna do this. You're the patient today <laugh>. So, you know, I was surprisingly a little bit nervous. I don't know why because I've had surgery multiple times. Not cosmetic, but other, and I didn't think that I was gonna be really that nervous, but I was a little bit nervous. And of course Dr. Brahme came in, talked to me, did the markings, reassured me that everything was gonna come out and it was look gonna look great. And I got to talk to anesthesia and Dr. Saltz was my anesthesiologist and he did a fantastic job. I woke up and I was in minimal pain, had no nausea. I mean it was fantastic.

Monique Ramsey (12:25):
Oh, that's nice. So let's say you're, you have your surgery, you're in recovery, they're like, okay, it's time to go home. Did you go home or did you go to aftercare? What was that like?

Nicole (12:36):
I went to the, one of the hotels here close by that we use a lot. But I did have aftercare, even though I am the director of nursing for this facility, I just, I knew that my husband would know kind of what to do, but he wouldn't really necessarily know how to help me or what might be normal or what might be abnormal. So I did choose to have aftercare. So the aftercare provider, she was absolutely fantastic. She helped me throughout the entire night. My husband got to just sleep so he didn't even have to, he would wake up for a minute and see if she had me. He's like, oh she's fine <laugh>. So yeah, it was great. I, from that experience have encouraged women that are having a tummy tuck, especially to have aftercare whether, you know their criteria requires it or not. Cuz we do have some criteria that requires aftercare, but I've been definitely encouraging it more.

Monique Ramsey (13:34):
And so was that for one night or two nights?

Nicole (13:37):
I had it for one night and then Dr. Brahme actually came to the hotel the next morning to check on me and make sure everything was okay and then I got to go home from there.

Monique Ramsey (13:46):
Oh, that's good. Yeah. And I would think, I don't know, I feel like knowing it's just that extra sense of security of having somebody who's medically trained looking over you. In the rare case, something would, it would be needed. It's,  I, I would And that you're not putting your spouse or your anybody who's taking care of you in a weird position where they're really stressed out on what exactly what should I be doing or how do I help you?

Nicole (14:15):
Yeah, I, I can't imagine that he would really know how to help me. He actually was very vigilant about what the aftercare provider was doing so that he could help me better when she was gone. So it was huge for me. I, like I said, I still tell people now, I'm like, you're having a, an abdominalplasty or a tummy tuck, you should definitely have aftercare. It's just makes life so much easier. <laugh>.

Monique Ramsey (14:41):
Yeah. Now did you find as far as for pain medication, cuz they're cutting into you in a pretty significant way for pain medication, did you find you needed, I mean I'm assuming the answer is yeah, you needed them, but like what does that look like for people who maybe wanna know like what's my pain control like and kind of how long will I need to have it?

Nicole (15:06):
So we have multiple modalities for pain management. We utilize Celebrex, which is an anti-inflammatory. We use Tylenol. Some of the physicians will use ibuprofen, which is also an anti-inflammatory. And you can have those four times a day at maximum doses on top of the narcotic pain medication that we prescribe. And also gabapentin, which is for neuropathic pain, which helps tremendously for post-op like liposuction or any kind of incisional burning or stinging that you might experience. I utilized the Tylenol, the Celebrex and the Gabapentin primarily. And I just took that four times a day kind of on a schedule for the first couple of days. And then I would use the narcotic pain medication for breakthrough pain and maybe a couple of times a day with that for the first, I don't know, probably four to five days. And then after that I just needed it kind of at night to help me sleep a little bit better.

Monique Ramsey (16:08):
So let's talk about the scars that you have and what you think about them and if it was worth it.

Nicole (16:14):
I would say the scars are 100% worth it. The number one thing that I always try to point out to patients when they are really concerned about the scarring is you are only gonna show the scars voluntarily. They are in places that are completely hidden by clothes. Typically even uh, bikini, you're not gonna see them. Dr. Brahmi and all of the surgeons that work with us, they all make sure that the scars are nice and low in the bikini line, top and bottom for the abdomen and the breasts. You're the only one that's gonna see your scars or your significant other and in clothes you're gonna look fantastic. And the scars eventually they fade. So yeah, they are bright and kind of ready and raised a little bit at first, but those scars fade just as well as any scar that you got when you were a kid that you could barely even see or don't even see anymore. So,

Monique Ramsey (17:14):
Yeah. So a hundred percent worth it. <laugh>.

