What is a Mommy Makeover, and who can benefit? The term Mommy Makeover has been given to a variety of paired cosmetic procedures designed to enhance the areas most effected by pregnancy: the breasts and the belly. The archetype for the Mommy Makeover is the combination of Breast Augmentation and Tummy Tuck. Other procedures can be substituted to enhance targeting your specific needs, but this is the most frequently used pairing. This combination of procedures can also be helpful after weight loss. More details are supplied below and are covered in today’s video segment.
Mommy Makeover – Belly Enhancement
A mommy’s abdominal wall, muscle and skin, is stretched maximally during the final trimester of pregnancy, and the result is often irreversible with diet and exercise alone. Once the tough fascial layer that surrounds the muscle is over-stretched, it does not spring back. Exercise is very important to maintain weight and to strengthen the muscle, but it cannot repair the loose fascial layer that supports the muscle deep within the abdominal wall. A Tummy Tuck, or Abdominoplasty, can tighten the fascia, repair the diastasis, remove the excess skin and remove any baby fat that remains on the lower belly. Mini Tummy Tucks (Mini Abdominoplasty) and Liposuction can also be part of a complete Mommy Makeover. For more about Belly Shaping procedures visit my Body Enhancement page.
Mommy Makeover – Breast Enhancement
Breast size changes with pregnancy, weight loss, weight gain and even as we naturally age. The Breast Enhancement portion of the Mommy Makeover is modified depending on the problem. Breast Augmentation is the most common procedure combined with tummy tightening in the Mommy makeover. Breast Implants are used to restore lost volume, and fill loose skin, and just about any size is available. Newer silicone filled and shaped Breast Implants give us safer and better options. If sagging is present, a Breast Lift can be used to reshape the breast. When breasts enlarge with pregnancy and do not deflate, Breast Reduction surgery may be a better answer, to restore a more comfortable breast volume. For more about Breast Shaping procedures visit my Breast Enhancement page.
Mommy Makeover Questions Answered
This Mommy Makeover Video features more answers to common questions about the Mommy Makeover. Host, Janelle Marie, asks me about Breast Augmentation, Breast Implant sizing, Tummy Tucks, combing procedures and the recovery time needed. After watching the video, if you have more questions, click on links provided at the end of this post, use the contact form on the left or just give us a call.
Mommy Makeover Video – Before and Afters
This is the fourth and final Mommy Makeover video segment from a live broadcast on the San Francisco Bay Area’s News Station, KRON4. The (415) number shown in the video clip was for callers to ask questions during the show. Andrea in San Francisco, California, called in to ask if her Breast Reduction can be revised. Another good question! If you have questions about Mommy Makeovers, Breast Augmentation or Abdominoplasty (Tummy Tucks) please call (925) 943-6353 for more information, or use the contact form on this page to e-mail me.
Mommy Makeover Frequently Asked Questions
This series of Mommy Makeover Videos includes answers to many Mommy Makeover Frequently Asked Questions. This segment reviews additional facts about both Breast Augmentation and Tummy Tucks and the alternatives. San Francisco caller, Andrea, also calls with questions about Breast Reduction and Breast Reduction Revision surgery. Some of the breast and belly shaping topics covered include:
Can Breast Augmentation and Tummy Tucks be safely combined as a Mommy Makeover?
What are the advantages of combining Breast Augmentation and Tummy Tucks?
Which are the most popular Cosmetic Plastic Surgery procedures?
Do Breast Implants have to be big?
What sizes are available in Breast Implants?
Can a specific size be guaranteed for Breast Augmentation?
How can I test the size of Breast Augmentation I want?
What is the most common reason for Breast Augmentation Revision?
What is the most common reason to replace a Breast Implant?
What is the recovery time for a Tummy Tuck?
What is the recovery time for a Mini Tummy Tuck?
Can Breast Reduction be redone or revised?
More Mommy Makeover Information
Thank you for watching part three of Mommy Makeovers. Be sure to watch the rest of the show. Links are provided below:
We had a great show. My most recent KRON4 Body Beautiful television appearance featuring Mommy Makeovers is packed with information that every woman considering Breast Enhancement or Abdominoplasty (Tummy Tuck) can use. Mommy Makeover is a generic term for any combination of procedures that restore both the breast and abdomen. Since this is very desirable after childbirth, mommies are the number one patients for Mommy Makeovers. The combination is also common after weight loss, when breast volume is lost and the abdomen is stretched out, and can be performed to enhance the results of Bariatric Surgery. As a member of the American Society of Bariatric Plastic Surgeons, Mommy Makeovers are an area of particular interest to me.
