Building the optimal in-office ORBy Lisette Hilton
1. Flow and Freedom of Movement
Beverly Hills-based plastic surgeon, Randal Haworth, M.D., says he needs to be comfortable and free to move in order to perform facial and body plastic surgery.
But space can be somewhat limited in an OR inside a boutique plastic surgery practice, he says.
“… so careful planning of the envisioned flow between patient, surgeon, scrub tech, circulating nurse and anesthesia provider must be done,” Dr. Haworth says. “In my case, I had to work with a rectangular operating room, in which case I first had to decide where the anesthesia machine would be situated, since its range of movement would be limited by the oxygen and vacuum hoses tethering it to the ceiling. Consequently, it was important for me to have a 180-degree turning radius for the operating table, so I could position it according to whether I am performing facial or body surgery. Of course, OR lights have to follow suit and must be very mobile and bright. My Trumpf LED [Trumpf Medical] system fits the bill nicely.”
2. A Quality Monitor and Sound System
Having a big monitor with a good sound system for music is not only a luxury but a necessity for the modern plastic surgeon. Having the monitor in constant view is a must, according to Dr. Haworth.
3. Intelligently Designed Cabinetry
Proper cabinetry, design to maximize space and efficiency, is essential, according to Dr. Haworth.
“You can never have too many cabinets from the get-go, since these promote organization and obviate the need for vulgar retrofits in the future,” he says. “When it comes to designing my clinic or the operating room, I think that creating and maximizing the feeling of unrestricted space is important for both the patient’s sense of security and the staffs’ sense of clarity.”
4. Don’t Cut Corners
Don’t cut expenses, when it comes to safety, according to Dr. Cohen.
5. Seek Expertise
Dr. Cohen says cosmetic surgeons should tap experts in designing operating rooms.
“Reach out to architects with experience in both the design and credentialing processes,” Dr. Cohen says. “Ultimately, certain third-party inspections may be required, and you don’t want to be caught off guard.”
Dos and Don’ts for the In-office OR
Erin Metelka, an interior designer with Studio Four Design, offers these design dos and don’ts.
- Use a sheet flooring, with heat welded seams and sanitary cove base.
- Use bleach cleanable/non-porous products.
- Use clean/calming colors.
- Provide a variety of adjustable ambient lighting options.
- Utilize floor patterns to designate the extents of the sterile zone and care-provider zones.
- With the wide variety of procedures that occur in an operating room, often times, the table is moved in order to accommodate the most efficient workflow with the other equipment in the suite. The floor patterns can also be used to dimension the proper location of the table for these various scenarios.
- When creating several operating rooms, utilize an identical layout (not mirrored). Often, physicians are moving into adjacent operating rooms for a procedure, while a room is being turned over and sterilized. Having identical layouts increases efficiency and reduces error.
- Do not have extraneous items of décor within the suite, such as artwork.
- Do not utilize fabric of any kind such as curtains/draperies. If there are windows, create privacy with natural light by using integrated frosted glass. If an upholstery is required for a physician stool or other items, a bleach cleanable vinyl is a suitable alternative, ideally with a Crypton or nano-technology finish applied (these finishes work to prevent moisture penetration to the cushion and function as an antimicrobial).
- Do not place any direct down-lighting, with the exception of the surgical boom, directly over the table.
As with any service industry, there are convenience stop businesses and destination businesses. You see that with restaurants (think of McDonald’s or Chili’s versus French Laundry, one of the best restaurants in the United States) and you see this concept applicable to the plastic surgery business. I stress the term business and not medical field for a reason in this essay. I can safely say that most people that pursue higher education in any country do so to seek a better life, better pay and have more opportunities come their way. Of course, most scrupulous doctors experience immense satisfaction from treating their patients as well and, cynically speaking, are not simply in it for the financial award.
