Wellness Unmasked: From Botox to Mommy Makeovers: The Art and Science of Plastic Surgery

Summary

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Podcast Summary

The Clay Travis and Buck Sexton Show

Wellness Unmasked: From Botox to Mommy Makeovers: The Art and Science of Plastic Surgery
Date: November 25, 2025
Host: Dr. Nicole Saphier
Guest: Dr. Jonathan Sherwin, Board-Certified Plastic Surgeon

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Episode Overview

This episode of Wellness Unmasked, hosted by Dr. Nicole Saphier, dives into the evolving world of plastic surgery for women, particularly around perimenopause, menopause, and the postpartum experience. The core focus is demystifying and destigmatizing “mommy makeovers”—a suite of surgical procedures including tummy tucks and breast reductions—which, as the guest Dr. Jonathan Sherwin emphasizes, aren’t just about aesthetics but also restoration of function and quality of life. The episode weaves in discussions about societal attitudes, new technologies, responsible decision-making, and the powerful impact of surgery on women's well-being, using a refreshing blend of medical expertise and candid conversation.

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Key Discussion Points and Insights

1. Wellness Trends and Societal Expectations (02:47–07:03)

• The Rise of Menopause Wellness: Dr. Saphier sets the stage by humorously referencing trends—weighted vests for perimenopausal women, diet fads, and fitness regimens—all as acceptable means for women to “feel better and live longer.”
• The Stigma of Plastic Surgery: While diet and exercise are widely accepted, procedures like plastic surgery remain stigmatized despite their potential to meaningfully improve health and happiness.
  • Quote: “Making changes to yourself on the outside doesn't necessarily help the person on the inside. But anybody who ignores the fact that it can make you feel better on the inside, they're being dishonest.” — Dr. Nicole Saphier (05:36)

2. Evolutions in Facial Rejuvenation (12:03–17:43)

• Subtle Facelifts and the Zoom Boom: Dr. Sherwin sees a rise in demand for “subtle” facelifts, influenced by GLP1 medications, self-scrutiny via video calls (“Zoom boom”), and earlier interventions he playfully dubs “prejuvenation.”

  • Quote: “More and more procedures are being done at a younger age... Some individuals refer to this early intervention as prejuvenation, if you will.” — Dr. Jonathan Sherwin (14:12)

• Technique Matters: The outcome depends heavily on the surgeon’s skill, with a focus now on hidden incisions and avoiding the “overdone” look:

  • Quote: “It is about the surgeon. It's about their technique. It's how fastidious they are, how particular they are, how exacting they are.” — Dr. Jonathan Sherwin (17:45)

3. Botox, Fillers, and Reversing “Overdone” Trends (18:16–22:27)

• Common Progression: Many opt for Botox and fillers before considering surgery. Old fillers can show up during surgery; overuse leads to the infamous “chipmunk cheek” effect.
  • “I'm a huge fan of Botox. Fillers have to be done very, very judiciously, very carefully, very cautiously, because once you cross that line, it becomes a negative, not a positive.” — Dr. Jonathan Sherwin (22:02)
• Cultural Awareness: There’s irony in people shunning certain substances while embracing others, e.g., “...I only eat clean...and now I’m on my way to get my botulinum toxin injected in my face.” — Dr. Saphier (22:27)

4. The Lymphatic Drainage Craze (23:46–27:17)

• Science and Self-Care: Dr. Sherwin explains the origins and benefits of lymphatic drainage, from reducing swelling and speeding recovery post-surgery to improving skin glow and even acne.
  • “Manual lymphatic drainage definitely has significant benefits... It reduces swelling, bruising, diminishes pain and discomfort, promotes relaxation, sleep. It accelerates the recovery process.” — Dr. Jonathan Sherwin (24:03)
• Both clinical and home-based therapies are discussed as proven, accessible tools for recovery and daily self-care.

5. Mommy Makeover: Beyond the Vanity (28:29–37:30)

• Redefining “Cosmetic” Surgery: Much of what’s lumped as cosmetic—tummy tucks, breast reductions—actually restore physical function, not just appearance.
  • “The first that comes to mind would be restoration of a woman's core as performed in tummy tuck or abdominal plasty...They come in very compromised. And this procedure is very impactful.” — Dr. Sherwin (29:29)
• Core Restoration and Health Outcomes: Tummy tucks correct diastasis recti, reducing back pain, improving stability, and even addressing urinary incontinence.
  • “There was a study...that listed the myriad benefits of correction of the diastasis and providing core stability... correction of urinary incontinence, improvement of bowel function...” — Dr. Sherwin (30:29)
• De-stigmatizing and Normalizing: Both hosts agree the label "mommy makeover" undermines the importance and function of these procedures. Dr. Sherwin urges society to “laud” women for regaining their health.
  • “I really don't think it should be stigmatized at all...turning back the clock or allowing women to have that restoration functionally and bringing them back to a better place.” — Dr. Sherwin (34:32)

