Early 30's Male, Stubborn Flanks. Extended Tummy Tuck/Belt Lipectomy = Life Changing - Thailand, TH

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About me, around 10ish years ago I weighed in at...

About me, around 10ish years ago I weighed in at 159kg. Now being 5'10" that means I was pretty round. Spent the best part of the last decade dieting and studying and testing different exercise and nutrition options and now sit between 92-95kg on any given day (at around 14-16% body fat) (ultimately Paleo and Intermittent fasting I found to be the best prolonged lifestyle choice, they keep weight under control and make me feel amazing).

I've yoyo dieted quite a bit around the 100-110kg mark and at one point plummeted down to 82kg at which point I had single digit body fat but still had my flanks and love handles. Nothing I did could get rid of them. I've always wanted to get them removed but in the last couple of years I've done everything I can to accept them and move on, out of expense and most prominently fear. I've always (since childhood) had a problem with them and they've always been a huge confidence crusher for me who's otherwise quite confident.

So I finally made the decision to do it. Now I'm an analyst by nature and profession so I spent around six or so months researching hospitals, surgeries and most importantly surgeons and I apologise for how much writing I'll probably do on this blog. Ultimately I picked Dr. Rushapol in Thailand at the PPSI institute. (A decision I could not be happier with).

I went through a third party Somnio here in Australia who were just amazing to deal with, they were friendly, warm and prompt when I made contact with them and the team was totally fine dealing with all my questions and offered a lot of advice and support as well.

On the 7th of June I had my surgery and I'm making this blog after the fact to provide feedback to everyone considering it, hopefully to kill some of the fear some people have about getting surgery in Thailand, provide progress shots on a weekly basis for the first few months (as I couldn't find this for men anywhere.. it all dies off after a week or two post op) as well as to make men looking for this kind of surgery feel better about it.

Day One.

The Saturday after we landed I spent with my wife and my mother in law generally wandering around Phuket and getting my head in a good place, had a massage, ate some food. All in all a good day and it was really nice to spend some quality time with my family before I was bed ridden. The day after was the surgery.

Day 1 - The Nerves hit me today, I woke up super early in the AM, last minute details were on my mind and mostly the fear of the unknown. Went in to PPSI (they picked us up from the hotel and took us to the institute). The nurses did all the normal final checks, blood pressure, took blood for mineral/nutrient/infection testing etc.. After an hour or so we had our consultation with the Doctor. Now, at this point my wife and mother in law believe me to be crazy by deciding to do this in Thailand. We sit down with Dr. Rushapol who greets us and immediately starts cracking jokes! By the time we got to any real discussion on the procedure everyone was well and truly at ease. The Doc walked us through the procedure, told us about his experiences and his opinions on the surgery, risks, recovery, everything.. as well as telling us 'I will treat your body like it was my own, I understand your goals and will do everything I can to make sure they happen'. By this stage I was confident I'd made the right choice and completely forgot about any fear I had.

We did the post op markings and he had me in all kinds of positions, he sketched and re-sketched to make sure he had the best markings and results from every angle and position. Throughout the sketching process (about an hour) he answered all my questions and offered information and interaction, making the entire process much less awkward.

After this was complete we had a short stop in the waiting room and then off to my hospital room where I got changed, dropped off my belongings and the nurses came to collect me in a wheelchair. They then transferred me to a gurney/bed and a teary goodbye was had by all as I was taken to the operating room. Laying in the operating room while the nurses set up was a scary experience, but to my surprise the nurses started talking to me almost immediately! They asked questions about my weight loss, how good it felt to have lost the weight and telling me how much better I would feel after the operation. I was blown away, they made me feel so much better about being basically stretched out completely naked in front of strangers, all the awkwardness was forgotten.

As the preparations started wrapping up, the part that I was really dreading finally came. The morphine needle in the back. There's something uniquely unsettling about someone telling you to curl into a little ball so they can put a rather long needle right into your spine. It was as this process began that the Doc came in, and he immediately walked up to me and joined in the conversation with the nurses. Then he did something I would have never expected, he grabbed my hand, held it tight and started rubbing my palm. It was the weirdest thing, suddenly it wasn't so scary it actually really felt like he cared about my well being and wanted to take my mind off it. It was the smallest but most supportive gesture I think I've ever experienced outside my own family. I don't think that's something I'll ever forget about that day. Shortly after that, everything went black.

