I think it was because of the size of her incisions. She seemed like she had more excess skin to remove, and gravity was going to be more of an issue for her, and her sutures were more likely to open up.
Because Steven is so big...Does his body require a higher dosage of painkillers to get him high? I work in healthcare ( in fact, one of the docs I work with is a Suboxone prescriber) and I would ASSume he'd need a higher dose but...
Meaning, Steven and his atrocious behavior....Acting like that is how James thinks he acts, like he aspires to come off like Steven. At least, that's how I see it.