6. Surgical Timing, Preparation, and Patient Candidacy (37:30–41:23)

• Best Practices:
  • Wait until childbearing is complete before surgery; for breasts, at least six months after breastfeeding.
  • Achieve a stable, healthy weight through diet/exercise beforehand for best results.
  • Quote: “Certainly if somebody is thinking about a five or ten pound fluctuation in weight, that's not much...But if considering a 15 or 20 pound reduction, we encourage that prior to procedure.” — Dr. Sherwin (39:31)
  • Dr. Saphier: “I'm on a mission now to destigmatize tummy tucks for women who have had babies. ...Functionally it makes you look better, yes, but it makes you feel so much better and stronger.” (41:23)

7. Credentials Matter & Final Advice (42:50–44:21; 49:17)

• Choose Wisely:

  • Ensure your surgeon is board-certified and practices these procedures often.
  • Avoid “travel surgery” for cost savings; the risks outweigh the benefits.
  • Do your due diligence—research, ask questions, and use reputable practitioners.
  • Quote: “Credentials matter. I'm not a fan of travel surgery...Do your homework, investigate, explore...the more questions, the better.” — Dr. Sherwin (43:20)

• Empowerment and Solidarity:

  • Dr. Saphier urges listeners to reject shame and seek what truly improves their lives.
  • “Bottom line, we only have one life to live, so do what you have to do to feel better and don't let anyone out there hate on you.” — Dr. Nicole Saphier (49:17)

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Notable Quotes & Memorable Moments

| Timestamp | Speaker | Quote | |-----------|--------------------------|--------------------------------------------------------------------------------------------------------------------------------------------| | 05:36 | Dr. Nicole Saphier | “Making changes to yourself on the outside doesn't necessarily help the person on the inside. But anybody who ignores ... they're being dishonest.” | | 14:12 | Dr. Jonathan Sherwin | “More and more procedures are being done at a younger age...Some individuals refer to this ... as prejuvenation, if you will.” | | 17:45 | Dr. Jonathan Sherwin | “It's about the surgeon. It's about their technique. It's how fastidious they are, how particular they are, how exacting they are.” | | 22:02 | Dr. Jonathan Sherwin | “I'm a huge fan of Botox. Fillers have to be done very, very judiciously, very carefully, very cautiously…” | | 24:03 | Dr. Jonathan Sherwin | “Manual lymphatic drainage definitely has significant benefits...It reduces swelling, bruising, diminishes pain and discomfort…” | | 29:29 | Dr. Jonathan Sherwin | “Restoration of a woman's core as performed in tummy tuck or abdominal plasty...this procedure is very impactful.” | | 41:23 | Dr. Nicole Saphier | “I'm on a mission now to destigmatize tummy tucks for women who have had babies....it makes you feel so much better and stronger.” | | 43:20 | Dr. Jonathan Sherwin | “Credentials matter. I'm not a fan of travel surgery...Do your homework, investigate, explore...the more questions, the better.” | | 49:17 | Dr. Nicole Saphier | “Bottom line, we only have one life to live, so do what you have to do to feel better and don't let anyone out there hate on you.” |

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Important Segment Timestamps

• Wellness Trends & Stigma: 02:47–07:03
• Facelifts & ‘Zoom Boom’: 12:03–17:43
• Botox, Fillers, and Face Trends: 18:16–22:27
• Lymphatic Drainage Demystified: 23:46–27:17
• Mommy Makeover, Function & Identity: 28:29–37:30
• Timing & Preparation for Surgery: 37:30–41:23
• Choosing a Surgeon & Final Encouragement: 42:50–44:21
• Empowerment, Closing Thoughts: 49:17–end

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Summary and Takeaways

• Plastic surgery can be a meaningful part of women's health and self-empowerment, particularly for mothers and aging women.
• Procedures like abdominoplasty and breast reduction are not just about aesthetics; they often restore function, confidence, and quality of life.
• Stigma around these procedures persists but is increasingly challenged by both data and personal testimonies.
• Selecting a skilled, board-certified surgeon is critical to safety and satisfaction.
• Wellness for women in perimenopause and menopause is multifaceted—diet, exercise, self-care, and, when desired, surgical interventions all play a role.
• Support, empathy, and informed decisions should lead the conversation, not shame or judgment.

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For more on this topic, or to connect with Dr. Nicole Saphire and Dr. Jonathan Sherwin, tune in to Wellness Unmasked on the iHeartRadio app or wherever you get your podcasts.