Week One Post Op

(Shorter posts now, I promise.. probably)
Day 2 - After the operation was a blur. The op was meant to be eight hours but instead went 10 so it was well into midnight by the time I got back to my room. Sleep was sporadic, constantly woken by nurses doing blood pressure and temperature checks. Most of this day following surgery was a blur of memory, while I was lucid my head was still groggy and I couldn't really focus on anything for too long. No nausea, no pain, mild discomfort, just lack of focus. I felt hung over more than anything.
Day 3 - A got a little bit of sleep, longer periods before waking up. My head began clearing up and I spent most of the day watching TV and reading (it's a hard life post surgery, hah!). Mid morning the nurses came and told me we're getting up and going for our first walk. Getting up was a challenge, but once you figure out the process of loading up your arms and legs instead of your core it's fine. The walk was a lap of the hospital room (in all fairness, it was a pretty big room) and it felt like I'd just run a marathon. By the evening however I was able to get out and hobble round with my loving wife in tow making sure I didn't do anything stupid and push myself too hard, but otherwise unassisted.

Day 4 - The catheter came out today, dear lord.. if there was one thing and only one thing I could change about this entire experience it would be the catheter. Not for any reason relating to the quality or medical facility just purely because it was the most awkward and unnatural thing. It's something that completely slipped my mind but was a constant source of frustration and sleeplessness.
The compression cuffs came off also and with the advent of these two modern day torture devices being removed I was finally able to chain together more than 20-30 minutes sleep intervals. I got up a few times, walks every couple of hours with my lovely wife sight seeing throughout the hospital and then later by myself to go to the bathroom and brush my teeth etc.

Day 5 - Best. Sleep. Ever. No catheter and no pressure cuffs meant I sleep almost through the night, the only exception was the diligent nurses getting my blood pressure and temperature, but they let me sleep right through the night this time, it was bliss. The Doc's usual round today was interesting as he said I could go home, we just had to remove the drains, change the bandages and re-tape me up. The drain removal was.. an experience, 1 of the anchors got stuck and it really was quite a challenge to stay focused while he pulled it out. Everything else went smoothly and I was sent home with instructions to stay immobile as much as possible to let healing take it's course. Of course, no alcohol, no swimming, no tattoo's or raving parties for the next few days.

Days 5-7 - Spent resting in the suite we were staying in. Mostly prone the entire time, I had a full raft of medicines, anti-inflammatories and vitamins to take but outside that I didn't take the painkillers. I was given some strong ones, but it was a personal preference not to use them. It wasn't too bad as I have quite a high pain tolerance, but unless there's complications I think most people should be ok by this point without the likes of morphine or codiene (maybe paracetemol or something on hand if needed). Occasional walks, several a day over the period, mostly to the bathroom as I was finally back in charge of my water intake which I kept quite high throughout the entire stay in Thailand. Humidity was killing me so stayed inside as much as humanly possible (because I’m a soft little girl like that).

Week Two Post Op

Day 8 - More rest and relaxation in the suite. Working my way through quite a few decent books, feeling pretty good all things considered. Started going outside for breakfast with my wife. Thankfully, she's amazing so she was bringing me lunch and dinner most of this time from nearby restaurants. On this note, I'm so happy I had recovery time in Thailand, because it's a tourist hotspot everything is so close by and getting around is super easy.

Day 9 - First post op with the Doc today. He removed the tape bandages, cleaned up all the incisions and re-dressed the wounds. Progress check, and all is going very smoothly. He prescribed me a new script of vitamins and said to keep up the resting and hydration. Now, I get to see the results for the first time.. it's emotional, I won't ruin it for anyone but it's unreal. I also get to see my brand new belly button! To say I was impressed with the work the doctor had done would be a significant understatement. At this point the Doc tells me about swelling, why it's there, how it works, how long it will last etc. Explains that the results at this point will be very different in 4-5 months once the healing is complete and that the swelling will disappear and the skin will 'snap back' to the muscle and tissues underneath. It was great, no matter what I asked he responded with sincerity and detail.. exactly what I needed. It was at this point that I can start wearing compression garments, I only have wound dressings over the new belly button and incisions.

