Should you Combine Plastic Surgery Procedures?

One of the questions I’m most often asked by patients: “Is it possible to have more than one surgery at the same time?” This has been a particularly growing trend in the past few years.   Over the last several years more and more patients come to the office wanting to address more than one problem area at the same time.

For many years plastic surgeons have been combining facial rejuvenation surgical procedures because as we all know, humans don’t age one facial part at a time.  We commonly perform eyelid surgery and facelifts surgery simultaneously   They are even combined with other rejuvenation surgical procedures because they can be done so safely.    Patients are recovering at one time, and they end up with a more harmonious result.

As long as sound judgment and safety are the primary focus of all consideration, then even larger operations on the body can be accomplished in one operative visit. Preoperative screening should always be completed prior to an operation of larger magnitude or other longer and delicate procedures.  The pre-op assessment will be a good indicator of what the patient will be able to safely handle.  It is also important to make sure that you are choosing a plastic surgeon with proper credentials and plenty of experience as well as one that performs their surgeries in a certified operating facility. 

As a double board certified surgeon, I say safety first! 

Breast Reduction

Breast reduction is often misunderstood online. The operation is defined as the reduction and lifting of breasts. This is not the same as removing or reducing the size of breast implants in a woman’s breasts. That is called an implant exchange.

Implants are not usually involved especially when an insurance company is scheduled to pay for it with the possible exception of surgery to reconstruct a woman’s breasts after breast cancer surgery.

It is difficult enough to get most insurers to pay for “clear cut” medically-necessary plastic surgery. Breast reduction surgery is the reduction of naturally enlarged breasts and that is all.

Breast reduction used to be one of the more common insurance-covered procedures. With the economy as of late, insurers are not always so quick to approve them, but for the right patient they are still do-able.

Usually we see our patients for a consultation and then apply to their insurers for pre-approval if the case seems reasonable by insurance company standards. We don’t make the rules on approval, but we do know the game. Appeals are not uncommon.

These days, insurers are looking for a certain amount of breast gland to be removed in a certain sized woman in order to allow coverage. In addition they like to see documentation of things like bra strap furrows, the “dents” some larger breasted women get in their shoulders from breasts weighing against them throughout the day. Insurers don’t tend to like claims where liposuction has been involved. This can trigger denials on cosmetic grounds at the time of billing.

Insurance pre-approval usually covers surgery for a 90 day period. The exact nature of that coverage varies by the plan.  Be sure to talk to your surgeon about what your options are and what the best plan of action is for you.

What to do when finding a surgeon.

As a plastic surgeon, people often share their fears of surgery.  Sadly, they also frequently share horror stories of botched surgeries, terrible results, and even the death of someone they knew.   Some of these fears were captured by a US Today article I read recently that showcases the story of the Howards, local to our very own South Florida.

It would be irresponsible of me to say that there aren’t risks in plastic/cosmetic surgery.  There are risks involved every time you go under the knife for sure.  However that doesn’t mean you should allow that to scare you from looking into the surgeries you would like performed to achieve the results that you desire. Unfortunately, you only hear about the bad or “horror” stories. There are plenty of plastic surgery “wows” that are unseen because the patients look so good. They look so natural, no one would know anything was ever done.

There is plenty that you can do to put yourself in the best possible hands to ensure not only your safety, but results you’ll be happy with.  

I feel that the most important thing you can do is to do you homework.   First, think long and hard about exactly what you want improved or what you’d be interested in.  Then form an idea of the results you’re expecting.  Once you’ve done this, find a few surgeons via credible recommendations.  Please do yourself a favor and check the surgeon’s web presence. Do you like the feel you get when you see the website? How glitzy? What’s the environment like? Can you see that Doctor treating you? Next, schedule your consultation. Don’t be afraid to ask the doctor about their experience, ask to see testimonials.  Most importantly ask questions. What are your different options? What exactly will happen during the surgery? What can you expect during your recovery time?  It is paramount that you do your due diligence and stay safe while seeking out the new you!

