Multiple plastic surgeries or combo procedures have become a common approach in facial rejuvenation. Typically, patients require facelift combined with structural fat grafting/injection, brow lift performed concurrently with forehead lift, and facelift with a simultaneous neck lift or neck liposuction.
In many cases, facial combo procedures, which generally involve closely related surgeries, make sense as they reduce the total time in surgery. Of course, the approach can also pare down the cost.
A huge chunk of plastic surgery expenditure comes from the anesthesia fee, surgical facility fee, and surgeon fee. Consequently, stacking multiple procedures means the additional cost related to anesthesia and surgical center is ruled out of the equation.
Some plastic surgeons even package certain procedures at a discounted rate, which further makes multiple plastic surgeries a cost-effective approach.
Nonetheless, patient safety should remain the utmost priority and so combo procedures come with stricter safety guidelines. For instance, being under general anesthesia for more than 5-7 hours is known to increase the risk of complication (cardiovascular issues and prolonged recovery) and so all efforts are made to complete any elective surgery within this time frame.
To further promote patient safety, leading Orange County plastic surgery expert Dr. Tarick Smiley says any combo surgery, or any type of elective plastic surgery, should only be done in an accredited surgical facility or hospital setting.
Accredited surgical facilities and hospitals are staffed by qualified medical practitioners and are fully equipped with medical apparatus should complications arise.
Due to the perceived challenges that come with multiple plastic surgeries, Dr. Smiley emphasizes the importance of lab screening and honest discussion between the surgeon and his patient. The goal is to rule out chronic medical conditions, or if they have been detected during physical exam, address them well in advance of the surgery through medications and lifestyle changes.
During pre-op consultation, Dr. Smiley says a prudent patient should disclose her medical background, previous test results, and medications, including those seemingly innocuous herbal supplements and vitamins, some of which have been found to interfere with healing.
To recap, multiple plastic surgeries on face are generally deemed as a cost-effective and safe approach provided these elements are present:
- The total time under general anesthesia does not exceed the standard safety limit.
- The surgery is performed by a board-certified plastic surgeon.
- The combo surgery is performed in an accredited surgical facility/hospital, which is staffed by qualified medical practitioners, including a licensed anesthesiologist.
- The patient is physically fit based on lab screening and is “honest” during pre-op consultation (in no way should a patient hide or omit medical information to avoid complications).
Tummy tuck healing complications can be prevented or at least minimized with strict patient selection, preparation, meticulous surgical techniques, patient commitment, and follow-up care, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley shares his core principles to minimize tummy tuck healing complications and ultimately promote the best results possible.
- Identify patients with risk factors for delayed wound healing
Dr. Smiley requires all his patients to pass lab screening and disclose their drug use and medical history to ensure that they can handle the surgery. The idea is to identify risk factors such as bleeding problems, diabetes, weak immune system, and other chronic medical condition; ideally, any elective surgery must be postponed until these are well under control through medication and/or lifestyle changes.
Dr. Smiley says that the success and safety of tummy tuck also boils down to patient candidness during consultation. They must fully disclose their drug and supplement use, previous surgeries, medical condition, results of previous tests, and other health-related information.
By knowing this information, surgeons can help their patients eliminate or at least control risk factors through right preparation.
Furthermore, patients are often instructed to avoid aspirin and other blood-thinners, too much alcohol consumption, and large weight loss a few weeks in advance of their surgery.
- Performing good wound closure
Each doctor has his own preferred wound closure technique, although there are generally agreed upon guidelines such as closing the hip-to-hip tummy tuck incision in multiple rows of sutures, and placing most of the tension on the deepest structures and progressively reducing it as one reaches the superficial layers and skin.
- Taking it slow during recovery
Over-exertion should be avoided for a minimum of three weeks, although most patients can safely return to work within two weeks provided that they are not doing rigorous activities.
Any activity that causes pain, discomfort, and persistent swelling might be a sign of over-exertion or over-straining. Hence, women taking care of small children are typically advised to arrange for childcare for at least 10 days.
A common advice is to stop smoking one month before and after tummy tuck, which typically involves large skin excision. It is important to mention the detrimental effects of nicotine on healing and blood supply, causing it to become constricted and thus increasing the wound complication rate.
