Sex after Plastic Surgery (Ep 35)

Dr. Hall: Welcome to The Trillium Show, where we help you make the changes you want to see in your body, in your mind, and in your life. I’m your host, Dr. Jason Hall.




Dr. Hall: Welcome to another edition of The Trillium Show. And this show is going to be a little different for a number of reasons. One, we’re obviously not in the office anymore. Secondly, we are talking about a topic that comes up quite frequently, and when it comes up, patients can be a little bit weird about it, it is just one of those things.




When a patient I can always tell when a patient wants to ask the question because there’s this kind of awkward pause during the follow-up visit, and things get real quiet, and then kind of right as I’m getting ready to walk out the door, there’s this, “Oh, well, you know, my husband really wants to know when we can start having sex again.” And sex is a really important part of life. It’s a really important part of surgical recovery. And so, this show, what we’re going to do is talk about different procedures and when you can get back to sexual activity after your cosmetic surgery. The big thing is that you want to make sure that you get the best result from your cosmetic surgery that you absolutely can.




You’ve spent a lot of time taking time off work, you’ve spent a lot of money, and you don’t want complications, certainly not complications that are completely avoidable. At the same time, you want to get back to normal life as quickly as you possibly can. And sex is a part of normal life. Disclaimer to all of this, though, is that if you’re not one of my patients, get your surgeon's recommendations first. Every surgeon has their own recommendations. They know what they did in the operating room, they know what is going to put your results are at risk, so you can take this as kind of broad guidelines, but please talk to your surgeon before acting on any of the advice or any of the recommendations that you’re going to get in this show.




So, I think the best way to go about this is to start at the top of the head, work our way down and talk about when you can get back to sexual activity based on which procedures you’ve had. It’s important, though, you’ve got to let your body heal before stressing it. So, for facial procedures, people think, “Well, if I had facial surgery, I mean sex, what’s the big deal?” You really want to let things heal in your face before getting back to sexual activity. In facelift surgery, eyelid surgery, there are a lot of really delicate incisions, those incisions are closed with really, really fine sutures, and you don’t want to disrupt those incisions or move skin around that has been moved and potentially cause a hematoma after surgery.




So, a good rule of thumb for facial procedures is minimum of two weeks once all of the significant post-operative swelling is gone, to get back in engage in light sexual activity. At that point, with normal sexual activity, you’re probably not going to hurt anything, but again, you don’t want to really stress those incisions. For patients who have had rhinoplasty surgery, it’s really important that you don’t want to hit or bump your nose right after surgery. And that goes really up until about six weeks when any bone work if we have to move the nasal bones around to straighten the bridge or take down a hump, that it takes about six weeks for those bones to heal. You don’t want to disrupt those while they’re healing. So, just be careful, kind of routine positioning [laugh] for a lot of that. You don’t want to hit your nose.




Same thing with oral sex. You want to avoid that for a couple of weeks after rhinoplasty surgery, specifically. Now receiving, that’s kind of up to you you’re not going to hurt anything there, but certainly you want to protect your nose, okay? That really is, for facial surgery, really is the kind of key takeaway for all of this is you want to protect your surgery, you don’t want to put your surgical results at risk. So, use positions, do things that are going to protect your surgery. So, that kind of encompasses facial surgery.




Where it starts to get tricky is with breast and body surgery, breast surgery, specifically women and especially some overzealous spouses, boyfriends, significant others, they want to try out those new implants; they want to give those new breasts kind of a test drive because they’re looking good and everybody kind of gets excited. It’s really important to avoid that urge, especially in the first two weeks after surgery to let things heal before stressing them. I’ve had patients who have gotten hematomas, I have had patients who have had to go back to the operating room, up to two weeks out from breast surgery because of some overexcited significant others. And so, you want to avoid that, you really want to protect that investment, protect that surgery for two to three weeks before you start doing anything. I tell all of my breast patients that you really, for the first month to six weeks, you want to avoid vigorous activity and you want to avoid lifting over about ten pounds, so no lifting and no bouncing for about six weeks. That includes sex. So, just be careful.




If you’ve had a breast lift or breast reduction, typically there is a little T incision at the bottom of the breast where, you know, the breast crease and the vertical incision that goes from the nipple down will meet, and that little T area is very, very tender in terms of its healing. It’s very easy to break down, even under the best of conditions, so you really want to avoid any stress and strain on that incision. So, as a general rule, two weeks for breast surgery is a minimum, three to four weeks is recommended. So, if you can hold out that long, you’re going to be much better off.




So, kind of moving south, we’ve got abdominoplasty surgery, and it kind of baffles me the speed at which people want to get back to routine sexual activity after an abdominoplasty surgery because your muscles are tight. A tummy tuck hurts, even with our tap blocks, even with all of the things that we do to try and minimize discomfort after surgery, tummy tuck surgery still hurts. I tell everybody in their preoperative evaluation when we’re kind of talking through the procedure, that during tummy tuck recovery, you are really going to realize how frequently you use your core muscles because any and everything you do with your core, you can feel right after a tummy tuck surgery. Give yourself some time to recover. And three weeks for tummy tuck is usually a minimum.




