How long should BBL surgery & 360 lipo, legs, arms upper back, chin & J-Plasma last?

Question

I had BBL surgery last year and am contemplating a round 2. With my first surgery I was in the theatre for over 6 hours which I was shocked and scared to hear. Is this normal? I had 360 lipo, legs, arms, upper back and chin, BBL and Jplasma. I'm considering the same Dr but am scared due to the time I spent under anaesthesia last time xx

Alan Gonzalez, MD, FACS · Answer

Hello @holiday81, thank you for your question. BBL surgery and 360 lipo, legs, arms upper back, chin & J-Plasma may vary greatly in terms of the time spent under anaesthesia. The amount of time spent can depend on the complexity involved in performing your individual procedure as well as any additional factors pertaining to a particular case (i.e., pre-existing conditions or age). As such, it is difficult to put an exact number on how long a specific procedure should last with out a proper assessment. The best course of action is to consult a board-certified plastic surgeon for more information and options tailored specifically to your needs. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS), Colombian Society of Plastic Surgery member (SCCP)

Ryan A. Stanton, MD · Answer

Allow me to answer your question as best i can without any photos. However, please keep in mind that an in-person, or at least a virtual, consultation with physical exam is first necessary before any legitimate evaluation or final surgical recommendations can be made.

You are in good company with many others who had high hopes for BBL but instead received disappointing results (lumpiness, unevenness, lack of projection in the central and/or lower buttock, post-deflation sagging, etc.) as most of the fat melts away. It is not quite as much the quality of the doctor nor liposuction technique but rather the quality of the procedure that is a large part of the problem.  Thus, going back for additional rounds of BBL most often produces the same disappointing results but at another financial loss.

Buttock implants, however, provide a more reliable, predictable, relatively safe, and permanent result, especially for adding projection to the buttock and often smoothing out lumpiness. Occasionally a lower buttock tuck may be advantageous for lower buttock fold asymmetries and/or sagging.  When considering buttock implants make sure that the surgeon is going to be placing the implants within gluteus muscles , (a.k.a. “intramuscular pocket”), and that they are using anatomically correct, oval-shaped implants, such as Stanton Anatomic ®️ implants. 
Please keep in mind that an extremely few number of board-certified plastic surgeons specialize in these buttock implants so be sure to consult with one that is reputable and experienced. Unfortunately you may have to travel long and far away from home to find this particular surgeon. Glad to help.

Daniel Barrett, MD · Answer

Dear holiday81,
I understand your concern. However, without a proper assessment, it would be difficult to determine did something went wrong. Generally speaking, surgeries that cover multiple areas can last several hours. It is best that you discuss your concerns with your plastic surgeon. 
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Geuris Cruz Quiroz, MD · Answer

Thank you for your question dear. The time is complete normal specially for doctors who does not have a big team in OR. Good luck in your 2nd round!

Mats Hagstrom, MD (license on probation) · Answer

The best plastic surgeons are detail oriented and do not rush surgery. I remember one time asking they had a nurse at the hospital where I work who they thought some of the best plastic surgeons were. The nurse I was asking was politically astute and her answer was “ the surgeons that don’t look at the clock are always the best”. There are little steps along the procedure that take time and it’s much better to not rush through surgery. One of them is the process of injecting numbing solution. When procedures are done with patients awake using local anesthesia with sedation it’s mandatory that we use sufficient amounts of numbing solution in order for the patient not to feel pain. The numbing solution used for liposuction and fat transfer is called tumescent solution. To inject the solution, especially on someone who is awake thoroughly enough to be able to do the well with minimal discomfort can take 45 minutes. On the week patient all areas need to be completely covered with the solution. Her patients will feel discomfort. With general anesthesia were not as concerned about discomfort during surgery. To Masson solution does more than just reduce discomfort during surgery. It also contains a drug called epinephrine which causes blood vessels to constrict. The effect of this medication significantly reduces bleeding during surgery. Dimmer throw a surgeon is injecting to message solution the lower the chance of having significant bleeding during surgery. So even if being thorough is not necessary because of general anesthesia, being thorough with injecting to message solution is important to reduce bleeding, which in turn significantly reduces bruising. Bruising is after all the breakdown of red blood cells in the body as a result of bleeding.
Quality work simply takes time. There’s no point in wasting time and most surgeons do not because operating time is expensive.
Quality Liposuction should be done with small Cannulas which are more gentle and reduce the chance of having deforming skin irregularities removing a large amount of fat with small cannulas takes hours.
There’s nothing dangerous about having a six hour operation and you should be happy that your surgeon was willing to take the time to do the job correctly. All surgeons I’ve seen who are really fast are always cutting corners. The results could always be improved if the surgeon was willing to take the time to do their best job. I’ve seen this over and over numerous times. Surgeons to operate fast are always driven by making as much money as they can and getting out of working long hours for the same amount of pay.
The fastest surgeons are not focused on what’s in your best interest, but are focused on what is in their best interest, and simply getting the job done as quickly as possible so they have time for themselves or can make more money.
I’ve also worked with surgeons who are indecisive and ridiculously slow. There’s no point in wasting time but quality work takes time and the best surgeons are never the fastest surgeons.
Don’t worry about how long the surgery takes unless it is beyond 6+ hours. 
Patient and surgeons should consider carefully if combined procedures are appropriate since doing multiple areas adds significant time.
After six hours of general anesthesia, certain medical complications increase in risk. The chance of these complications is the low and there are lots of people who have a very long operations and do just fine. Ideally elective, cosmetic surgical procedures should be kept down to around six hours if possible. The way operating time is calculated also varies. Usually the clock starts the second you roll into the operating room. Getting patients prepared for surgery can take a significant amount of time. Anesthesiologist need to get everything ready. it can easily be 30 minutes from the time. The patient enters the room until the surgeon is ready to start surgery. Getting out of the operating room can likewise take half an hour, depending on circumstances. Six hours of operating time does not always mean six hours of active undergoing surgery.
If you’re happy with your provider, and they gave you a good result, then stay with that provider. If you have issues with the outcome or feel like you weren’t getting the care you deserved, didn’t have more consultations and consider using other providers.
Most patients typically do not need secondary procedures, but if someone desires more accentuated fat, grafting results second procedures are often a good idea. Secondary fat transfer works far better than secondary Liposuction.
You didn’t include pictures so we can’t make an assessment. Six hours sounds reasonable for someone who is detail oriented and that is generally what you want.
Best,
Mats Hagstrom, MD

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