Plastic Surgery: Should You Or Shouldn’t You When You’re Over 40?


Should you or should you not have plastic surgery? Those are questions that only a board-certified surgeon can answer for you after a consultation. However, some guidance to make that decision can be given to help you make the best choice possible. Dr. Marcus Crawford has some honest pointers about just what can be changed via surgery and what might be best taken care of with diet, exercise or just acceptance. Here’s some guidelines for those interested and the special considerations for those older than 40.

Dr. Crawford:  First and foremost, let me say that plastic surgery is not the answer for everything.  As physicians, plastic surgeons always encourage lifestyles filled with healthy eating habits and routine exercise.  However, certain life events such as aging, C-section childbirth, and changes in breast anatomy can’t always be fixed, no matter how many hours per day she spends in the gym.

What effect does C-section childbirth have on a woman’s body and how do you fix it?

Childbirth is a beautiful thing, but sometimes the changes it causes to a woman’s body aren’t.  During a c-section, women usually receive an incision in the lower part of their abdomen and the muscles of the lower abdomen are divided so that the obstetrician can open the uterus to deliver the baby.  Even though the muscles are sewn together at the end of the operation, many women often develop a separation or weakness in the lower abdomen after the surgery, and that can be permanent.

In addition to the bulge that is often created as a result of this surgery, certain genetic factors predispose women to gain weight in the lower abdomen. Now, all of this can create an abdominal appearance that isn’t as flat as it once was and can’t be improved in the gym.  This is where tummy tuck surgery comes in.  During a tummy tuck, we make an incision in the lower abdomen, often in the region of the prior C-section or hysterectomy scar if she has one, and we lift the extra skin off of the abdominal wall.

We tighten the skin of the abdominal wall and remove any excess skin, keeping the scar in an area that can be hidden with normal underwear or a two piece bathing suit.  During the surgery, we inspect the muscles of the abdominal wall that can become separated during pregnancy or from prior surgery and we place stitches in the muscles to return these muscles to their normal position.  This helps define her waist in addition to restoring any muscle separation that might have occurred.  At the end of the surgery, the patient will wake up with a flattened stomach and more narrow waistline.

That sounds like a lot. Are tummy tucks painful?

Well, not when I do it! But seriously, the surgery is not very painful because we don’t cut into or through any muscles, so the recovery is often less than what women would feel following a C-section.  The surgery is usually performed as an outpatient procedure and most patients feel like they are back to 100% by 7-10 days after surgery.

 What happens to breasts after 40?

Breasts can be tricky because, with time, they can get larger, get smaller, look deflated, or hang low.  Large breasts can be very distressing not only because of the pain and discomfort they create in the neck, back, and shoulders, but the strain they put on the bank account due to the expense of unusually large bras.  Breast reduction surgery is very common in plastic surgery and, you know, these patients are amongst the happiest patients we have.  Breast reduction surgery not only makes the breasts smaller, it lifts them into a more youthful position on the chest wall.

Whereas tummy tucks and liposuction are self-pay procedures, breast reduction surgery is often covered by health insurance assuming certain criteria are met.  Now, when a woman has breasts that have an appropriate size but hang low on the chest wall, a breast lift is usually a possibility.  I always as patients, “do you like your volume and the way that you look in a bra, but are unhappy with your breast appearance out of clothing?”

If the answer is yes, then a breast lift is usually all that is necessary.  However, if she thinks her breasts hang too low and don’t fill out her bra in clothing, a breast implant can be added to enhance the breast volume at the time of the lift.  Now each one of these breast surgeries does an amazing job helping women improve their appearance in clothing, and since most women spend more time dressed than undressed during the day, they really appreciate these changes.

So should every woman with extra-large breasts consider breast reduction surgery?

It is all about symptoms.  Some women are blessed in the breast but don’t have symptoms and are happy with their appearance.  And for them, let the church say AMEN.  But for those who have pain and discomfort that is due to excessive breast volume, plastic surgery is absolutely an option and does a great job addressing their symptoms.

What is the most important thing for a woman to know about her breasts?

Aside from the cosmetic changes we have already discussed, breast awareness is EXTREMELY important, especially in our communities.  In addition to routine breast awareness for unusual lumps and bumps, women need to remember to get annual mammograms starting at age 40, sooner if they have a family history of breast cancer.  Breast Cancer Awareness month starts in less than a week so I want to remind everyone to make sure your mother, daughter, sister, wife, cousin, big mama all go out to get a mammogram if it is due.

Dr. Crawford answers your  “Text Tom” questions on the next page:


 Is there a surgeon that specializes in keloid skin and will scarring be an issue?

Most plastic surgeons have experience treating patients who suffer from keloid scarring.  Treatment options often include the addition of steroids injected into the skin or radiation therapy to the area to prevent additional keloid formation.

What are the risks of pannus removal after 55. I have had it since C-section 30 years ago and never knew until recently it had a name and could be removed?

The risk of pannus removal is very low in patients who are in good general health. During a consultation with a board-certified plastic surgeon, a patient’s overall health is evaluated to determine any risks associated with potential surgeries.

How do you find out how many operations a surgeon has botched?

When choosing a plastic surgeon, patients should verify that they are board-certified in plastic surgery by the American Board of Plastic Surgery.  Unfortunately, complications do occur in surgery and are usually not a result of surgical incompetence, but any surgeon should be judged on how the complication is handled and not only by the event itself. Surgeons who have an unusual number of complications are usually evaluated by the respective state board of medical examiners, so that could be a good starting point.  However, any surgeon who reports that he or she has never had a complication is being dishonest.

