Drains and why we use them in Cosmetic Surgery

Drains are used in all of the Surgical fields, General Surgery, Orthopedics, Urology and Plastic Surgery etc… The purpose of a drain is to evacuate fluid from building up in an empty space or a potential space where the surgery was performed.This helps lower the chances of post operative complications and infections.

What actually is a drain? Most are small, hallow tubes, made of silicone that we place in the empty space and then outside of the body they are attached to a small bulb that creates suction. This allows us to keep fluid from building up in the operative area.

In Cosmetic Surgery they are often used in Tummy Tucks, Face Lifts, and some Breast surgeries. Tummy tucks are probably the most common instance. In a tummy tuck the drain removes the fluid that naturally builds up between the top of the abdominal muscles and the overlying fatty tissue. Without a drain in place, the fluid would just collect and distort the appearance of the abdomen and could lead to wound healing problems. In most instances that we use drains we remove them not based on time but on how much fluid is actually draining out. When the output is low enough, the drain is removed. Usually this ranges from a day or two up to a week.

So, while not terribly popular with patients, drain are sort of a ‘necessary evil’ that helps your surgeon get the best outcome with your cosmetic procedure.

Lee Corbett, MD

Corbett Cosmetic Aesthetic Surgery and Med Spa

Do I have to stay in the hospital after Surgery?

This is obviously a pretty common question patients have when they are considering cosmetic surgery. The answer is “probably not” in most all cases. Let me explain.

As the surgeon, when I make that decision, I am factoring in many issues. The time under anesthesia, the scope of the procedure, anticipated level of post op pain, and your co-existing medical problems all are considered to maximize patient safety. Let’s look at each of these factors individually and I’ll elaborate.

Time of under anesthesia: Most of the operations I do are pretty short. An hour or two, if we combine procedures 3-4 hrs. A long procedure would be one lasting say 6 hours or more. A healthy person can easily tolerate an hour or two of anesthesia and go home after. Examples of popular surgeries that fall into this category include Breast Augmentation, Breast Lift, Breast Reduction, Blephaorplasty, Facelift, Necklift, Liposuction, and a Tummy Tuck. These cases are commonly done as out patient procedures. When patients opt to have several things done at once, the time in the OR can get longer. Once OR times pass the 6 or 7 hour mark chances of complications can go up. In those cases it makes sense to keep the patient overnight for monitoring. It’s ok to go past 6 hours, I’m not saying that, but those patients may have needs that first night that are best handled with good nursing care.

Scope of procedure: A lot of times patients are surprised I will do 4 or 5 different surgeries in one setting. It’s not the number of procedures so much as it is the time they will all take and the scope of the procedures. For instance, the impact of the combination of a blepharoplasty, liposuction under the chin, and a breast lift on your system is less than if you have a lot of liposuction. The recovery from the eyelids, a small area of lipo and a breast lift are fairly benign while high volume lipo ( > 5 liters) can result in fluid shifts where we need nursing care to monitor IV fluids and urine output. Likewise I can lipo 4 or 5 areas on a patient who has small localized problems areas removing a total of 1-2 liters of fat and safely send that person home. Conversely, I might keep a person who is heavier and we are treating just one area, like the front of the abdomen and flanks but here we might be removing 4 or 5 liters of fat. Those are two completely different operations in regards to their impact on your system the night of surgery.

Post of pain: Some surgeries just hurt more than others, it’s that simple. A great example is a thigh lift. These leave the patient uncomfortable and they often do better staying over night. It’s not that the surgery is all that long, usually 2-3 hours, or anything like a big lipo case or an extended tummy tuck case like we see with patients who have had lap bands with weight loss in excess of 100 lbs. It’s just that the patient may need more than pain pills to be comfortable.

Medical Problems: In general, if a patient is unhealthy, I wont operate on them. Why take the risk of having a problem for what after all is an elective procedure. But I do see a lot of patients with well controlled diabetes, or high blood pressure or asthma who seek cosmetic surgery. These patients are very good candidates for surgery, but sometimes they need a little monitoring after surgery. The diabetic patient is the perfect example. We don’t let you eat after midnight, then we do surgery, and sometimes patients are nauseated and don’t feel like eating. So how much insulin they need can require more checks and monitoring. It’s not a big deal or hard to do, but it needs to be done and the overnight stay and good nursing care solves the problem.

So in summary, I’d say that 99% of my surgeries are done as outpatient because I am operating on healthy people and rarely combine things that will take more than 3 or 4 hours. Now, I might ask you to come to the office the day after for a check (I do this with some of my face lift patients) but you can still go home. And in the end, if you do need or want to stay, the hospitals only charge around $250 for the night, so it’s very reasonable.

Hope this helps

Lee Corbett, MD

Corbett Cosmetic Aesthetic Surgery and Med Spa

Perfect Symmetry…is it possible?