Day 10 - All medication stopped, anti-biotics, sleeping pills and anti-clotting meds all finished. Only vitamins remaining, of which there is more than a weeks worth to go. Struggling with the new compression garment, in hindsight this style of garment just didn't work for me (bizarre S&M-esque thigh to abdomen total garment). The advertised size was not what it appeared but I had no other option so persevered. And eventually I even figured out the highly complex series of steps needed to go to the bathroom.

Day 10-12 - Resting in suite. Again, mostly prone. Going out and walking to hotel breakfasts and out to close by restaurant for dinners. Still large water intake so frequent bathroom breaks. Feeling bloated sometimes from the garment and pressure, we noticed the garment was pinching in the wrong places entirely but can't think of a way to fix it so we left it as it was.

Day 13 - The second and final post op with the Doc. He removed the stitches/sutures but left the dressing on the belly button and said to give it a few more days to seal completely. Primary incision is cleared and completely sealed so the Doc advised I can begin using scar gel on it finally, which is excellent news. He prescribed another complete script of vitamins as he believes that's the best thing you can do for the healing process and advised once these were gone to keep up with multi vitamins just to help out. He and I had some lengthy discussion on swelling (it's going to get worse before it gets better), expectations, realistic limitations and how I can best recover and he gave me some personal advice from when he had the same operation himself years earlier. The Doc noticed that the marks on my body were not in the right areas so we discussed my compression garment and he had a great idea to supplement it with a breast band (a wide elastic band that's given to people who get BA's) to use around the incision area specifically, so I purchased one of those and it was perfect! I still use it a month later and have no intention of stopping.
He cleared me to fly and told me to please keep in contact and reach out to him with any questions or concerns. It's odd to say it, but by this stage we felt pretty close to him so it was kind of sad to go.

Day 14 - We flew home, took a couple of quick shots in the morning and then flew in the afternoon. After a couple of short stopovers we arrived back in Sydney in the morning (around 7am). I managed to get a couple of hours sleep but the swelling and pressure was pretty bad by the time we finally got out of the airport. I made sure throughout the flight that the compression garment remained tight and every couple of hours I got up to walk around the plane, stretch and do calf/shin raises. DVT wouldn't have really been a problem but I'd prefer never to take the risk for something that's so easy to avoid.

Final Post Op Shots

Put these on their own as they were taken at the hospital as the record of results. Also it's a good example of how much swelling is there to compare later on.

Week Three Post Op

Day 15 - Jet lag, lack of sleep overnight and generally feeling pretty miserable today. Back at work for the first time in two weeks, but luckily I am a nerd by trade so I can do my job from home. I've arranged to do the next two weeks working remotely.

Day 16 - Full day of work, had friends over that night for a pizza and catch up/show off session. It was good to do something more normal. I'd also tried (where possible) to control what I ate in Thailand out of fear of bathroom issues so it was nice to have something intense like a pizza.

Day 17 - Full day of work. Went out for my first outside walk, walked 2km. Nothing amazing but it felt pretty good to get up and get mobile again. It's a real mental struggle at this point to take it slow for me, the urge to lift and go and do things is really strong especially after doing almost nothing for two weeks.

Day 18 - Full day of work. Went out for another walk, 2km. Felt fine after so decided I can start ramping things up a little.

Day 19 - Full day of work. Went out for a walk, 3km this time, aside from being a little tired (really, from a 3km walk? Yes, sadly.. yes) was fine. Today was my first public outing back home. Going out for a date night with the wifey to the movies and dinner. Wore formal wear and ended up with odd pains and much discomfort from where the belt line dug into the scarring and how tight the pants were. Really wished I was back in comfy track pants at this point, I had purchased a few pairs before surgery as I wasn't sure what size I would end up but this ended up being the best idea ever and I lived in them most of the time. While it was awesome to get out with, and spend some quality time with, my wife, we were both disappointed by the movie... PS - Warcraft sucks.

