Tag Archives: 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

Think Yourself to Health

Yoga mumbo jumbo may actually work!


Healing after cosmetic plastic surgery is affected by many different factors. None is more important than the patient’s attitude toward surgery and healing.

Here is a list of some factors that influence healing after plastic surgery:



Yoga and plastic surgery

Positive thoughts and attitudes toward healing will improve a patient’s cosmetic surgery results. Plastic surgeons have always known this, but now comes the first glimpse into research that may one day actually prove this notion once and for all.

If you have ever taken a yoga class, you know that the first thing they teach you is how to breathe. You breathe in through your nose, expanding your belly, and then exhale through your mouth, letting the air out of your lungs and and relaxing your abdomen.

Breathing exercises are supposed to relax you and get you in touch with your inner being… etc., etc. Recent research shows that all this breathing stuff may actually work to make you healthier!


The vagus nerve and plastic surgery

   vagus nerve










One of the main nerves in the body is the Vagus nerve (Latin for wandering nerve), which wanders from the brain down to the heart, lungs and intestines,  regulating their function. If the Vagus fires off, heart rate and breathing are slowed, blood pressure is lowered and stomach motility and emptying of the bladder is increased. It can be thought of as the nerve that relaxes everything! Too much firing and we faint, a so-called “ Vaso-Vagal” reaction. The opposite system to the “parasympathetic” action of the vagus is the “sympathetic” system of nerves in the spinal cord. When these nerves fire, we have a  “flight or fight” response. We get all excited!

Researchers have measured what is known as “Vagal tone,” which is associated with health.
When we breathe air in, our heart rate slows ever so slightly, and as we breathe out, our heart rates speeds up a bit. The difference between these two rates is known as “vagal tone.”

Now, it turns out that vagal tone is higher in patients who are healthier and happier. Also, it seems that if you think of yourself as happy and healthy, vagal tone increases—it’s a feedback loop.

Low vagal tone is associated with disease, heart attack and stroke—that is the thready rapid pulse that is barely palpable.

The research showed that patients who thought good thoughts—happy , kind, loving thoughts—were able to increase their vagal tone, which may lead to a more relaxed and stress-free existence. Think those thoughts over a lifetime and you may actually be able to ward off disease and illness.

So the next time you do those “silly” yoga breathing exercises, you may not be as silly as you think.

Morad Tavallali, M.D., FACS

Don’t Lie to your Plastic Surgeon!

Lying to your plastic surgeon can be deadly


I was recently lied to.  I’ve become better over the years at figuring out when a cosmetic patient is fibbing, but the point is that a determined patient will be able to lie and get away with it until the lie catches up to them. In plastic surgery, the lie always catches up to you. Don’t Lie to your Plastic Surgeon!

Just so we’re clear, I have lied to my doctors too… in the past. For years I used to tell them I smoked only 2 to 3 cigarettes a day when in fact it was more like 5to 7. So no holier-than-though stuff here, but I do need you to know that lying or not telling the truth (a distinction to be noted) is dangerous to a plastic surgery patient undergoing cosmetic surgery.


Types of untruths in plastic surgery


Patients lie because they are embarrassed and they know they are doing/not doing something they should/should not be doing (smoking, being fat, not exercising, etc.). Of course, some may have truly forgotten! Patients tell untruths about their medical history in two ways.

Lying by omission

These plastic surgery patients will not fill out their medical history form completely. They will omit or “forget” to write down:

  • Medications they take – Cross reactions with medicines prescribed for plastic surgery or anesthesia can be deadly. Smoking and recreational drugs are included in this section. You would be amazed by how many people diminish the amount of alcohol they claim to drink on a regular basis!
  • Previous surgery – Abdominal surgery in the past will affect the results of your abdominoplasty badly. Breast biopsies cause scar tissue and loss of breast tissue, which will also affect your breast augmentation or breast lift results. Previous rhinoplasty can be disastrous if the surgeon operates on the nose without knowing about it. Facelift patients who do not tell the plastic surgeon they have a history of cold sores set themselves up for painful bouts of shingles!
  • Medical history – Cosmetic surgery patients who forget to write down that they have heart conditions, asthma, hypertension or other medical problems are literally risking their life. Anesthesia can have fatal consequences if administered to a patient who has not been properly treated for a serious medical condition.
  • Psychological history – Many medicines interact with psychiatric medications and can have bad reactions for the patient if the surgeon does not know about them.