Perhaps one of the biggest challenges I face when operating on paired structures, usually breasts, is making both sides perfectly even. Why? Well, because if you divide the body into right and left sides, we are all uneven. It’s just the way we are made. So, creating identical breasts, via implants, a lift or reduction isn’t really possible. Think fraternal twins, not identical. Of course my goal is perfection every time, but some degree of asymmetry is always going to remain.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa.

Cosmetic Surgery more popular than ever in 2013

In the annual report from my national society, the American Society of Plastic Surgeons, it appears that Cosmetic Surgery and Cosmetic Procedures are at an all time high, up 3% from 2012.

Leading the way surgically was Breast Augmentation  which is typically the most common cosmetic surgery with almost 300,000 being performed each year. The top 5 most common procedures across the board were 1) Breast Augmentation 2) Rhinoplasty 3) Blepharoplasty 4) Liposuction and 5) Tummy Tucks.

For the non-surgical cosmetic treatments, Toxins, think Botox® and Dysport®, were far and away the most sought out treatments with over 6 Million people being treated. Fillers, such as Juvederm®, Restylane®, Perlane®, and Voluma® were a clear second with over 2 Million treatments offered.

Curious to see if a cosmetic procedure might be right for you? Visit our website at www.CorbettCosmeticSurgery.com and www.KentuckyBreast.com or give us a call at 502.721.0330

Lee Corbett, MD

Kentucky’s Only SmartLipo® Triplex Trained Surgeon

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

Medical Tourism and its’ disadvantages

Medical tourism is gaining popularity. If you are not familiar with the concept it boils down to this. Patients will travel internationally to a destination spot. They will then combine a cosmetic surgery procedure and spend their immediate recovery in this vacation spot. Typically the surgery is much less expensive than in the US and they get to go somewhere tropical. Sounds ideal. However…

The problems with this approach are two fold. First, the training of the surgeon and the quality of the facility where the procedure is performed may not be up to U.S. standards. Plastic Surgeons in the U.S. are overseen by the American Board of Plastic Surgery, American Society of Plastic Surgery, their State Medical Boards, and on the local levels the hospitals and surgery centers credential all of their surgeons. This may be true in other countries but there is no way to know. It is true in every American city.

Secondly, if after you come home, you have a complication it may be very difficult to find a surgeon willing to assume your care. In general, amongst surgeons, the general rule is that you handle your own complications. Plastic surgeons charge global fees that include your surgery and all aftercare. Thus, if you call on a plastic surgeon to handle your complication, you may find that they are less than enthusiastic and may charge you significant fees to assume you care.

Think carefully before you travel for cosmetic surgery.

Lee E. Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

How many cosmetic procedures can I have done at one time?

There are several factors that you and your surgeon need to consider if your are thinking of having more than one procedure. Patient Safety is our primary concern. The primary issue is “How healthy are you?”. The reasons that people have serious complications around the time of surgery is because they have a bad heart and/or bad lungs. So if someone comes to me with emphysema from smoking their whole life I tell them no. If someone has active chest pain or a heart attack history I’m not operating on them either. People with a history of a blood clot that required blood thinners is also a “no go”. Now, if your lower back hurts everyday, and you had a hysterectomy, and you are hypothyroid, well none of that really factors in. None of those issue will affect how you do during anesthesia so they aren’t relevant. The summary statement is we need to look at your combination of medical problems and see if any of the constitutes a ‘red flag’. The second issue is time under anesthesia. Most plastic surgeons that I know will call it quits after about 6-7 hours for elective cosmetic procedures because after this point complications rates can go up. The third issue is “What are we combining?”. I’ve had patients request 5 or 6 things be done at once and we did them all because they were relatively small operations. Usually it is a breast & tummy combo, the Mommy Makeover, and I do those all the time. That being said I’ll never combine a thigh lift or a body lift with anything else because they are significant operations. So the answer is we have to look at the scope of procedures and base our answer off of that.

So, combining procedures is fine and we do it everyday in plastic surgery. We just need to make sure, as with any surgery, that you are a good candidate based on the factors described above.

Lee Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa

Who is your Cosmetic Surgeon?

I ask this question because most patients don’t realize that there are no regulations on who can claim to be a “cosmetic surgeon“. Your ‘cosmetic surgeon’ might be a plastic surgeon, an ENT surgeon, an Ob-Gyn, a dermatologist, an ER doc, or a Family Practice doctor. Any doctor with a medical license can advertise to be a ‘cosmetic surgeon’. And that doctor can make that claim having worked not even a single day as a surgery resident. Now, the majority of ‘cosmetic surgeons’ are Plastic Surgeons and Otolaryngologists (ENT) doctors. Most plastic surgeons are fully trained general surgeons(5-6 years of residency) who went on to a plastic surgery residency (2-3 years). The ENT doctors typically train 5-6 years and a lot then did an extra year of just facial cosmetic training. If your cosmetic surgeon has either of the above qualifications, you are probably in very good hands.

