Size DOES matter…in Plastic Surgery

Patients are demanding surgical procedures with smaller scars, faster recovery, and less pain. This has lead to the increased popularity of minimally-invasive procedures such as the “mini facelift”, “mini tummy tuck”, and “mini brachioplasty”. People even go so far as to request “scarless” surgery. It should be obvious to anyone reading this, that “scarless” surgery does not exist. As plastic surgeons, we try to make scars that are well hidden, but they are always present.

Are these “mini” procedures better than their alternatives? This is difficult to answer because it is impossible to define “better.” Yes, the scars are shorter and the recovery is faster. There is generally less bruising, swelling, and pain (although pain is subjective and not related to the length of the scar) after your plastic surgery.

The problem is that these “mini” procedures are just that….mini. They are a smaller version of the traditional procedures that they have evolved from. Oftentimes, there is less “internal work” performed. For example, a “mini facelift” does improve the mid face and cheeks, but does not allow for significant correction of the aging jawline and neck. For the person who only needs midface correction, this is a great option. However, many of my patients require rejuvenation of the lower face and neck as well, making a “mini facelift” suboptimal. A “mini tummy tuck” will improve the area of the abdomen beneath the belly button. There is a shorter scar as compared to a traditional tummy tuck and the recovery is faster; however, there is no improvement of the area above the belly button which is an area that bothers most people. A “mini brachioplasty” limits the scar to the armpit and eliminates the sometimes unsightly scar of a traditional brachioplasty that extends from the armpit down to the elbow. Eliminating this scar also eliminates the ability to remove excess skin in all directions, reducing the amount of improvement that can be achieved.

For the lucky few, a “mini” procedure may be exactly what they need – a person with early signs of aging and only mild skin excess. But for the majority of people, the decision for a traditional versus a “mini” procedure is an evaluation of cost and benefit. Is the shorter scar and more rapid recovery worth the small sacrifice in cosmetic surgery results? I commonly ask my patients “would you be willing to accept a 20% less improvement in results, in exchange for a recovery that is half as long?” If the answer is “yes”, then a “mini” procedure is a viable option. If the answer is “no”, then a traditional approach is more appropriate.

Many plastic surgeons in new york have marketed these “mini” procedures as a way to make themselves stand out in a competitive marketplace – myself included. I believe there is a role for these procedures but, it is important to be honest about the results these procedures offer. I never tell my patients that these “mini” procedures are better. Rather, I explain that the smaller, less invasive procedure offers a more rapid recovery and potentially less pain, there may be some sacrifice in terms of overall results. Many of my patients do accept this sacrifice and elect for the “mini” procedure. In fact, I perform more of these “mini” procedures then their traditional counterparts and my patients have been happy.

It is indisputable that larger incisions lead to longer scars and more potential for post-operative bruising, swelling, and pain. But larger incisions allow for better visualization and more “internal work” , often resulting in a better overall cosmetic outcome.

I tell my patients that in general, the more they are willing to accept in terms of scars, the better contour I can create. So, at least in terms of plastic surgery, size DOES matter.