Tag Archives: surgical specialties

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

Plastic Surgery Information

The amount of cosmetic plastic surgery information on the internet is truly astounding; equally astounding is the amount of false and just plain wrong information. I have written about differences in medical information in the past:


Every day I have patients come in to my plastic surgery practice for a cosmetic consultation. Most have done research on the internet before coming in. Often, I am one of several  cosmetic plastic surgeons they are visiting—a practice I particularly encourage. The problems occur when patients have done “research” on the internet and come to the plastic surgeon’s office not informed, but rather hopelessly confused.  The worst cases occur when cosmetic patients come to the consultation having consulted with Dr. Google and then actually say that based on their research, this or that surgery is what they want and this is the way to perform it! This actually happens!


Sources of medical information


There are a number of reliable sources of medical information on the web. Some of these are actually sites I refer to myself when I need to get information about topics outside of my specialty. I use them as a sort of medical encyclopedia or memory aid. These sites are maintained by government departments like the CDC or NIH and can be relied on for at least a relatively correct answer to medical questions.

Here are a few of the better medical information web sites:





Websites run by plastic surgeons


Websites promoting cosmetic plastic surgeons are a good source of medical information if taken with the caveat that they are espousing a particular technique or method of  practicing plastic surgery. If the plastic surgeon has bought a new machine they need to pay off, the website may make all sorts of fantastic claims about this “new” technology. Another reputable plastic surgeon may give you a less biased consultation!

Remember that cosmetic plastic surgeons have a wide array of training and experience, and even those trained in the same residency programs will have different approaches and techniques they prefer for different surgeries. There is no one way to perform surgery or practice medicine!


Medical information from technology/drug companies


When anyone is trying to sell you anything, you should have your guard up! Drug companies and medical technology companies have significant  economic incentives to give favorable reviews of their products, and the claims they make are at times amazing and… complete rubbish. Their incentives are purely commercial, and mixing that with medicine always leads to bad medical care—especially in plastic surgery. In fact, did you know that other than New Zealand, the USA is the only other country in the world that allows direct marketing of drugs to consumers?


Blogs run by non-specialist doctors and lay people

As comforting as these blogs may seem in terms of “the girl next door’s cosmetic plastic surgery experience,” they are only one experience out of thousands of possible outcomes and possibilities that can occur after a cosmetic plastic surgery. One patient’s experience, though possibly similar, will not be the same as another patient’s. Patient’s bodies, frames, healing process and scarring potential are all different. Don’t pay too much attention to one patient’s experiences—yours will be different.


The best place for cosmetic plastic surgery information

By far the best place to go for cosmetic plastic surgery information is to a cosmetic plastic surgeon at a consultation. In fact, you should see several plastic surgeons to get an overview of the different techniques and possible results before making your choice of surgeon. The feeling of the quality of your skin, its elasticity, color, thickness, amount, etc., all make a difference to your surgical results. No amount of reading plastic surgery information will be better than that.

Morad Tavallali, M.D., FACS

Dangers of medical blogs

Medical blogs dangerous for plastic surgeons


I just came back from the annual meeting of ASAPS (American Society of Aesthetic Plastic Surgery). This is the society of plastic surgeons who primarily specialize in cosmetic plastic surgery as opposed to reconstructive surgery.

It’s good to go to these meetings, not so much for the “latest advances” in medicine, which tend to be agonizingly slow, but for all the other tidbits one learns.

Turns out that what I am doing is now is fraught with danger for me! Although there is a huge demand for cosmetic plastic surgery information on the web and a huge number of sources that provide plastic surgery information, the basis of the concept is under attack.

Plastic surgery information for patients

There are numerous websites and blogs on the web, including mine, that provide medical and surgical information. The problem, of course, is that most people searching for information do not know enough to judge whether what they are reading is worth anything! Think about it: if you knew the answers you would not need to search for them. In addition, in a field as controversial as cosmetic plastic surgery, even experts disagree with one another. There is a lot of what I consider total rubbish written on my colleagues’ websites, for example.

