As the world of plastic surgery continues to expand and patients become savvier about the need to combine procedures for superior results, the process of stacking body treatments is certainly having a moment.
What it means to stack treatments
Adhering closely to its name, stacking body treatments refers to the concept of performing more than one body treatment in the same procedure or surgery. “Stacking treatments can be an effective way to ensure patients get the most value out of their experience,” explains Tucson, AZ plastic surgeon Raman Mahabir, MD. “One of the best examples of stacking treatments is the ‘Mommy Makeover,’ which is a combination of procedures performed at the same time to restore the shape and appearance of a woman’s body after childbirth. This could mean undergoing a breast augmentation and tummy tuck or a breast lift and tummy tuck with liposuction in the same surgery.”
“The concept of stacking nonsurgical treatments for body and facial applications typically refers to using different types of energy-based treatments to create improvement in a particular area,” explains Newton Centre, MA plastic surgeon, Joseph Russo, MD. “This is accomplished by using different devices, which create more overall improvement.”
For example, Dr. Russo explains, you could combine a superficial treatment like microneedling with an intermediate-level treatment like highly focused ultrasound, along with a deeper-level treatment like laser. “All of these treatments are done in the same area and literally stacked on top of each other,” he says. “Treating the superficial, intermediate and deeper layers in a specific area will result in greater overall improvement, along with a more rapid recovery and less downtime. The concept of stacking can also be used with a single device like laser hair removal. For example, instead of just pulsing each area one time, you can double—or in some cases—even triple pulse an area to increase the amount of damage to the hair follicle resulting in less hair regrowth, and a more effective result.”
Chicago plastic surgeon Michael A. Horn, MD combined liposuction and an tummy tuck to define this 50-year-old patient’s abdomen.
The Benefit Breakdown
When, where and why patients should consider stacking treatments
There are many pros and cons to stacking body treatments, but according to Dr. Mahabir, one inarguable benefit is the recovery time. “While stacking procedures may make recovery slightly more tiring, you are still benefiting from having just one recovery period for multiple procedures. To use the Mommy Makeover example again, the recovery time for a tummy tuck for someone with a physical job or even someone that just likes to work out is six weeks, and for people with very physical jobs like nurses or competitive athletes it can be closer to eight weeks. Now, if they come back a few months later for a breast lift or arm lift, that recovery time starts all over again. But, by combining something like a breast lift and implants with a tummy tuck and liposuction, the total recovery time is just six weeks. The benefit is obvious.”
Houston plastic surgeon Henry Mentz, MD, emphasizes the benefits of stacking treatments when it comes to downtime. “Mothers who are prepared to reverse the changes of childbirth will often combine a breast lift, breast augmentation, body contouring, liposuction, and a tummy tuck,” he explains. “If a patient had all these done separately, it might require separate weeks of recovery, but by stacking or combining these cases, the recovery time could be as little as 10 days total.”
Another benefit to stacking treatments comes in the form of finances. “There is also a financial benefit to stacking treatments in that you save money on the anesthesia and operating room time,” explains Dr. Mahabir, “Many clinics also offer a multi-procedure discount, meaning patients get a discount off every procedure after their first if they are performed at the same time.”
Mothers who are prepared to reverse the changes of childbirth will often combine a breast lift, breast augmentation, body contouring, liposuction and a tummy tuck.Dr. Mentz
In terms of what procedures professionals recommend stacking, Dr. Mahabir begins again with the classic Mommy Makeover. “The Mommy Makeover consists of stacking breasts and abdomen procedures, in any combination. Stacking different treatments in various ways that can allow us to tailor the combination of treatments to achieve the individual patient’s desired results is an effective way to provide the best care, value and overall experience. Some examples of treatments I recommend stacking include a breast augmentation and tummy tuck, a breast lift and fat grafting with tummy tuck and liposuction, or a brachioplasty (arm lift) and breast lift with implants.”
How to Stack
Breast + Chest
In terms of how stacking works on different areas of the body, Dr. Mahabir recommends a “less well-known, but possibly even more meaningful,” stacking treatment, which is that of a lateral chest wall liposuction with breast procedures. “When it comes to a breast reduction, the reduction makes the breast smaller and perkier, but leaves the bra line ‘fat roll.’ Adding liposuction can dramatically improve the result, so much so that we include it with every breast reduction and lift.”
Rochester, NY plastic surgeon Calvin Young, MD combined a breast augmentation and breast lift to address volume loss and sagging postpartum.
Stomach + Waist
“As emphasized earlier, by combining surgeries you can actually improve the results of the individual procedures,” Dr. Mentz says. “For example, when you combine waistline liposuction with a tummy tuck, it allows more skin advancement on the tummy tuck and, in turn, tighter skin and a more beautiful abdominal and waistline contour.” Combined body-contouring procedures, specifically that of sensitive regions like the stomach and waist, can be uncomfortable, which is why Dr. Mentz turns to the innovative, pain-reducing drug Exparel for many body-contouring procedures. “Body-contouring combinations can be more painful, so I use a drug called Exparel, which is a long- lasting, local anesthetic that can reduce pain substantially. There’s also a special technique in which we use Exparel with a small pump and longer needle at the end of the operation to inject local anesthetic on the entire operated surface, so that if you have a tummy tuck and liposuction, for instance, you can inject local anesthetic into the entire area, allowing patients to be relatively numb for three days afterwards.
Houston plastic surgeon German Newall, MD stacked a breast augmentation with a tummy tuck and liposuction of the hips, flanks and back.
To Keep In Mind
As with any plastic surgery procedure, stacking body treatments comes with its own set of risks. “As surgeons, we pride ourselves on safety and will do everything we can to optimize your results while minimizing your risk,” Dr. Mahabir ensures, “This includes pre- surgical medications to minimize the risk of infection and post-op nausea as well as intra-operative techniques aimed at minimizing discomfort over the first four days, and even post-op devices to decrease the risk of blood clots, like calf massagers or sequential compression devices SCDs. But, even with all those precautions, there are risks. Stacking procedures increases the length of surgery which does, in turn, slightly increase the risk of infection, blood clots and other complications, so it’s important to discuss this with your surgeon as part of the surgical plan.”
While Eugene, OR plastic surgeon Mark Jewell, MD says it’s common to combine liposuction and abdominoplasty, as well as lipo and breast augmentation (which can make use of fat grafting), he does offer a word of caution: “Patients should be cautious in the area of stacking of technologies when it comes to radio frequency helium plasma and laser liposuction,” he says. “All of these technologies are being promoted for skin tightening after liposuction, but none have FDA-approval for being combined with liposuction, so this is still currently considered off-label use.”