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Transcript

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[Dr. Nicole Safire]

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[Dr. Nicole Safire]

Welcome to Wellness on Mass. I'm Dr. Nicole Safire and today's episode is an interesting one and I'll tell you why. As a woman, there is no escaping perimenopause and menopause. I'm sorry ladies, but everyone is going to go through it. Is there a manopause? Yes, there absolutely is a manopause, but that is for an entirely different episode. So men, listen to this one because you may be able to learn some things. But ladies, this is for you. One of the things that I find honestly a little bit comical is we have so many things to make us feel better. And right now, if you're not wearing a weighted vest as you walk outside, you're not part of that perimenopause menopause club. Apparently. I have yet to purchase one, but it's certainly on my list. People love it and I do want to be a part of that club, I guess. But here's the question I have. Yes, I know that taking our life into our hands with some wellness stuff, changing our diet, exercising, wearing weighted vests, weightlifting and all these other things can be really good for us. It doesn't just make us look better, feel better, but it actually makes us healthier and improves our quality in life and may even help us live longer, healthier and longer. But one of the things that is less talked about is that there are actually some surgical interventions that might be able to help women get to the place where they feel better as well. And yes, I'm talking about plastic surgery, but I'm not talking about plastic surgery kind of as you traditionally think about it. One of the things that we don't talk about as much is yes, there are all these things that we can do to look better, feel better, but there's a lot of stigma around some of it. There's not a lot of stigma around weightlifting for women, eating healthier, wearing these weighted vests, they kind of go in that pool of acceptable things we can do to make ourselves feel better. But what about plastic surgery? Now, I'm not talking about cosmetic plastic surgery in that traditional sense where it's like, oh, I have an Italian bump on my nose, which I do if you ever see me from a profile shot, I want to get rid of My bump, that's going to make me feel better. Okay, that's fine. I mean, whatever you got to do to make yourself feel better, you know, making changes to yourself on the outside doesn't necessarily help the person on the inside. But anybody who ignores the fact that it can make you feel better on the inside, they're being dishonest. So whatever actually makes you feel better, I'm all for. Do I think people overdo it with plastic surgery? Undoubtedly. But there are some things that you can actually do specifically for women like myself who have had children, our bodies, God bless our bodies, because we are able to hold these children, create these children, grow these children, birth these children, and then raise these children. But yes, pregnancy, birth, it takes a toll on our bodies. And one of the things we keep telling women, you have to be exercising, you have to keep a strong core, you have to do all these things if you want to be healthy, healthy for your children as they grow up. Okay. Well, for some of us, we can get some conditions that leave muscles incredibly weak and make it very difficult to do some of those exercises. So I am very excited to have on Wellness Unmasked today a friend and colleague, Dr. Jonathan Sherwin, who is a board certified plastic surgeon in the New York City area. Plastic surgeon to the stars. I know many people that he has worked on. I've referred many people to him. He does an excellent job and he is about trying to make a woman feel better functionally. And he is here to talk all about mommy makeovers. And I am on a mission to get rid of the stigma behind these mommy makeovers because it's not just about getting rid of excess skin and fat, it's about so much more than that. And it's about setting us up to a place where we can get back to the gym, get back to feeling stronger and healthier and really living that life that we want to live and throwing on a weighted vest if that's what we want to do. So let's bring in Dr. Sherwin.

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[Dr. Nicole Safire]

Okay, well, I am very excited to have on today a friend of mine, but also a colleague and someone I Admire very much, Dr. Jonathan Sherwin. He is a board certified plastic surgeon in Manhattan and Greenwich area and he is just a wealth of knowledge and excited to have him today because I have a lot of plastic surgery questions. Dr. Sherwin, thanks for being on.

[Dr. Jonathan Sherwin]

It's a pleasure and a privilege.

[Dr. Nicole Safire]

Okay, so I just have to, I have to talk about the elephant in the room. Although this is not the big thing I really want to talk to you about. I'm more interested in the functional aspects of plastic surgery. But inquiring minds want to know. If you look at social media or I've had to talk about it on tv, people are starting to pop up with what they're calling these subtle facelifts. I think Kris Jenner, who's the matriarch of the Kardashian family, has recently, recently looking mightily refreshed, people have questioned whether Lindsay Lohan and some other people. What do you make of this?

[Dr. Jonathan Sherwin]

Well, I think that a lot of the popularity in facelifts today are a reflection of use of GLP1s social media, also FaceTime and Zoom. Some, some individuals refer to it as the zoom boom because people are seeing themselves on camera. What I would say in respect to the subtle facelift, the first thing I would say is that the beautiful thing about plastic surgery is that everybody is an individual. Their needs are individual, their requirements are individual. And so each procedure has to be, has to address that individual's needs and requirements. So that's the first thing I would say. Plastic surgery, particularly when it addresses facial rejuvenation, reflects a targeted approach. So you have to address the areas of concern, the patient's goals. To that end, I think that more and more procedures are being done at a younger age.

