44-year-old Having Tummy Tuck and Breast Lift in Thailand, TH

Hi. I have three kids and my weight has fluctuated...

Hi. I have three kids and my weight has fluctuated over the years between 55kg and 73kg (I'm 5ft 4in) outside of pregnancies. My breasts are set low and grew droopy with big areolas. I have always had slack stomach muscles and a stomach that you constantly have to hold in, despite exercise. Since my pregnancies my stomach skin has been very stretched out and droopy. I am a natural apple shape and carry most of my excess fat on my torso. I have lost 10kg over the last year and although I'm pleased with the results, I still look in the mirror naked and feel depressed by the melted candle I see before me. I feel I've never had a good figure and would like to feel good before I'm too old to care! I have wanted a tummy tuck and different boobs for years, and now I can afford it and my kids are older so I'm finally having surgery on 23 April 2016 with Dr Amorn Poomee at Bumrungrad Hospital in Thailand.

I am a UK expat living in Singapore. I have lived overseas for many years. I have been looking into these surgeries for years. I chose Thailand because it is close to where I live, it is cheaper than Singapore (by more than $25,000) and because I researched this Dr and this hospital and liked what I saw when I visited. I previously tried to arrange surgery with a surgeon called Adrian Richards in the UK but frankly it was so difficult to get information and correspondence going with his office, I just gave up. I felt they were not geared up for patients coming in from overseas and they also said I would have to be in the UK for at least 6 weeks, which is not possible for me. In Thailand I can be home within 2 weeks and it's only an hour or so flight away if I have to return for any reason.

My surgery is now less that one week away and I'm very, very nervous. My concerns are like the layers of an onion - with the worst fear obviously being death (the outer layer)! As you work your way inside my 'worry onion' :-) the next concern is that I don't die but there are serious complications, then that there are no complications but I hate the result and need revisions, then that the results are fine but disappointing or just 'ok', then that I feel really terrible after the op and take forever to recover/see results, then finally that I just regret it for some reason. Other than that, I'm really looking forward to it ha ha!
Assuming everything goes OK in general, I'm most concerned about scar position. I really don't want a high scar and I've seen his work on other patients on here and they look pretty high to me. If I go through all this, put my family through it and spend all this money, I will be seriously disappointed if I get dog ears and a really high scar that means I can't really wear a bikini in the end after all. Can anyone offer any reassurance on the best way or most likely scenarios to get a low scar and no dog ears? And who pays if revisions to dog ears are needed - you or the surgeon? I should ask him this, of course.
Any advice or words of reassurance would be very very welcome at this stage! Thanks for reading!

3 days post op update

OK, this is going to be a long update including all the things I would liked to have known about this experience. I hope it's helpful and you don't fall asleep!

I arrived for the pre-op appointment on Friday afternoon. I was there from 1pm to around 4pm in the end and by then the aircon had chilled me to the bone, so wrap up! I met Dr Poomee's wife in the waiting room and we had a bit of a chat before I went in to see him. He was very sprightly and cheerful and talked me through the procedure. I wanted some info about scar placement and dog ears etc so that I could manage my expectations, which he discussed honestly. He said there are usually dog ears unless you extend the scars quite a lot, but he said they often flatten by themselves and if not it was very quick and easy to correct them under local anaesthetic once the swelling had gone down. He said he would try to place the scar as low as possible but that the final outcome depended on how much loose skin there was below it, because if there's a lot, it allows the scar to move up with tension. I am quite baggy down there (yuck!) so I knew this would be an issue for me. I put my underwear on in a slightly higher position that I normally would and he said the scar would likely extend a bit from the top waist band at the ends. Once I pulled them up to what I would call 'mum levels' - (sensible but not granny high!!) he said yes, that would probably cover the scar. So it's sensible bikini bottoms for me after this op, at least until the scar fades. He talked me through all the stages and explained that I would only have to keep the drains in for two days because of the newer stitching technique he uses (when he pulls the skin down, he uses lots of small stitches along the way to reattach it to the fascia inside, so the skin is attached more tightly and there's less of a big gap for fluid to build up). He gave me some antibiotics to start taking straight away, told me not to take anything that could cause bleeding (NSAIDs, vit E etc) and he'd see me in the morning. Then I went and paid upfront to the cashier and did some tests (blood test, ECG and chest x-ray because I'm and old lady of 44).