Like all professionals, doctors do seek out (and deserve) a certain financial reward for all the years of dedication, study, stress and life sacrifice they undergo in order to carry out their profession and deliver the best care they can to their patients. However, in this day and age of increasing competition and commoditization in all aspects of health care including plastic surgery, surgeons are forced to perform more surgeries at lower costs and possibly increased medical risk to patients. This alarming trend can especially be seen in plastic surgery where the end results of a hastily performed surgery are not hidden within a body cavity but are plainly visible on the face. Some of my colleagues brag about the speed at which they perform a surgery citing the many corners that they “cut” during an operation as unnecessary steps (no pun intended). I suppose they feel more akin to a Usain Bolt than that of a gifted watchmaker.
This brings me to the title of this blog post-The Lifestyle Lift. To the unsuspecting public this facelift is heavily marketed as a viable, simpler, safer, faster quality facelift at a fraction of the price. In fact, this facelift is an overly simplified distillation of pre-existing ideas wrapped in a new packaging as something brand-new and revolutionary. The one aspect that is revolutionary about this facelift is that it is one of the first surgeries that has been rebranded and marketed directly to the “consumer”. The company then refers the “consumer’ to one of their participating surgeons in the network to become a patient. Unfortunately, as a Beverly Hills plastic surgeon board-certified by the American Board of plastic surgery, I have seen many results of this “Lifestyle Lift” that reek “cookie-cutter surgery” in which performance is measured in terms of speed and not quality.
I have seen many unacceptable, hideously widened scars most probably stemming from the fact that the surgeon did not perform a wide enough dissection to allow a tension-free closure (which is tantamount to a good scar). I have also consulted with many patients who were dismayed by how the “Lifestyle Lift” failed to meet their expected goals with incomplete treatment of their jowls, neck and midface.
While it is true that all surgeons have their small subset of unhappy patients either because of unrealistic expectations, sub-optimal results or unexpected complications, the large percentage of unhappy patients complaining of their “Lifestyle Lift” is too hard to ignore. For a good article on the subject that appeared in Plastic Surgery Practice.
The appeal is obvious: less bruising, less prolonged swelling, less initial expense, less scary for the wary and more predictable (in the proper hands) with less risks. However, the injectable technique cannot be used to correct all types of cosmetic nasal problems and deformities. This is especially true for noses that need to be reduced in size and refined in shape. One does not need to be a genius to realize that fillers may do little to make a nose smaller by removing humps, refining tips and narrowing bones, no matter how well injected they are. The ideal candidate for an injectable rhinoplasty is the nose that needs to be augmented, either via it’s bridge (or dorsum) or it’s tip or both. A drooping tip can be elevated only to a subtle degree with filler.
Filler is also a great solution to those noses that have minor irregularities stemming from prior rhinoplasties. Filler will generally not help breathing problems. To learn more about this elegant solution to a rather common problem, check out these videos:
1.Extra Injectable NoseJob
2.Today Show Injectable NoseJob
3.Extra Artefill Injectable revision rhinoplasty
Dr Randal Haworth of Beverly Hills counts primary and revision rhinoplasty as one of his specialties of plastic surgery
Not only do I find it immensely gratifying to invent new solutions to challenging problems, I actually like the ” feel” of the surgery- the intricate interplay between skin, cartilage and bone. Even after 16 years of private practice, I discover new, exciting nuances in techniques that the average surgeon performs without feeling. Though I considered myself “top of my game” at the time I was doing plastic surgery on ” The Swan” in 2004, I look back upon those patients today and realize I could do better on a third of those rhinoplasties I performed! Like an artist, I always aim to do better and realize that my work today is better than it was in 2004 and will be better still 5 years from now, barring some personal tragedy.
The first era for me in rhinoplasty surgery was about creating beauty and my second era is about controlling beauty- imbuing a subtle softness into the result, and erasing all signs that humans hands had anything to do with the patient”s nose. A good pianists doesn’t just play the notes and chords accurately but also with crescendo and pianissimo- with feeling. My next series of blog posts will revolve around the subject of nasal surgery and aim to share with you certain concepts, both basic and advanced, that are important to both the lay person and surgeon alike.
Dr Randal Haworth of Beverly Hills is a specialist in all forms of aesthetic plastic surgery including primary and revision rhinoplasty.For further information go to drhaworth.com