Day 20 - Today I spent the morning at a friends place watching a movie, then the rest of the day out at the movies doing a bit of a marathon. Felt good that evening, even stayed up late for the first time. I'd been going to bed early the entire time so this was much harder than it sounds. Dressed comfortably having learnt from the day before and it wasn't an issue. Also my friends are awesome so they made sure I was comfortable throughout the day. Yay, I feel like real people again!

Day 21 - This is the real checkpoint, how are things improving while actually doing things in the real world. Working remote was really helpful and if possible I would totally suggest it. Even this long after the surgery you get awkward and uncomfortable quite easily so doing something like work somewhere you feel more comfortable made everything easier. The healing is really improving.. the scars looks like I’m much further along than I thought I would be at this point. Spent the day cleaning the house and pottering around.. nothing really interesting or strenuous.

Week Four Post Op

Day 22 - Full day of work, attempted some basic push-ups to start getting upper body active again. Bound up tight.. couldn't manage to get up to a full push-up position without abdominal pain so decided it wasn't worth it. I did manage a set from my knees. Felt mild discomfort afterwards for a while.. really not sure if gravity is doing damage by pulling on the swelling and skin so decided I’ll avoid these for a little while.
You may notice in my last shots and these ones a grey singlet/vest. This is the compression solution I came up with to replace my super kinky S&M garment. It's basically a strong compression singlet (just google mens compression singlet, or posture correction singlet) which holds everything in place, I then put the breast band around my midriff over the top. All in all it holds well, breaths and supports my back and the incisions quite thoroughly. I would REALLY recommend this over the total thigh/ab garments, at least for men. It's far easier to manage yourself and is way more comfortable going to the bathroom and removing for showers etc.

Day 23 - Full day of work, nothing major today. Went for a 3km walk with no issues, so at least my energy level is improving. Was a little sore from doing the push-ups the day before (which was quite shocking) and the swelling was a little worse so I left any kind of exercise progression out today.

Day 24 - Full day of work. Really angsting to get back into the gym or get active now, so starting slowly at home to get my body ready for real gym work again. Did some basic dips which didn't go too badly, managed to do three sets of my bodyweight. My core started aching pretty bad but not painful like push-ups and I think it's because I wasn't loading my arms up enough and still trying to cushion it with my core so I’ll start these regularly next week.

Day 25 - Crazy busy day of work, it was nuts. I did however manage to do some slow controlled body weight squats. Three sets of 15 in fact, I have to stop at around 15 because my hips start aching after not doing anything for so long and it really starts compromising my form.

Day 26 - Looong day of work. Managed to squeeze in a 2.5km walk still, but not much else. At this point I was happy the week was over, swelling is really getting to me and I'm getting really frustrated with how easily I get tired with exercise, staying up and mental focus.

Day 27 - Had my second coffee since surgery today, felt good. We had people around for a board games night, we binged a little on food (god I love Apple crumble.. like more than friends) then managed to stay up most of the night till early AM for the first time since surgery. Things are starting to feel a little easier. I'm comfortable with the garment, the swelling is consistently better in the morning but worse at night so I can at least plan for that now. All in all, feeling pretty good.

Day 28 - Four weeks since surgery. The one month mark and the end of my little winter hibernation. Finished up the doctor prescribed vitamins this morning so that's one less thing I need to track and focus on and I no longer need to have a dedicated breakfast in the morning now so I'll be swapping back to a black coffee and a multivitamin tomorrow.
I hit the gym today and feel amazing for it, god I missed endorphin's. I wore tight fighting sport shirt and had a wee moment to myself when I looked in the mirror, I think the change is finally starting to sink in. Only did 10 minutes of light jogging and a few basic exercises, mostly trying to understand what did and didn't affect my core so I can get a basic program together. It's hard shifting from 'use your core for every exercise you do' to 'don't use your core for anything, ever, it's going to hurt'.
Really, really happy with the progress so far, it's looking so much better than even last weeks shots. Healing fast and really impressed by the work the scar gel is doing (NewGel+ FYI).

Week Five Post Op

From this point on, I'll do a single weekly update with key things that happened each week.