Safety is job one!

Insurance Dollars for Rhinoseptoplasty

In recent years many celebrities have explained going under the knife for a nose job by stating it was a performed for medical purposes.  So it’s no surprise that I have been asked various times by patients about the likelihood that their insurance plan would cover the surgery. 

It has been my experience that it behooves the surgeon to obtain pre-authorization for the surgery from the specific insurance company as they all have varying policies.  The third party will usually pay for medically necessary surgery, provided that the appropriate medical documentation to support necessity of the proposed surgery is available.   If there is associated trauma to the nose, the third party will often pay for reduction of a nasal fracture more readily than pay for a rhinoplasty.   Third parties typically deem rhinoplasty a cosmetic surgery.  They regard septoplasty and turbinectomy as medically appropriate surgeries performed for medical necessity.

Septoplasty and turbinectomy procedures are performed to improve breathing; therefore third parties tend to pay for these procedures.   However, if a rhinoplasty is performed at the same time, the third party will deny payment for the cosmetic portion of the surgery---- the rhinoplasty, including anesthesia and operating room fees incurred during the cosmetic portion.

There are always exceptions to the rule, but it is better to expect that there is a very small likelihood that your insurance will cover your rhinoplasty.   The best course of action is to talk to your surgeon about what your options are and what payment alternatives exist.

Does Obama look 50?

I shared earlier how I felt that fifty was the new thirty. Baby boomers today are more active, vital and involved with their health and fitness than their parents were.  A great example of this is our very own president.   President Obama is making the headlines not only in the political arena, but also among those of us in the plastic surgery field.   I read an interesting article by the American Society for Aesthetic Plastic Surgery blog that talks  about how the President’s recent 50^th birthday has brought to the forefront what a fifty year old should look like.

They mention the “’holy trinity’ of aging: (1) wrinkles, age spots and other superficial changes exacerbated by too much sun and smoking; (2) loss of facial volume, which highlights under eye bags and, finally, (3) drooping of the eyelids, nose, corners of the mouth and jaw.”

If we consider this trifecta in reference to President Obama we can see that he doesn’t exactly fit the mold.    The biggest reason is the president’s race.   His skin better protects form the harmful UV rays of the sun.  It’s also not only thicker, but oilier too.  A combination that save guards against the proclivity to wrinkle of paler skin.

Also helping the President’s appearances are the balance of exercise as an avid ball player and the healthy diet provided by the presidential chefs.     You can also not discount his cool as a cucumber attitude.   A relaxed personality avoids not only frowns but age lines.     The president is a great example of how we can all feel and look better with age.  After all, remember, 50 is the new 30!

Preventing stitches from popping after surgery.

I love when patients have a lot of questions during their consultations.  I think it’s an important part of the process, and insures the best results for the patient.  A question I’m often asked by patients looking to have a tummy tuck is: In What Percentage of Tummy Tuck Cases Do MR Stitches Pop?

That’s a very good question.   Sure, some sutures may "pop" or break.   But the better question is why did one pop?   Was it poor technique? Was it deficient diet and nutrition?   Or was it a lack in patient compliance with post-operative instructions?   All things being equal, I am always concerned about this possibility.  The major control I have in prevention of this occurring is performing safe surgery techniques, giving appropriate post-operative instructions, and advising the patients to eat properly.  However, I cannot control patients who exercise or exert themselves prematurely compromising their surgical result.

At surgery, I approximate the muscles with interrupted permanent sutures rather than one long running suture.   If the one long running suture breaks then the suture has the potential to unravel.   This could effect the result of the tummy tuck.  I  believe that over time, some of these sutures may not hold as true as they did when they were originally placed.  Scar tissue grows in, among, around the placed sutures.  This increases the strength of the closure.  Certainly, this strength increases with time after the surgery.  The repair is the "weakest" in the early 2-3 weeks after the surgery.   This is one of the reasons my patients are advised to refrain from vigorous activity in the early post-operative period.