I was nervous and ready to burst into tears on the morning of the operation and it seemed like I was whisked in very quickly after all these years of waiting . Before I knew it I was on my back, arms out while they apply monitoring pads, tubes and the gas mask before drifting into unconciousness. It didn't help that I had to remove my contact lenses and so was blind as a bat. Felt very vulnerable and when Wannie (Mrs Poomee - the sugeon's wife) held my hand as I went under I was ready to start blubbing!

Next thing I knew I was coming round in the recovery room, trussed up in dressings, a bra and binder and feeling very panicky and sorry for myself indeed! Very sick, dizzy, miserable, vulnerable and like I was about to vomit, in fact I thought I already had, but I don't know if I actually did. This was the worst part of the experience. I was being sporadically jostled about on the bed by a lot of young nurses who were all squabbling and gabbing on to each other across me and it felt like I was at the mercy of a lot of Saturday shop girls which was alarming when I felt so vulnerable and clueless. I really wanted there to be a 'grown-up' to take charge and help me and shush them all. I felt quite frightened and miserable and there were communication problems due to my language being very slurred and knowing no Thai, and their busyness and limited English. They kept messing about with my catheter and arguing about it in Thai so I was worried there was a problem. They weren't unkind, just insensitive. Once they understood they gave me a sick bowl and anti-nausea meds. Really I just wanted to be left alone and for a calm older person to say "there there, just relax, everything's OK, nothing to worry about you silly old woman."

They put some pneumatic leg squeezer things on my legs at some point - possibly before the op, to prevent DVT. I loved them and the massaging action was quite a good distraction from all the nausea and discomfort. They took them off when they de-catheterised me on the Sunday - bye bye old friends!!!

Later they took me up to my room where my husband was waiting and I was very pleased to see him, though still quite out of it. I still felt very nauseous and miserable and was terrified of vomiting because of the pain in my abdominal muscles and not wanting to tear the stitches - and just because vomiting is the worst!

From waking up in the recovery room until late on Sunday I felt so rotten that I regretted doing this. If I could have snapped my fingers and just hopped off the bed and gone back to how I was before the op I would have done. If a friend had asked me if they should do it themselves, I'd have said 'no, don't!' I think this was largely because of the medication involved in the general anaesthetic and/or the pain relief that was given intravenously (an opioid). Until that was all out of my system I felt completely wretched, nauseous, dizzy, scared, guilty, and foolish. I was also quite shocked at the level of incapacitation the op involves - I didn't realise how vulnerable it would make me feel. Of course I did know what was involved, I just didn't truly 'get it' until I did it. You daren't move an inch for ages and you're just stuck, very uncomfortable in the bed and you feel very very vulnerable. I also hated the canula that was still stuck in my left hand and stayed until I was discharged - it goes right through me and reminds me of the time my husband grabbed my hand and SQUEEEEEZED with excitement when my daughter was born. I coudn't feel a thing from the birth, I was screaming because he was jamming the bloody needle further and further into my hand!!! I also got a very sore neck, throat and headache from the weird sleeping position and that, the nausea and the canula were what bothered me most, my boobs and stomach being largely numb, though the stomach muscles are very sore, like a major stitch or cramp.

ANYWAY - once the meds were out of my system it was like the sky cleared and the sun came out! Everything started to seem manageable and I started to tentatively imagine a good outcome! Must just say here that I can't believe that I often considered doing this on my own. Now I can't imagine how much worse it would have been if I hadn't had my lovely husband with me. I really needed that support, practically and emotionally. And he gave me a life-saving neck, head and face massage when I had the drug hangover from hell - darling man! That made up for 'the canula incident' 13 years ago.

After we established that I didn't want any more sick-making opioids, I was given 1 x 500mg Tylenol every six hours and antibiotics twice a day I think. I asked them to up the Tylenol to the recommended dose of 2 x 500mg tabs per dose, as per the Tylenol website. They eventually agreed but had to get the doctor's approval to do so and as it was Sunday they couldn't get hold of him for a while. Apparently the lower dose had been prescribed because of some recent findings about Tylenol side effects or something. To me, there's about as much point in taking one Tylenol as there is in using one clove of garlic in your cooking :-)

I have been kept in a position of back of bed raised and knees raised at all times, apparently this helps relieve tension on the scar.