Breast Enhancement includes many different procedures. The most common, by far, is Breast Augmentation with Breast Implants; however, Breast Lifts, Breast Reduction, Areolar Reduction, Inverted Nipple Correction and even Nipple Reduction are all types of Cosmetic Breast Enhancement.
Mommy Makeovers Upstairs – Breast Augmentation
Breast Augmentation is the upper half of the Mommy Makeover. The first video segment from Body Beautiful focuses on Breast Augmentation with Breast Implants. When the skin is firm, Breast Augmentation alone is a great way to restore volume and beauty to the female breasts. If the skin is loose, a Breast Lift can be added to improve the shape and firmness of the breasts.
Mommy Makeover Video – Breast Augmentation
The Mommy Makeover video segment below was broadcast live on the San Francisco Bay Area’s New Station, KRON4. The (415) number shown in the feature was for callers, like Sandra from San Jose, to ask questions during the show. If you have questions about Mommy Makeovers, Breast Augmentation or Abdominoplasty (Tummy Tucks) please call (925) 943-6353 for more information, or use the contact form on this page to email me.
Mommy Makeover Frequently Asked Questions
This Mommy Makeover Video includes answers to many of the frequently asked questions about Breast Implants and Breast Augmentation. Multiple Breast Augmentation Before and After pictures are shown, and I answer questions from a viewer from San Jose about Breast Augmentation Revision:
What is a Mommy Makeover?
What are Breast Implants?
Are Breast Implants Safe?
What are Breast Implants filled with?
What advantages do Saline Breast Implants have?
What advantages do Silicone Breast Implants have?
What advantages do “Gummy Bear” Breast Implants have?
What advantages do Round Breast Implants have?
What advantages do Shaped Breast Implants have?
Is Cleavage always possible with Breast Implants?
Breast Implant Before and After Pictures
Breast Augmentation Revision – Can switching from Saline to Silicone gel filled Breast Implants help a firm Breast Augmentation?
More Mommy Makeover Information
Thank you for watching part one of Mommy Makeovers. Be sure to watch the rest of the show. Links are provided below:
The ASAPS is the largest professional society for Board Certified Plastic Surgeons who practice Cosmetic Plastic Surgery. The group split from the American Society of Plastic and Reconstructive Surgeons (ASPRS) to provide Plastic Surgeons with a professional organization dedicated to the specialty of cosmetic surgery. Most members maintain membership in the ASAPS and the mother society, now renamed the American Society of Plastic Surgeons (ASPS). The national meetings of the ASAPS and ASPS are two of the largest of their kind in the world.
What’s new in Plastic Surgery?
The ASAPS meeting provides scientific papers, lectures and instructional courses covering the latest refinements in Cosmetic Plastic Surgery. This is one reason I go out of my way to attend. The other main reason is the manufacturers displays. The latest innovations in plastic surgery are there to be seen, and the manufacturers representatives are available to explain it all.
What’s New in Breast Implants
If you are a frequent reader of the San Francisco Plastic Surgery Blog, you may already have the latest cosmetic plastic surgery information, but here is a recap of some of the newest offerings in Breast Implants. Both these implants are next generation products with highly cohesive silicone gel interiors. The terminology for these devices has become very confusing, but you may know them as gummy bear, form-stable or high-strength silicone gel filled breast implants.
New Breast Implants from Allergan
So what was new? For Breast Augmentation, this was the first national meeting with the newly approved Allergan style 410 shaped breast implants.
Allergan Natrelle 410 Breast Implants get FDA Approval.
These are the latest generation of silicone breast implants. The improvement is inside with these implants. They are filled with a form-stable, high-strength gel that maintains its shape better than any other implant. While not right for everyone, they do represent an improvement in shaped breast implant technology, and will be especially useful for women needing breast reconstruction after a mastectomy and for women born with little to no breast tissue.
New Breast Implants from Sientra
Sientra was well represented too. Sientra offers the latest in smooth round breast implant technology. Sientra’s breast implants are made with a stronger shell and form-stable high-strength gel.