In addition to muscle soreness, you’ve got a lot of skin that has been undermined. Now, a lot of that skin has been tacked back down with what we call progressive tension sutures, you can listen to the tummy tuck episode where I talk about some of that, that minimizes the shear of the skin and the muscles, but too much movement of that skin as it’s trying to heal can cause seromas, can also cause hematoma formation. And those can require a trip back to the operating room first of all, but even if they don’t, it turns into a pain in the butt. Draining seromas usually requires multiple trips to the office over multiple days and weeks to get that seroma to go away. You really want to let that heal and prevent that if at all possible.




After that three weeks, then you kind of have to listen to your body and do what feels comfortable. You know, from a positioning standpoint, you’re not going to want to do anything crazy, I would leave the trapezes and all of the crazy stuff for a little bit later after you’ve recovered. You want to do things that are not going to be uncomfortable. Very similar to getting back to exercising, listen to your body. If something hurts, stop. Don’t use any sudden movements because that’s what’s going to pull things and cause things to tear. So, just be very careful once you start back into sexual activity after about three weeks with abdominal surgery.




In terms of moving even further south, the Brazilian butt lift, that’s fat injections to the buttocks. You can’t sit on your butt for two weeks after surgery. Some people still want to get back to sex quickly. I would avoid it. I would kind of use the same guidelines as for tummy tucks: give yourself about three weeks.




It’s going to be sore. A lot of liposuction, you’re going to be sore if you do things that are going to hurt, you’re going to realize it pretty quickly. Again, just don’t push it. Don’t try too much too fast and go slow. In terms of liposuction, again, the same thing. You want to let your skin heal, you don’t want too much friction and shear forces on that skin, so give yourself about three weeks.




People tend to be pretty sore for a couple of weeks after liposuction anyway, so that’s kind of a good deterrent. We’re kind of talking about normal things there. Certainly in terms of self pleasure, masturbation, totally fine. Have at it. Don’t get yourself too worked up, get your heart rate up too high. You know, you don’t want to give yourself a hematoma, but you’re certainly not going to hurt anything.




And kind of like when we talked about oral sex, being the recipient, not a big deal. You want to be careful on the giving end. Although use less caution with breast and abdominal surgery than you do with facial surgery; you just don’t want that to turn into something that’s going to give you problems down the road.




Continuing our journey south. Next up is labiaplasty surgery. And this is kind of the exception to the rule for the three-week don’t do anything, I tell all my labiaplasty patients, no vaginal insertion of anything—tampons, anything else—for four weeks, those suture lines down there are incredibly delicate, that skin is incredibly thin, and just the act of moving around puts those at risk just from day-to-day activities. You certainly do not want to stress those incisions by inserting anything into your vagina for at least a month.




And so, that is kind of a hard and fast rule. Do not have intercourse, really in that case, masturbation for the most part—at least anything you insert—is out of the question, and be very, very gentle. So, really with labiaplasty, nothing for four weeks. Again, we kind of come to the point where you’ve had big surgery, you’ve just had a major operation, no matter what we’re talking about and you want to let your body heal before you start to stress it. And sex, at least for some people, sex can be a significant stressor.




Certainly around delicate incisions, you really really want to be careful, so give yourself the time to heal before stressing areas of your body that have been operated on. Lastly, kind of in our journey south we get to your thigh lift procedures. And really we didn’t talk about arm lift. Arm lift kind of goes along with thigh lifts. These incisions tend to be very lengthy, they tend to be placed—the incisions themselves are placed along the axis of your arm, along the long axis of your leg.




And those incisions themselves are very prone to break down. Most thigh lift and arm lift will get a little bit of breakdown up in your groin or in your armpit under the best of circumstances. This is an area where you really do not want to do anything to strain those incisions for six weeks. And certainly, with a thigh lift, any sexual activity at all is going to put pressure and put strain on those incisions. You really want to lay off for a good six weeks to let those things heal before you stress them.




You know, I keep saying over and over again, kind of like a broken record. You’ve got to be careful after having surgery in getting back to sexual intercourse because you want to let yourself recover. You spent a lot of time, you spent a lot of money on getting the result you want. Don’t get back to sexual activity too quickly and put your results at risk. The other thing to really tell you, and we touched on this a little bit at the beginning of the show, is you really want to talk to your surgeon about your procedure or set of procedures and get their direct input as to when you can safely returned to sexual activity. This offers a very broad overview as my perspective. Every surgeon kind of has their own way of dealing with this, so talk to your surgeon about your procedure or set of procedures before getting back to any type of sexual activity after your operation.




I hope that you found this interesting and insightful. It is a topic that comes up all the time. This show, really wanted to kind of get this out in front of everybody so that it can help to give you kind of a broad overview and some general guidelines about when sex after surgery is safe and advisable.




Dr. Hall: Thanks for listening to The Trillium Show. You can keep up with the latest on the podcast at jhallmd.com. Be sure to follow us on Spotify, Apple Podcasts, or wherever you listen to podcasts. If you want to connect with us on social media, you can find us at@jhallmd on Instagram and Twitter and@DrHallPlasticSurgery on Facebook. Remember, be the change you wish to see in the world.