Sleeping was surprisingly OK, uncomfortable but possible. I just woke up a few times but easily went back to sleep. I was offered a sleeping tablet on both nights I was in the hospital but declined - I can usually sleep for England!

Woke with a splitting headache on Sunday which just got worse all day - like a super massive hangover headache that was making me feel nauseous again. Begged for more Tylenol - it was a while before they agreed to give me two per dose. Early doors on Sunday Dr Poomee arrived to say all had gone well and check how I was. I think Mrs Poomee came too and said they should take the catheter out and I should get up to pee. About mid-morning they did this and around lunchtime I shuffled bent over and very very very tentatively on the arms of two nurses to the bathroom. I was surprised to feel as though my breath was taken away and I couldn't speak at first when I was vertical - something to do with your diaphragm no doubt. It's improved every time. The nurses gave me a bit of a wipe down with some clean facecloths and then shuffle shuffle shuffle back to bed.

I won't lie, the binders and bra band are tight and uncomfortable all the time. And I'm really sick of tape stuck on me.

Went to the loo a few more times. It got easier each time. Had to try really really hard not to laugh - trust me DON'T LAUGH OR COUGH at the ridiculousness of the bathroom shuffle. At one point my husband was holding my hand as I shuffled along bent over and I said, and instantly regretted saying 'Aw look, it's like you're taking a chimpanzee for a walk'. DON'T LAUGH!

Oh, forgot to say, I've also been taking daily arnica pills for bruising, colace for constipation and vitamin C for healing from about Wednesday before the op on Saturday. Also had a glass of prune juice on Monday and hey bingo! no constipation!

Monday the drains came out - not pleasant but not terrible. Mrs Poomee (who is a nurse) did it with another nurse. They also changed my dressings and binder. Said I must keep it on, no shower before the appointment on Weds. Later that day checked out of hospital with some more Tylenol and anti-biotics and an appointment card for Wednesday back at the clinic.

Felt like a right idiot in my tracksuit and sunglasses sitting in the wheelchair to go home. Took a bumpy no-seatbelted taxi to the hotel (get an Uber instead, don't know why we didn't). Paranoid about catching a cough or cold from EVERYONE - cannot face the thought of coughing or sneezing.

On arrival at the hotel, crawled out of the taxi and bent over like a demented Mrs Overall attempted to scuttle round the umpteen staff determined to block the path and ceremoniously 'Sawadee Ka!' me while I tried to flee to the shame and privacy of our room!!

Today is Tuesday lunchtime. Still sore but somehow not as much as I thought I'd be. I thought it'd be the incisions that would cause pain, but apart from feeling a little tender and sometimes a bit prickly, they're not a problem. The abdominal muscles are the main concern - still terrified of coughing or making a sudden movement. Eating light but regularly and drinking lots of water. Trying to steer clear of salt to minimise swelling and anything that might constipate me. Watching lots of telly. Lovely husband is going back to Singapore today because he needs to attend something with our daugthter. Will be sorry to see him go but feeling more confident and able every day. Right now, can't imagine going to an airport with a suitcase myself, but maybe by Tuesday (which will be 10 days post-op) I'll feel quite differently. I'll get help at airport just in case I still need it.

Too scared to take off all the bindings and dressings right now but have attached a couple of photos that show a good boob uplift so i'm pleased about that, though I have to say from the view looking down at them they don't look pleasingly round like boobs with an implant do. I opted for lift, no implant. Still, much better than they were.

Oh, one last funny thing - my husband started to open one of two red plastic bags they sent back up to the room with me in hospital thinking it was my pre-op clothes. Thank God before he got it open the nurse told him that my old stomach skin was in one and my lipo fat was in the other!!!!!!! Poor man would have fainted!!! We couldn't get the nurses to throw it away (even though I had signed a form saying I didn't want it) and they seemed surprised we didn't want to see it! I suppose people might be curious but if you're squeamish like me, DO NOT OPEN any mystery red bags!