[Dr. Nicole Safire]

How young is too young? Like what are you, what are you seeing?

[Dr. Jonathan Sherwin]

Well, I've seen patients in their late 30s come in, believe it or not, patients that have lost a significant amount of weight. I have even been very, very surprised at the amount of laxity that some younger individuals maintain for a variety of reasons. And as much as I try to ask these patients to wait or try to delay their procedures, they're very, very dogged. They keep coming back and they really push to have the procedure done. But I've been personally very surprised pleasantly by the great rejuvenation that you can accomplish. Some individuals refer to this early intervention as prejuvenation, if you will. But I think I want to emphasize too that it is a targeted approach. I think that techniques today are emphasizing more hidden incisions, inconspicuous closures, inconspicuous incisions, minimal incisions. I think that's been very, very greatly emphasized even in the literature today. And the other thing that I would emphasize as well is that the procedure and the outcome must be aesthetically pleasing, tastefully done, not overcorrected. And the results have been, I think, much improved in that regard.

[Dr. Nicole Safire]

Well, so when I think of kind of traditional facelifts, to be honest, someone who I saw all the time always saw the scars was former president Joe Biden. I mean, that was, you know, he had a very obvious facelift.

[Dr. Jonathan Sherwin]

Yes, yes.

[Dr. Nicole Safire]

You saw the scar kind of going perioricular around his ear. And he always just looked a little bit too surprised. What's different about what he had done versus, I mean, I'll be honest, Kris Jenner, she looks amazing. Now, I get it. If you have hundreds of millions of dollars and can have and have a lifestyle that is. I don't want to say she lives a stress free lifestyle, but we probably live different lives that may have something to do with it. But why does she look so refreshed? And Biden always looked like he was scared or surprised.

[Dr. Jonathan Sherwin]

Well, you know, a lot depends on the individual surgeon and their approach. I do know the individual surgeon who did her procedure. I know exactly what her procedure entailed because I know the surgeon's particular technique. I just think that it is the approach and how the procedure is executed. I think that, you know, that factors very importantly to outcome. Placement of incisions, how the incisions are concealed, the procedure itself and what it addresses, whether it addresses the neck, the submentum, or the area under, beneath the chin, cheeks, only the vector of the lift, meaning the direction of the lift, and how every soft tissue is reached, draped, those are. It's a very, very multifactorial procedure. And each factor has to be correctly addressed in order to have a successful outcome. I agree with you in terms of former President Biden, I think it's pretty obvious to the, the person who's observant that he had work done. And I don't think that his incisions were particularly well placed or concealed, et cetera.

[Dr. Nicole Safire]

It really is about the surgeon.

[Dr. Jonathan Sherwin]

It is about the surgeon. It's about their technique. It's how fastidious they are, how particular they are, how exacting they are. It's not just the technique. It's also how the individual surgeon performs that individual specific technique that makes the difference. And that is plastic surgery. It's not just a hernia repair or removing an appendix. A lot more goes into the procedure.

[Dr. Nicole Safire]

When you find people who are coming for facelifts, I mean, they tend to be older, but as you're saying, with the weight loss from the GLP1s, maybe people are wanting these a little bit earlier. Most of these women, I have to assume, have probably done Botox and fillers in their face. I mean, usually, I mean, that's kind of the progression. You start out with Botox, maybe then move on to fillers and then I guess, facelift for people. Does that cause any issues for you? Like, do you feel any of those fillers that are in the face? Anything like?

[Dr. Jonathan Sherwin]

Well, not infrequently when you're performing a facelift. And this has happened to me, I know it's happened to other surgeons as well. You'll come across old filler. It'll still be there as you're performing the facelift, elevating the layers, you'll come across old filler. Now, if there are occasions when a patient is over volumized that we will Dissolve the filler.

[Dr. Nicole Safire]

We all know that look, right? That's like big like chipmunk cheeks, kind of like pushing in their eyes.

[Dr. Jonathan Sherwin]

Yeah, sometimes. We will recommend that the filler be dissolved prior to procedure. I have done that on several patients who are so heavy with volume, there's such distortion that we will recommend dissolving filler prior to procedure. On other occasions when the filler may not be that evident, you'll just be, you know, performing your procedure in the middle of procedure and you'll come across old filler that, that doesn't create a problem per se unless it's done to such a degree that it generates scar tissue. Not to digress too much, there are other procedures which generate a fair amount of scar tissue. Thread lifting is one of the procedures that are out there that can generate a fair amount of fibrosis and the surgeon just has to work through that scar tissue or fibrosis in order to successfully perform the procedure. But. Sounds terrible. Yeah, fillers per se, they don't, they don't really compromise the procedure. But again, I think the factor is whether to dissolve before or not. The surgeon just has to be aware and that's part of taking a very, very thorough history and physical on your patients.