The problem is doctors incomes have plummeted, especially in the past 10 years, and so doctors in other specialties are becoming “cosmetic surgeons” to replace that lost income. The issue is that as a Dermatologist, ER physician, or family medicine doctor these physicians have no formal surgical training. They go to weekend long courses and learn how to operate. Well, your plastic surgeon and ENT doctors did 6-8 years of training working 100 hour weeks to learn to operate. We trained that long for a reason. There is a whole lot to learn about surgery and its effects on the body. I’m not sure a Friday and Saturday seminar can replace my 7 years of residency.

Now, I am not discrediting all non plastic surgeons and ENT’s. We certainly don’t ‘own’ the rights to cosmetic medicine. In my community there are Derms who have done lipo for many years and do a nice job and are good doctors. My advice to you as the patient is to look at your doctors back ground training. Not all ‘cosmetic surgeons’ are made the same. Look at what specialty they did their residency in, if it wasn’t surgical in nature I think you need to ask some serious questions.

Who has Cosmetic Plastic Surgery?

These stats are taken from the American Society of Plastic Surgeons annual release of trends in Plastic Surgery. The numbers are gathered by the members of the society and submitted each year. The ASPS then analyzes the numbers and publishes them each year.

So, who is having plastic surgery…

Gender wise, women still are the majority of the patients making up 91% of those having cosmetic  procedures. Procedures meaning both surgery and non surgical treatments like peels, laser treatments, and injectables. Men are having things done too, mainly non surgical treatments such as laser hair removal, Botox and Dysport, and fillers like Restylane and Juvederm.

As for age, as expected the largest age category is the 40-54 year old segment. Teens make up a very small minority as do the twenty somethings. Patients in these younger age segments typically seek rhinoplasty, ear pinning, breast augmentation, breast reduction, laser hair removal and skin care.

As we get into the 30-54 age group more issues creep into the picture with aging, weight gain, and pregnancy related changes explaining the spike in procedures. The 30-39 and 40-54 age groups account for about two thirds of all patients seeking cosmetic procedures.

A couple of more interesting facts before I sign off. 11 Billion dollars was spent in 2012 on cosmetic procedures! And more and more patients are seeking office based procedures as opposed to a hospital setting.

If you want to learn more click on the ASPS link above for more details.

Lee Corbett, MD

Medical Director Corbett Cosmetic Aesthetic Surgery and MediSpa

Cosmetic Surgery and the Internet

My name is Dr. Lee Corbett, I am a Board Certified Plastic Surgeon in my 16th year of practice. I finished my plastic surgery residency in 1998 and so my career has spanned the huge explosion in information that is available on line. Be it via commercial websites, blogs, YouTube, etc…you can find information and/or videos of just about any and every cosmetic surgery that exists. A lot of the information is really good, accurate, factual stuff that is valuable for people who are considering surgery. BUT…there is also an enormous amount of the most ridiculous, outrageous, bunch of misinformation interspersed, making it impossible for someone who is not a Dr. or a nurse to sort it all out. For instance, two days ago I was meeting with a very intelligent, well informed patient who wanted breast implants. When we got into the silicone vs saline debate & she immediately opted for saline. Which is fine because I use both types, but when I asked her why she had eliminated silicone she told me that she had read on a blog that if the implant shell split the gel would leak out into her body, that it was poisonous and it would kill her! I couldn’t believe it. Unfortunately I’ve heard that before. That is absolutely, utterly false. First, the gel is a solid and doesn’t ooze out and secondly it most certainly is not poisonous in any way. That’s just absurd. The other common rumor I hear is that breast implants have to be replaced every 10 years. Again, that’s absolutely ridiculous and untrue. The failure rate on a gel implant at that point is very very low, way less than 5%. No surgeon is going to take out a perfectly good implant just because it is 10 years old. These are just two examples and there are dozens more related to just about any cosmetic operation. So, here’s my advice. Be very wary of what you read on blogs and non medical commercial websites. When you seek out information look at the blogs and websites of Plastic Surgeons. When you do you will notice a trend, and that is that we all say just about the same thing. Why, because our national society, the American Society of Plastic Surgeons, has very strict ethics by-laws prohibiting us from dispersing false or misleading information or claims. So, we tell it like it is, not only to keep out of hot water with our society but because we want our patients to have solid information upon which to base their decisions about surgery or medi-spa treatments. And not to blow our own horns too loudly, but as a group we are a bunch of highly trained and educated men and women. Plastic Surgeons go to 4 years of medical school and then complete 7 or 8 years of residency, where, in my era, 100 to 120 hour work weeks were the norm. We live and breathe this specialty and we know our stuff. I’m biased but that makes me feel like my colleagues and I are more qualified to disseminate information about our specialty than anyone else. Ok, I’ll hop off my soap box but it drives me nuts when my patients are scared/misinformed/misled by bogus information.

Lee E. Corbett, MD

Medical Director, Corbett Cosmetic Aesthetic Surgery and MediSpa