S05E99 - All About Surgical Swelling & Compression Garments (Faja)

How can compresion garments, or faja, help you better recover from body contouring surgery?

Dr. Sam Jejurikar @samjejurikar, Dr. Salvatore Pacella @sandiegoplasticsurgeon, Dr. Lawrence Tong @yorkvilleplasticsurgery, and Dr. Sam Rhee @bergencosmetic dive into the oft-overlooked yet critical topic of postoperative swelling and the role of compression garments in plastic surgery recovery.

You'll gain a profound understanding of the crucial but often misunderstood role of compression garments in managing swelling after surgery. From patients choosing tighter garments based on misguided advice to the importance of proper guidance for optimal recovery, we promise you'll never look at compression wear the same way again. And yes, you'll finally get the answer to why tighter isn't always better when it comes to healing.

Filled with expert tips and light-hearted exchanges, this episode promises an engaging listen for both medical professionals and patients alike.

#MedicalPodcast @3plasticsurgerypodcast #podcast #plasticsurgery #cosmeticsurgery #plasticsurgeon #beauty #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bergencosmetic ⁠#bestplasticsurgeon #beforeafter #aesthetics #realpatientrealresult #boardcertifiedplasticsurgeon #njplasticsurgeon #njplasticsurgery #nyplasticsurgeon #nyplasticsurgery

S05E99 - All About Surgical Swelling & Compression Garments (Faja)

TRANSCRIPT

[00:00:00]

Dr. Sam Jejurikar: Another edition of 3 Plastic Surgeons and a 4th. As always, I am Sam Jejurikar in Dallas, Texas, and I'm joined by Dr. Sam Rhee at Bergen Cosmetic, who is in Paramus, New Jersey, Dr. Sal Pacella at San Diego Plastic Surgeon from La Jolla, California, and Dr. Sal Pacella And Dr. Lawrence Tong aka Larry Tong, uh, who is at Yorkville Plastic Surgeon, Yorkville Plastic Surgery, damn it

um, in

Dr. Lawrence Tong: All good, it's all good.

Dr. Sam Jejurikar: which one is it?

Dr. Lawrence Tong: Where's Reef?

Dr. Sam Jejurikar: Yorkville Plastic Surgery, uh, in Toronto, Canada. Welcome gentlemen, as always. Today we have a scintillating topic to plastic surgeons, and that's compression garments and the broader issue of swelling after surgery. And I say that with some sarcasm in my voice because plastic surgeons talk about swelling all day long to patients and compression [00:01:00] garments all day long.

But it is an important topic for us to, uh, to visit. So before we get into the meat of the topic, I'm gonna throw it over to Drella who's gonna read our normal disclaimer?

Dr. Salvatore Pacella: This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes only. Treatment and results may vary based upon the circumstances, situation, and medical judgment. After appropriate discussion, always seek the advice of your surgeon or other qualified health provider.

With any questions that you may have regarding medical care, never disregard professional medical advice or delays seeking advice because

of something in the shoot

Dr. Lawrence Tong: she do this?

Dr. Sam Rhee: Just remember life is a game and p so you have to play it.

Dr. Lawrence Tong: with that.

Dr. Sam Jejurikar: Ooh, that's a good, good strategy, Dr. Rhee. Throw that out there before one of us can quote it. Still gonna quote it, though. So So, question for you guys. Can you guys name a solitary operation that you do that doesn't result in some degree of swelling? Um

Dr. Sam Rhee: no. Mmm.

Dr. Salvatore Pacella: question.

Dr. Sam Rhee: Mmm.

Dr. Sam Jejurikar: Exactly. [00:02:00] And Is there, um, been a single day where you have seen patients, any time in the last ten years where you haven't had a conversation to patients about post operative swelling? Yeah.

Dr. Sam Rhee: Man, jeez. I

Dr. Sam Jejurikar: Dion in concert in Las Vegas. She sang a duet with a hologram of herself. So it was a duet with Celine Dion, singing a duet with Celine Dion, and I've often thought it would be great if I

could actually have a hologram of myself. Talking about swelling that I could just play for patients and disappear and go somewhere

Dr. Salvatore Pacella: I don't know. Which is more disturbing the idea of a hologram of you or a clone of yourself, or the idea that you went to see Celine Dion in concert

Dr. Sam Rhee: was about to

Dr. Sam Jejurikar: not once, not So, I'm totally getting thrown off topic. But, uh, I've seen Slinky on multiple times in concerts. And I probably do not know another [00:03:00] heterosexual man that loves Celine Dion more than me.