Nicole (17:17):
Absolutely.

Monique Ramsey (17:19):
Yeah. I think, you know, for people who, I remember when I was backing up for being a patient coordinator, if we had somebody on vacation and I would quote patients and I remember a few times women were like, yeah, they wanted like their breasts restored to where they were, but they didn't want the scars. And it's like, well you can't get there <laugh>. Right. You can't get there unless you have the scars to be able, and I mean it's gravity and physics and stuff, <laugh>, but it's worth it. And I think when people just think, oh, I have enough skin, you could just put an implant in there. Well no <laugh> because that is just gonna be hanging. 

Nicole (17:55):
Right. Gravity does happen. <laugh>

Monique Ramsey (17:56):
Gravity happens. Yeah. So you have to be able to support it. But you're right, they, they do fade and it, you don't even think about it. And it's a lot easier to hide the scars because you're, like, you say you're wearing clothes anyway, then have like an extra bulge of fat around your middle. You're like, I can't set my jeans up <laugh>. So having that skin gone, it's like, okay now everything zips and is is perfect, so.

Nicole (18:20):
Yeah, I mean I was wearing a form fitted dress and I couldn't hide the skin that was there. I mean, no matter how tight of a garment I put on to try to suck it in and hide it, it was just not going anywhere. And if it did go somewhere, it came out the other side. <laugh>. So <laugh>,

Monique Ramsey (18:39):
I've been there <laugh>,

Nicole (18:40):
And now I don't even have to think twice, you know, it's just, it's gone. And yeah, I have a few scars, but I would rather have the scars to cover up with my clothes than try to hide all my extra skin and fat <laugh>.

Monique Ramsey (18:53):
Yeah, the bulges are, yeah. Not fun. Shapewear is great, but shapewear can't do everything. So now you had the, you said the fat transfer, like they're taking some fat out from some places like you to get a more defined ways to round your, your hips and then having that transferred into your buttocks. So do you know how much fat was transferred?

Nicole (19:15):
Yeah, so it was about 12 to 1300 milliliters. So that's a little over a liter. There was a little bit more on my left side because I had a little bit more of a flat indentation there just from aging and muscle atrophy. Um, it happens to everyone. You get those little side hip dips and I had more of a prominent one on my left side, so he put a little bit more there to just round that out and then fill it in the other side with the rest of it.

Monique Ramsey (19:44):
Perfect. That's nice. And did that cause any difference I guess in, in how you healed or what your healing plan was? That your, you know, I'm wondering if your tummy's been cut into and you've got, uh, you know, scars that wrap around your waist, and then you also have fat that's been put into your buttocks. It's like there's no safe space. Like where, where do you go <laugh> to get re did it feel like more numb or did it feel like you had pain in certain areas? And how did you stay comfortable?

Nicole (20:17):
That was the biggest challenge. So trying to figure out how to lay in the bed was a conundrum. <laugh>

Monique Ramsey (20:28):
<laugh>.

Nicole (20:29):
So I did have, luckily I have an adjustable base bed, so my bed lifts up and down. So that I found extremely helpful. But you know, if I didn't have that, I would say I would probably just prop myself up on a ton of pillows. But I had my BBL pillow under my thighs, like the bottom, the base of my buttocks. And then I had pillows that kind of went under my back and my head elevated with my bed so that my butt would kind of float in the air <laugh> ah, I guess, while I was laying down and I

Monique Ramsey (21:03):
You made yourself a donut somehow. 

Nicole (21:05):
Exactly. That's essentially what I did.

Monique Ramsey (21:06):
A pillow fort.

Nicole (21:08):
A pillow donut. Yeah. So my butt could kind of suspend in the air and then I would lay on my back and I'm not a, I'm not a back sleeper at all, I'm a side sleeper. So that was an adjustment. But once I got through, you know, the first week or so, I started trying to like slowly turn myself on my sides and figure out how I can make myself more comfortable, uh, on my sides. And at first it was kind of not working out, but after a while of continuing to try to do it, <laugh> it, it just worked itself out probably a couple weeks. I was able to sleep on my side again comfortably.

