Latest / HKB Uncut | A Cosmetic Surgery Podcast / 17. Combination Procedures Explained | Mommy Makeovers, Safety Limits, Team Surgery, and What You Can (and Shouldn’t) Combine

Transcript

17. Combination Procedures Explained | Mommy Makeovers, Safety Limits, Team Surgery, and What You Can (and Shouldn’t) Combine · HKB Uncut | A Cosmetic Surgery Podcast

• 0:00
  SPEAKER_00: Do how often do you use the trust me?
• 0:01
  SPEAKER_00: It'll be fine.
• 0:03
  SPEAKER_00: Never.
• 0:04
  SPEAKER_01: So I told him trust me because I would take care of them, just like you do.
• 0:08
  SPEAKER_01: But I I never talk a patient into a procedure.
• 0:10
  SPEAKER_01: Yeah.
• 0:11
  SPEAKER_00: Ever.
• 0:11
  SPEAKER_00: Yeah.
• 0:16
  SPEAKER_01: Welcome to HKB Uncut, the health, knowledge, and beauty podcast.
• 0:20
  SPEAKER_00: On this show, we unpack the newest techniques and trends in cosmetic surgery, how to tune out the social media noise to make empowered decisions about your appearance and what you need to know before you book a procedure.
• 0:30
  SPEAKER_00: I'm Dr.
• 0:30
  SPEAKER_00: Bill Cortesis.
• 0:32
  SPEAKER_00: And I'm Gorov Bahardi.
• 0:33
  SPEAKER_00: We are board-certified plastic surgeons and co-founders of HKB Cosmetic Surgery, an award-winning practice with 11 locations across six states.
• 0:41
  SPEAKER_01: In other words, when it comes to aesthetics and cosmetic surgery, we've pretty much seen it all, and we want to share our knowledge and unique approach to aesthetics and beauty with you.
• 0:50
  SPEAKER_01: Whether you're interested in cosmetic surgery for yourself or want to separate fact from fiction in the plastic surgery world, we hope you'll tune in each week.
• 1:05
  SPEAKER_01: And Bill Cortesis, another episode.
• 1:07
  SPEAKER_00: Today we're going to talk about combination procedures.
• 1:10
  SPEAKER_00: And this is something that's very near and dear to the core heart of HKB.
• 1:17
  SPEAKER_00: Bill, you know, to kick this off, you know, we do a lot of combination surgery.
• 1:22
  SPEAKER_00: Why do we do combination surgery?
• 1:24
  SPEAKER_01: One, you know, I I would tell you a lot of patients want to knock out, you know, a bunch of different body parts at one particular time, right?
• 1:33
  SPEAKER_01: They want to have one recovery from their aesthetic needs and goals and desires, right?
• 1:38
  SPEAKER_01: And so for us, it's like we if we can do it safely, why not?
• 1:41
  SPEAKER_01: Right.
• 1:41
  SPEAKER_01: So I I would say that's one of the reasons why.
• 1:44
  SPEAKER_00: So it's just one recovery.
• 1:45
  SPEAKER_01: One recovery.
• 1:46
  SPEAKER_01: Um, sometimes, you know, it is from our suggestion because, you know, a patient may come in for, you know, a tummy tuck, and they're and we're like, hey, you know, oftentimes when we do a tummy tuck, we want to do kind of lower back liposuction at the same time because we want to take care of the whole unit, right?
• 2:02
  SPEAKER_01: So combo procedures just happen naturally from kind of the consultation process, us talking about it.
• 2:08
  SPEAKER_00: So what I'm hearing though, is important is that you know, the first one was, you know, you lump things together because, hey, I only got this time, one recovery, and there's maybe we'll get it, we'll get get to kind of how much could you do in one place.
• 2:19
  SPEAKER_00: But the other one is you had mentioned, let's talk about the abdominal plastic, a tummy tuck.
• 2:25
  SPEAKER_00: Um, your best tummy tucks have what done to them?
• 2:27
  SPEAKER_00: You have is it just when you're taking care of the tummy?
• 2:30
  SPEAKER_01: No, we do circumferential contouring, right?
• 2:32
  SPEAKER_01: We found taking care of the whole unit actually makes the entire aesthetic look way better.
• 2:37
  SPEAKER_00: Perfect.
• 2:37
  SPEAKER_00: So the biggest thing is so combination procedures uh in certain situations lead to a much better aesthetic outcome.
• 2:43
  SPEAKER_00: So I think that's what I hear.
