Tag Archives: Cosmetic Surgery Patients

Cosmetic Surgery Scheduled at 7 am?

Early morning cosmetic surgery


It’s 7 a.m. and I am waiting for my cosmetic plastic surgery patient to arrive at the surgery center for a gynecomastia surgery and a tummy tuck procedure. a cosmetic surgery scheduled weeks ago.  He may still be sleeping, but hopefully he is just late because of traffic.

I have written about pre-operative preparation for cosmetic plastic surgery in the past;



Why surgery starts early

There are several reasons why surgery of all types, including cosmetic surgery, traditionally starts early in the morning. These include medical reasons and non-medical ones.


Medical reasons for early morning cosmetic surgery

1. Hormonal cycle

Perhaps the most important medical reason for starting surgery early in the morning is the body’s normal cycle of contra-stress hormones.

Cortisol is the major anti-stress hormone in our bodies. It has a “diurnal” rhythm of its levels. It is at its lowest level at around midnight and rises sharply to its maximum between 6 a.m. and 9 a.m. It falls during the afternoon.

High cortisol levels protect the body against stress, psychological or physical. In the early morning, the associated high cortisol levels provide a little extra protection against surgery stress. Other hormones also play a similar role in stress reduction, but cortisol is the most important.


2. Blood sugar levels

Before any surgery requiring general anesthesia, cosmetic plastic surgery patients are required to fast for eight hours. This is important in preventing having any food in the stomach and decreases the risk of aspiration of stomach contents into the lungs—a condition that can be fatal!

The fast makes sure that your blood sugar levels are low in the morning. If surgery takes place later in the day, it’s like not eating breakfast. The low and decreasing blood sugar levels cause fainting, weakness and headaches, in addition to adding extra physical stress to the body.

3. Hydration

Having an early surgery means there is less chance for your body to become dehydrated. Not drinking water is part of the fasting process. Dehydration has obvious physical consequences and sets off its own series of stress responses that are not good for cosmetic surgery patients.


Non-medical reasons


1. Cosmetic plastic surgeons

Starting early in the day with cosmetic surgery allows the cosmetic plastic surgeon to have some time to see post-operative and pre-operative patients in the afternoon. Some plastic surgeons will operate all day long on certain days, but in general I like to break my days up and not operate for more than five hours a day.

Also, surgery is unpredictable in terms of timing. Though most plastic surgeons know how long their surgery takes, unforeseen circumstances like extra bleeding can occur and cause delays. This can have a domino effect and cause a string of delays extending into the evening.


2. Hospital staff

The workday at hospitals also starts early for nurses and staff. Hospitals are busy places, and the full day is needed to get all the work done; much medical care continues straight into the night! However, as in any workplace, hospitals are not fully staffed at night. The minimum number of staff required to take care of emergencies is usually what’s available. Most of the staff is at home, sleeping like normal humans! At 7:30 a.m., most hospital staff and nurses are at work.


3. Surgery complications

As with any other form of surgery, sometimes a complication arises after cosmetic plastic surgery. The complication of the surgery may require the patient to be taken back to the operating room.  Starting early in the morning means there is more time to deal with this possibility with the full complement of hospital nursing and support staff. It’s safer!

These are some of the reasons why cosmetic plastic surgery is started early in the morning. It’s  better for the cosmetic patient, better for the plastic surgeon and better for all the nurses and hospital staff.



Morad Tavallali, M.D., FACS

Cosmetic Surgery Viewpoints on Beauty

Women more beautiful than they think


In cosmetic plastic surgery, the perception of the physical attributes patients have is sometimes very different from what the cosmetic plastic surgeon sees. Here are some posts I have written on the subject:


It turns out that women are particularly adept at thinking of themselves as having physical faults, whereas other view them as more beautiful than they see themselves. Cosmetic surgery viewpoints om beauty are often wrong.

 before and after

Dove evolution

Dove, the soap maker, has been making headlines with its advertising campaigns for a while. The first campaign from years ago called “Dove evolution” showed how cosmetics and digital manipulation are used to give us a sense of “natural beauty” that is far from reality.