Dr. Salvatore Pacella: Titanic.

Dr. Sam Jejurikar: by the way, her triumph at the Olympics brought me to tears. So anyways, getting back to the topic. Okay, but all joking aside, all surgery results in swelling and compression garments.

Dr. Salvatore Pacella: Sorry. Sorry.

Dr. Sam Rhee: Wow, this went off the

Dr. Sam Jejurikar: This tells you how interested surgeons are in talking about swelling. I mean, like, innumerable number of times. An amazing vocalist, gentlemen, like literally, and her command of the stage and the way she interacts with the crowd. You just want to be her best friend. So, okay. So compression,

Dr. Salvatore Pacella: Fascinating.

Dr. Sam Jejurikar: I'm going to, I'm going to, limit our topic to compression garments. [00:04:00] With body contouring surgery, um, because I think that that'll kind of get us more streamlined where we need to be because we have no ability to focus right now. So, you know, a lot of times we'll do surgery on a patient and we put them in these relatively innocent looking compression garments and abdominal binder or these body suits, and we put them in them right after surgery. Commonly though, we see patients that come in after surgery and they're, and they're showing up in different compression garments than what we put them in. Do you guys have any problems when your patients do that? When your patients accelerate the, you know, the compression regimen faster after surgery?

What are the potential problems with that?

Dr. Sam Rhee: Yeah, absolutely. This is one of the biggest problems. And, uh, like you said, if I could just put a play tape, like a play tape recorder, and just like recite everything that I know about swelling to every patient, that would save me years off my life. Um, every patient, especially doing liposuction or any kind of body contouring procedure wants to know about their Faja.

[00:05:00] Faja is Spanish for

Dr. Sam Jejurikar: enough for you to

Dr. Sam Rhee: it's always Faha, And no matter what I put them in, you're right. Like, I'll see them later. They got something five times tighter than they bought because someone else told them that this is what they needed. Either on Facebook, one of their friends, you know, whatever. Their massage therapist.

And the biggest thing that I see with really tight compression garments is when they're overly tight, They're actually making the swelling worse, which is a little con like, a little surprising because they think, oh, the tighter it is, the less, uh, swelling you get. Well, when you're squeezing, for example, your arm, okay, guess what

happens? Your hand will swell because you're not allowing the return of lymphatics, venous return, to to operate normally. And instead of actually making that swelling better, when you jam yourself into a ginormously tight compression garment or Faja, oftentimes [00:06:00] worsening the recovery that you have, uh, from that procedure, especially early.

Dr. Sam Jejurikar: I always thought Faja was Dutch for father.

Dr. Sam Rhee: That's Faja. That's

Dr. Sam Jejurikar: out. Okay, got it. Alright.

Dr. Sam Rhee: job.

Dr. Salvatore Pacella: to prepare them for the swelling. Um, I say, you're here, there's nothing to fear, and I know That

the swelling will go on. So we just gotta

Dr. Sam Jejurikar: You know, I don't know. I don't know how many of the viewers will actually pick up on the Celine Dion link to that, but, uh, that was good.

Dr. Sam Rhee: brought a tear to my eye.

Dr. Sam Jejurikar: I mean, there's a trite saying that surgeons have, though, that, um, you know, swelling happens in every case and all swelling [00:07:00] eventually goes away. Um, and it's, and I think, um, you know, what Sam was talking about is there's this phenomena of garment trauma, where if You try to squeeze yourself into a compression garment, that's too tight, too quickly, too many hooks.

Um, there have been numeral, numeral, uh, numerous times that I have, and I know, all of you guys have seen patients come in that have self induced wounds from these garments. I've been texting back and forth with a patient today who's, who's basically did this with a Faha. So, I generally do believe that compression garments are very important after body contouring surgery. I think they can actually have a big impact on the final results. I, think you have to be smart in the process that you go af you know, you go after it. Do you, do you guys have any sort of guidance that you give your patients in terms of how they should think about compression or how they should transition the the compression garments and how long they should wear them for

Dr. Salvatore Pacella: You know, I think I, you know, I try to tell them that, you know, compression garments are an investment in your recovery, right? Because, um, [00:08:00] you know, the, the postoperative massage can only do so much. So they, the garment is actually pretty critical and you don't want to skimp on the garment, right? You, You've got to stay into it.

It's, you know, that's, this is the critical time for it. So I think if you, if they sort of buy into the idea that it's an investment, they start to think about higher quality garments. Um, you know, you, do you provide them for patients, uh, Dr. J or the rest of you guys, or how does that work for you?