• 2:44
  SPEAKER_00: All right, what are other reasons?
• 2:45
  SPEAKER_01: You know, sometimes you want another surgeon.
• 2:47
  SPEAKER_01: It's part of the the the situation, right?
• 2:49
  SPEAKER_01: You have an expert in in one particular area, and that's the benefit of a practice like ours, for instance, is like all right, we have a distinct facial plastic surgeon and we have a body surgeon that's our expertise.
• 3:03
  SPEAKER_01: And so you want to utilize kind of both surgeons at the same time.
• 3:07
  SPEAKER_00: One of the things that I noticed too is that we're taking care of a aspect of the body, meaning like you're you're approaching the face, and it's like, yes, you could do the upper lids at some point, you could do the brows at some point, you could do the microfac wrapping at some point, you could do the facelift at some point, you could do the central lip lift at some point, or you can amass those those things together and get a more harmonious result.
• 3:29
  SPEAKER_00: The other times too, it's like so if you do, let's say you do a lower face and neck lift and you do upper lids, so you've done, you've restored two areas that are gonna be restored, and then you're gonna have these areas, the forehead, the nose, the cheeks, and the remainder of the face that have been left untouched.
• 3:45
  SPEAKER_00: And so, in my opinion, sometimes those places are they're discordant.
• 3:49
  SPEAKER_00: And so, in those situations, I always tell patients, like, listen, one thing you might want to consider is have a um CO2 laser or any kind of laser resurfacing at the same time so that it's like things are kind of just blended together.
• 3:59
  SPEAKER_00: So I think that obviously I think the result's better, but also it's more blended, like it doesn't look discontinuous.
• 4:05
  SPEAKER_00: So I think it's one thing I think about too.
• 4:07
  SPEAKER_01: You know, there are there reasons why you would not kind of go down this road of doing a combination surgery on somebody?
• 4:14
  SPEAKER_00: Yeah, jumping back, let's jump back to face.
• 4:16
  SPEAKER_00: Like if someone's gonna get a panfacial rejuvenation, I may not do like the rhinoplasty with it.
• 4:21
  SPEAKER_00: I might be like, hey, yeah, you need to see my my brother Rich Cow and do that later because that's gonna be its own, because it's gonna be too long of an intervention, you know.
• 4:28
  SPEAKER_00: So I think that timing is a real issue.
• 4:31
  SPEAKER_00: You know, when we do combination surgery, you want to be more convenient for the patient.
• 4:36
  SPEAKER_00: You want to get a a better result than doing them potentially separate or not doing another part of the procedure, but we never ever want to compromise their safety.
• 4:44
  SPEAKER_01: What's your time limit?
• 4:45
  SPEAKER_00: My time limit, six hours is really kind of the a number that sticks out in my head.
• 4:50
  SPEAKER_00: But like I we have to talk about this because it's not a firm number, right?
• 4:53
  SPEAKER_00: If you go over six hours, things are probably gonna be fine.
• 4:56
  SPEAKER_00: If you're under six hours, things will be good too.
• 4:58
  SPEAKER_00: People need to understand that you can do there, there are some of our colleagues out there who do surgeries much longer and patients do just fine.
• 5:05
  SPEAKER_00: But I personally don't like it.
• 5:07
  SPEAKER_00: I get personally, there's there's a surge and fatigue, also a piece that's there.
• 5:11
  SPEAKER_00: And the other is like, you know, I just you want to keep it tight and I want my patients to have an easier recovery, keep them cool.
• 5:16
  SPEAKER_00: Sorry, not cool, keep them warm.
• 5:18
  SPEAKER_00: But, you know, I think that there's different ways to do that.
• 5:21
  SPEAKER_00: Some of our colleagues will do surgery under different levels of anesthesia, right?
• 5:24
  SPEAKER_00: They'll do anesthesia, they'll do surgery under Tiva, total intravenous anesthesia, so they're not actually getting general anesthesia and they might go longer.
• 5:30
  SPEAKER_00: So maybe their blood clot risk isn't higher than if they were getting general, but still, you know, there's this, there's this piece of like we want to keep it tight.
• 5:36
  SPEAKER_01: You know, people talk about length of surgery.
• 5:38
  SPEAKER_01: I don't think it's necessarily the the number or time in surgery, but it's it's blood loss.
• 5:45
  SPEAKER_01: Exactly.
• 5:45
  SPEAKER_01: Right?
• 5:46
  SPEAKER_01: It's keeping them warm.