[Dr. Nicole Safire]

I always ask, don't you think women tend to lie? It's kind of like that, yes.

[Dr. Jonathan Sherwin]

You know what, not only, not not only do they lie, but you know, frankly, some women are very poor hist. So you don't know prior to procedure certain things and then once you're in the heat of battle, as I call it, you come across various things and then when you query the patient after procedure, oh, by the way, we found X, Y, Z. And then it jogs their memory.

[Dr. Nicole Safire]

Speaking for women everywhere, I'm going to push back on the women or poor historians. I think we're selective historians because I think when women, we tend to think that we know better and we just tell our doctors what they think is important for them to know.

[Dr. Jonathan Sherwin]

Okay. I don't mean to make a blanket statement about being a poor historian. Some patients in general, male or female, are poor historians. But you know, it's, it doesn't really compromise procedure. It's just nice to be aware, that's all.

[Dr. Nicole Safire]

I guess that's good to know. I really do hate that look of the over filled face. Just that chipmunk look. I look the same after a while.

[Dr. Jonathan Sherwin]

Absolutely, absolutely agree. I think when it comes to Botox or injectables, as we say, I'm a huge fan of Botox. Fillers have to be done very, very judiciously, very carefully, very cautiously, because once you cross that line, it becomes a negative, not a positive.

[Dr. Nicole Safire]

Well, you know what I think what I have a little chuckle at these days. You have so many of these wellness people online and on tv, and they're like, oh, I only eat clean and I only do loose sleep teaks. I'm avoiding microplastic. And now I'm on my way to go get my botulinum toxin injected in my face. It's like, all right, pick or choose your battles. That's fine. I digress. One thing that I talked about on TV recently on Fox and Friends, we did a segment. It was all about the fact that one of the Kardashians, Kim Kardashian, came out with this device that you sleep in that strangles you. Essentially. It's like a compression device, but for your chin and neck and just to try and have, like a chiseled jawline when you wake up in the morning. And I guess the overarching theme there is compression, almost like corset work of the abdomen, but maybe on the neck and the jaw, which, again, I thought, again, was a little cheeky in the sense that her mother just displayed this beautifully done face. But, yeah, no, no, the rest of us, we'll just wear this corset on our neck while we sleep. Sounded like a terrible idea to me, but that got me doing a lot of research on the benefits of lymphatic drainage of the face, something that I kind of have doing myself personally. But I'm curious, what's your thoughts on lymphatic drainage?

[Dr. Jonathan Sherwin]

So lymphatic drainage, just a little historical perspective, believe it or not, was first described in the 1930s by a gentleman by the name of Emil Vader. And since that time. So that's about 100 years ago, believe it or not, that it's been in existence, there have been about three modifications of that original description. But manual lymphatic drainage definitely has significant benefits for a variety of reasons. First of all, it represents one of the adjunctive therapies that plastic surgeons, healthcare professionals use for patients. Initially, it was couched in reconstructive surgery, if you will, or following reconstructive surgery, it's now progressed into body contour surgery in terms of lifting techniques or excisional procedures, liposuction revision surgery. It has a multitude of very definite benefits. It reduces swelling and bruising, diminishes pain and discomfort, promotes relaxation, sleep. It accelerates the recovery process.

[Dr. Nicole Safire]

Yeah, it Boosts the immune system, too. It helps flush out.

[Dr. Jonathan Sherwin]

Yes, it absolutely does. It. It eliminate those circulating toxins which are a byproduct of surgery and surgical procedures. It improves circulation. So it has a multitude of benefits. And it's actually become more. Much more mainstream these days. A lot of patients will come in and even ask about it. They'll volunteer in terms of, well, should I look into lymphatic, manual lymphatic massage or drainage after my procedure? And we actually provide a number of location, centers, practitioners who do this procedure for those persons who are a candidate or inquire about it and really wish to go that route. But it's definitely very, very beneficial. It has to be performed, certainly by qualified practitioners. Certified therapists have to.

[Dr. Nicole Safire]

There are some things you can do at home as well. Yeah, you can have a therapeutic lymphatic drainage massage. Absolutely. And there's nothing better than that. But, you know, for people every day, I mean, you can wake up and, you know, do some massages on your face or on your legs kind of help.