Monique Ramsey (21:46):
Well that's good. That's good. Yeah, I think body position is kind of a tough one and it'll be nice that, you know, as now you've gone through it, you know, you can help other patients and go, you know, try this or try this or don't try that <laugh>. The, the adjustable bed is like a game changer for life in general, I have to say. I, that's what I did when I moved and I got a new bed. My mom said, you gotta get the adjustable base because it really, if you're not feeling well or whatever, you just, you can elevate yourself and feel better. So that's good for surgery. So if the goal of a mommy makeover is to really kind of, you know, feel confident and reclaim your body like you were pre-baby, even though you're still healing, it's only been a month, but do you feel like your surgery's been successful in kind of helping restore that for you?

Nicole (22:38):
Oh, it's better than I could have ever imagined. I actually have never had a body that looks like I have now. It's better than pre-baby, ffor sure. So I mean, I knew that it would come out good, but I did not know that it would come out great. Like more than I could have ever asked for.

Monique Ramsey (22:57):
Wow. Oh that's, that's huge. That's huge. That's huge. So let's go back to my question earlier where you alluded to getting, kinda, what did you say about kind of what surprised you after surgery?

Nicole (23:10):
Oh, I got a little, it got a little squeamish.  

Monique Ramsey (23:12):
Squeamish. That was the word. Afterwards. So what was that like? What were the things that sort of were a challenge for you that you weren't expecting after surgery?

Nicole (23:21):
Definitely the drains. I've never had drains before. And with the extended tummy tuck, you end up with four drains. They're JP drains and essentially what they do is they create a negative suction so that you can suck out any extra fluid that your body naturally produces to help with healing. But if you don't get that fluid out of there, then it's, it accumulates under your skin and it becomes very uncomfortable and you're swollen even more. So those drains really help mitigate that. I went in to have my drains removed and I immediately just got really hot and flushed and sweaty. 

Monique Ramsey (24:04):
Oh no.

Nicole (24:04):
And just, I never even expected it. I was like, oh, it's easy. It's a drain pull. It's no big deal because essentially all they have to do is snip a suture and it comes out just super easy. Like it just pulls right out. And I've pulled 'em out a million times out of other people <laugh> and I'm like, oh my gosh, what is wrong with the, here I am getting sweaty. And I told the nurse that was helping me, I was like, oh my gosh, I'm so sorry. And she's like, no, it's okay. It's okay. But yeah, quite embarrassing. <laugh>

Monique Ramsey (24:32):
Maybe because you knew what was coming. I guess I'm not,

Nicole (24:36):
I'm not really sure. But <laugh>, it does happen with other women and I never thought it would happen to me. 

Monique Ramsey (24:41):
Yeah, yeah.

Nicole (24:42):
You know, here I am, <laugh>,

Monique Ramsey (24:43):
Here you are. And that takes like what, 10 seconds? 20 seconds. 

Nicole (24:47):
A few seconds. 

Monique Ramsey (24:48):
Very quick. <laugh> very quick. So what would you tell somebody who's thinking about having really any, whether it's a mommy makeover or any kind of plastic surgery, what advice would you give them?

Nicole (25:01):
I would advise having consultations with multiple physicians. Just to know who you're comfortable with because the more you're comfortable you are with a plastic surgeon, the better outcome you're gonna have. If you go into surgery feeling like, yes, this is great, I have a hundred percent confidence in this person, then of course your healing time is, is going to be much better than if you go into surgery and you're like, oh my gosh, I'm not sure if this is the right thing to do. You know, what am I doing? I think the biggest thing is being confident and going into surgery knowing that it's gonna turn out fantastic. Having that positive attitude because it really does play into your recovery. The other thing would be to make sure you have backup plans. So if you do have your surgery scheduled and then something happens on either end your schedule, something happens, you get sick, or a family member who's supposed to take care of you ends up sick, then you have somebody to help either during that time that your family member's sick or a secondary plan for another surgery date. Just in case um, anything happens because, you know, we plan our lives around these events and, you know, unforeseen things do happen. So that would be my biggest advice.

Monique Ramsey (26:21):
Now, Dr. Brahmie he's kind of like the master of all the things <laugh>, you know? He's really good at everything he does. And he does a lot of mommy makeover surgery. So what was the thing that made, you know, you have six wonderful surgeons to choose from, five of whom do body procedures. How did you select Dr. Brahme?