Dr. Lawrence Tong: when, when when somebody comes for surgery and they have a procedure that would typically use compression garments, that would be something we would supply. I don't think, um, It's ideal for, you know, patients that try to find their own. I mean, I guess if, if you have a supplier and you tell them, okay, go get it from this place, maybe that's a different story.

But I just think it's easier and more streamlined if you just say, well, we're going to supply the garment because they might not know the size, [00:09:00] you know, that they should be choosing either. So I think that in that situation, uh, supplying the garment is probably the, the most straightforward and most efficient path forward.

Dr. Sam Jejurikar: Yeah, I um, we supply them the initial garment that they use after surgery. Um. They're more sort of an off the shelf thing that they can, they can wear. Um, these tend to be, have minimal hooks. They have compression, but not the tightest compression in general. um, they're more sort of geared towards helping to prevent seroma or fluid collections.

Afterwards, they're not necessarily doing a great job for shaping. Uh, we've actually developed our own garments that, um, we start, uh, and we will, patients can purchase from us starting around three or four weeks post operatively that are a little bit tighter. Some of the, um, and then we have different garments that we've developed that are for somewhere for around six to eight weeks post operatively as well.

Um, those are ones that are much tighter, [00:10:00] much, you know, much more rigid material, much more hooks in them. Um, some of them are geared for daily wear, some of them are geared for going out. Um, but I think, um, at different stages as patient's swelling gets better, our, our general thought is the compression should get tighter, the material should get more rigid, um, and it, and it can be more important for shape.

Dr. Sam Rhee: I um, I provide the first stage Garmin and then I usually work with the patients after that and I am along the lines of Sam. Um, my general rule of thumb is if it hurts, if it's causing pain, if it's causing, you know, indents or other types of, you know, major marks into the skin, that doesn't work for me.

And, um, I'll generally work with patients, uh, to increase the level of compression afterwards. The first ones are usually just for, um, ease of use. So they usually have holes in the crotch, um, easier access, easier, um, uh, to put on and off. And then later, [00:11:00] as, uh, Sam says, they get more rigid. Uh, it also depends on the season, you know, some

patients,

Dr. Sam Jejurikar: That.

Dr. Sam Rhee: uh, will help them pick something different

if it's, uh, July versus December, in terms of comfort, but, uh, yeah, you gotta find something that doesn't cause, um, skin trauma, and as Sam says, I think more compression later is important, but at the beginning, uh, yeah, overly tight

causes, uh, can cause some major, major,

problems sometimes.

Dr. Sam Jejurikar: do. How long do you guys tell patients, um, that they will have swelling after surgery? And how long do you encourage 'em to wear compression after surgery? Like for how many weeks or months?

Dr. Salvatore Pacella: If we're talking about body surgery, I, I try to tell them to wear it for about six weeks knowing I'm only going to probably get four weeks out of them because, you know, nobody wants to wear anything for six weeks. Um, and then, You

know, I, I usually say, you know, three to six months is kind of the turnaround [00:12:00] time, I think, um, of,

Dr. Sam Jejurikar: Swedish. In

Dr. Salvatore Pacella: of the, uh, the dissipation of most swelling.

Dr. Sam Jejurikar: in a

Dr. Salvatore Pacella: If I've done a lot of fat transfer to the breast or fat transfer somewhere else on the body, you know, I think it's a little bit more, a little bit longer, six, six months or

so, you know.

Dr. Sam Jejurikar: little difficult to understand in

Dr. Lawrence Tong: there?

Dr. Sam Jejurikar: In

Dr. Sam Rhee: the adjunctive treatments as well. If they're, if they're massage fanatics, if they're getting a lot

of other non invasive types of treatments, like it can, it can go by, um, it's always months, but it could be six months. It could be 12 months. And it also depends on the level of degree of invasiveness of the surgery itself.

Um, I also have some patients that use their Faha or their, you know, Garments like security blankets. I mean, I have seen patients who are loath to give it up after. Six months, 12 months, and I don't have a outside timeline. I tell patients, if you feel comfortable wearing it for as long, like 12 months, go for it.

I have no problem [00:13:00] with it. Uh, I'd love if they can wear it for at least, uh, six weeks, as Sal says, minimum. I push hard for that, but I usually would love to have them in it for three to six. And I know there's going to be some residual swelling depending on the individual and the type of surgery. So I, I'm sort of a longer term proponent rather than a, a shorter term proponent.

But like Sam, uh, Sal said it's very patient dependent. Like they are will only, they will only be as compliant as they're willing to be. So I, I try to advocate, but I know that, uh, that they will probably make up their own mind.