The patient coming in with “I read that on the internet” is a red flag for me. I encourage questions and am ready to answer them, but I just wish patients would not believe everything they read on the internet.  The internet is not a reliable source for information! Equivalents of Nigerian money scams exist in cosmetic plastic surgery also.


Cosmetic Plastic surgeon blogs

Plastic surgeons and doctors write medical and surgical blogs to:

  • Provide information to prospective patients
  • Provide information or opinions to patients with questions
  • Promote their web rankings
  • Have a platform for expressing their ideas and espousing their techniques

When a plastic surgeon offers advice to you on the internet and you rely on that information for your medical and surgical care, this is construed as practicing medicine in some states. The very act of replying to your specific question can lead to the cosmetic plastic surgeon being charged with practicing medicine without a license in the particular state in which the patient lives. This can lead to the surgeon losing his or her license in the state where they actually practice! Plastic surgeons can even be sued by patients for “advice” given, even though they have never even seen each other.

Sadly, both of these travesties have already occurred.

From now on, I have to give very general answers to questions and preface everything by saying “in my opinion” and ending everything with “I recommend you see your plastic surgeon.”


Cosmetic plastic surgeons can communicate with their own patients via the internet, messaging systems, email, twitter, etc. as long as patients have given consent for such electronic communications (I have included such in my basic information sheet, which patients sign at their first consultation). Without that permission, if you text me with an urgent question, I can’t text you back! However, you can still call me on the phone!

Morad Tavallali, M.D., FACS

Face lift with local anesthesia

 Local anesthesia and face lift surgery


A couple of years ago, I wrote  this post about performing facelift surgery under local anesthesia: https://tavmd.com/2011/02/14/face-lift-surgery-under-local/

The other day, I saw that the technique is now being offered as a  training course for cosmetic plastic surgeons.  A nice holiday in Portugal, and any plastic surgeon can learn to do face lift surgery under local anesthesia. That is a good thing.

Like most other cosmetic plastic surgeons, I learned how to do a facelift with the patient under general anesthesia. Training plastic surgeons has to occur, and some patients are always going to be learned on, especially those who go to teaching hospitals with residents. Facelift surgery is particularly sensitive, since any error can be easily seen by all. That is why few training programs afford that particular luxury to their residents and fellows. I  was lucky enough to go to such a training program in Houston and saw and was trained in many different types of facelifts, including:

  • deep plane face lift
  • skin only face lift
  • Smas face lift
  •  S-lift
  • Fat injection face lift

I was not trained in face lift under local anesthesia. I had to start my own practice to do that.

I don’t really remember when or why I started to perform all my facial surgery under local anesthesia, but it was at least 15 years ago. These days, I perform my face lift surgery, blepharoplasty surgery (eyelid surgery), chin enlargement surgery (mentoplasty) and tip rhinoplasty (nose tip surgery) under local anesthesia.

Many cosmetic plastic surgeons simply do not want to interact with the patient during surgery and prefer to have a silent body to work on. Perhaps they find it too stressful to cut and sew a person who is actively chatting! On the other hand, I enjoy talking with the patients during facelift with local anesthesia, though at some point most patients fall asleep!

Advantages for face lift with local anesthesia

  1. Less physiologic trauma to patient; blood pressure remains more stable
  2. Less anesthesia concerns post-surgery
  3. More natural look after surgery due to inherent muscle tone
  4. Lower cost for patient
  5. Faster recovery


Disadvantages of face lift with local anesthesia

  1. Need for patient to interact with surgeon—say when it hurts!
  2. Need for surgeon to interact with patient
  3. Time limitation of about four hours, the amount of time before patient usually becomes fidgety
  4. Limitation on amount of anesthesia given, though I have never found the need to use high levels

As I have said many times before, there is no right or wrong way to do surgery if you go to a properly trained, board-certified cosmetic plastic surgeon. Each plastic surgeon will have their own techniques and preferences that give them the best possible results.  Don’t ask your plastic surgeon to deviate from the technique they feel most comfortable with; if they are happy, so will you be!

I should have given a course years ago, but Lisbon sounds more fun than D.C.

Morad Tavallali, M.D., FACS

Cosmetic Surgery by Plastic Surgeons?