Nicole (26:45):
Honestly, I, I see his work all the time and he does so many mommy makeovers and he's just got it down to a science and his eyes for perfection are just amazing. You know, you can tell him what you want and like I said before I was heard, he, I told him what I wanted and he delivered a hundred percent actually more than what I could have imagined. And I just knew that he was the one, I mean he does so many and they all turn out so well. And people come back the day after surgery and they're in tears of joy. Not even in tears of pain because of how he performs.

Monique Ramsey (27:28):
Yeah. You know what, and I think you alluded to something at the beginning, which is sort of that feeling comfortable with your team. Not not just with your decision, cuz you have to feel comfortable about your decision to do something, whether you're gonna do it or not. Where you're gonna do it, where you feel safe. But then also feeling comfortable just person to person, like in a human way with that surgeon, with that nursing team. And some people want something that, you know, a person like Dr. Brahme is really fun and outgoing  and you know, very serious about his work, but he's has a more effervescent sort of personality. Other doctors might be more reserved. And so there's no right or wrong answer for how you feel when you experience. And I think, so your your advice about meeting with more than one surgeon, even if it's at La Jolla Cosmetic, if it's outside of La Jolla Cosmetic, to get that comfort level because it is a partnership as you go through.

Nicole (28:28):
Absolutely. Dr. Brahme is so personable and like I said, it's like when you're talking to him, you're telling him what you want and it's almost like he sees it as you're describing it and you know, he just, he can deliver.

Monique Ramsey (28:43):
So what would be your, anybody who's listening, you know, you probably all have questions for Nicole, but <laugh> will will answer them if you post on social media or on YouTube and if you have any questions. But, you know, if you were gonna give advice to someone who's thinking about a mommy makeover or any surgery, you know, what, what should they look for in a plastic surgeon?

Nicole (29:09):
The number one thing to look for is that they're board certified. All of our plastic surgeons here at La Jolla Cosmetic are board certified. We also have board certified anesthesiologists. We don't utilize nurse anesthetists. We have a certified surgery center. Those are all really key elements into having a successful surgery experience, I believe for plastic surgery. Especially because there are unfortunately some other places out there that are, that don't hold the high standards that we do here at La Jolla Cosmetic. The board certified plastic surgeon, number one is, is the one thing to definitely look out for.

Monique Ramsey (29:50):
Yeah. And actually you're bringing this up, it's very interesting. Just yesterday there's a story in the news and there this is, the story's been in the news cuz it was happened four or five years ago. But a patient had surgery with a doctor here in San Diego and she was having a breast augmentation, but there was no board certified anesthesiologist there. There was no accreditation for his facility from, based on what I've read. And unfortunately she passed away and nobody should be giving their life up for surgery and you know, so I think we need to do an episode on it, you know, really to diving into what some of these certifications and accreditations mean and you know, what you bring up is really important that, you know, having a board certified anesthesiologist who solely dedicated to your care, that's a little more expensive than having the doctor doing it under local or something.

Nicole (30:50):
Or even have a nurse administer moderate sedation or anything like that. 

Monique Ramsey (30:55):
Yeah, or having surgery not in something that's accredited at a high level and all these little shortcuts. And that's kind of what the article I was reading was alluding to the shortcuts that this surgeon was taking that in their lawsuit that they're having, you know, it it, there's now a murder charge. And so that was kind of the new thing that came up and, and so being educated, I think, you know, your point about making sure that it's a board certified plastic surgeon that you know who's doing your anesthesia, you know, what kind of facility is it in? Those things aren't, they're not silly <laugh> . To think oh everybody's probably good and everybody's probably, or they wouldn't be able to do it. Right. Well there are a lot of laws on the books but you know, things happen and so you know.

Nicole (31:45):
There are loopholes everywhere.

Monique Ramsey (31:46):
Exactly. Exactly. And so, you know, doing your homework ahead of time I think is a really critical factor.

Nicole (31:53):
Absolutely. A hundred percent. Because you don't want to be that person. I mean yeah, it's absolutely tragic to go in for something that seems pretty benign. It's essentially a skin surgery and you come out on the other side not waking up.

