Surgeons preparing for an operation

Two plastic surgeries at once? By two surgeons? Yes.

It’s extremely efficient for one patient to have two plastic surgery procedures by two rejuvenation surgeons — Drs. Linder and Kotler–during a single session.

It’s a common service offered by the eminent Beverly Hills board-certified cosmetic plastic surgeon Robert Kotler, M.D.  (who blogs as Dr. Face) and Beverly Hills board certified plastic surgeon Stuart Linder, M.D (the Dr. Body blogger) tell why it’s to a patient’s advantage to have several cosmetic plastic surgeries in one session when he or she wants procedures of the face and body.

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Dr. Face (Dr. Kotler):  We’ve already talked a great deal about how a patient is well served by seeing a superspecialist cosmetic plastic surgeon, one who specializes in just a handful of procedures and performs them at least weekly, if not daily.

Dr. Body (Dr. Linder): Because that surgeon performs the procedure so often, he or she is swift and efficient. That leads to less bruising, bleeding and soreness so healing is usually quicker.

Another benefit is that surgeon has seen all the wrinkles in a particular surgery. For instance, one rare complication of breast surgery is when a patient’s breast implants roll together under the skin. Known as symastia, many refer to it as a “uniboob” deformity.  It is extremely difficult to repair but many cases are referred to me because I specialize in surgery of the breast.

(See a picture of a breast augmentation that resulted in symastia.)

Dr. Face:  The two surgeon approach translates to a savings of time, money and convenience.  Two cosmetic plastic surgeons teaming up to do their respective cosmetic surgery work during one operation equals one session under anesthesia, one charge for the M.D.-anesthesiologist and one recovery and healing period. Not to mention one stay in Beverly Hills if you have traveled here from abroad as many of our patients do.

Dr. Body: Recently, a patient wanted to have liposuction of the body and cosmetic nasal surgery as well as some surgery inside the nose to correct and improve her breathing. Of course, we can’t work simultaneously. So I go first because liposuction requires vigorous movement, using long, thin tools through fatty areas of the body and that creates a little jostling. Dr. Face’s nasal surgery, however, is extremely delicate and the patient cannot be jostled.

Dr. Face: As you may know, I specialize in cosmetic procedures of the head and – on a daily basis — perform rhinoplasty and other nose surgery, face lift, eyelid lift, ear pinning, or otoplasty plus nonsurgical wrinkle removal. I was trained in all aspects of  face and neck plastic surgery but limit my practice to just the cosmetic procedures, including revision rhinoplasty.

Dr. Body: I, on the other hand, only perform procedures of the body and specialize in breast surgery, including breast surgery revision and reduction – for both men and women – plus liposuction and tummy tuck. Revision breast surgery is also one of my specialties.

Dr. Face: When the patient goes under anesthesia, one or the other of us will do our procedure and then step aside for the other surgeon. The anesthesia time considered safe in cosmetic plastic surgery is up to ten hours.

Dr. Body: But because we are both highly focused specialists, the total time for our joint procedures is usually somewhere around two and one-half hours.

Dr. Face: There are over 125 different plastic surgery procedures. It’s impossible for any one surgeon to master them all. Plastic surgeons are becoming ever more specialized. For  instance, some do only plastic surgery of the hand while still others only do reconstructive surgery.

Dr. Body:  In fact, all of American medicine is becoming extremely superspecialized.  While some surgeons specialize in chest surgery, others specialize in heart surgery only. Some eye surgery specialists only perform surgery on the retina while others limit their practice to cataract surgery.

Dr. Face: Today,  some heart surgeons super specialize in one area like the coronary arteries while another will specialize in operating on heart values.

Dr. Face: I know superspecialization is great for the patient because I was a surgical patient not long ago.

Dr. Body: What did you have?

Dr. Face:  I needed a hernia repair and choose a surgeon who does nothing but hernia repair. A neighbor of mine had the same procedure but went to a general surgeon who does many other operations.

Result? I was hiking  the next day! But my neighbor took weeks to recover.

Look at Dr. Body’s before and after breast augmentation pictures.

See Dr. Face’s before and after rhinoplasty (nose job) pictures.

Infectious agents are always lurking in some corner and watching over a surgeon’s shoulder  for a happy place to land and multiply.

Even in the most experienced of hands that follow all the sterilization guidelines in the cleanest and most sterile of operating rooms, the standard rate for infection everywhere is about one patient per hundred.

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Dr. Face: (Dr. Kotler) Have you been stern lately, doctor?

Dr. Body:  (Dr. Linder) Yes, I had a patient recently to whom I gave an absolutely beautiful breast augmentation that healed nicely. But when she went home, she thought that she – and perhaps others – could see that one breast was a tad larger than the other. And she wanted a redo – she wanted the equivalent of a shot glass worth of silicone (50cc’s) added to the breast implant she perceived as smaller.

Dr. Face:  What did you do?

Dr. Body: I explained the risks that attend any plastic surgery and that such a tiny adjustment was not worth risking a possible infection or other complication and thanks for asking but I could not do the procedure. She went elsewhere, had the surgery, got a terrible infection and had to have one implant removed while that breast healed for six months.

Dr. Face: Plastic surgeons are, by nature, perfectionists but that is a perfect case of what we mean by “reasonable expectations.” Most people, including her significant others, only saw a huge, healthy improvement. But any time the surgeon opens a chest or takes a breast implant out of its sterilized package and exposes it to air, the slight risk of an undesirable complication like infections is present.

Dr. Body: Unfortunately, most rejuvenation surgeons are wont to talk about a negative issue like infection. But the truth is:  infective agents are floating around in the cleanest, most sterile of operating rooms. Also, human skin is alive with all sorts of flora, including bacteria that can get into an open wound. Of course, the surgical area is painted with germ killers but there are super resistant bugs that can survive and start their own colonies.

Dr. Face:  Make that, their own colonies even though every precaution is taken. Implants for the face and body are packed in sterile materials, the implants are soaked in sterile agents after opening and the surgical site of the body or face is irrigated with an antibacterial solution before closing.

Dr. Body: That’s one of the reasons we want to see plastic surgery patients in the morning after the procedure. It’s apparent to us — even before the patients — when an infection is developing so we leap on it as early as possible. Some infections are so powerful, they can digest cartilage. But if the surgical area can go three to six days with no infection, we can be relatively sure we are home free.

Dr. Face: American plastic surgeons and the U.S. medical care system is very concerned about infections and also happens to be very good at tracking down the source.

Dr. Body: I bet you are talking about the case several years ago when the U.S. Centers for Disease Control (CDC) got involved in solving an infection outbreak in New Jersey.

Dr. Face: That’s right. An unusually large number of women were reporting to their doctors with infections in what appeared to be liposuction cases. The CDC interviewed the women and found they all had liposuction in the Dominican Republic at a particular clinic. The source of the infections turned out to be  unsterilized liposuction wands.

Dr. Body: So it’s more important than ever to check your surgeon’s website for information about his or her surgery center. Those facilities marked:

• AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities)
• JACHO, (Joint Commission on Accreditation of Healthcare Organizations)
• AAAHC (Accreditation Association for Ambulatory Health Care)  
• Medicare certified

and will be following all the the standard sterilization procedures known.