Dr. Lawrence Tong: I think, you know, the duration of the swelling is, uh, in, in my experience, yeah. Somewhere in that four to six month range for sort of if you're doing liposuction kind of thing. Uh, I think it's important for patients to know that, uh, the swelling resolution is not linear. There's a lot more swelling that goes away in the first.

couple months, [00:14:00] and then it really slows down. And so, I usually tell patients that, you know, they look, they look pretty decent at about four to six weeks, uh, after surgery in terms of swelling, but there still is a fair amount of swelling will still go down, um, as time goes on. And, you know, four to six months is an average, but it depends on the patient, depends on the area, depends on the surgery that you've had.

So, it could be much longer than that. For how long I have them wear it, I'm sort of like Sal. I don't think that patients are very compliant in wearing these things, so I usually tell them to wear it 24 7 for the first three weeks after surgery, and then I just have them switch it over to just another three weeks, but just at night when they go to bed.

And maybe that's not the optimal way Um, you know, to, to shape and, and to, cause I don't do progressive, um,

Dr. Salvatore Pacella: Tension

Dr. Lawrence Tong: progressively tighter, you know, I don't do progressively tighter, um, garments, um, afterwards. I'm not 100 [00:15:00] percent convinced that, that makes a big difference. So usually it's just the same garment, wear it for the first six weeks, 24 7 the first three weeks, 24, uh, and then just half the time the following three weeks and, and then they're done.

Dr. Sam Jejurikar: That's interesting because my protocol is a little different. I'll tell people first of all, you got to change the way you think about swelling. Patients obsess and worry about swelling and they think that something is going wrong when they have swelling. As every doctor knows, swelling is a natural part of the healing process.

The more we do to your body, the more swelling there is. The more aggressive the operation, the more the swelling tends to be. I use a lot of energy devices with liposuction, you know, whether it's body tight, whether it's phaser, pretty much all of my cases have some component of that. And I do think that prolongs the post operative swelling.

Um, so I tell them, and I'm a big believer in lymphatic massage as well. I do think it helps my results quite a, bit. So, um, I want them to get lymphatic massage. I think particularly in the first six weeks, [00:16:00] that can be helpful. I want them to wear their garments 24 seven for six weeks. I tell them for the next six weeks after that, I want them to wear at least 16 to 18 hours out of the day.

And we've transitioned them to more flattering garments. I mean, even after that time when they're past three months, I want them to wear it, you know, 10 to 12 hours. And I tell them at that point, I don't think it changes their final results if they're wearing it all the time, but they have liposuction for a reason.

We're not people that like delayed gratification. Like people are not generally okay with me telling them, You could look better, so I'll tell them, wear your compression during the daytime, Monday through Friday, when you're home on the weekend, so that when you go out and you're trying to look your best, you look your absolute best, you look the way you're going to look when your swelling is gone, when you wear your compression, it should not be comfortable, you should be cursing my name when you put it on, it should be really, really tight, but then that way, when you're, when you're out there and you're, you know, at the pool or you're out on Friday or Saturday night, people look at you and they think, [00:17:00] Damn, like, she looks

Dr. Salvatore Pacella: That's a, that's an important point. I mean, like if you, if you stop wearing the compression garment early, um, the swelling's going to come back, just like Celine says, it's all coming back. It's coming back to reality. laughter

people If the gate

Dr. Lawrence Tong: I think Pacella has too.

Dr. Salvatore Pacella: laughter

Dr. Lawrence Tong: stiff man syndrome for Celine Dion's.

Dr. Sam Jejurikar: how you changed Stiff person syndrome.

back to stiff man syndrome, just for that reference.

Dr. Lawrence Tong: Sorry, my

mistake. Stiff person syndrome.

Dr. Sam Rhee: an

Dr. Sam Jejurikar: yeah, I don't know where to go from this.

Dr. Sam Rhee: do you have, uh, do you have particular models or, or you, you, you designed your own. So how, tell me about that, Sam, how are you designing your own faja? Faja.[00:18:00]

Dr. Sam Jejurikar: So,

Dr. Lawrence Tong: of many talents.

Dr. Sam Rhee: I know,

Dr. Sam Jejurikar: Um, yeah, so, um, it was done with help, obviously, and it's, uh, um, sold through our skin care center, EpiCenter. It's a relatively new development in our practice, but it's, it was with the help, uh, that it's from, uh, you know, some Colombians that have basically helped us with this, where they kind of knew the general shape of our patients in Dallas.