Sientra Breast Implants made by Silimed
The gel in the Sientra Breast Implants is not as stiff as the new Allergan 410′s; however, it is stiff enough to resist flow, as the breast implant that I divided in half last year can attest to, but feels softer. It also does not suffer from problems with shell separation and gel shearing that the 410 does. Both Sientra’s and Allegan’s latest offering represent improvements from the previous Breast Implants.
New Dressing to Reduce Scars
Last year, I was a clinical investigator for a novel scar treatment manufactured by Neodyne Biosciences.
Embrace – A novel scar treatment.
The product, Embrace, was launched last weekend, at the ASAPS meeting in New York City. Embrace is a new silicone dressing specifically designed to shield an incision from stress and improve the appearance of the scar. Initial trails were conducted for Tummy Tuck scar, and the results were good. Dressings of various shapes and sizes are available to match the size of the incision. Notice I say incision not scar. These dressings are made for use right after an incision is closed, or a scar is surgically revised, to help improve the scar formation.
But Wait! There’s More!
These are just three of the most exciting offerings from ASAPS. This is also the 250th entry for the San Francisco Plastic Surgery Blog. As long as there is something new to present, I will keep blogging. Thank you for all your support, and interesting questions. If you have a question, feel free to email using the form on the left.
If you are interested in learning more about a cosmetic plastic surgery procedure, the best way to learn is by consulting a Board Certified Plastic Surgeon, like myself. While the Internet is amazing, there is no substitute for an in-person consultation. To reach my San Francisco Bay Area Plastic Surgery office in Walnut Creek, CA, call (925) 943-6353.
Breast Augmentation remains the most frequently requested and performed Cosmetic Plastic Surgery procedure. Breast Augmentation provides a safe and effective means of providing breast volume for women who have always had small breasts, and for restoring breast volume for women whose breasts have lost volume after pregnancy or weight loss.
Breast implants are a safe and effective means of providing or restoring breast volume during Breast Augmentation surgery.
Breast Augmentation for Small Breasts
For women who have always had small breast, Breast Implants can provide the breast volume that has been missing. If you are considering Breast Augmentation, and have never had large breasts, you have an advantage. The advantage is tighter skin. Firm skin will stretch and fit smoothly over the Breast Implants, giving a youthful result, without the need for a Breast Lift.
Breast that have always been small have an advantage when it comes to Breast Augmentation.
Breast Augmentation for Deflated Breasts
During pregnancy, or weight gain, the breasts often enlarge. In the process, the skin is stretched and the amount of skin increases. After childbirth or weight loss, the breast may not return to its original size and shape. The result is often a breast which looks deflated. The breast volume is lost, but skin does not shrink enough to provide firm coverage.
Breast pseudoptosis or “fake sagging” responds well to Breast Augmentation.
There are two types of deflation. When the breast “pancakes” or “bottoms out,” the nipple remains elevated and near the center of the breast. This is termed pseudoptosis, or “fake sagging.” Breast Augmentation is usually all that is needed to restore a more ideal breast shape when there is pseudoptosis. However, when the nipple is low on the breast, or the nipple is lower than the inframammary fold (the fold beneath the breast), this it termed ptosis, or “sagging.” When true sagging is present, Breast Augmentation alone is not enough, and a Breast Lift is used along with a Breast Implant to provide the best results.
Tune in to KRON4 on Monday, March 25, 2013, at 11:00 AM, for 30 minutes of Body Beautiful dedicated to Body Work. Board Certified Plastic Surgeon, Dr. Joseph Mele, will show Breast Augmentation, Tummy Tuck and Mommy Makeover before and after pictures, and answer your questions during the live broadcast.
Dr. Mele discusses Body Work (Breast Augmentation, Tummy Tuck and Mommy Makeovers) on the Bay Area’s News Station, KRON4.
Body Shaping Plastic Surgery
Spring is in the air, and there is no better time to get in shape. The gyms are full and the winter pounds are being shed. While diet and exercise can tighten muscles and reduce fat, there are some problems that require direct intervention. Loose skin will not shrink with dieting. There is no exercise to fill deflated breasts, and disproportionate fat won’t sculpt itself. Dr. Mele will present the latest plastic surgery techniques designed to compliment your hard work.