There are many tummy tucks done each year.  Few have popped sutures requiring re-operation.  As a double board certified surgeon, I take every possible precaution so that my patients don’t have a “popped” suture as part of their tummy recovery experience. 

Feel free to ask me about tummy tucks or other plastic and cosmetic surgery procedures.

Rhinoplasty : Shaping your nose

A nose job or rhinoplasty (Greek: ῥίς rhis, nose + πλάσσειν plassin, to shape), is a delicate work of art that requires clear communication of desired results and a solid pre-operative strategy to achieve the best results.  Rhinoplasty is an operation that is a sum of its parts.  The various parts of the nose need to be brought to a perfect harmony.  Should tip work be performed, then in all likelihood that the nasal dorsum needs to be recontoured to properly align with the newly created tip.   The width of the nasal bones will probably need attention as well.  Welcome to delicate balance that is Rhinoplasty!

Patients often present with large bulbous tips for rhinoplasty.   Rhinoplasty can change the shape of the nose by removing/adding structural elements.   There is some skin retraction following rhinoplasty.   After all, once a bump is taken down or a tip cartilage removed, where does the extra skin go?

Often, the patient who has a big nasal tip has thick skin.   The rhinoplasty surgery does not really address this issue.   Excess skin/tip width can often reduced by reducing the alar base width which is removing part of the nostril.

We still do not have the ability to decrease large excess and thickness of skin on the nose without causing severe changes to the nose.  There are surgeries to help but it is difficult to control scar formation and further thickening of the skin.

By changing the structure of the nose by altering its cartilaginous or bony framework will make a smaller nose, but still a thick nose.

There are patients where "most" of the work needs to be addressed at the tip.   Those patients require more tip work than others but still often need surgical refinement of their nasal dorsum, nasal bones, etc.

I have been performing Rhinoplasty for more than 20 years.  It is a procedure that you continue to learn to perform better.  If you want to learn more I invite you to leave a comment and contact my office.

Breast Enhancement that fits your Lifestyle

Breast enhancement surgeries are is one of the most sought after cosmetic surgery procedures performed today. I’d like to outline some of the various types of these procedures to help women decide which is best of them.  Ultimately, the goal is for my patients to achieve the shape, volume and size of their breasts that best matches their unique goals and physique.

Breast Implants

Breast implants are used to increase the size and fullness of a woman’s breasts. Breast implants are filled with either silicone gel or a saline solution, and can be found in variety of sizes and textures.  Each offering different aesthetic effects. Typically, implants are inserted into a pocket created beneath the breast or behind the pectoralis muscle. However, the implant may be inserted through the areola, the armpit, the belly button, or at the breast crease for better results for certain patients..

There are many benefits to breast implants.  Most notable, most women report  a greater self-confidence, and happily report that they are able to expand their wardrobes to include styles of clothing that they couldn’t wear before.

Breast Lift

Breast lift surgery (mastopexy) is used to treat breast sagging – the natural loss of elasticity, firmness and shape caused by pregnancy, nursing, excessive weight loss and aging. A breast lift typically consists of the removal of excess skin, tightening the skin and, in some cases; it is combined with breast augmentation in order to restore shape and volume.        

Breast lifts result in “perkier” breasts and a more youthful overall look. Because of this, breast lifts are a popular component of the “Mommy Makeover,” a series of cosmetic procedures that is designed to reverse the effects of childbirth and nursing.

Breast Reduction

Excessively large breasts can cause neck, back and shoulder pain, which can lead to chronic health complications. Breast reduction surgery helps correct this issue by removing fatty tissue, glandular tissue and excess skin so that your breasts better match your frame size and become smaller.          

Breast reduction helps alleviate strain on your neck and back and makes it easier to shop for clothing and exercise. Because of the long-term health benefits of breast reduction, these procedures are sometimes covered by insurance.

If you’d like to find out more and further discuss what breast enhancement procedure fits your lifestyle contact my office or leave a comment!