Non-plastic-surgeons doing more cosmetic surgery


For a multitude of reasons, more and more untrained doctors are performing cosmetic surgery and making themselves out to be plastic surgeons. There are even reputable “board-certified” doctors doing cosmetic plastic surgery. The only problem is that they are not board-certified in plastic surgery. They are “certified” in any one of 30 other medical specialties but not qualified to do any plastic surgery at all. A surgeon is only qualified to perform plastic surgery if they have been certified by the American Board of Plastic Surgery, which means they have taken multiple exams after a minimum of six years of training after medical school. (Many plastic surgeons, like myself, have eight years of post-medical-school training.)

It’s like having your “certified” electrician do the work of your “certified” accountant! There is even a TV ad like that going around these days!

For the past three years I have written about the problem of unqualified doctors (or even non-doctors) performing cosmetic plastic surgery. Here are two of those posts:




I recently heard that the radiologists (those are the doctors trained to look at X-rays) at Inova Fairfax Hospital outside of Washington, DC, where I perform some of my cosmetic plastic surgery, have started to perform laser liposuction. They feel that since they can put in IVs to inject patients with dye or tubes to drain fluid, they are now trained to do liposuction! They are even advertising themselves as “board-certified surgical specialists” in a wanton attempt to confuse and trick cosmetic surgery patients into thinking they are being treated by a plastic surgeon. They take a two-day course in laser liposuction and then let themselves loose on the uninformed public.

Katie Couric had a show last week on her TV program “Katie” in which she interviewed a number of patients who had sought cosmetic surgery by untrained doctors and suffered horrific consequences. Surgery always has risks, and even board-certified plastic surgeons will have complications, but you can at least mitigate the chances by going to someone who has trained for years. Watch this:


It’s high time for the government to intervene to protect the public from the “wild west” mentality that exists in cosmetic surgery today.


Morad Tavallali, M.D., FACS

Facelift Surgery: A Modern Approach

Modern facelift surgery

Facelift Surgery (rhytidectomy) is a cosmetic plastic surgery that is increasingly being performed to rejuvenate the facial structures that sag with age.

If you want to see some photos of facelift surgery patients, look here: https://www.tavmd.com/Facelift_photos.html

For more information about the surgery, look here: https://www.tavmd.com/facelift.html

What happens to the face as we age?

The aging process has specific effects on the skin of the face:

  • The skin color changes and blemishes occur
  • Skin elasticity decreases because the elastin and collagen proteins disintegrate
  • Skin thins out as structures such as dermis and hair follicles undergo involution
  • Fat deposits of the face move down as the ligaments and facial structures holding them up stretch and break
  • Muscles loosen and stretch down with gravity
  • The bone structures of the face resorb and cause regression of the maxilla and mandible

What a plastic surgeon does in a facelift

Facelift surgery is designed to address each of these different situations using different surgical techniques:

  • The muscles and fat are lifted up in a rotational manner and sutured into place.
  • Skin is elevated  and excess removed from behind and in front of the ears.

The surgery typically takes about 3-4 hours and  is often accompanied by eyelid lift (blepharoplasty) and/or forehead lift surgery.

Facelift techniques

Although multiple techniques have come and gone over the years, these basic principles have stayed the same:

  • Remove skin only,
  • Lift the skin and muscle/fat, or
  • Lift all of the facial structures clear off the facial skeleton.

In my opinion, a skin-only facelift is a waste of time, a deep plane facelift is horrendous and a skin and muscle/fat elevation facelift is… just right.

A modern facelift

What has not stayed the same is the difference in philosophy with respect to the surgery. Twenty years ago, plastic surgeons would wait until the patient needed a full facelift and often a brow lift, too—a full overhaul. Indeed, cosmetic patients would only come in when everything had drooped!

A more modern approach is to view each cosmetic facelift patient individually and address only the areas of the face that have sagged and need to be lifted. For example, a patient may need to have their neck and jowl lifted but not their cheeks, or they may need a brow lift but not an eyelid lift (blepharoplasty).