Back at work in the office full time, walking a few KM roughly each way to get to work so it's helping me get more mobile and it's nice to feel like my routine is back to normal. I got stuck in meetings literally all day on the second day back and couldn't get up and walk around much so I was really drained and uncomfortable by the time I got back home, lesson learned, always get up every hour or two and walk a little to shake off the garment and swelling effects even if you’re in a meeting.

I started weighing myself this week, oddly I found I had dropped from around the 95kg that I was while recovering in Thailand to 93kg and later in the week 92kg. I'm assuming this is mostly loss of muscle mass from inactivity however as the swelling fluctuates but doesn't effect weight very much. In any case I'll keep an eye on it going forwards because that kind of drop wasn't something that was easy to do before.

Active week really, hit the gym twice. Again, nothing very hard but general exercises and slowly improving them. More jogging (not very far each time, just until it gets uncomfortable.. because jogging is a terrible exercise), then basic muscle group type stuff, squats, dips, bicep curls etc. I also discovered Pokemon GO was launched here in AU and accidentally released my inner teenage nerd unto the world and walked 5km during a lunch break trying to find digital creatures to capture. This may or may not have occured a couple of times after.

Included a selfie just after hitting the gym this week, mostly to show that even with swelling my primary goal has already been achieved, flat tshirts. The shirt doesnt stick or hang on anything, just goes straight down. It’s an amazing feeling!

Now things are stabilising, I’m thinking back on what worked and what didnt. What I planned for and what just ‘kind of happened’, so please excuse me if I wax rhetoric going forwards, hopefully there will be some useful information in there for you and not just me waffling. (I did warn you I was an analyst)

Week Six Post Op

Sorry for the shots, had to rock a couple of selfies for it this week.

Update on NewGel+ : Scarring is going a deep red/purple and the skin and scar are both really flattening out. I can't tellwhere the scars on my back are by touch anymore and need to use a mirror to apply the gel. It's great stuff!

Short week, not a lot of activity (outside Pokemon Go walks.. ) because I started the week with a cold. This brings me to my next point and one I should have mentioned much earlier in this blog.. Sneezing after this surgery is about the worst thing I can possibly imagine.

I have a high pain tolerance, but even I can tell you exactly how many times I've sneezed since the operation. It's, considerably uncomfortable. If I had to put it in words, it's like having your legs waxed. Only your abdominal muscles are the leg and the inside of your skin is the wax strip, so it sucks.. big time. My advice is to learn how to deal with sneezing and de-escalate it the second you start getting that 'tickle'. I find blowing out hard through the nose while rubbing the Columella between two fingers works better than almost all other home remedies I've tried.

Other things that are tricky to do that you dont think will be a problem but are:
- Coughing, same deal as sneezing only much less instense. Drink warm water or sip on it to get rid of the coughing urge, catch it early.
- Going to the bathroom.. this has only just recently become easier for me. You can go, but squeezing anything in the area is hard and hurts for a few weeks. This one is just patience.
- Sitting angles, upright with great posture or reclining is fine. Any kind of slouching makes you feel absolutely terrible after a while so just control your posture (or try standing while you work, I find this really helps me for a couple of hours a day).

Everything is going well, swelling is still sticking around as you can tell. I've got this weird 'ponch' deal going on right above the incision where it lumps out. The upper abdominal area is starting to shrink back down so it's good to see what it's like once the swelling resides but this ponch will be sticking around for a bit I think. :)

Week Seven Post Op

Managed to get some new compression gear so I don't have to keep recycling the same ones and washing them frequently. My gym membership also got unfrozen, so I hit the gym pretty hard to figure out what I could/couldn't do.

Turns out there's a lot you can once some of the abdominal pain subsides from activity but I didnt have sufficient support while I was running so that really messed my stomach up, the result is an inflation in swelling (which you can see in the shots). It's still sticking around but slowly getting back on track.

Otherwise all good. The new garments I got were from 'Leo', so I'll do a quasi-review on those next week after I've had enough time using them. Scars are still improving and flattening, thank you New Gel +! :)

Week Eight Post Op

Update shots attached.