[Dr. Jonathan Sherwin]

Absolutely. The literature even points to providing at when it's done on the face, providing more of a glow, improving the skin, the look of the skin, even acne. Believe it or not, there are reports in the literature that it's beneficial in that regard as well. So you're absolutely correct. It does not have to be at a center or with a certified therapist. It's becoming very, very mainstream. And I do think that it's very, very advantageous on many levels.

[Dr. Nicole Safire]

Put some videos up on my social media after this launches, just to give some technique on the face so we can all save a couple dollars and try and get that beautiful glow.

[Dr. Jonathan Sherwin]

Absolutely. Definitely. It's certainly stood the test of time, and it definitely has very, very tangible benefits. I've seen it many, many times in my practice.

[Dr. Nicole Safire]

So I really thank you so much. I wanted to get into that. But what I really want to talk to you about as I get older and older by the minute, it feels like, and entered my perimenopause menopause era, obviously, you know, in medical school a couple decades ago now. I don't want to age myself, but, you know, we don't really talk much about what happens to our body after pregnancy and the hormones and the mental and physical effect, the toll of pregnancy and just being an aging woman has on the body. There's a lot of stigma around plastic surgery, as you know, people are kind of whispering like, oh, did she have something done? She looks different. And in fact, people sometimes it's hard for people to even compliment on a woman after she's had work done. Sometimes that's because the work can be just so over the top that it's like, whoa, we've gone too far. I feel like the goal should be where you almost don't even realize that they had plastic surgery.

[Dr. Jonathan Sherwin]

Absolutely agree.

[Dr. Nicole Safire]

I want to ask you what's really the difference about, you know, functional or reconstructive plastic surgery? Now, I'm not talking about, you know, like war victims or trauma victims. I'm more talking about for, like, a woman who's, you know, getting a little bit older. What are some things that plastic surgery offers? While it's thrown in the bucket of being cosmetic, it's actually a lot more towards the reconstructive.

[Dr. Jonathan Sherwin]

Well, I think there are a number of procedures that fall into that category. Certainly the first that comes to mind would be restoration of a woman's core as performed in tummy tuck or abdominal plasty, how we refer to that. I think that's one of the most significant.

[Dr. Nicole Safire]

And so what is that? That is just removing a bunch of excess skin from.

[Dr. Jonathan Sherwin]

Well, yeah, it's. It's correcting the. What's called the diastasis. Technically, it's referred to as diastasis recti abdominis, where the abdominal canyon that forms.

[Dr. Nicole Safire]

Down the woman's abdomen when the muscles don't come back together all the way.

[Dr. Jonathan Sherwin]

Exactly. So prior to pregnancy, your younger years, the muscles are more anatomically aligned and with pregnancy they separate. And that can represent a significant compromise to somebody's core. And the core is really defined as the level from the diaphragm all the way, including the pelvic floor. And as such, restoration of a woman's core can be extremely significant to a patient. Many times patients will come in with back pain or back instability or discomfort that's very, very resistant to core training, as we call it, and they come in very compromised. And this particular procedure, where there is restoration or correction, I should say, of the diastasis is very impactful. As a matter of fact, there was a study, a very excellent study, published in the British Journal of surgery in 2021. It was a retrospective three year study out of Sweden and it was actually republished by the National Institutes of Health. And it was an excellent study. And it listed the myriad benefits of correction of the diastasis and providing core stability, stability of the abdominal muscles, the back muscles. It even found, objectively, I might add, that there was correction of urinary incontinence, improvement of bowel function, basically because of stabilization of the pelvic floor. So the first thing that would be on my list, if you will, would be the abdominoplasty, which works to correct the core. And the other thing I would mention is many, many times incidentally or discovered and diagnosed preoperatively, a lot of patients will come in with ventral hernia, either.

[Dr. Nicole Safire]

That are fine like bowel or fat. The abdomen kind of goes through the abdominal.

[Dr. Jonathan Sherwin]

Yeah, I mean, and the ventral hernia consists of a number of different types of hernia. It could be an epigastric hernia, it could be an umbilical hernia or an incisional hernia from prior procedures. Even laparoscopies that are found incidentally during procedure. All of those corrective measures are extremely significant for patients in terms of functional restoration. Really? In addition to that, I mean, there are other procedures that we categorize as reconstruction, if you will. Breast reductions are categorized by plastic surgeons as reconstructive, not aesthetic. Even though there is certainly an aesthetic component to the procedure, Many times it's categorized as more reconstruction. Whether a patient comes in with neck pain, upper back pain, shoulder discomfort, rashes beneath the breasts, all of those things can become manifest perimenopausally or postmenopausal or postpartum. That's one of the procedures that's very commonplace in the so called mommy makeover, if you will. But these all provide for functional improvement, restoration, recovery for women who present with these issues.