Dog ears tummy tuck refers to skin puckering and/or excessive fullness at one or both ends of a scar. While there are ways to prevent or reduce the chance of this minor complication, certain types of patients remain susceptible.
For instance, massive weight loss patients—i.e., those who had lost more than 50 percent of their excess weight—have large redundant skin and markedly poor skin tone that makes them prone to dog ears tummy tuck, with medical literature suggesting that 15-20 percent will even require some type of revision to improve the appearance of their tummy tuck scar.
The first and most critical step to prevent dog ears tummy tuck is to use the right incision technique during surgery.
Nonetheless, there is one potent technique to avoid or at least minimize the risk of dog ears tummy tuck and other surgical “stigmata”: Use the right incision length, placement and shape during surgery.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the vast majority of patients need the standard hip-to-hip incision pattern due to the natural diffusion of loose skin. Meanwhile, the mini tummy tuck in which the scar runs just a few inches below the navel is rarely beneficial.
Using a tummy tuck incision that is too short—i.e., it does not cover the entire span of redundant skin along the abdomen and flanks—is the primary cause of large dog ears, surface irregularities, and less than optimal contour of the waistline.
In order to prevent dog ears tummy tuck, achieve smooth results, and ultimately promote faded and well-healed scars, Dr. Smiley says that massive weight loss patients may even have to accept a longer scar that reaches their posterior flanks.
Despite the longer scar resulting from extended tummy tuck technique, Dr. Smiley says all efforts are made to position it very low that it goes within the groin and pubic hairline. Furthermore, suturing the surgical wound in which there is no or very little tension on the skin surface can help promote the best scar possible (i.e., almost as thin as a human hair and so it blends into the background after 6-18 months).
Another possible way to prevent dog ears is to perform a simultaneous liposuction of the flanks and hips. In Dr. Smiley’s previous posts on Snapchat, he says that with this ancillary procedure he is able to pull and tighten more skin, ultimately resulting in smoother and flatter contour.
Despite best efforts from the surgeon, dog ears tummy tuck may still occur in patients with a markedly poor skin tone. Fortunately, most will only require minor revisions that are performed in-office.
Dog ears revision is usually performed by slightly extending the scar, which allows the surgeon to remove the loose skin. Occasionally, liposuction is used as well to further eliminate the “fullness” at the edge of the scar.
Obesity and plastic surgery simply don’t mix. Several studies have already shown that obese patients—i.e., their body weight is at least 20 percent higher than it should be—face higher risk of wound infections, heart attacks, nerve injuries, and urinary tract infections after surgery.
Furthermore, morbidly obese patients, meaning their weight is more than 100 lbs. over their ideal weight, are twice more likely to die as a result of any non-cardiac surgery.
Due to higher risk of postop complications, leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that obese patients also tend to incur more hospital bills, citing a 2015 study suggesting that they paid additional $7,100-$7,400 after tummy tuck and breast reduction.
The study has also suggested that obesity was linked to higher risk of serious complications that required hospital admission within 30 days after plastic surgery: About 72 percent higher compared to non-obese patients.
Obese patients are also at an increased risk of poor scarring and healing problems because they typically suffer from some type of malnutrition and their skin has been damaged by the excess weight over the years, as suggested by experts.
While it might be easy to turn down obese patients seeking an elective body contouring surgery, this may not be the case with someone considering breast reduction to help improve her mobility, which could allow her to increase physical activities to promote weight loss. In this scenario, Dr. Smiley says the benefits should always outweigh the potential risks.
Furthermore, the celebrity plastic surgeon says obese patients should be made aware of the risk so they can make an informed decision.
“Letting them know of the increased risk in terms of wound breakdown and delayed healing also allows them to handle postop complications better should they happen,” says Dr. Smiley.
Should a plastic surgery is deemed necessary to improve the patient’s quality of life, experts recommend at least a 24-hour hospital stay for closer monitoring.
News of botched cosmetic surgeries have recently circulated the Internet, most of which demonstrate stories of permanent deformities, life-threatening complications such as septic shock, and even death.