• 5:47
  SPEAKER_01: You mentioned kind of the the cooling part of it, it's whether or not you're, you know, they're paralyzed or not with their anesthetic.
• 5:54
  SPEAKER_01: Because all this kind of plays a part into whether or not they're gonna get a blood glide or not, or you know, hopefully you know everybody mitigates that risk as much as possible.
• 6:01
  SPEAKER_01: But these are the factors that we try to eliminate.
• 6:04
  SPEAKER_01: And I think surgery and fatigue is real, people don't talk about it all the time.
• 6:08
  SPEAKER_01: It's it's real.
• 6:09
  SPEAKER_01: And so it's like, what is the capability of that surgeon and what are they used to?
• 6:14
  SPEAKER_01: Um and what can they get done?
• 6:16
  SPEAKER_01: And you know, you might go to a number of different consults, and somebody says, Oh, you know, I can do a tummy tuck, it takes me four hours, and you go somewhere else and takes them an hour, right?
• 6:25
  SPEAKER_01: And so these are things you gotta really elicit as a patient.
• 6:28
  SPEAKER_01: It's like, how long does it take somebody to do a particular part?
• 6:32
  SPEAKER_01: You know, for me, I tend to say, you know, I can do a body part in roughly, you know, an hour and a half, right?
• 6:37
  SPEAKER_01: So that's why I like to keep mine under five hours.
• 6:40
  SPEAKER_01: And so my limit is usually about three body parts at one time.
• 6:43
  SPEAKER_00: And you know, my thing is I I've you know, I've gotten experience, you've gotten a lot of experience that I always post longer.
• 6:49
  SPEAKER_00: I'll post a case for four or five hours, do it in three, three and a half.
• 6:53
  SPEAKER_00: And and the problems I like to have grace.
• 6:55
  SPEAKER_00: Are we on our team and staff to have grace?
• 6:57
  SPEAKER_00: The other thing is we're doing a lot of surgery, we're doing position changes.
• 6:59
  SPEAKER_00: So some of a lot of our time is spent literally on changing positions interoperatively.
• 7:03
  SPEAKER_00: And we are changing positions interoperatively, we have to control multiple variables.
• 7:08
  SPEAKER_00: We have to control the room temperature, we have to control the patient's skin exposure, we have to control blood loss, we have to control fluids.
• 7:15
  SPEAKER_00: So we have a lot of things, it's like an orchestra in there.
• 7:17
  SPEAKER_00: It's like this symphony.
• 7:18
  SPEAKER_00: I mean, everything is just like, you know, it's a, it's a, it's an incredible production that's happening.
• 7:22
  SPEAKER_00: And so when we do that, it's kind of I I I love the combination surgical approach because you're you're approaching multiple different areas, and then you end up with this amazing masterpiece at the end.
• 7:32
  SPEAKER_00: So I mean, I'm big fans of combination, but that doesn't mean like when a patient comes in, they're like, I just want to have a shorter surgical time and I want to I just want to have one thing done at a time.
• 7:40
  SPEAKER_00: And there's nothing wrong with it.
• 7:42
  SPEAKER_00: If every patient said I just wanted one thing done at a time, I'd be like, awesome, let's do it.
• 7:45
  SPEAKER_00: Because like it's a small intervention.
• 7:48
  SPEAKER_00: But I think there's a place for that combination things.
• 7:51
  SPEAKER_01: I mean, here's the thing we do a lot of body contouring.
• 7:53
  SPEAKER_01: I know you're an out of practice, we do a lot of body contouring.
• 7:56
  SPEAKER_01: And typically, if you're doing body contouring, it's not isolated to one location, right?
• 8:00
  SPEAKER_01: Right?
• 8:00
  SPEAKER_01: It's like, hey, doc, can you look at my lower back?
• 8:02
  SPEAKER_01: Hey, doc, can you look at my legs too?
• 8:04
  SPEAKER_01: Or by while we're here, can you look at my arms?
• 8:06
  SPEAKER_01: It's it's common for them to do so.
• 8:08
  SPEAKER_01: And you know, we talked about the mommy makeover in a prior episode, but in the same time, you know, people come in wanting their tummy and their breast known at the same time.
• 8:16
  SPEAKER_01: It's and it's routine for us.
• 8:19
  SPEAKER_01: Right.
• 8:19
  SPEAKER_01: And you and I both do a lot of massive weight loss.
• 8:23
  SPEAKER_01: And for us, it's anything over 80 pounds.
• 8:25
  SPEAKER_01: You know, if they've lost over 80 pounds, they're gonna have multiple body parts that they're gonna want to operate it on.