Day 5 post op update

Op was Saturday, today is Thursday. Today was the first day I could stand up almost completely straight. I am sleeping well and woke up feeling significantly better - abs feel less sore. I usually take Voltaren 75mg twice a day for Ankylosing Spondylitis (random back inflammation) but had to stop in preparation for surgery as it's an NSAID drug which may cause bleeding. Anyway, I took one for the first time at bedtime last night and I feel significantly less swollen and sore today - not sure if it's the Voltaren or just the regular healing process. Despite feeling better, I still took it easy all day, just stayed in my hotel room and did a bit of stuff on my laptop etc. I'm taking advantage of the peace and quiet before returning home, putting my feet up as often as possible.

Yesterday I saw Dr Poomee for a follow up review. It was uncomfortable to go there as I was still fairly stooped etc. I am also paranoid about catching a cold because it is murder on your abs when you cough so I'm avoiding going outdoors/getting in taxis and lifts etc.

He removed the bindings and dressings and took some fairly gruesome photos. I couldn't stand with normal upright posture so I look very boxy and osteoporotic in them. I still look very bruised and lumpy, with swelling below the stomach incision creating a pot-belly which he assures me will all settle down. No pronounced dog ears as yet, the slight one I saw he felt would go away on its own... The scar was higher than I would choose but then I expected that. I pulled my underwear up to cover it for the photos - nice and frumpy! Although my boobs are a bit misshapen right now (which he said will all settle down) I was impressed by how much sag he got rid of. However, today, when I look at them, I wish they'd been lifted a little higher up my torso (which I can achieve by pulling them up from above the nipple), but I'm quite prepared to accept that that may not have been possible - they are very low set to start with. Maybe they'd look higher up if I'd had a small implant, as there is very little fullness above the nipple, but I chose not to. In fact, he told me a few years ago when I first met him that the only way I could achieve fullness above the nipple was with an implant. I was pleased with the areola reduction. So, in a nutshell, pleased with the surgery but still not feeling much love for my god-given figure. I'll keep watching my diet and will do something like Pilates to tone and build muscle when I'm allowed. I suppose the lesson is to accept what you've been given and make the best of it, instead of wishing for what you can never have.

He put gauze over my incisions (without tape because my skin has really reacted badly to the tape - I knew it was up to no good! It was driving me mad!) and put the binder back on considerably tighter and gave me a new soft cotton bra. He said I can wear my own bras but I must wear the soft one while in bed at night. He told me it was OK to stand up straight now when it's possible and that I could sleep in any position except on my front.

He didn't remove the external sutures yet, I'm assuming he'll do that at my appointment on Monday afternoon before I go home on Tuesday. I had the kind of 'anchor incision' uplift on my boobs and I'm surprised to see that the lower curve of the scar doesn't sit on the crease where the boob meets the torso - it's slightly higher up on the boob. I wonder if that's normal? It will make wearing a bra more comfortable I suppose.

He said wait until Saturday to shower because it was very difficult to replace the binder by yourself. He gave me a set of 'before (during!!!) and after' photos to keep (won't they look nice in the family album?). I'm still taking the arnica, vit C and Colace.

I just took another quick look at my boobs and the shape looks much more natural today - just wish they were a bit higher up my torso aaaaarrrghhh!!!! This is so typical of my mentality and I will just have to tell myself to 'shut up'! Will post some more photos tomorrow.
Dr Amorn Poomee

I liked Dr Poomee and Mrs Poomee when I met them for a consultation a few years ago. It's quite a bonus that they work as a team (she is a nurse) so you feel you have double the point of contact. He seemed more 'gentle natured' than some Drs I consulted, which was reassuring and Mrs Poomee is warm and comforting. I know he is very experienced and worked in the US for many years as well as Thailand. Some people online have expressed concerns about his advanced age affecting his ability. I'm not sure exactly how old he is, but he looks and seems A LOT younger than I've heard he is. So I was happy to dismiss those concerns. He has been very clear and pleasant throughout this process, he's honest in managing your expectations and responds to your email queries very quickly.

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
4 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
5 out of 5 stars Wait times
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