Robert Singer, M.D., FACS
Is it OK and safe to have your surgeon manage a Demerol twilight anesthesia during a facelift?
Safety should always be the primary concern. While some surgeons manage the anesthesia and also simultaneously perform the surgery, the safer method is for the surgeon to concentrate on the surgical procedure and have a board certified anesthesiologist or certified nurse anesthetist provide and monitor the anesthesia.
There are a variety of effective anesthesia techniques, including "twilight" anesthesia, which utilize different approved pharmaceutical agents. No matter which drug or drugs are administered, surgery should only be performed by a board certified plastic surgeon, in a licensed hospital, or more commonly today, in an accredited office-based or ambulatory surgical facility, which is inspected by a recognized nationally recognized accrediting organization like the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). The surgeon should have hospital privileges for the procedures that will be performed in any facility.
Robert Singer, MD FACS
Is it OK to have twilight anesthesia instead of general anesthesia for a facelift and eyelid surgery?
Will twilight anesthesia be OK for a 4+ hour facelift, along with upper and lower eyelid surgery?
Either sedation or general anesthesia may be used for a facelift and blepharoplasty. It depends on the concerns of the patient as well as the experience and preference of the plastic surgeon and the anesthesiologist. The key issues should always be safety and the comfort level of the patient.
No matter what method of anesthesia, the procedure should be performed only in an accredited facility by a national organization like AAAASF (the American Association for the Accreditation of Ambulatory Surgery Facilities) or a state licensed facility, and by a board certified plastic surgeon, with anesthesia delivered and monitored by an appropriate anesthesia provider.
Robert Singer, MD, FACS
I had a couple of questions about liposuction. I am considering having it done to my inner thighs only. I have heard the skin in this area is not very elastic. Is this still an area that has a high success rate?
The inner thigh is an area that is often suctioned. The patients who undergo this area of suctioning are usually pleased with the improvement, as long as they have realistic expectations. The procedure makes the thigh appear more slender and the leg longer. It frequently corrects the inner thighs from rubbing against each other.
Like lipoplasty in other areas of the body, it should be performed to contour excessive bulging of the fat in that region. It is not a weight loss procedure. Patients who are in good medical health, have localized areas of fullness that will not respond to exercise and diet, and have reasonable skin tone are good candidates for the procedure.
Any patient must be realistic about the limits of what can be achieved. If there is satisfactory elasticity to the skin in the inner thigh, then the skin will generally contour nicely. If there is poor elasticity and the skin has significant sagging in the inner thigh, suction alone may not produce a pleasing result. Patients with poor skin tone in the inner thigh may benefit from an inner thigh lift in conjunction with lipoplasty.
Inner thigh lipoplasty can be performed as an isolated procedure, in conjunction with lipoplasty of other areas, or with other cosmetic (aesthetic) surgical procedures. If a member of my family was going to have the procedure, it would be performed by a plastic surgeon who is certified by the American Board of Plastic Surgery, a member of the American Society for Aesthetic Plastic Surgery and in an accredited or state-licensed ambulatory surgery facility.
I had a healthy 10 lb girl 3 years ago. She came through c-section because she was too big. I now have a diastasis recti of about 2 fingers and a half and a hernia at the level of my belly button despite practicing pilates, cardio, swimming and tennis. I am in great shape except that my belly always looks swollen and the skin is a bit saggy especially when I sit. I would like to know if repairing the diastasis and having a mini skin tuck would be enough, or do I have to have another procedure?
A mini or modified tummy tuck, with or without liposuction, as well as one of a variety of full tummy tucks that exist can produce a good cosmetic appearance in the appropriate patient. Following the advice from a surgeon or any other website who proposes to tell you what to do without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure would not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.
A modified abdominoplasty, which may include the diastasis repair, with a floating of the umbilicus can produce a very nice significant result in many patients. The result depends on the extent of looseness of your tissue above the umbilicus (belly button), since there is a limitation of how much tightness you can get with that procedure and still maintain a normal appearing position of the navel.
If you plan on having additional pregnancies, I would wait until you are finished having children before repairing the muscle diastasis.
Robert Singer, MD FACS
La Jolla, California