Back in the gym multiple times a week really starting to push back towards what I was doing before. Still get some abdominal pain if I accidentally use my core so hoping that will subside in a couple of weeks and I can go back to compound lifts etc.

Leo compression garments: I've now used these for a week or so in various circumstances. The ones I got are below with a blurb of how I find them.

Leo extra firm control tank: http://www.leonisa.com/en/products/leo-firm-control-tank/?F_All=y&ColorSelectionId=12891
I found this tank snug fitting, pretty difficult to get on and off solo but provided decent compression. It's lighter and more comfortable than my existing compression tank so it's more an every day wear type of thing. However I found that I still needed to use my compression band over the top of this to support myself enough while exercising, also if using this while I sleep. Basically it's snug but not snug enough around the incision area to reduce swelling as much as it could. It's good when you're going out or sitting around watching movies and things though because it's not rigid and allows some slouch while still giving compression.

Leo Torso Toner Body Shaper: http://www.leonisa.com/en/products/torso-toner-full-compression-men-shaper/?F_All=y&ColorSelectionId=457
For my needs (post op, still active swelling and just hitting the gym again), I found this to be a much better buy. It's easy to get on and off myself via the front zipper. It's very rigid so provide's great support and compression while exercising or moving around. The only downside is that you basically feel like you have to stand all day, otherwise the zipper bunches/bends and digs into you and then basically reduces compression around your waist (where you want it). So if you're sitting a lot this isn't the greatest option. I've just started standing more at work.. which can only be a good thing. If that's not for you, get both of these the one above is great for a lot of seated time then switch to this for gym work.

Week 9 Post Op

Hey guess, radio silence for a while so back filling the updates. So week 9 I had my first lymphatic massage and I've given it a two week gap after this to see before/afters.

No major updates outside that. Dealing with swelling and generally in the grove of stuff now.

Week 11 Post Op

Updates this week! Skipped the week to see a real before/after of the lymphatic. Honestly, not a major difference, but at this stage of the game I didn't expect it to get fixed overnight.

I did find it seems to have helped a lot on my back. The 'roundness' of my bump at my incision site on the front has reduced a little too. All in all I would say it's definitely worth doing, if for nothing else than the fact I hadn't had a massage or used my core in two months and this really helped with activation and relaxing. I did notice I drained a bit more and it helped the scar tissue too, so a win all around IMHO. :)

This week I've been starting core work, I can't lie it hurt like a bitch and still does. I'm keeping it simple each morning and separate to gym work, just get my core activated and acclimatised to being used for the first time in nearly three months. I'm focusing on doing it consistently every day for a week or so which should get my core usable enough to start trying larger or more compound movements back at the gym.

Next weekend will be three months exactly and I'm advised I should be able to ramp back up to normal exercise at that point, however I notice that I still get a 'pinching' feeling around where the incision site is at the very front when I squeeze my core so I'll keep an eye on that and try find out how long that takes to go away completely.

Exciting stuff, hopefully be fully functional again in a couple of weeks (swelling and constant compression garments aside).

Week 13 Post Op

Hey team!

Back in the gym full time now. Started doing low weight deadlifts and squats again and it's magical. Not too much issue with most exercises, I'm still avoiding rotation stuff just to be on the safe side for a few more weeks.

I do however still have very sharp pain in the middle of my incision at the front when I cough or sneeze. There is very definitely a lump there, almost like scar tissue so not sure what that's about but I'll keep an eye on it.

Outside that everything is progressing fine. Waiting for the remainder of the swelling to go down now. Doc said 5 months it would be gone so the countdown is on.
Dr Rushapol

Dr Rushapol was amazing. He explained things thoroughly in plain english and was more than willing to offer any detail or answer any question I had (of which there were many). He said at the start, "I will do this surgery like it was my own body", and he really did. The care and attention to detail he showed was amazing. It not only made me feel comfortable with my decision in surgeon but made me feel happy to have gone to Thailand in the first place (would prefer it than staying in Sydney he was that good). Scarring and incisions were extremely neat and heal fast, bedside manner was excellent and the honest care in my results was amazing. Could really not be happier (and I investigated around a dozen surgeons).

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
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
3 out of 5 stars Wait times
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