Monique Ramsey (32:10):
Right, right. Two kids have no mom and you know, it's just, and I think, you know, we don't always question the things we should, you know, so, so I think it's good to do your homework and we have a lot of information both on our podcasts. We have in an episode with Dr. Steve Saltz in a, when I'm of our anesthesiologists and he goes into what you should be looking for and kind of some of the most common concerns about anesthesia. So, we'll a link to that in our show notes. We also have a page on our website that explains board certification accreditation of your facility and has links to you so you can check and see that you know, the doctor that you've chosen or that you're thinking about has the right certifications and that you're, you're in the safest hands and I think that's, you know, all of us wanna look great and feel great in our bodies, but also like how we get there is, you know, and a really, really important thing. And I'm glad you brought that up.

Nicole (33:12):
Absolutely.

Monique Ramsey (33:14):
So let's see, is there anything we haven't covered?

Nicole (33:18):
Well I can maybe speak a little bit to resuming normal activity.

Monique Ramsey (33:24):
Oh yeah.

Nicole (33:25):
So like I said, I'm only four weeks out. You're not released back to full activity until six to eight weeks after a tummy tuck. So that is one of the things to consider if you're going to have a tummy tuck specifically or any probably any, any type of plastic surgery, you're gonna want to give yourself six to eight weeks to fully recover and just know that that's including your workouts and gym time. <laugh>.

Monique Ramsey (33:52):
Well

Nicole (33:53):
Cause, that's a big question that comes up almost right after surgery. Patients are like, oh when can I go back to the gym? And I'm like, hmm, that's gonna take a little bit. <laugh>

Monique Ramsey (34:02):
Yeah, you don't wanna set yourself backwards in your healing cuz then it's hard to get back to where you were if you overdo it. But also, you know, you were mentioning the ages of your kids and your youngest is six? 

Nicole (34:15):
My youngest is three. 

Monique Ramsey (34:15):
Oh three. Oh sorry, three. Okay. So what have you been having to do with your three-year-old or not do during this time? 

Nicole (34:27):
Well, you know, it's really kind of a funny story. So I came home after the night at the hotel, I went home and you know, I had to explain to my littler ones, my three and six year old, you know, mommy has owies, <laugh>, I had surgery at work and it's gonna take a little while to recover. So you have to be gentle. And my three year old Beckham, he would <laugh>, he would accidentally, you know, elbow me in in my, one of my breasts or whatever and then he would turn around and go, it's okay, it's okay. And he would <laugh>, I'll make you better <laugh>. So I really had to just prepare him that mommy had owies. And then when it came to seeing the drains, those are kind of scary for a little kid, you know? And so we made a game out of them. So the drains, they put out like a little bit of bloody drainage and he sees these and he is like, what are you Frankenstein? You know, <laugh>, I can just imagine that's what he is thinking, <laugh>. So we made this little game and he got to shake my drains like they were like instruments like Moroccas or something. And he would call them my blood bags <laugh>. And so <laugh>, after I got them out, he was like, I came home and he goes, mommy, I wanna play with your blood bags. Where'd they go? <laugh>.

Monique Ramsey (35:43):
That's funny. Yeah, I enlisted my daughter, I don't remember how old she was, but I enlisted her in my drain care. You know, she was very, yeah. Oh yeah. She was fully into it and you know, like marking how much output, you know, you have to keep a little chart uhhuh. And so she would come in and she'd be very studious. It was <laugh>, it was actually

Nicole (36:05):
My six-year-old did that for me too. He thought it was cool. I was like, okay, write this number here, write that number there <laugh>.

Monique Ramsey (36:10):
Yeah. Yeah, exactly. So it was, you know, I think it's all in how you, as long as they know you're not really hurting or you know that it's like, it's okay, these are, these are things that are okay and.

Nicole (36:21):
Yeah and kind of uh, no I can't carry you right now. Remember mommy has some owies they're getting better and so, you know, they kind of didn't like it sometimes. Especially my three-year-old. He was like, but, but I need you <laugh>. But he, we, we got through it.

Monique Ramsey (36:40):
Yeah. Yeah. So are you back up right now to have like full, you're in a month?  So full working. And are you finding that you're more tired at the end of the day or anything kind of like lingering from the recovery that you're having to sort of plan your life around a little bit?

Nicole (36:59):
I definitely was the first three weeks, this last week I think I've kind of built my endurance back up. So this last week hasn't been as bad. The biggest thing which I was kind of surprised about was lower back pain that I was having. And it turned out it was just swelling between, so I have the incisions that wrap around my waist and they don't connect in the back, but they do wrap around in, you know, in the, between those in my lower back and sacrum area. I had some just, you know, normal swelling of the tissue and out was surprisingly the worst part of the pain actually <laugh>, which is weird cuz they didn't even do surgery there. That part wasn't even touched. But that was where I had the most like tender, pinpoint kind of pain. 