• 8:30
  SPEAKER_01: And they want to limit the number of times they ultimately have to go to the operating room.
• 8:33
  SPEAKER_01: Sure.
• 8:34
  SPEAKER_00: And like there is, I mean, listen, there is a micro increased risk of having multiple anesthesia events too, but that's obviously lower.
• 8:40
  SPEAKER_00: But there's you can look at it through different lenses.
• 8:42
  SPEAKER_00: The other thing is, though, is that when we're doing an intervention where we literally are resecting or removing something like fat, like skin, when we could take that and literally at that intervention repurpose it and use it somewhere else.
• 8:53
  SPEAKER_00: I mean, that kind of combination surgery just makes intuitive sense, right?
• 8:56
  SPEAKER_00: You know, if you're doing like a 360 body lift, why wouldn't you use some of that fat to enhance the buttock a little bit or enhance the chest a little bit versus just chucking that in the trash?
• 9:05
  SPEAKER_00: I think there's certain situations where it makes sense.
• 9:07
  SPEAKER_00: And you mentioned this too.
• 9:08
  SPEAKER_00: It's like when you're doing the mommy makeover, like a lot of times these moms, like they have a lot of responsibility.
• 9:13
  SPEAKER_00: They're obviously the key person in the household, but there are certain areas that they're just either they're functionally causing issue or maybe that they're personally, you know, concerned, but they really want to have addressed, you know.
• 9:23
  SPEAKER_00: But I'll give you some certain examples though.
• 9:25
  SPEAKER_00: Like, so if a mother has wants to get like a circumferential trunk contouring, abdominal plasty, breast procedure, and then also wants to have maybe like a labioplasty.
• 9:35
  SPEAKER_00: You know, there's certain instances where we might say, Yeah, we're gonna do all that, but we're not gonna do that part of the procedure because you're gonna have tremendous swelling in the vulvar area, combining that with a labioplasty, you're gonna be miserable.
• 9:47
  SPEAKER_00: So there are certain things that we just that don't make sense, you know.
• 9:51
  SPEAKER_00: I know some of the ones that you we all we both I think we think similarly on is if we're gonna do like a body lift after a massive weight loss.
• 9:57
  SPEAKER_00: And someone's like, I want to do a body lift, I want to do brachioplasty, I want to do thigh lift, and like we just won't do all those things at once.
• 10:04
  SPEAKER_00: Some of it because just too much surgery, but the other is like to have like your thighs taken care of and your abdomen and then walk around bent over.
• 10:11
  SPEAKER_00: Fundamentally, how is this patient gonna be up and moving and walking?
• 10:14
  SPEAKER_00: Like we have to, you know, really think for the patient.
• 10:17
  SPEAKER_00: We don't want them to not move or to be unable to or have a complication.
• 10:21
  SPEAKER_00: Complications are the things we're trying to avoid.
• 10:23
  SPEAKER_01: You know, you bring up a good point.
• 10:25
  SPEAKER_01: I'd I'd love to kind of expand on this massive weight loss surgery and um what that looks like for us is how do you separate those?
• 10:33
  SPEAKER_01: Right, and and what do you do first?
• 10:35
  SPEAKER_01: You know, what takes precedence, um, and what can safely be done in one operation?
• 10:40
  SPEAKER_00: Yeah.
• 10:40
  SPEAKER_00: This is a great question.
• 10:41
  SPEAKER_00: And I think that um with massive weight loss, it affects it can affect every single part of the body, but historically, massive weight loss will affect the trunk, which is the abdomen, the tummy.
• 10:52
  SPEAKER_00: Um it can affect the back, it can affect the arms, legs, face, and there are different things that can be done.
• 11:01
  SPEAKER_00: When we went through training, and it's still taught now, the typical concept is to kind of take care of the kind of circumferential trunk first, the lower part of the trunk.
• 11:09
  SPEAKER_00: So that's when you do something called a you know, body lift or a circumferential abdominal plasty or a belt likepectomy.
• 11:15
  SPEAKER_00: Um, that kind of serves as the foundation piece.
• 11:17
  SPEAKER_00: That is not the holy grail, though.
• 11:19
  SPEAKER_00: I mean, you could we can go in any order that a patient wants.
• 11:21
  SPEAKER_00: I like that approach personally, um, but sometimes there's variability in that.
• 11:25
  SPEAKER_00: Like, so you can do a circumferential abdominal plasty, you can do a circumferential abdominal plasty with you know a fleur-delie resection.