They helped design garments with appropriate waist to hip ratios. As we got sort of further out, the material got more rigid. And then there's some practical issues that go along with it. One of the biggest complaints people have with their compression garments is going to the bathroom. So there needs to be.

An appropriate zipper like, um, you know, zipper like, uh, component to it so that you can unzip it and you can go number one or number two and go to the bathroom pretty easily. Um, they can go in the freezer, you know, so they're cool when they go on. We tell our [00:19:00] garments patients to get two of them and it's pretty fricking hot right now in Texas right now.

So being able to put on a garment that's a little bit colder when you put it on is, is, is helpful for people. Um, and then particularly the ones that are for greater than six weeks, you, know, there's ones that are easy to wear during the week and then there's ones that are more appropriate if you're wearing like a dress or you're going out so that they're not, they don't go quite as high.

Um, and that way when you, even when you're going out. You look like you have to serve because again, we live in an age of Instagram filters where people change the way they look and the way they present to the outside world. They are not, we're not in a world where people are, at least my patients are okay being swollen.

Dr. Sam Rhee: man,

Dr. Sam Jejurikar: a lot of thought that went into them. Like

Dr. Sam Rhee: Dallas guys have this vertical integration thing taken to the nth level. We're gonna be like living in DP S'S world. For everything. This is very impressive Sam. Very nice. hear

Dr. Lawrence Tong: in the freezer to wear is not a problem in my part of the world. [00:20:00]

Dr. Sam Rhee: it in the Follow

Dr. Sam Jejurikar: it? Kind of warm there right

Dr. Lawrence Tong: Yes, it's warm.

You know, we've got our, we've got our eight weeks.

Dr. Sam Jejurikar: There you go. One joy While

Dr. Salvatore Pacella: gets humid up there too. I'm from that part of the world.

Dr. Sam Jejurikar: well, hopefully patients found this podcast instructive, it is not a topic that surgeons love talking about swelling, but it isn't important part of the recovery process. Any last thoughts, gentlemen?

Dr. Lawrence Tong: Take it away.

Dr. Sam Rhee: Yeah, I think, well, he, wait, while he's thinking his next, uh, Celine Dion reference here, I just want to say, uh, it's funny how much patients obsess over garments and how little surgeons want to talk about it, but that's where we decided it is important for us to, to share our knowledge, to, to make sure that you understand every surgeon is different.

The types of surgery they do, The Faha, or the pressure garments that they use, they're [00:21:00] customized for what their practice is. Like, how I operate is probably different than Sal, or Larry, or Sam, so what I do with my recovery is slightly tailored differently. You know, we can't, like, dude, this is, that's copyright, and we can't

Dr. Sam Jejurikar: That's copyrighted material, man.

Dr. Sam Rhee: Dude, you're gonna get us, it's not,

Dr. Sam Jejurikar: Right. You're gonna have Selene coming after us,

Dr. Sam Rhee: there's,

Dr. Sam Jejurikar: my heart, man.

Dr. Sam Rhee: she's gonna sue us, dude. Her and her husband, Rene, or

Dr. Salvatore Pacella: Oh, they're divorced. Are they divorced? I thought they were

Dr. Sam Rhee: uh,

Dr. Sam Jejurikar: Well, he died many years ago, guys. Come on, it was tragic. He had cancer. It was one of the great

Dr. Sam Rhee: okay.

Dr. Sam Jejurikar: to watch the movie. You guys need to watch the movie on Amazon. I am Celine Dion, and I challenge you not to shed at least one tear. It is, it's a beautiful story, what she's going through right now.

Dr. Sam Rhee: Okay,

Dr. Lawrence Tong: have you. seen

Dr. Salvatore Pacella: it's on my list, it's on my list.

Dr. Sam Jejurikar: It's so good. It's so good. It's a, it's a, it's a heart rendering story.

Dr. Sam Rhee: I just saw [00:22:00] Deadpool Wolverine, that'll be the next one now.

Dr. Lawrence Tong: yeah, it was either that or the boys when I turned on Prime, so.

Dr. Sam Rhee: Tough choice there, I don't, I don't

Dr. Lawrence Tong: really a hard

Dr. Sam Jejurikar: You know, guys, you guys can live the male stereotype. Don't be afraid to have some feelings, guys. It's okay.

Dr. Salvatore Pacella: Megan You did

Dr. Sam Jejurikar: Alright, well, I'm not sure that was our best podcast, but I'm definitely entertained. So, on that note, gentlemen, have a great rest of the day.