Monique Ramsey (37:47):
Now did you have any lymphatic drainage or massage or anything like that after?

Nicole (37:52):
I didn't, I didn't really feel like I needed it so I, you know, I didn't utilize that but I know a lot of women do and you know, if you're having a lot of fluid production then ha moving that around is helpful. But I didn't have a lot of that so I was kind of lucky.

Monique Ramsey (38:08):
Oh yeah, that's nice. That's nice. So all in all your, your recovery I think went pretty smoothly.

Nicole (38:15):
Oh wow. It was <laugh> better than I could have imagined for sure. I thought I was gonna be down and out for at least a month. <laugh>. 

Monique Ramsey (38:23):
Yeah. So let's say if you were going to do three things that any mommy makeover, you know, if they've had their surgery, like three things you have to have on hand.

Nicole (38:36):
So three things you have to have on hand is probably a nice big jug of water that you can fill up <laugh> because you're not gonna wanna get up to get more water <laugh> in the first week or so. You're just not gonna want to do that. Lots of pillows. I definitely suggest lots of pillows, especially if you don't happen to have an adjustable base bed, you're gonna need those pillows to prop you up. And my third thing would be somebody to help. I mean that was huge. Having the aftercare the first night was amazing. And then my husband taking off several days after my surgery just to be there to help was huge.

Monique Ramsey (39:17):
Yeah, that's really important that you have, especially that first couple days before, you know, just to get up to go to the bathroom is like an endeavor. <laugh>,

Nicole (39:26):
Oh, taking a shower took everything I had in me <laugh>. I took a long nap just after showering. 

Monique Ramsey (39:33):
And then, you know, if they have any garments and you're, you know, trying to get everything hooked back on. And

Nicole (39:38):
I had my daughter, my 18 year old <laugh>, I had her coming in to help me after my shower to like put all my garments back on and it's not even that difficult but it was like, I was just so exhausted after the shower. I was like, okay, I can't do anymore <laugh> you, you're gonna have to do the rest of it.

Monique Ramsey (39:52):
Have your little like post-op squad. Have them ready. <laugh> <laugh>. Well that's so nice of you to talk with us Nicole and share your experience and you know, we'll put in the show notes some, some of the links we have things we talked about earlier. And just so the audience knows, and this isn't something, you know, we talked about at the beginning, the how a mommy makeover can be different things. You know, sometimes it involves the breasts in some way, shape or form a lift or an augmentation or you know, sometimes it involves the tummy in some way, shape or form, maybe some liposuction. And even with Dr. Brahme, you know, he has a specialty and, and so does Dr. Breister in Labiaplasty. Other things that might have gotten a little messed up <laugh>. Yeah. During childbirth he does vaginalplasties. And so for sometimes a mommy makeover can be things that you might not know that people do and they do it pretty often. So that's something that I think we did do a, a podcast on the Lady Bits <laugh> and Dr. Brahme, you know, talked about that. And I think that's becoming more common for women to say, you know what, if you need a little restoration downstairs, they can happen. And so, you know, all of those things could be part of a mommy makeover. And so it's a little bit, you know, I, I guess like you said at the beginning, it's very individualized to what your specific needs are.

Nicole (41:25):
Mm-hmm <affirmative>. Absolutely. And like I said, having those consultations just with different doctors to figure out not only who you, you know, meld well with, but just kind of different opinions too on the different surgeries that could help your body. That's important too cuz you want somebody who's also gonna see what you see and maybe even give you some insight that you didn't even think about.

Monique Ramsey (41:49):
Yeah, that's a good point. That's a good point. Well thanks again Nicole. And of course we'll let you get back to work. <laugh>. 

Nicole (41:56):
Yeah. Okay. 

Monique Ramsey (41:56):
Run on downstairs and thank you again for, for joining.

Nicole (42:01):
Yeah, thanks for having me.

Speaker 1 (42:07):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XiMed Building on the Scripps Memorial Hospital campus. To learn more, go to lj csc.com or follow the team on Instagram at lj csc. The La Jolla Cosmetic Podcast is a production of The Axis, t h e a x i s.io.