• 11:32
  SPEAKER_00: Some of our colleagues, which we're not from, we don't do this, they'll do big, huge lateral excisions, flank plasties.
• 11:38
  SPEAKER_00: Nothing wrong with it, but we just don't like that scar approach.
• 11:41
  SPEAKER_00: Um, but I think that typically is one of the first things, but we will combine that with other stuff depending on the size of the patient, the extent of what's happening.
• 11:49
  SPEAKER_00: So, I mean, I don't know about you, I'd love to hear what you say.
• 11:51
  SPEAKER_00: I would do like a circumferential contouring, skin resection, and potentially like breast together, okay?
• 11:57
  SPEAKER_00: Um, or one other area together, but more than that, that'd probably be the first thing that I would do.
• 12:03
  SPEAKER_01: Yeah, I usually break it down pretty easy for patients.
• 12:06
  SPEAKER_01: It's like, all right, do there's two camps.
• 12:09
  SPEAKER_01: Do you do the one with the biggest recovery first, or do we do the one that bothers them the most?
• 12:14
  SPEAKER_01: Right.
• 12:15
  SPEAKER_01: And then combine that with a unit that makes sense, right?
• 12:18
  SPEAKER_01: Right.
• 12:19
  SPEAKER_01: Let's just say they come in and I've had a numerous number of patients come in and say, Hey, my arms are the one thing that bothers me.
• 12:27
  SPEAKER_01: Over everything else, it's my arms.
• 12:29
  SPEAKER_01: Then seconds my legs, third is my belly.
• 12:32
  unknown: Yep.
• 12:32
  SPEAKER_01: In that case, I'm like, hey, you know what?
• 12:34
  SPEAKER_01: We can do your arms and legs at the same time.
• 12:36
  SPEAKER_01: Right?
• 12:36
  SPEAKER_01: No problem.
• 12:37
  SPEAKER_01: You know, oftentimes to your point, they come in and they're like, hey, it is the tummy.
• 12:42
  SPEAKER_01: I'm really not happy with the way my tummy looks.
• 12:44
  SPEAKER_01: And you're like, all right, we're gonna do this body lift.
• 12:46
  SPEAKER_01: Now, sometimes they don't need the posterior excision, but I would tell you nine times out of ten going all the way around.
• 12:52
  SPEAKER_01: And it actually makes the front part look better.
• 12:54
  SPEAKER_01: Look better.
• 12:55
  SPEAKER_00: But you know, sometimes you'll see this patient, and they they not only need that, or some of them will not need that posterior lower excision, they need an upper excision.
• 13:01
  SPEAKER_00: So they need that, they need like a hybrid where they people talk about upper body lift, lower body lift.
• 13:05
  SPEAKER_00: Sometimes you have to do a you have to fractionate it.
• 13:07
  SPEAKER_00: You do a bra line backlift, you do a uh, you know, extended uh flirtly abdominoplasty.
• 13:12
  SPEAKER_00: So what is a bra line backlift?
• 13:13
  SPEAKER_00: So bra line backlift is a procedure that you know what's really special about HKB is Joe Hunstead essentially kind of developed that procedure.
• 13:20
  SPEAKER_00: Joe Hunstead is you know was the H in in the Hunstead Center, then the Hunstead Cortesis, and then then us, and now Health November.
• 13:33
  SPEAKER_00: But um he developed that and it's a it's a super incredible procedure, but it's become so incredibly popular.
• 13:38
  SPEAKER_00: And he every time I do one, I think about him.
• 13:40
  SPEAKER_00: We actually are revising a chapter in the uh Mathis Nhai book or the Foyad and High's book, sorry, not Mathis Nhai, um, of of that and kind of updating results.
• 13:49
  SPEAKER_00: And he was like, make sure the picks are really good.
• 13:51
  SPEAKER_01: In the upper back, in the upper back, in the brain, right underneath the kind of the bra strap that removes all that laxity in the upper back part of the skin.
• 13:59
  SPEAKER_01: The laxity in the upper back.
• 14:00
  SPEAKER_00: Right.
• 14:00
  SPEAKER_00: And in that one, for example, like we'll combine that, it'll go all the way across to the chest, to the breast, and then you will do like a breast lift with it.
• 14:07
  SPEAKER_00: And like, this is the crazy thing about like this combination surgery, mass weight law, these are a lot of incisions.
• 14:11
  SPEAKER_00: So sometimes it's also like thinking about the amount of incisional surface area you have and how much raw surface you're leaving behind.
