The question “What’s the best treatment for me?” comes up in almost every consultation. Dr. Smith likes to answer this by offering what we like to call “Dr. Smith’s plastic surgery spectrum”. For any aesthetic concern, there are many different treatment options. The best approach for a given patient will depend on the severity of the issue and how aggressive the patient wants to be in treating it. The treatment options can be thought of as existing on a spectrum that ranges from the least invasive (with the least dramatic results) to the most invasive (with the most dramatic results). An in-depth consultation beginning with a thorough exploration of the patient’s goals and concerns and including a physical examination and often other tools like 3D imaging will help you find your place on the plastic surgery spectrum.
The Face and Neck
We can divide face and neck rejuvenation into two categories: texture and structure. Texture refers to things like lines and pigment irregularities. Structure refers to anatomical changes that occur over time (like drooping fat and skin). The texture is like the paint on a house and structure refers to the frame and foundation. Examples of treatments on the less invasive side of the spectrum for textural changes include things like filler, Botox, and more superficial chemical peels. More invasive textural options include things like fat grafting and deeper chemical peels. Less invasive options for structural concerns might include Morpheus8 radiofrequency skin tightening. Something in the middle of the spectrum would be a minimally invasive treatment like FaceTite. A facelift or neck lift would be on the invasive end of the spectrum. These options can be mixed and matched to combine highly customized approaches that can be designed to be the perfect fit. For example, if a patient has mild skin laxity of the face and neck, but pronounced vertical neck bands, FaceTite for skin tightening can be combined with a platysmaplasty. This approach allows for minimally invasive procedures to address less severe concerns and an open procedure to address the most anatomically significant issue. This approach decreases scarring, recovery time, and cost while very effectively addressing the patient’s primary concerns.
A patient that comes in wanting larger breasts can also use the plastic surgery spectrum to think about available options. There are essentially two options for breast augmentation. The classic method is implant-based breast augmentation. This operation works very nicely and we can achieve large volume changes with this approach. Implant-based breast augmentation sits on the invasive end of the spectrum as it involves an incision to place the implant and dissection of a pocket to hold the implant either above or below the pectoralis muscle. It also requires the placement of a foreign material (a saline or silicone breast implant). For patients that desire a less invasive approach, fat transfer-based breast augmentation might be a good option. This less invasive procedure begins with fat harvest (liposuction) of a donor site, often the abdomen, waist, or both. The fat is then injected into the breasts. Fat transfer (or fat graft) procedures are minimally invasive, use only 1-3mm incisions, and do not require the use of foreign material. It is not, however, possible to achieve the same degree of volume enhancement with fat grafting as it is with an implant. Fat transfer can be performed under IV sedation and does not require general anesthesia. We generally advise our patients that they can expect a maximum increase in breast volume of 1 – 1.5 cup sizes. For patients desiring a modest size increase and who only want a minimally invasive procedure, fat transfer breast augmentation can be a great choice.
A patient coming in for body contouring arguably has the broadest range of options available to them across the plastic surgery spectrum. Body contouring procedures can be completely noninvasive with no downtime on one end of the spectrum, and significantly invasive with a several-week recovery period on the other end of the spectrum. Abdominal contouring is a great example. A patient that wants a flatter abdomen has several choices depending on what his or her underlying issue is. For a patient with mild rectus diastasis, mild to moderate excess fatty tissue, and a moderate amount of excess skin, a nearly completely flat abdomen can often be achieved with a classic abdominoplasty or tummy tuck. The tummy tuck allows for the complete removal of excess fat, and excess skin, and a repair of the rectus diastasis. This procedure delivers stunning results but comes with a scar around the belly button and a horizontal scar that goes from hip to hip, hidden beneath the underwear line. A return to work is usually reasonable at about 2 weeks. The same patient that is not interested in an extended recovery or extensive scarring can opt for a minimally invasive approach combining VASER ultrasound to tighten deep tissue, BodyTite radiofrequency energy to tighten skin, and liposuction to remove excess fat. Emsculpt Neo can be added to address the rectus diastasis. This combination of procedures can yield a very satisfying result. It will not achieve as dramatic a change as a full abdominoplasty, but this trade-off may be desirable for some patients. For those desiring no surgery at all, a non-invasive body contouring procedure might be a reasonable option. These generally involve no downtime and yield modest results. Again, some patients may prefer this approach.
Problems with the Spectrum
With so many options available, there is room for confusion. This is especially problematic when aggressive marketing tactics are used to convince patients to choose a procedure that is not appropriate for their concerns or desired outcome. This may take the form of implying through marketing either that a procedure is less invasive than it is, more effective than it is, or both. Here are some common marketing terms and their definitions that might guide you as you research possible procedure options:
- CoolSculpting – A noninvasive body contouring technique that can remove localized fat deposits (average 22% reduction).
- Emsculpt Neo – A noninvasive body contouring technique that can reduce fat volume, build muscle mass, and tighten skin (average 30% fat reduction, 25% muscle mass increase).
- Liposuction – Minimally invasive procedure for fat removal (can use local, twilight, or general anesthesia depending on the case)
- Laser Liposuction – Liposuction with the addition of heat from a laser to tighten skin. Less effective than ultrasound and radiofrequency energy in our experience.
- Air Sculpt – Trade name for laser liposuction, used by Elite Body Sculpture
- VASER Liposuction – Liposuction with the addition of heat from ultrasound energy to tighten deep tissue and make fat cell removal less traumatic.
- BodyTite – Bipolar radiofrequency energy used to tighten skin. Safer than unipolar radiofrequency energy which is not as well controlled for temperature or direction. Usually paired with liposuction.
- JPlasma – Unipolar radiofrequency energy used to tighten skin. Not as safe as bipolar radiofrequency energy which is more controlled for temperature and direction. Usually paired with liposuction.
- TriSculpt – Trade name for laser liposuction, used by Sono Bello
- AbEx- Trade name for an abdominoplasty performed under local anesthesia. This does not include muscle repair (rectus diastasis repair).
- Tummy Tuck – This is an abdominoplasty, the gold standard for abdominal contouring. Usually performed under general anesthesia, this procedure removes excess skin and fat from the entire abdomen and usually includes muscle repair (rectus diastasis repair).
- Mini Tummy Tuck – An abdominoplasty that addresses only loose skin and fat below the belly button.
- Sono Bello – A national company that refers patients to doctors throughout its network across the country for body contouring procedures. General anesthesia is not offered, and the doctor may not be a board-certified plastic surgeon.
- Elite Body Sculpture – A national company that refers patients to doctors throughout its network across the country for body contouring procedures. General anesthesia is not offered, and the doctor may not be a board-certified plastic surgeon.
Success with the Spectrum
The key to success with the plastic surgery spectrum is making your desires and expectations clear to your plastic surgeon. If you want the most dramatic results possible, you may need an invasive procedure to achieve them. If, on the other hand, you don’t want to go through a major procedure you may be a candidate for a less invasive procedure. This call comes back to a high-quality consultation where you make sure your surgeon understands your desires and concerns. We are fortunate to be able to offer a host of treatment options from advanced noninvasive procedures like Emsculpt Neo to world-class surgical procedures in our state-of-the-art operating room.