[Dr. Nicole Safire]

So I almost wonder because even that term mommy makeover in itself, that kind of seems like frivolous to a woman that it's not. I mean, you just laid out many reasons why women should absolutely consider this. Increasing their core strength, increasing their pelvic floor. Many women, after having children, have some urinary incontinence. And no, that doesn't sound very sexy, but try jumping on a trampoline with your kids after having those kids. Sometimes that's a little bit tricky. There's actually something that can be done to improve that. We should be normalizing a little more. I mean, you see women walking out on the streets with their weighted vests every day now. I mean, that is like the hallmark sign of I'm in perimenopause menopause, and I'm working on my core. Well, that's great. You want to be exercising, you want to be eating right, you want to, I guess, be wearing your weighted vest and lifting weights and all these other things that women are being told we should do. But how can we remove that stigma of this quote, unquote, mommy makeover and maybe it should just be given a new name to kind of help?

[Dr. Jonathan Sherwin]

Yeah, I, I, I really don't think it should be stigmatized at all. I mean, I tell the, the moms that come into my office that, you know, having children is a wonderful gift and it's a great thing. And you know, this is just part and parcel, sometimes not for every woman, but for many women, part of that journey, if you will. And I find tremendous satisfaction and gratification for turning back the clock or allowing women to have that restoration functionally and bringing them back to a better place.

[Dr. Nicole Safire]

So.

[Dr. Jonathan Sherwin]

I hope it's not stigmatized. It shouldn't be stigmatized. If anything, I think women should be lauded for what they've, what they've been able to do in life and that, you know, giving birth and having children. I think it's just a wonderful, wonderful thing and I feel very, very happy to just be a part of that journey, if you will.

[Dr. Nicole Safire]

I've heard many women talk about improved energy, posture and just being able to exercise again after they've gotten, you know, they've had their, the abdominoplasty or the tummy tuck or mommy makeover, whatever you want to call it. From your experience, how transformative do you see in your patients on their day to day quality of life?

[Dr. Jonathan Sherwin]

Well, I appreciate your bringing up the exercise factor because I think that's very significant. Many, many women are very exercise driven today. And to your point, in that particular study that I cited a month a moment ago, quality of life was one of the factors that they studied and the significant improvement of it was statistically significant and very, very to a very great percentage. But I find that the quality of life in terms of every activity, whether it's activity of daily living or exercise, or just overall function, or even discomfort, if you will, the back discomfort, the lower back discomfort. I've been very stricken by the fact that women who've come in with very significant back discomfort after procedure, they're markedly improved. So I think the procedure is hugely beneficial. I'm not happy about any kind of stigma. It should not be stigmatized at all. I think that this is just an opportunity to help women regain a better quality of life and function better on a daily basis, whatever that means, whether it's activity of daily living, exercise, et cetera, or just being symptom free or pain free or discomfort free.

[Dr. Nicole Safire]

What's the ideal timing for women who are considering having the mommy makeover? Like how Long after pregnancy, should they wait until they've finished having babies? Like, what do you think?

[Dr. Jonathan Sherwin]

So, great question. First and foremost, I always tell women, please wait until you're finished childbearing. I had a patient come in recently who really was pushing to have a procedure, but then in the same breath was saying, well, I'm thinking about having another child in a year or so, and I really recommended that she wait. That being said, I've had the opportunity to go back in on patients who became inadvertently pregnant after having a procedure done.

[Dr. Nicole Safire]

So you still can get pregnant and successfully have a baby if you have this work?

[Dr. Jonathan Sherwin]

Absolutely, absolutely, yes. It does not compromise pregnancy and women can do that. So to answer your question, I recommend waiting until childbearing is complete if there is a breast procedure involved. As part of this procedure, the factor that becomes important there is breastfeeding, whether a woman is still, you know, there's still milk letdown. Typically we ask women if they're about to have a breast procedure after childbearing or breastfeeding, we ask them to wait a minimum of six months so that there is no additional letdown which can take place during procedure. So I would say with respect to breast procedures, we typically ask a minimum wait time of six months. Generally.

[Dr. Nicole Safire]

Really, after having your children, you can consider this surgery kind of whenever you want. I mean, would you recommend that they try to get in like the best physical shape possible, get their muscles as strong as they can before surgery, or should they have the surgery and then work on it?