• 14:17
  SPEAKER_00: Because if a patient does have an issue, they do have a bleed, they have a problem, like that's when things can get a little hairy.
• 14:23
  SPEAKER_00: And we don't want things to get hairy.
• 14:24
  SPEAKER_00: You know, only hairy things we want to think about are, you know, my my hair here.
• 14:28
  SPEAKER_00: But like it's important to think about that and be cautious.
• 14:31
  SPEAKER_00: You know, we were we were talking about like other reasons for combination surgery.
• 14:34
  SPEAKER_00: Like, what about the breast?
• 14:36
  SPEAKER_00: When you're some of these massive weight loss patients or women who've had children, you can't just lift the breast up only.
• 14:42
  SPEAKER_00: You can't just add volume to the breast only.
• 14:44
  SPEAKER_00: And this is something obviously we've published on, we wrote books on.
• 14:47
  SPEAKER_00: You know, talk about the breast and how you restore the breast and why most breast procedures after massive weight loss or after children often has to be combination surgery.
• 14:56
  SPEAKER_01: Yeah, I mean, ultimately they they're they've lost the volume in their breasts, right?
• 15:01
  SPEAKER_01: And so lifting it alone is not gonna restore that volume where they ultimately need.
• 15:05
  SPEAKER_01: So they need some sort of restoration of volume.
• 15:08
  SPEAKER_01: And most of the time, they don't want it with fat grafting, although it can help.
• 15:13
  SPEAKER_01: Most of the time they want an implant to kind of restore that volume back for them.
• 15:17
  SPEAKER_01: Right.
• 15:17
  SPEAKER_00: And then the other thing about when we were asking me about the order and when how I would sequence, the other thing I tell patients, especially after they have had a tremendous amount of weight loss, and we're going to be tackling multiple areas potentially in stages, is that don't be surprised.
• 15:29
  SPEAKER_00: There might be a spot that I'm not you might be a little loose in somewhere that I might want to come back and tackle, tighten a little bit, revise, adjust.
• 15:37
  SPEAKER_00: Um, and then especially in the real massive weight loss patients, it's a very, very common thing.
• 15:41
  SPEAKER_00: So patients just need to know that.
• 15:42
  SPEAKER_00: I've always come to learn, and honestly, me as a consumer is like as long as I'm not surprised, I'm not upset.
• 15:47
  SPEAKER_00: So we try to do that with our patients also.
• 15:50
  SPEAKER_00: You know, going back into um combo procedures, you know, there are patients though where they're like, you're doing like uh breast surgery or tummy surgery and they're like, Hey, I I need to get my neck taken care of, and this is my one chance.
• 16:02
  SPEAKER_00: And you talked about this, and we've done some of those patients, and um, they're so happy when you can just knock this stuff out together.
• 16:08
  SPEAKER_00: And I think you can do it.
• 16:10
  SPEAKER_00: You just gotta be you have to have a plan of attack of either how we can manage that solo surgeon style, but otherwise tag teaming with the team and getting that patient where they need to works beautifully.
• 16:21
  SPEAKER_01: My my preference is always a team approach, right?
• 16:23
  SPEAKER_01: Uh hence why I'm in a group practice, right?
• 16:26
  SPEAKER_01: I don't I I don't think I would thrive individually.
• 16:28
  SPEAKER_01: I think I my old adage is we're always better together.
• 16:31
  SPEAKER_01: And I think that's the beauty of a group practice personally, is that you have experts in fields and you can combine surgeries really well and easily.
• 16:39
  SPEAKER_01: I do combo surgeries with you know, I do I might do the tummy tuck and then I might have one of the other surgeons come in and do the facelift, and we do it routinely.
• 16:48
  SPEAKER_00: And the other thing too is just having um you know, we think about all these procedures, just having good support after, and there's always being multiple surgeons available to kind of help handle anything that could come up.
• 17:00
  SPEAKER_00: You know, from a from a standpoint of combination interventions, too, there's there's important things to think about where not only is it just like actual surgical stuff, it's actually combining with technology.
• 17:11
  SPEAKER_00: So we're doing a tremendous amount of that, and there's real value in that because using regenerative technologies in our space, you can downgrade the surgical intervention too.
• 17:19
  SPEAKER_00: So using energy-based liposuction, for example, really valuable.
• 17:22
  SPEAKER_00: So doing just like liposuction on its own, we rarely ever do that.
• 17:26
  SPEAKER_00: Combining it with ultrasonic energy and combining it with RF helium-based energy for tightening almost every time.