Can you get a breast reduction and lift at the same time?

Breast reduction surgery usually includes a lift. Not only does breast reduction surgery make the breasts smaller, it puts them in a higher position on a patient’s chest wall.

About how much is it (tummy tuck) price wise?

Prices for tummy tuck surgery vary nationwide depending on location. Also, additional procedures may be needed (such as liposuction) which can change the baseline cost.  The American Society of Plastic Surgery lists average pricing information on it’s website, but the best approach to achieve accurate pricing is to visit a local board-certified plastic surgeon.

What about Cool Sculpting versus surgical tummy tuck?

CoolSculpting can result in elimination of fat under the skin in certain patients, but it does not result in skin removal.  A tummy tuck not only excises fat in the lower abdomen, it removes excess skin to tighten the skin appearance.

Is there a new procedure for bat wings arm skin?

Brachioplasty surgery is the surgical removal of excess skin in the upper arm. This skin is usually a result of massive weight loss.  The surgery can be performed as an outpatient procedure with minimal recovery.

 Is there such a thing as too much plastic surgery or at what point is there too much plastic surgery?

“Too much plastic surgery” could be defined as a patient choosing to have an excessive number of procedures that cause irreversible changes in function (i.e. too many nose jobs).  If someone wants to change his or her appearance multiple times, this can be acceptable as long as there is not excessive damage to the tissues of the body.

Doctor, what do you recommend for lower abdominal scar tissue after having a myomectomy and a hysterectomy?

Depending on the location of the scar tissue, abdominoplasty surgery (Tummy tuck) is an excellent option.

I’ve previously had an abdominal hernia repair. Is a tummy tuck safe for me or could I be in jeopardy of affecting that area?

Tummy Tuck surgery is extremely safe after hernia repair as long as no surgical complications occurred following the hernia repair surgery.

What about plastic surgery for men over 40?

A:  Many men receive plastic surgery and are very happy with the outcome.

Do you do Bariatric surgery?

Most bariatric surgery is performed by general surgeons, however most plastic surgeons have a working relationship with a bariatric surgeon if a referral for a patient is needed.

For people who tend to keloids, does liposuction cause scarring and/ or keloids? What about breast contouring?

Most patients who consistently form keloids will form additional keloids with liposuction or breast contouring.

What do you recommend for lower abdominal scar tissue after having a myomectomy and a hysterectomy?

Depending on the location of the scar tissue, abdominoplasty surgery (tummy tuck) is an excellent option.

I got a hernia after I had my 2nd child. Went to see about the surgery and they deemed it cosmetic. $2000. Would a tummy tuck also fix the hernia?

Depending on the location of the hernia, hernia repair can be performed at the time of a tummy tuck.

My girl had butt implants and they’ve looked great for years. As she gets older, they are spreading and the shape of her buttocks is beginning to look weirder. Are there any health implications to aging implants? What can be done to make her butt look normal again?

She should be evaluated by a board-certified plastic surgeon to determine if removal of the implants and revision of the area (possibly with fat grafting) is an effective option.

What is the risk of blood clots and embolisms following a tummy tuck or liposuction?

The risk exists, but early mobilization by the patient after surgery is encouraged to minimize the risk.  For patients with a history of blood clots, special medications and precautions can be taken before and after any surgical procedure.

 I am a 60 years young woman with high blood pressure – obese edema really and plaugued by old knee injury PAIN BAD/Swelling. I’m considering weight loss surgery, but afraid. What surgery do you recommend surgery for me? 

Multiple health issues increase the risk of elective procedures and tummy tuck surgery might not be an option for any patient who is overweight.  However, many patients who successfully have weight loss surgery visit plastic surgeons to remove the skin after weight loss has occurred.  If a recommendation for bariatric surgery (weight loss surgery) has been made by an orthopedic surgeon, that recommendation should be strongly considered before consulting with a plastic surgeon.

Can you transfer cells from butt to your breasts?

Most often, fat cells are harvested from the abdomen, waist, back,  or inner thighs and are used to transfer to the butt or breasts.

Can I take fat from my stomach and put it in my butt?

Fat transfer from the abdomen to the butt is extremely popular now and performed often.

Can I have my fat sucked out from my underarms, thighs & abdomen area and injected into my breasts and buttocks? What is the price range of that kind of surgery?

Fat transfer from one area of the body to another is very common, but the price range varies based on the amount of time needed for the procedure.  To receive an accurate price estimate, consult with a board-certified plastic surgeon.

Will health insurance cover cosmetic surgery?

No. (Editor’s Note: Some breast reduction surgery is covered by insurance – consult your doctor).


Kennesaw plastic surgeon Marcus Crawford attended Morehouse College on a full academic scholarship and graduated with honors before attending Baylor College of Medicine in the legendary Texas Medical Center. Prior to his medical education, Dr. Crawford spent summers during college performing polymers research at NASA research centers around the country

Following medical school graduation, Dr. Crawford stayed at Baylor College of Medicine to receive training in one of the most rigorous training programs in the country located in the largest medical center in the world. This program is home to the surgical pioneers who developed today’s techniques and devices for breast augmentation.

In addition to extensive training in all aspects of cosmetic surgery, Dr. Crawford received training in state-of-the-art reconstructive techniques at the world-renowned M.D. Anderson Cancer Center. He is board-certified by the American Board of Plastic Surgery and is an active member of the American Society of Plastic Surgeons, American College of Surgeons and Cobb County Medical Society. 






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