[Dr. Jonathan Sherwin]

Well, I would say after childbearing is complete, I would tend to wait three months minimum. But in terms of wait time in general, if a woman is anticipating or thinking about weight loss or reaching more of her goal weight, we encourage that. Certainly if somebody is thinking about a five or ten pound fluctuation in weight, that's not much of a factor or much of an influence or impact on outcome. But if somebody is considering a 15 pound or 20 pound weight reduction, we encourage that prior to procedure. And so, yes, exercise, weight loss, we haven't really yet touched upon nutrition or diet. I think that's also very, very important, important consideration as well. So there is, as I mentioned a moment ago, this multifactorial approach to improve outcome and result. And I do think that trying to approach goal weight, exercise, good nutrition, they all are important considerations when it comes to this procedure. It definitely affects outcome. And my best results, really, when I reflect on my outcomes, have been a combination of not just the procedure, but exercise and diet and good nutrition. Those are the Most stunning results that I've ever received in or experienced in my career, truthfully.

[Dr. Nicole Safire]

So for anyone listening, is there anything else that we should kind of know about in the realm of plastic surgery? I'm on a mission now to destigmatize tummy tucks for women who have had babies. I think the data is clear that it's not just about cosmesis. I think functionally it makes you look better, yes, but it makes you feel so much better and stronger. And as women, it's hard enough as it is as we go through perimenopause and menopause. And I think if it's something you want to consider, you should.

[Dr. Jonathan Sherwin]

I couldn't agree with you more. And the data, the research, the literature substantiates that unequivocally, uncategorically. I don't think that it's conjecture at all. So to your audience, I would just advocate. If you are considering embarking on this journey, consider this multifactorial approach, if you will, of good nutrition, healthy eating, exercise. It will enhance your outcome. And to your earlier point about stigma, I don't think anybody should feel stigmatized about wanting to have better quality of life. Whether it's, as you say, cosmesis or even functionally.

[Dr. Nicole Safire]

Well, and you said we talked about this earlier, it's really also about, yes, all of that matters. You know, I'm a huge advocate of that. RFK Jr and Maha, everyone's talking about it, but it's also the surgeon. And you being a board certified plastic surgeon, you know, you want to make sure you do your due diligence, make sure the person that you go to is, does this often. I recommend not leaving the country like some people do, trying to find better rates, but work with the doctor's office, your HSA funds, whatever you got to.

[Dr. Jonathan Sherwin]

Do to make it work, I would echo that. I think credentials matter. I'm not a fan of travel surgery. I've seen a number of problems with that. Do your due diligence as you suggest. Do your homework, investigate, explore. I always encourage patients to come in with questions or even submit follow up questions via email or even via virtual visits. I encourage patients to do that. Come in with having done your research and your homework. It's an important consideration for patients. It's an important step that patients take and I appreciate the significance of it. So I wholly endorse patients to do their research, homework, ask the hard hitting questions, the more the better.

[Dr. Nicole Safire]

Dr. Sherwin, thank you so much for being on wellness unmasked. Dr. Jonathan Sherwin, friend, colleague out of New York City Appreciate having you on.

[Dr. Jonathan Sherwin]

It's a pleasure and a privilege to be with you and your audience today. Thank you so much for this opportunity. I really appreciate it.

[Dr. Nicole Safire]

You're listening to Wellness on Mass. We'll be right back with more.

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[Podcast Guest or Host]

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[Dr. Nicole Safire]

All right, that's it. That's my mission. We are getting rid of the stigma associated with mommy makeovers. And first thing we have to do is get rid of that name because there's something about that name that just drives me bananas. Maybe it should be like Stronger Together. Oh no, that sounds like a political slogan. How about for her or the Core Makeover? Oh, I like the Core Makeover or Bringing it all together, because that's what we're doing. We're bringing those muscles back together. Whatever it is, whatever you want to call it. If you have a friend who is talking to you about maybe wanting to do one of these procedures to really just start feeling better, support them. If you're thinking about it yourself, I encourage you to go talk to a doctor about it. It may not be for you, but it doesn't hurt to ask, especially if you find yourself having limitations or something that's keeping you from getting back to the gym. Maybe it's an abdominal hernia. Maybe it's very weak stomach muscles or weak pelvic floor. Maybe you're dealing with urinary incontinence. You heard me kind of joke about jumping on a trampoline with K. Yeah, that's a real thing. It's hard. Bottom line, we only have one life to live, so do what you have to do to feel better and don't let anyone out there hate on you. And don't take the fact that you're talking to a plastic surgeon make you feel any less. Because this is your body, this is your health and we need to get rid of the stigma when it comes to some of these plastic surgery procedures. Thanks for listening to Wellness and mass on America's number one podcast network, I Heart Follow Wellness on Mass with Dr. Nicole Stapfire and start listening on the free iHeartRadio app or wherever you get your podcasts and we will catch you next time.

[Kal Penn]

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[Dr. Nicole Safire]

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