Ricardo Izquierdo, MD (retired)

Operating room fees are usually charged by time, as are anesthesia fees.  Combining procedures is actually more cost efficient because most operating room and anesthesiologist fees begin the moment you enter the operating room.  Assuming there is a 15 minute lag until you are put to sleep, and also after you wake up, you will save money by not having two operations and replicate the O.R. "inflow-outflow" time period.

Though liposuction uses blunt cannulas, there is a small, but appreciable chance that a nerve, most commonly the marginal mandibular nerve to the corners of the lip, can be traumatized.  When this occurs, the affected side will not be able to "frown" and smiling will occur only on the opposite side.  This injury is usually temporary and will resolve in several weeks time.

An experienced board certified surgeon should be highest on your list for a rhinoplasty.  Your nose can be changed by either method.  However, reducing your hump only will leave your nose too wide and your tip too large.  Balance of all the nasal structures is more important than the method used.

If you put a pencil under your breast at the inframammary fold (lower crease) and your nipple is below the level of the pencil, you most probably would benefit from some sort of lift along with your augmentation.  Otherwise, you will be left with the "Snoopy" look:  lax and loose breast gland hanging down from the curvature of the implant.

It may be that you only need to lift the nipple/areola (peri-areolar lift), or possibly a vertical lift to map them look natural.  A natural look for ANY age is NOT having the nipples below the breast crease.

In experienced hands, both open and closed rhinoplasty give a surgeon options to achieve the desired outcome.  An open rhinoplasty will leave a scar in the columella, which is usually imperceptible when healed.  Also, an open rhinoplasty may have a slightly longer time of tip swelling.

Liposuction is a cosmetic procedure.  No insurance company offers payment or coverage for cosmetic surgery.

The question that needs to be asked to determine what options are right for your is, "If the fat around my trunk is removed, will my skin shrink-wrap enough to look smooth, or will it stay loose and create folds?"

In general, abdominal skin with stretch marks does not have the elasticity to shrink or contract.  Smoother skin with taut fat (not loose, shaky fat) may tighten adequately.  I find that I do liposuction in almost all my tummy tuck patients.

Consult with a board certified plastic surgeon.  He/she will be able to assess which procedure, or combination, is best for you.  If you do the best procedure, regardless of recovery time, you will be happier in the long run.

Your insurance will pay a portion of your nasal surgery for the reconstruction from trauma.  You should understand that they will not pay for all of this portion, and you should check with your insurance documents regarding your deductible and co-pay.  The cosmetic portion, to "shave down parts....I dislike" will not be covered.  You will pay for this portion along with the deductible and co-pay out of your pocket.

From your photos, your tip will require some sort of support and/or projection, whether it be a tip graft to augment the tip and/or a columellar strut to support the tip.  Your hump will not be "disguised"  by these manuevers and may still requires some reduction.

In general, the farther away a deformity is from the incision, the less effect any surgery will have on the problem.  Your specific issue is in an area rarely directly lifted or tightened by any kind of facelift.  The pull of the skin in any surgery progressively diminishes as the distance to the problem grows, despite what you see when you pinch your skin.  You will be disappointed with the results in an extended surgery, and there is a high possibility of injury to the nerves which move the lips.