OH Magazine

A Day in the Life of a Body Contouring Fellow

In July 2008, Dr. Daron Geldwert uprooted himself from San Diego, California to begin a year-long fellowship with Dr. Dennis Hurwitz in Pittsburgh designed specifically for young surgeons who wish to specialize in Body Contouring surgery. In addition to his clinical responsibilities, he will be conducting research related to body contouring surgery after weight loss.

Since the beginning of his career as a plastic surgeon nearly three decades ago, Dr. Hurwitz has been committed to intense hands- on education of residents in training. As a reflection of his effectiveness, he was voted their best teacher at the University of Pittsburgh in 2005. This fellowship was made possible through the funding of Aniogiotech, Inc, the maker of Quill sutures.

 

 

Below is a snapshot of Dr. Geldwert?s rigorous and rewarding fellowship schedule. Upon completion of his fellowship, Dr. Geldwert will join the Hurwitz Centers for Body Contouring Surgery.

Monday

5:30am:

I woke up with great anticipation for my first bodylift case since arriving in Pittsburgh.

6:30am:

Arrived at the hospital and met Lisa, who drove from West Virginia for her body contouring procedure after losing 160 pounds.

6:35am:

A University of Pittsburgh plastic surgery resident, a physician assistant and I listened and watched Dr. Hurwitz draw the pre-operative surgical markings on the patient?s abdomen, lower back, thighs, and buttocks for the planned lower body lift. He patiently explained the reason for each line and the order of this complex procedure. Our individual tasks were assigned, just as aviators are given a flight plan. As he took his preoperative photographs, final minute adjustments to the operative plan were made. We answered the patient?s last-minute questions and shared in her enthusiasm to ?re-shape? her life.

7:32am:

Lisa arrived in the operating room. Dr. Hurwitz comforted her until the anesthetics took effect. We then proceeded to carefully turn Lisa on her stomach and began the operation with excision of her lower back rolls and a lower body lift. He was sure that the anesthesiologist protected Lisa?s eyes and did not over extend the neck. Dr. Hurwitz paid attention to every detail. He made sure that the operating room, intravenous fluids, and infusion saline were all warmed to the proper temperature. The arms and legs were carefully padded. While the patient was being induced under anesthesia, he huddled with the scrub technician and nurses to check the equipment and outline the plan and order. Once Lisa was turned it was Dr. Hurwitz who adjusted her position on pads and pillows, while making last minute assignments of his assistants. He taped the forced hot air warmer for optimal patient warmth. While I was scrubbing to prepare for gowning and the prepping the patient, Dr. Hurwitz was reviewing with the anesthesiologist details of Lisa?s medical condition and how it might impact on the course of her surgery and what special monitoring and medications may be necessary. Finally contingency plans were being made should Lisa?s condition falter and we need to abandon any of the schedule procedures.

8:04am:

The operation started with a long incision between the buttocks and lower back. Because of the preliminary infiltration of saline with epinephrine, I was pleased at how little bleeding there is. Nevertheless, I am quick and precise to stop all bleeders with pinpoint electocoagulation. With this type of care and the use of autotransfusion, we should not have to use banked blood. Dr. Hurwitz skillfully separated the tissues and with proper assistance immediately found the desired plane of dissection as if following a road map. As surgery proceeded, Dr. Hurwitz explained the reasons for the order. The operation is like building blocks onto a firm foundation. Today I was only to be a helper, even though I had just completed my formal training in Plastic Surgery. Only after weeks of exhausting operations would I be able to actually excise some of the tissue in tandem with Dr. Hurwitz. He re explained the reasons for his incisions and how he would confirm the area of excision so that enough but not too much tissue would be removed. This is a judgment that is best honed from years of experience. He demonstrated the method of closure of the tissue and the preservation of blood supply to the areas left behind during body contouring. The buttock lift would clearly have left her flattened so a nearby fat flap was carefully mobilized to fill the buttocks. The resulting sensual curvature was amazing.

10:48am:

We carefully turned Lisa onto her back to complete the front portion of the operation. He showed me how to safely and easily turn her while under general anesthesia. Without special care there could be injury, especially to her arms or neck. Wrapping the patient in a sterile surgical paper gown and turning her as if she were is a hammock was a stroke of genius. Lisa was very self-conscious about her redundant abdomen. She could not wear regular clothing even after her massive weight loss. Pre-operatively, she was embarrassed to admit that her pubic area had descended and wanted to be certain that this could be corrected. Dr. Hurwitz reassured her that she was not alone and that we almost always performed what is called a ?mons reduction and lift? at the time of the lower bodylift procedure. 

1:12pm:

We completed the abdominoplasty and mons reduction portions of the procedure. Dr. Hurwitz emphasized the meticulous preservation of perforating blood vessels with the use of strategic liposuction and minimal undermining. I was surprised how rapidly he removed all that excess skin and organized us into three sewing machines to close her massive wound up in less than an hour as he crafted her umbilicus. After about 5 hours into the operation, I could see Lisa?s transformation taking shape. At this point, I took a 5 minute break and grabbed a protein bar to get me through the second half of the case.

4:47pm:

We completed the medial thighplasty. I was feeling pretty exhausted after putting in what felt like a thousand stitches. It was surprisingly difficult to suture close the thigh skin at the buttocks fold. Meanwhile Dr. Hurwitz removed the excess fat from her arms through liposuction and then carved out the inner skin to restore a feminine shape and firmness long lost. At the end the transformation of Lisa?s body was inspirational, maybe awe inspiring. The day long operation was worth it. I understood for the first time, the artistic advantage of combining multiple operations. While I was there for virtually every moment, I felt inadequate to retrace every defining moment. I realized that it would take many months before I would be ready to take on such a challenge, but with Dr. Hurwitz?s patient teaching I know I will succeed. I was so excited by the results and looked forward to talking with Lisa when she woke up. Dr. Hurwitz and I reviewed his post-operative instructions and I wrote physician orders for her admission to the hospital.

5:01pm:

Dr. Hurwitz and I spoke with Lisa?s husband and her daughter.

6:13pm:

I was informed by Lisa?s nurse that she was requesting medication for break-through pain. I increased the rate of her patient-controlled pain pump.

8:20pm:

Saw Lisa in her hospital private room. Her nurse reported on her progress and with her assistance we changed bandages, examined her skin and made sure her two drains were functioning. She had pain all over, but it was well controlled by self administered low dose of intravenous narcotic. Lisa was tired but relieved that the surgery went well.

12:02am:

Called the nurse on the ward. Lisa was sleeping comfortably.

12:15am:
Off to bed. Tomorrow I will be seeing dozens of postoperative patients and three new consultations for Total Body Lift surgery, who have flown in from around the country. I need my rest to be fresh and alert. Dr. Hurwitz spends considerable time getting to know his patients and examining the skin problem to devise customized surgical transformations.

For more information on the fellowship, please visit hurwitzcenter.com.

January 2009