The Newest Breast Implant Technology – Allergan 410′s
The show will also feature the newest Breast Implants available from Allergan. Allergan’s 410 Breast Implant is form-stable, shaped, textured and filled with the highest strength silicone gel available in an FDA approved Breast Implant. The implant has been available outside the United States for over a decade. FDA approval was obtained after the review of a seven-year premarket approval study. During the study, the 410 Silicone Breast Implants performed well. Perhaps most significantly, during the 7 years of the study, there was a 0% incidence of gel migration. The San Francisco Plastic Surgery Blog has more information here: Allegan Natrelle 410 Breast Implants get FDA Approval.
Tummy Tucks and Mommy Makeovers
Breast Augmentation is just one of the body shaping techniques featured. Body contouring with Abdominoplasty (Tummy Tuck) will also be reviewed. The Tummy Tuck can remove lower abdominal fat and stretch marks, tighten the abdominal muscles and firm up loose redundant abdominal skin. Crunches can strengthen the rectus abdominus muscles, but they cannot repair an over stretched muscle. After pregnancy, or after massive weight loss, the fascia (a tough layer that surrounds and supports the muscle) stretches out and cannot recoil. The result is a round lower belly, despite strong muscles. When associated with loose skin, this is the situation the Abdominoplasty was made for.
Body Work by Plastic Surgeon
If you want to learn more about what plastic surgery can do for your body, call Board Certified Bay Area Plastic Surgeon, Dr. Joseph Mele at (925) 943-6353. You can watch him on Monday, March 25, 2013, at 11:00 AM on KRON4′s Body Beautiful, or you can use the contact form on the left to learn about Breast Augmentation, Tummy Tuck (Abdominoplasty), Mommy Makeovers or many more Body Shaping Procedures.
Allergan Natrelle 410 Breast Implants get FDA Approval.
Seven years and 941 women later, Allergan has received FDA approval for its newest cohesive silicone gel breast implant. The Natrelle 410 Breast Implants are teardrop shaped, highly cohesive (gummy bear) implants that are approved for the cosmetic enhancement of breast volume in women 22 years or older, and for breast reconstruction at any age. Since the gel in these new breast implants is firmer, it retains its teardrop shape, but still gives when touched.
New Breast Implants Approved with a Condition
The approval comes with a condition. A breast implant follow-up study must be completed including 3500 women followed for 5 years and 2000 women for 10 years. Follow-up studies have been an FDA recent requirement for the approval of implantable devices, including previously approved breast implants.
What is a PMA Study, and Why They are Important?
I have been an investigator for the post-market approval (PMA) studies for all three US Breast Implant Manufacturers: Allergan, Mentor and most recently, Sientra. PMA studies are very important. They assure us that the new breast implants are as good as the pre-market research proved. The PMA studies also provide objective data that can be used to compare one type of breast implant to another. Larger numbers of participants also allow for the identification of the very rare occurrences.
Join a PMA study – It’s Less Than Free
PMA studies for breast implants carry no additional risk, and often include a small financial incentive to encourage continued participation. The amount is not enough to cover a Breast Augmentation, so it shouldn’t encourage anyone to get breast implants who wasn’t already considering the idea. However, the small financial carrots may help with the biggest problem encountered in long-term studies — people dropping out and becoming “lost to follow-up.”
Who is Eligible to Join?
PMA studies are designed to learn what happens after implantation. Participants are enrolled prior to surgery, and need to meet certain minimal requirements. The studies are closed once enough participants are recruited, and these participants will continue to be followed for the duration of the study (5 to 10 years). For Breast Implant Follow-up Studies, a yearly survey is completed in the comfort of your own home, and periodic follow-up examinations are performed in the office. Typically these are at 1, 5 and 10 years, though there is some variation.
Current PMA Studies with Open Enrollment
Currently, Sientra is enrolling new Breast Augmentation patients for the Sientra PAS (Post-Approval Study). It is named OASIS (Online Annual Sientra Implant Study). The PMA Studies for Saline and round Cohesive Silicone Gel Implants for Allergan and Mentor are closed; however, with the release of the 410′s a new PMA should be opening up. The investigators have not yet been selected. Stay tuned to the San Francisco Plastic Surgery Blog for more details!
One of the first, if not the first, in the area to complete FDA mandated training on the use of Allergen’s Natrelle 410 Breast Implants.