Facelift under local anesthesia

Another modern innovation has been performing facelift surgery on cosmetic patients under local anesthesia. The patients are given a mild sedative by mouth such as Valium and some pain medication. The areas for surgery are then injected with local anesthetic to numb the skin.

The advantages of facelift with local anesthesia are:

  • No general anesthesia and its side effects
  • No changes in blood pressure as with general anesthesia
  • Less complicated recovery
  • Less “frightening” surgery
  • Reduced cost

The modern facelift has developed into a safe, reliable and uniquely tailored cosmetic surgery procedure in the hands of board-certified plastic surgeons—of course! A small procedure under local anesthesia and a fortnight of healing can make a huge difference in your face.

Here is another post about facelift surgery: https://tavmd.com/?s=face+lift

Driving through Cosmetic Plastic Surgery

Plastic surgery driving techniques


Cosmetic plastic surgery gives me the opportunity to think about different aspects of my non-surgery life through the eyes of a surgeon due to my professional surgical training. Sometimes this has advantages…
My daughter turned 16 a few months ago, and we are in the middle of that all-American period of our lives when she is learning to drive. I have a silly aversion to the many talented and caring driving instructors who nourish young adults in teaching them to tame 250-300 horses under the hood, but I decided to teach her driving myself.

That may seem strange to those of you who know that I have never passed a driving test!

I learned to drive while in England. Every week, there I was, driving around the business parks and dull streets of Slough, which later became a world-famous town as the set for the English version of “The Office.” I failed my test. In fact, at one point, the official giving the test had to reach over and yank the steering wheel away from me to prevent an accident…
The following month, I arrived in the US and applied for a driver’s license. I showed my English learner’s permit as ID. I did pass the “written” test, and they must have assumed I could drive because they gave me a full license without a test. I had my share of fender benders while growing up, but only totaled one car.

I finally learned how to drive properly once I trained as a surgeon. That is what I wanted to talk about: the similarities between driving and cosmetic plastic surgery. Some basic rules apply to both tasks. Here are my ten:

  • Have a surgical plan—always know where you are going

In cosmetic surgery, a plastic surgeon should have a plan before starting. A driver should have looked at a map and gotten an idea of where to go. Situations may change as one moves through, but at least there’s a plan.

  • Plan your next move while performing the current one

In surgery and driving, you need to look ahead. Your brain is performing one task ahead of your hands. You also need to look at traffic two blocks ahead and not just at the car in front of you.

  • Go twice as fast in the easy areas and twice as slow in the difficult ones

That surgical wisdom was given to me by one of my old professors in New York. In cosmetic surgery, there are times when more care is needed than in other more routine movements. Likewise, you can go faster on a straight road and slower on a curve.

  •  When in doubt, stop and think

If you are not sure of who is going to take the priority at a stop sign, stop! Likewise, in plastic surgery, if you lose your way, stop and re-think your approach.

  •  Make sure you have fuel

Performing plastic surgery on an empty stomach is as silly as driving on an empty tank. You will stop too soon.

  •  Make sure you have good instruments to work with

Obviously you need a car that works, and having A/C and heating can only help. In plastic surgery, specialized equipment like liposuction may be necessary, without which you cannot perform cosmetic surgery.

  •  Don’t speed

A good plastic surgeon, as well as a good driver, will keep a constant and steady rhythm. Some may go slower and some faster, but at no time should a plastic surgeon or driver speed just to get to the end.

  • No jerky movements

Rash, unexpected or jittery movements may harm the patient or your assistant and must be avoided. Likewise, the driver should not turn the wheel in a jerky manner or change lanes in such a way.

  •  Do not operate for too long

Becoming a tired plastic surgeon is as bad as becoming a tired driver. Only bad things can happen thereafter.

  •  Always give priority to humans

No matter how involved you get with the task of surgery or driving, you still have to remember to give way to humans/pedestrians. The plastic surgeon should never forget that it is a patient he or she is operating on and not just a belly or a breast.

That should do it—I now feel a little like Abraham with these commandments.  Next time you drive, think of yourself as a little bit of a surgeon when you follow these rules.
By the way, my daughter is coming along just fine and is an excellent driver.