The vast majority of botched results were performed by doctors with no or very little training in plastic surgery. For instance, one OB-GYNE was able to operate a “beauty clinic” in Manhattan and performed liposuction and Brazilian buttock lift, which mostly resulted in serious complications and deformities, because of the legal loophole.
Dr. Smiley advocates patient safety, which he believes can be bolstered by stringent state laws and patient awareness campaign.
In New York state law, any doctor may wish to offer cosmetic surgeries even without an anesthesiologist or nurse.
Further complicating things is the proliferation of board-certifying bodies and professional organizations claiming to possess superior training compared to other competing groups. Nonetheless, there is one ultimate parameter patients can rely on: Physicians certified by the American Board of Plastic Surgery, which is a member board of the prestigious American Board of Medical Specialties, are deemed to be the crème de la crème.
Aside from passing a rigorous oral and written exam that they must retake every 10 years, ABPS members must have also completed their education from an accredited medical school; they should have at least two years of supervised residency in plastic surgery; they must have completed a minimum of three years of general surgery; and they must have two years of professional practice under their belt.
Meanwhile, other cosmetic surgery organizations, despite their professional sounding names, have been criticized for their very lax standard. For instance, they might accept doctors from non-surgical specialties as long as they have liposuction machines and several days of training offered by the manufacturer.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that other doctors from other specialists encroached the cosmetic surgery field due to its lucrative nature, making it more critical for anyone to do their “homework and conduct extensive background check on their surgeons.”
Dr. Smiley says that prudent patients should also take into account the “staple practice of their plastic surgeon’s.” For instance, someone doing hundreds of breast augmentation every year is markedly more adept than someone only doing it as a “side business.”
“In plastic surgery, we should do it right the first time. Hence, plastic surgeon selection should not be taken lightly,” he says.
Brazilian buttock lift is perceived to be safer than butt implant. Instead of synthetic prosthesis, doctors reshape and augment the backside with the most natural material—i.e., the patient’s own fat derived from other areas of the body, typically the abdomen, flanks, and lower back.
Despite the impressive safety record of Brazilian buttock lift, news of fatal complication due to fat embolism has been circulating the Internet recently.
Dr. Smiley uses a blunt cannula to perform microdroplet fat injection, a technique known to deliver natural results and to improve safety.
Fat embolism happens when fat particle or droplet is inadvertently injected into the blood vessels. In mild cases it simply causes low oxygen level in blood, but in serious conditions it leads to lung and brain impairment. According to medical literature, the risk of death is 10-20 percent.
However, fat embolism can be prevented with proper injection of fat. Hence, a prudent patient always ensures that her surgery is performed by a board-certified plastic surgeon—i.e., certified by the American Board of Plastic Surgery.
The list below explains the basic guidelines known to improve the safety of Brazilian buttock lift.
- Avoiding the deeper muscle during injection
A US study has suggested that fat embolism generally happens when fat injection is performed deep into the gluteas muscle, which has large blood vessels. To prevent this complication, fat grafts are ideally injected into the existing buttock fat (more superficial layer than muscle).
Simply put, doctors with deep understand and respect of the anatomy can avoid fat embolism and other serious complications.
- Honeycomb or microdroplet injection technique
Beverly Hills plastic surgeon Dr. Tarick Smiley says the honeycomb or microdroplet fat injection (inoculation of less than 0.1 cc of fat at a time) increases the survival rate and helps achieve near permanent results from Brazilian buttock lift.
Furthermore, the injection technique, which also entails continuously moving the cannula (hollowed steel probe), prevents fat embolism that happens when fat is inadvertently injected into the blood vessels.
- Use of the most innovative liposuction devices
The use of blunt cannulas not just prevents accidental injection of fat into the blood vessel; studies have also suggested that it promotes higher survival rate of fat grafts (70 percent and higher).
- Accredited surgical facility
Dr. Smiley has previously posted a video on Snapchat explaining the importance of having one’s surgery in an accredited ambulatory center, which means that it has passed the rigorous patient safety standards imposed by health authorities.
Accredited surgical facilities are staffed by board-certified anesthesiologists and emergency personnel who can treat patient should an untoward event occur.