Answering your questions is one of my favorite parts of being on Body Beautiful. Since it is a live show, I never know what you’ll ask, but it gives me a chance to share a bit of what I have learned in over 15 years of my private practice of Plastic Surgery in the San Francisco Bay Area city of Walnut Creek, CA.
Breast Augmentation Video Presentation
Breast Enhancement was the theme for my recent appearance on the San Francisco Bay Area’s News Station, KRON4‘s Body Beautiful. Watch the Breast Implant Questions Video segment below for the latest information about Breast Augmentation and Breast Implants. Our caller, Sonia from Pacifica, asks good questions, and I supply her answers about Breast Lifts, Breast Augmentation, Mastopexy Augmentation (the combination of the two), and Breast Implants.
Breast Implant Video
The following Breast Augmentation Video is the last of four segments on Cosmetic Breast Enhancement Surgery. In this segment, the newest information is presented about Breast Augmentation including: updates about the procedure, breast implants like the new gummy bear breast implants, techniques, options, recovery and the importance of choosing an experienced Board Certified Plastic Surgeon for your breast procedures. The (415) phone number shown in this video, was for viewers to call in with questions during the live show. If you have a question, please call my Walnut Creek Plastic Surgery office directly at (925) 943-6353. We are open weekdays from 9 am to 5 pm.
The Lastest in Breast Augmentation (with Breast Implants)
Reduction Mammoplasty – Breast Reduction Information
This Breast Enlargement Surgery Video includes answers to frequently asked questions and general information about:
Is a Breast Lift enough?
Can a Breast Implant be used during a Breast Lift?
What is the lifespan of a Breast Implant?
When do Breast Implants leak?
What is the leakage rate for Breast Implants?
What is a Breast Implant warranty?
Adding a Tummy Tuck, Is that a Mommy Makeover?
Who is qualified to perform Breast Augmentation?
What does it mean when my Plastic Surgeon is Board Certified?
Who gets Plastic Surgery more men or women?
What types of Plastic Surgery do men get?
More Breast Enhancement Information
The other video segments from my Body Beautiful appearance are available here:
The best information is obtained in person. If you are considering Cosmetic Breast Surgery, the most reliable way to clarify the specific options that will work for you is with a personal consultation. To schedule a Breast Reduction consultation in our San Francisco Bay Area, Walnut Creek Plastic Surgery Office, call (925) 943-6353, or use the contact form to the left.
Recently, I had the opportunity to discuss Cosmetic Breast Surgery on the San Francisco Bay Area’s News Station, KRON4. Watch the Breast Augmentation Video below as host Janelle Marie and I review the latest information on Breast Augmentation, Breast Lifts, Breast Reduction and Breast Implant Revision.
Breast Augmentation Video
The following Breast Enhancement Video is the first of four segments on Cosmetic Breast Enhancement Surgery. In this segment, vital information is presented about Breast Augmentation including: updates about the procedure, breast implants, techniques, options and recovery. The (415) phone number shown in this video, was for viewers to call in with questions during the live show. If you have questions, please call my Walnut Creek Plastic Surgery office directly at (925) 943-6353. We are open weekdays from 9 am to 5 pm.
The Lastest in Breast Augmentation
Augmentation Mammoplasty – Breast Implant Information
This Breast Enlargement Video includes answers to frequently asked questions and general information about:
Who is a good candidate for Breast Implants?
Saline Breast Implants
Silicone Breast Implants
Gummy Bear Breast Implants
The benefits of Gummy Bear Silicone Breast Implants
The benefits of Saline Breast Implants
Breast Augmentation Incisions
Breast Augmentation Before and After Pictures
Can I get a specific cup size?
Breast Implant Placement
Advantages of placing Breast Implants behind the muscle
Breast Enlargement Recovery
More Breast Enhancement Information
Additional segments from this Body Beautiful appearance are available via these links:
If you are considering Cosmetic Breast Surgery, the best way to clarify the specific options that will work for you is with a personal consultation. To schedule a Breast Augmentation consultation in our San Francisco Bay Area, Walnut Creek Plastic Surgery Office, call (925) 943-6353, or use the contact form to the left.
A Breast Lift is used to firm a saggy breast. The procedure, also called a Mastopexy, changes the shape, but not the volume of the breasts. San Francisco Breast Lift patients can have their Mastopexy combined with Breast Augmentation or Breast Reduction, if a change in breast volume is desirable.