Lying on purpose

The patient that lied to me recently lied to me on purpose. It was a deliberate and purposeful lie to have a surgery she had been told by my staff that I do not perform until a certain date. Specifically, I do not—nor should others—perform a tummy tuck on a woman who is less than six months postpartum (after having a baby). She was told that an abdominoplasty could not be performed until six months after the end of pregnancy, and when asked by my staff, she lied and said it had been six months. When she filled out the form, she did not write down the date of her childbirth and lied again when asked by the surgery center staff. After the surgery, I found out that she was only three months postpartum.

These types of patients are frustrating because they ensure a lesser surgical result by their own stupidity. In many cases, the body needs time to recover, be it pregnancy or even a previous plastic surgery, before cosmetic surgery can be performed again. Operate too early and the surgical results will by definition not be ideal, and healing will take longer.

Patient who think they are being so clever by fooling their plastic surgeon are in fact only fooling themselves.

So go ahead and lie to your parents, partners and loved ones. Even lie to your priest. But do not lie to your plastic surgeon—about  your medical history, that is; you can still lie to him/her about what a great surgeon you think they are…

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

Plastic Surgery on the Body Affects the Mind for the Better

Botox, cosmetic plastic surgery and body language


I have written in the past about plastic surgery and how muscle action affects our mood. Early experiments of this type involved measuring brain endorphins (happy-feeling brain hormones) after patients were asked to hold a pencil in their mouths to simulate grinning. We know that then we are happy, our mouths turn into a grin. The experiment showed that when we force a grin by using the same muscles, we become happy!


Botox (botulinum toxin) useful against depression and headaches

Last year, a study showed that Botox, a medication that blocks muscle action, has beneficial effects in patients who suffer from migraines. Patients with migraine headaches suffer a tightening of the muscles of the scalp as one of the sequels to migraine attacks. Injecting Botox or any other Botulinum toxin effectively knocks out the muscles, relaxing them and improving migraine symptoms.


tummy tucks for men photo

Body positioning affects body hormones




Recent research has shown that body position affects our hormonal levels within two minutes! Specifically, taking on a dominant or “powerful” stance for two minutes,  such as placing your hands on your hips with your legs apart or holding your arms up in a “victory” stance, such as that of Rocky Balboa above, will decrease your cortisol (stress) hormone levels and increase your testosterone levels, which are associated with feeling in control, being more outgoing and being more self-confident. In contrast, sitting quietly in a chair with hunched over shoulders and crossed arms and legs will increase your stress levels and decrease your testosterone levels.  Here is a link to a TED talk by the researcher who discovered this fact: http://www.ted.com/talks/amy_cuddy_your_body_language_shapes_who_you_are.html


Plastic surgery affects mood?

The study that begs to be performed next concerns whether patients who have had plastic surgery also benefit from an increase in self-confidence and empowerment and whether they have decreased stress hormone levels and an increase in testosterone.

Any cosmetic plastic surgeon will tell you that they have seen a change in their patients’ body posture after surgery, be it a breast augmentation or a facelift. Plastic surgery patients hold themselves straighter, walk more confidently and even dress in a more extravagant way after cosmetic surgery. They typically also smile more.

In fact, one of the main reasons patients go to a plastic surgeon seeking cosmetic surgery is to “feel” better about themselves, and they will often voice that.  If you think about it, all of us have the same feelings on a daily basis when we look at ourselves in the mirror. On good days, when you wake up looking better, you will tend to enhance that by dressing up and thereby reinforcing your “on top of the world” look—which makes you feel even better! On a bad hair day or when you get up on the “wrong side of the bed,” you will look less attractive and may even dress down, thereby reinforcing the image of the “depressed and less attractive” you.

Why does all this matter, anyway?

Simply put, more attractive people have been shown in multiple studies to make more money. That’s one reason. See how I said attractive people and not beautiful people. There is a difference, as few of us are beautiful but many are attractive. The French even have a saying for “attractive ugly women”: une jolie laide!

Tall people tend to dominate us shorter folk, and it seems we pay them more for it. Thin people feel more confident than chubbier ones, and we also pay them more. This means that physical shape will affect financial earning potential. Some of our physical shape is determined by our genes, and there is little we can about that other than having plastic surgery to enlarge breasts, reduce nose size or remove excess skin and fat. The other part of our physical appearance is determined by aspects of posture, which you can control much more easily by keeping  your head held up high and standing tall! Plastic Surgery on the Body Affects the Mind!

Morad Tavallali, M.D., FACS