Here is the link to the ad for women: https://www.youtube.com/watch?v=iYhCn0jf46U

and similarly for men: https://www.youtube.com/watch?v=-_I17cK1ltY


Cosmetics have camouflaged skin blemishes and scars for years, made eyebrows and cheeks seem higher, and mouths larger. That is fine and truly acceptable. What is not so nice is when digital photo manipulation is used to deceive us about what is truly possible for the human body. For cosmetic plastic surgeons, this causes a serious problem in meeting the expectations of patients.  Of course, I could perform a plastic surgery procedure, take a photo of the results and then have it digitally manipulated to give an ideal result, but I doubt my patients would fall for that trick!

Dove Real Beauty

The new ad campaign is much more poignant and important. The new “Dove Real Beauty” campaign (http://www.youtube.com/watch?v=XpaOjMXyJGk) asked women to describe themselves to a forensic artist.(Those are the guys who work for the police, getting descriptions of suspects from witnesses at a crime and coming up with a sketch of the suspect. They are very good artists.) The artist drew a sketch based on their auto-description. This depicted how the women saw themselves.

Next, the artists drew a sketch of the same person based on a description by someone else who had met the subject. This sketch depicted how other people saw her.

The results showed that women are particularly severe and harsh judges of their own physical attributes. They typically see themselves as having more faults and being less attractive than they really are.

There is sure to be a lot of psychological discussion about this. We know that women tend to be less self-confident than men, take less risks, are more likely to admit having made mistakes, etc. But seeing themselves as less beautiful than they really are is a new one.

They haven’t done the study on men yet, but I suspect that men will think they are more handsome than they are perceived to be by others. “Beauty is in the eye of the beholder” seems to be true after all.

Morad Tavallali, M.D., FACS

Cost of Plastic Surgery: Nickel and Diming Cosmetic Patients

Cost of tummy tuck surgery increases with technology


We live in an age of exponential growth in information and technology and in the cost of surgery. Even in the past few years, advances in cosmetic plastic surgery techniques have been enormous—and so has the cost of surgery! Some cosmetic plastic surgeons still cling to old methods. That is sad.

Here are a few other posts on these topics:



dollar sign

New surgery techniques  come with  a higher cost. How to deal with an increase in the cost of surgery in an era when we are all trying to keep surgery costs down is problematic.

As a cosmetic plastic surgeon, I have a certain cost for my surgeries. Regularly, costs of implants and garments are added to  costs for surgery in addition to hospital/anesthesia fees. Think of it as the cost of performing surgery + materials.



I have previously written about Exparel.  This slow-release formulation of a common local anesthetic (Bupivacaine) that many plastic surgeons use is set to explode on the market and change the way we practice medicine. The drug  provides for a three-day area of numbness when injected into the surgical field. That means three days of reduced need for narcotics (with all of its problems), not suffering pain and getting back to normal faster!

It adds $285 to the cost of surgery (breast augmentation or tummy tuck).

The hospital doesn’t provide it to plastic surgeons; they do provide regular bupivacaine as part of a global surgery cost. What do they care if you have less pain once you are out the door?  They don’t save any money.

This leaves cosmetic plastic surgeons with the sad choice of telling cosmetic patients that a drug exists that will reduce their pain but add to the cost of surgery. Patients can then choose whether to buy it or not. First-class ticket or economy? I find it hard to practice medicine knowing that a better alternative exists for my patient but that it will not be offered due to cost. That just seems wrong. Reduce my fee and eat the cost? OK; but by the same token why not increase my fee and include Exparel?


This is a new wound closure system from  the Ethibond suture company. The combination of Dermabond (tissue glue) and tape makes for a far superior dressing after surgery that stays on patients for about one month. Scars are rare because it decreases incision and tension on the skin for most patients.

My surgery center used to provide it as part of the hospital fee. Not anymore.  I have to either abandon what I know to be a far better closure system and go back to the old, lesser techniques… or have patients pay an extra $250.


For my abdominoplasty/tummy tuck patients, I regularly include abdominal and hip liposuction. It turns out that many plastic surgeons do not include  liposuction, and if they do, they charge patients extra for it… like I used to!