• 17:32
  SPEAKER_00: So that's combination surgery.
• 17:34
  SPEAKER_00: The other concept is when we're doing like a uh facelift at the end, we're also doing laser resurfacing.
• 17:40
  SPEAKER_00: So you're combining, you know, a technology, energy-based technology with a traditional surgical approach.
• 17:46
  SPEAKER_00: That's combination surgery.
• 17:47
  SPEAKER_00: So combination surgery is very important to get the best results.
• 17:51
  SPEAKER_00: Doing things solo on its own is fine, also, but it's like we're trying to elevate the output, reduce the signs of surgery, and um shorten the recovery time.
• 18:01
  SPEAKER_00: So I think combination surgery is key in that.
• 18:03
  SPEAKER_00: What do you see as any other interesting combinations that you've done in the past?
• 18:07
  SPEAKER_01: I think minimally invasive stuff with invasive stuff.
• 18:10
  SPEAKER_01: You know, patients come in all the time and they're like under anesthesia and they're like, hey, can you do my injectables?
• 18:15
  SPEAKER_01: We do that routinely.
• 18:17
  SPEAKER_01: You know, they're they're coming in for their tummy tuck and they're like, hey, it's winter, can I have my my laser under my face?
• 18:23
  SPEAKER_01: And we we do that as well.
• 18:24
  SPEAKER_01: So again, it even even little nuances like that are things that people ask us about all the time, and they can be done.
• 18:33
  SPEAKER_01: Right.
• 18:33
  SPEAKER_00: You know, one of the big ones is we became, we were actually the world's number one provider of ELICOR services, which is the microcoring thing.
• 18:40
  SPEAKER_00: It's because we were doing that.
• 18:41
  SPEAKER_00: Like people were getting their breasts done, they were getting their body done, and they wanted to get you know something the treatment on their face, they didn't want a facelift, but they wanted something to look a little refreshed, get a little bit of tightening.
• 18:51
  SPEAKER_00: They had that.
• 18:51
  SPEAKER_00: So they had that combination intervention at the same time.
• 18:54
  SPEAKER_00: And I think um that's really nice for patients, and like that's the best situation because their anesthesia time is not prolonged at all, and they're getting another treatment, another area treated, because they have to be down anyway.
• 19:03
  SPEAKER_01: So what's your most common combo treatment?
• 19:08
  SPEAKER_00: Number one.
• 19:09
  SPEAKER_00: Number one will be kind of you know, augmentation, mastopexy, circumferential trunk contrast, traditional mommy makeover.
• 19:15
  SPEAKER_00: Yep.
• 19:16
  SPEAKER_00: Number two would be same with me.
• 19:18
  SPEAKER_00: Yep.
• 19:18
  SPEAKER_00: Next would be facelift, eyelid surgery with laser resurfacing and fat grafting.
• 19:22
  SPEAKER_01: Um number two would be massive weight loss, without a doubt.
• 19:26
  SPEAKER_00: Massive weight loss.
• 19:27
  SPEAKER_00: And then the other would be energy-based liposuction.
• 19:30
  SPEAKER_00: I mean, we do it all day, all day long.
• 19:32
  SPEAKER_00: One thing that we forgot is, you know, guys, when we we're approaching men, men are the same too as women, just a little different.
• 19:38
  SPEAKER_00: But when men will approach their chest sometimes, and I rarely will ever just get just a chest contouring procedure without some energy-based liposuction of the abdomen and the hip roll area.
• 19:49
  SPEAKER_00: And I think that's really valuable in adding high definition, you know.
• 19:52
  SPEAKER_00: So high definition adjuncts are really big too now.
• 19:55
  SPEAKER_00: And I think we talked about this the other day, is that maybe toning it down just a little so it's not so harsh.
• 20:00
  SPEAKER_00: I think that's super valuable.
• 20:02
  SPEAKER_00: What do you think is uh another combo thing?
• 20:05
  SPEAKER_01: I like I said, I think number four for with me is probably doing a uh combined surgery with another surgeon.
• 20:11
  SPEAKER_01: You know, I think we do that pretty on the regular here.
• 20:15
  SPEAKER_00: You know, one of the things is you know, every once in a while you'll see a patient, you'll make this you you know what's gonna get the best result for them, but you can tell they don't really want to do that.
• 20:22
  SPEAKER_00: Yep.
• 20:23
  SPEAKER_00: What's your approach on that?
• 20:25
  SPEAKER_01: Um, you know, I'll leave it in their hand to to make the final decision.
