How Stella-May Got Her Smooth Back

Stella and May have never met, but both experienced the six stages of body grief: shock, denial, sporadic dieting, various degrees of exercise, avoidance of full-length mirrors, and finally, surgery. Both had liposuction of upper and lower abdomen, excision of excess abdominal skin and liposuction of inner, outer and backs of thighs, waistline and back. May also opted for a breast lift with augmentation, and Stella, the mother of four, added abdominoplasty—the tightening of childbirth-ravaged abdominal muscles. Today they’re both svelte and smooth; both relish their new, 40-something-like bodies and wardrobes in considerably smaller sizes than before. Both went into surgery a size 10 and emerged a size six. Both now admit to the guilty pleasure of pausing ever so briefly these days as they pass a mirror, to marvel at their youthful new shapes.

What woman over 40—especially here in this land of beaches and perennial swimsuit weather—hasn’t stood before a mirror, pinching here, lifting there, sucking in all over, imagining what a bit of surgical help could do? Because they had similar body types, the same goals and chose the same plastic surgeon (real name, Dr. Stanley Gulin), Gulfshore Life created a fictitious composite and named her Stella-May. This is her story. Stella-May Speaks First "At five-foot-six and 150 pounds, I was just 10 pounds over my ideal weight, but it looked like a lot more. It was all in the tummy and thighs. Exercise wasn’t touching those areas, and it was so discouraging. I could lose weight in other areas, but I just couldn’t get the midsection to move. I love wearing classic knit dresses and knit clings. I wanted my 22-to-24-inch waist back. I decided to look into surgery. "I spent a year doing research, looking at Web sites, talking to people and reading magazine articles. Finally, after deciding that body sculpting by a board-certified surgeon was safe, I scheduled consultations with several respected surgeons. When I met with Dr. Gulin, I knew he was the one I wanted. He is a very concerned and caring person. He patiently listened to me, asked a lot of questions and answered all of mine. He explained the surgery options in detail, pointing out the pros, cons and realities—for example, you can’t be any smaller than the width of your hipbones—and he let me make my own decisions.

"We did the surgery in two sessions. The tummy was first, with four weeks to recover, followed by the less intense session for thighs and legs. After the second surgery, I was back in my daily life the next day with no down time. I didn’t tell anyone except my husband about the surgery, but all of a sudden I was getting compliments. The most common reaction from my friends is, simply, ‘Wow, you look great!’ But the one I love the most was a day recently when I was standing beside my daughter and someone said, ‘Which one is the mom?’ It’s just the best thing I’ve ever done for myself."

A Conversation With Dr. Stanley Gulin

Dr. Gulin is a board-certified aesthetic and reconstructive plastic surgeon with 22 years of experience. He was chief resident in general surgery at Tufts-New England Medical Center, Boston, and held a plastic surgery fellowship at Georgetown University Medical Center before entering private practice. Known for his delicate touch and conservative approach to facial and body rejuvenation, he enjoys a reputation for turning back the hands of time without that "just-had-work-done" look. He sees his role as a surgical architect and sculptor of the human body.

"I believe that less is more and that earlier, less-aggressive procedures are most effective," he explains.

"Stella-May and I have a good working relationship," he continues, "because we initially took the time to plan the most appropriate approach for her. My first step with a new patient is always to understand her or his goals: What really bothers you? Stella-May had clear and realistic expectations. Our goal was not to flatten her stomach like a boy’s, but to restore it to her natural, youthful soft curve. It’s all about proportion. She also took responsibility for the recovery and maintenance of her new shape.

Q&A with Dr. Gulin

Q. Which should come first: weight loss or surgery?
A. We usually do the surgery first, because if she’s in our office it means she’s been unsuccessful with diet and exercise. The surgery gives her great immediate results and gives her the necessary kick-start—the inspiration to start and maintain a healthier lifestyle. Our best results are not, as one might think, with seriously obese people, but with people like Stella-May.

Q. Could she have accomplished the same results with professionally directed diet and exercise?
A. In some areas, over time, yes. But as astute trainers know, no amount of sit-ups can restore abdominal muscles that have been separated due to pregnancy. In fact, sit-ups could actually stretch that separation further, causing even more distention of the abdominal area.

Another nearly impossible area to resolve with diet and exercise is around the midsection. For example, I see many men in great shape, with six-pack abs, who can’t get rid of those love handles. Like Stella-May, he may have just 10 extra pounds, but it is all in a specific area. The difference between trying to diet this off and the body sculpting might be likened to spray painting. He can diet, and the weight loss will come from the total body. Imagine standing him up and spray painting his whole body, versus just spraying that little area.

Q. After body sculpting (liposuction and skin removal), how probable is it that one could slip back to the "before?"
A. This surgery is not a cure—it’s a remedy. In liposuction, fat cells are permanently removed. It’s impossible for the fat to come back into a cell that’s not there. But if you start over-eating and you regain weight, that fat is going to go somewhere; not to the same place, but somewhere else. Those male love handles, for instance, will probably resurface on the thighs.

Q. Where are the primary scars?
A. For the tummy area, where liposuction is followed by skin excision, there will be one long, thin scar in the shape of a slight smile from hipbone to hipbone. We work on or below the bikini line; often with existing caesarean section scars. The patient brings in her bathing suit and we make every effort to place the incision where it won’t be seen.

Q. What about scars on the hips, back and thighs?
A. For Stella-May, I did ultrasound-assisted liposuction on the lateral (outside), medial (inside) and anterior (back) areas of the upper thighs. I also removed some back fat just above the waist. The skin of the hips, thighs and back has more elasticity and is more forgiving than the abdominal area. Ultrasound-assisted liposuction helps the contraction of skin on moderately overweight people, so there was no need for cutting and no scar.

Q. Isn’t "body sculpting" just a romantic way to describe fat removal?
A. Not at all. Back in the 1980s when I began performing liposuction, the procedure was more of a de-bulking. Now, with refined techniques, much thinner and less-invasive instruments, very selective removal of fat cells and a more graceful hand, it is truly a sculpting procedure.

Q. Why did Stella-May require two surgeries? Could it not have been done all at once?
A. It could have been, yes. You see this on TV shows such as Extreme Makeover. But that’s "rush surgery." If doctor and patient are really particular, they will choose the most important areas, take their time and work extremely carefully to contour these key sections, then, if desired, go back later and address other distinct areas. This is elective surgery, not an emergency. For my patients, the convenience [of a single recovery] and the small amount of money saved by combining everything just aren’t worth it. More importantly, planning out an operation in more stages reduces the risk of complications. There’s so much hype to aesthetic surgery these days, people tend to forget how serious it is.

More and more doctors are jumping in and performing procedures with certifications that are not from the American Board of Plastic Surgery. When you consider that there are whole books written about minute aspects of a single procedure, you realize how specialized and complicated it is. A significant amount of my practice is correction of a patient’s previous surgeries; sometimes they were disastrous, but often they were simply not what the patient expected.