I used to offer patients the option of liposuction at the same time as abdominoplasty because I knew that the cosmetic results were better.  Most would say “no thanks”—the cost was another 20% on top of  tummy tuck fees and that turned out to be too much for most patients. Those who had the liposuction at the same time were happy, and the ones who did not returned later to have it or left unsatisfied despite my best efforts to forewarn them.

I have decided to include the liposuction in all my abdominoplasty operations as standard. I had to cut my fee down for the lipo, but I now get better results. I was able to do this because it was my work and time, not a fixed cost of materials from another company.

Medical economics

The above gives you an example of how the cost of plastic surgery continually rises advances in technology.  New medical advances cost money, which is usually transferred to the patient’s insurance company, which may or may not pay for particular therapies.

In cosmetic surgery patients who pay out of pocket, a new/better treatment modality will cost more. As a cosmetic plastic surgeon, I want the best possible results for my patients, but now I have to offer them a choice between the “best” techniques and simply “good” ones.  If I keep on eating the cost, eventually I will be performing the surgery for free, as my costs will be greater than my income. After all, this is how I make my living.

I can’t decide what to do! I fear that increasing the cost of plastic surgery without telling patients the reasons will frighten away patients who may not understand the nuances of surgery and differences in results.

Or should I be offering a two-tier surgical result—a basic economy tummy tuck and a first-class tummy tuck with all the extras ? Advice is welcome—only first-class advice at no extra cost please!

Morad Tavallali, M.D., FACS

Cultural Differences in Cosmetic Surgery Patients

Cosmetic surgery reactions differ by culture

I have been practicing plastic surgery in a metropolitan, multicultural area of the world—Washington, DC, and its suburbs—for the past 20 years. During this time I have come to learn about the different cultures to be found in a diverse area such as mine and the way that different patients deal with their plastic surgeon. Perhaps because cosmetic surgery is so different from other types of surgery on an emotional and expectation level, the cultural differences is acute.

I may offend some of you with my candid observations, but I can assure you that this is what I see day in and day out.  Of course, these are generalizations, but they may still be worth something.


Difficult plastic surgery patients

Difficult plastic surgery patients tend to:

  • be misinformed about cosmetic surgery (my friend had…)
  • lie about their medical history
  • have unrealistic expectations of results (e.g., thinking recovery takes hours instead of months)
  • not follow doctor’s orders (they know better)
  • be particularly mistrustful of the plastic surgeon (do not believe anything the surgeon tells them)
  • be mistrustful and secretive of and about family members (do not tell partners they are having surgery)
  • be unhappy with results before the surgery is even performed
  • be very needy 
  • have no family support structure they can rely on
  • be overly cautious and worried about healing
  • be very demanding
  • not listen to what they are told and have their own fixed ideas

Culturally, these patients tend to come from societies where people are more individualistic and out to profit from one another with less scruples. This may lead to the lack of trust in those caring for them, which leads to an erosion of the doctor-patient relationship.  They approach everyone, including the surgeon, with suspicion and cannot believe that their surgeon wants only the best results possible for them. In essence, they project the type of person they are onto the rest of the world. They may be the sort that cheats and lies through life, or they may merely be very frightened and insecure. The patient’s office visits become a dreaded event for the cosmetic surgeon and staff. This is NOT the type of patient you want to be.



Easy plastic surgery patients


These patients tend to be very courteous and grateful for the plastic surgeon and his/her efforts, sometimes to the point of being obsequious. They are:

  • Happy and thankful
  • Pleasant  
  • Understanding of normal healing processes and time requirements
  • Open in dialogue with the surgeon and with family
  • In possession of a family support structure to rely on
  • Trusting of the plastic surgeon’s team and recommendations
  • Perhaps overly trusting of the cosmetic surgeon (don’t ask enough questions)

Thankfully, most plastic surgery patients fall into this group. Their recovery is smoother and their interactions with the plastic surgeon and office staff much more pleasant. As we are all human, in the end I think they get better cosmetic surgery care!

Morad Tavallali, M.D., FACS