• 20:28
  SPEAKER_01: Ultimately, I I don't push anything on anybody.
• 20:31
  SPEAKER_01: Um, and so I just give them the facts and let them make the ultimate choice and decision.
• 20:35
  SPEAKER_00: I'll tell you, I'll give you an example.
• 20:36
  SPEAKER_00: I had a patient this morning that I saw that saw another surgeon, saw a couple other surgeons, and um, to really summarize her thing, she definitely would benefit from uh uh full abdominal plasty, you know, and just you know, muscle repair.
• 20:50
  SPEAKER_00: But she's just like, listen, I just I just can't.
• 20:53
  SPEAKER_00: I just want I want you to do something to thin down this abdominal wall and make it maybe petition make it a little bit tighter, but I just want this push to be lessened.
• 21:00
  SPEAKER_00: I know that I won't have the muscle repair, I know that I'm gonna have extra skin.
• 21:04
  SPEAKER_00: And I was like, listen, if you clearly understand that I can tell you that I can effectively do energy-based liposuction, improve your result.
• 21:11
  SPEAKER_00: She's gonna let me treat her whole entire trunk.
• 21:13
  SPEAKER_00: But I told her, I said, the worst case scenario is that you will want to have a more invasive procedure done in the future.
• 21:20
  SPEAKER_00: And we had this discussion, and if you're okay with it, I can move forward.
• 21:23
  SPEAKER_00: I said, But the one thing I can do is you've had a C-section already, so let's at least revise that scar and tighten the skin some.
• 21:28
  SPEAKER_00: So I think that there are there there's a way to approach that patient because the worst thing I think is doing something against the patient's will or saying you have to do this, just trust me.
• 21:39
  SPEAKER_00: I don't do the do how often do you use the trust me?
• 21:41
  SPEAKER_00: It'll be fine.
• 21:42
  SPEAKER_00: Never.
• 21:43
  SPEAKER_01: So I tell him trust me because I would take care of them, just like you do.
• 21:48
  SPEAKER_01: But I I never talk a patient into a procedure, yeah, ever.
• 21:51
  SPEAKER_00: Yeah.
• 21:52
  SPEAKER_00: I think that's our biggest thing that we both have learned that is you know, do what a patient wants, but make sure they understand what they want.
• 21:58
  SPEAKER_00: And then there's times like you said, you just You just send them to a specialist, quote unquote.
• 22:02
  SPEAKER_01: But you know, there there are certain things that probably should be done in conjunction, like you said.
• 22:08
  SPEAKER_01: It's like, hey, by the way, when we're doing the lift and you want volume, we should probably do the implant at the same time.
• 22:14
  SPEAKER_01: Right.
• 22:14
  SPEAKER_01: Right.
• 22:14
  SPEAKER_01: Hey, we're doing your upper eyelids.
• 22:16
  SPEAKER_01: You want to consider doing your lower eyelids at the same time.
• 22:20
  SPEAKER_01: So there's some combination treatments that make sense.
• 22:22
  SPEAKER_01: Right.
• 22:23
  SPEAKER_01: And then you just give them that that advice and see what they want to do ultimately.
• 22:27
  SPEAKER_00: For sure.
• 22:27
  SPEAKER_00: So combination surgery is something that is really valuable in our space.
• 22:31
  SPEAKER_00: It can be done very safe and effectively, but again, it depends on each patient, right?
• 22:35
  SPEAKER_00: I mean, that's the biggest thing is you have to really customize it to that individual and go back to the simple addities that no two patients are the same, and therefore no two deserve the same exact combination of surgical procedures.
• 22:47
  SPEAKER_01: Exactly right.
• 22:48
  SPEAKER_01: And for us, it's like that that's it to a nutshell.
• 22:51
  SPEAKER_01: We tailor everything we do for that individual patient.
• 22:55
  SPEAKER_00: Well, it was an amazing episode.
• 22:57
  SPEAKER_00: Please don't be strangers.
• 22:58
  SPEAKER_00: Hit us with any questions or comments on our social media platforms or on a YouTube channel.
• 23:03
  SPEAKER_00: Tune in next time.
• 23:06
  SPEAKER_01: Thank you for listening to HKB Uncut.
• 23:08
  SPEAKER_01: If you enjoyed this episode, please subscribe to us on Apple, Spotify, or YouTube.
• 23:13
  SPEAKER_00: To book a surgery consultation or med spa appointment with our team, visit our website at hkbsurgery.com or head to the links in our show notes.