Combined Procedures

Before and After Photos

Procedures May Sometimes Be Combined
If you are interested in treatment of more than one area, the treatment of these areas may often be combined under a single operation. The advantages of doing this are a decrease in down time as your recovery is combined and shortened. The cost is usually less than two procedures done on separate days, as the procedures are combined under a single anesthetic and operating room charge. The most common of the combinations is on the face. Frequently a facelift or blepharoplasty is combined with the use of Botox and/or Restylane. Other frequent combinations are listed below.

Breast Lift or Mastopexy
Breast lift is a surgical procedure to enhance the size and shape of a woman's breast: It can relocate the nipple and correct drooping, balance breast shape and is used as a reconstructive technique following breast surgery. Breast volume can be changed with augmentation or reduction at the same time as mastopexy or breast lift.

Breast Augmentation
Breast augmentation is a surgical procedure to enhance the size and shape of a woman's breast. It is used to make a small breast larger, and may be used for the atrophic breast to restore fullness, balance size and to change the fullness of the upper breast in a mastopexy.

By inserting an implant behind each breast, we are able to increase a woman's breast size by one or more bra cup sizes. The implants may be placed above or beneath the muscle, depending upon anatomy and preference.

Liposuction
Liposuction is best used in areas that have a thick layer of fat that is beneath elastic skin. If you find an area where the fat is much thicker than fat in surrounding areas, you may have found a spot that will respond nicely to fat removal or liposuction. Liposuction is most successful in healthy active individuals who have a persistent area of fat that does not respond to weight loss and exercise. Age is not a contraindication to lipoplasty but a lack of elasticity of skin may require removal of skin as well as the fat to achieve the best result. Lipoplasty incisions are quite small and easily concealed. If extra skin is present more traditional methods of excision such as a tummy tuck or thigh lift may be considered. Associated procedures include a change in breast shape or removal of skin from the upper arms or abdomen. Many of the individuals who are good candidates for liposuction have other areas of concern so that a combined approach is utilized.

Tummy Tuck or Abdominoplasty
Abdominoplasty, often called a "tummy tuck," is a surgical procedure used to enhance abdominal contour. It reduces a roll of fat and skin in the lower and middle abdomen, and corrects a diastases or separation of the abdominal muscles after pregnancy. By excising a wide wedge of skin and fat, tightening of abdominal muscles, and relocating the umbilicus, a prominent abdomen can be flattened. A modification of the abdominoplasty is used if the muscles are in good condition and the problem is largely in the lower abdomen.

Restylane
Restylane is most frequently administered as a stand alone office procedure under local anesthesia. Restylane is a filler that is often used during a general anesthetic for other procedures. This tag along procedure allows filling of problematic folds and the softening of lines while you are asleep. It may be an "add on" to a procedure done under general anesthesia, and is often used in combination with Botox. Botox may produce a decrease in mobility of the areas treated with Restylane, prolonging the result.

Botox
Botox®, is a popular non-surgical injection that temporarily reduces or eliminates frown lines, forehead creases, crows feet near the eyes and thick bands in the neck. The toxin blocks the nerve impulses, temporarily paralyzing the muscles that cause wrinkles while giving the skin a smoother, more refreshed appearance. It to may be used in a combined procedure, or more often, in the office with no anesthesia.

Planning Your Surgery
At your consultation we will listen to your medical history, examine you, take photographs, and try to give you a look at what a change in breast shape and volume will do for you. We will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your body and skin tone. If your breasts are smaller than you wish, you may benefit from augmentation, if to large from reduction. If they are ptotic or droopy a combination of mastopexy and/or augmentation may produce the appropriate change.

If the skin and fat excess is in the lower abdominal area and the muscles are in good shape, a modified abdominoplasty may be suggested. Associated procedures include a change in breast shape and liposuction. Many of the women who are good candidates for abdominoplasty are troubled by heavy or drooping breasts, or troublesome areas of persistent fat, and a combined approach is utilized At the end of the initial consultation you should have the information you need to make an informed decision about the possibility of plastic surgery and a good understanding of which procedure will produce the desired result.

Not all procedures lend themselves to combination. They may be in areas that inhibit your activities and recovery. It is hard to work on both the front and the back as you have no place left to rest comfortably. In general the time constraints are about 5 hours in a single operation.

Preparing For Your Surgery
We will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Types of Implants
A breast implant is a silicone shell filled with either silicone gel or a salt-water solution known as saline. These implants are available in a variety of sizes and shapes. Currently silicone gel implants are available through the Mentor adjunct study protocols.

Note
Plastic surgery is relatively straightforward. But with any operation, there are risks associated with surgery and specific complications associated with this procedure. At the time of your consultation these possibilities will be reviewed in detail.

The Surgery
These procedures are done as an outpatient at our fully accredited operating rooms at the Plastic Surgery Center, at the Asheville Surgery Center on Sweeten Creek Road, or at the Mission Memorial Hospital. They are usually done as an outpatient and is often done under general anesthesia. At any of these locations anesthesia will be provided by the anesthesiologists and CRNA's of Asheville Anesthesia Inc. We use the Care Team Approach to anesthesia with a MD-CRNA model. The operation takes a few hours and then requires some quiet time away from your usual schedule as you recuperate. Most individuals are more comfortable with ice and some elevation as in a recliner. Many people are up and about driving and doing light activities four to six days after the operation. You may return to aerobic exercise in about three weeks. You will be seen in the office in follow up at regular intervals

Looking Good
You will see a noticeable difference in the shape of your body quite soon after surgery. However, improvement will become even more apparent after about four to six weeks, when most of the swelling has subsided. After about three months, any persistent mild swelling usually disappears and the final contour will be visible.