Breast Lift with Breast Augmentation Before and After
The Breast Lift is combined with Breast Augmentation when we want to increase the size of the breasts or when more upper pole fullness is desired. Before surgery on the left; After periareolar mastopexy augmentation on the right.
When Breast Size is Good, Just Lift Them
The Breast Lift is primarily a Breast Shaping procedure. Larger breast can be left larger, and smaller breast can be left smaller, depending on what you are comfortable with. Larger breasts do tend to require more maintenance in most cases, and may be at higher risk for needing another Breast Lift in the future. It is important to seek a Board Certified Plastic Surgeon, and be fully informed before any procedure.
Large Breast Lift Before and Afters
Below is an example of a Breast Lift for a patient with larger breasts. If desired, the breast could have been reduced at the same time.
Breast Lift can be performed for larger breasts without a Breast Reduction. Often the vertical scar can be eliminated in these cases.
Small Breast Lift Before and Afters
It is not always desirable to increase the size of small breasts during the mastopexy surgery. The bridge, as they say, is not burned however. If in the future a larger cup size is desired, a Breast Implant can be inserted in the future. There are certain cases when it is better to stage the Breast Lift and Breast AUgmentation, but most the time they can be performed at the same surgery.
Breast Lift can also be performed for smaller breasts without making them larger. This is especially helpful for very active, athletic women who do not want to deal with the added weight of larger breasts.
Mastopexy Before and After – Side View
A breast lift not only raises the nipple up on the breast, but can raise the breast mound on the chest. This is best seen in the lateral (side) before and after pictures. My patient has a conveniently located skin lesion that makes this amount of elevation easy to see. The red spot (hemangioma) along side her breast is seen just in front of her arm, at the level of the elbow. After her Mastopexy, the breast is back on the chest, leaving the hemangioma on the abdomen, and well below the perky breasts.
Mastopexy Before and After Pictures: The side view dramatically shows the amount of lift possible with today’s modern breast lifting techniques. A red spot (hemangioma) is seen just in front of he elbow. On the left, the before breast sags well below this marker, while on the right, after the breast lift is well above it.
Breast Lift Specialist
If you are considering a Breast Lift, Breast Augmentation, Breast Reduction, or any other Cosmetic Breast Enhancement, give us a call at (925) 943-6353. We can discuss all the latest innovations, and find the procedure with the right aesthetics for you. Many Breast Lift procedures exist, and it is good to review your options before surgery. That way you can make the best decision, one that is the safest and most predictable means to achieve the goals you want.
If you are a Plastic Surgeon you likely feel that the TV show Nip/Tuck portrays plastic surgery as accurately as West Virginia’s Senator Joe Manchin feels Buckwild represents West Virginia. However, in Spain yesterday, fiction became fact.
In Episode 12 of Nip/Tuck’s inaugural season, drug lord Escobar Gallardo blackmails plastic surgeons Sean and Christian to remove liquid-heroin implants from one of his many drug couriers illegally entering the US. Sounds insane right? Well … yesterday, December 13, 2012, airport security in Barcelona, Spain, detained a Panamanian woman arriving from Bogota, Columbia, and found she had three pounds of cocaine on her … actually … in her.
Can I Fly After I Get My Breast Implants?
Cocaine filled breast implants – definitely not FDA approved.
The short answer is yes, you can fly with Breast Implants, but I don’t suggest it immediately after your surgery. It was especially true in this case. Immigration officials were suspicious of the Panamanian woman’s story, and a pat-down revealed bloody bandages in her bra. Long story short, a medical team removed two plastic bags from her breasts containing three pounds of white pasty cocaine. Her Breast Implants were worth about $50,000 each, and a trip to prison. Maybe, if she had liquid-heroin filled implants, the result would have been more natural.
Truth is Stranger Than Fiction
I watched Nip/Tuck. I had to. My patients would ask me about the plot line, and I couldn’t venture a guess of what the characters were up to without actually seeing it. Some of the strangeness was plausible: Ghost surgeon, Alec Baldwin, as founding father of male-to-female surgery, maybe, but the abomination of smuggling drugs within Breast Implants seemed beyond the pale. I can only imagine the desperation and delusions of those involved in this tragedy. Makes Jersey Shore seem pretty reasonable.