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Local Treasure

This past week, we spent an evening with dear friends at the Mission Inn in Riverside and had a wonderful dinner at Duane’s Prime Steaks and Seafood at the Inn. Duane’s has an AAA Four Diamond rating, as well as top awards from Wine Spectator and others – truly a remarkable dinner! But what struck us the most was the spectacular architecture, which reminded us of many similar places we had visited in Europe.

A look at the history of the Inn is quite interesting. First of all, “No”, the Inn has never been a mission nor was it built on the site of a mission! It was opened in 1887 as a luxury hotel, long after the Spaniards stopped building missions, a full 27 years after California was accepted into the Union! Over the years, it has gone through good times and bad, and has changed owners a number of times. A President’s Lounge in the Inn is lined by paintings of the ten US presidents who have visited the Inn.

Richard and Pat Nixon were married in the room now called the President’s Lounge, Ronald and Nancy Regan honeymooned at the Inn, and eight other presidents have visited. A cherished annual tradition, running from the day after Thanksgiving to the 6th of January, is the Festival of Lights, which has been voted as the best public lights display by USA Today. This event draws thousands of visitors each year. This place is definitely worth a visit!

Spotlight on Plastic Surgery---To Combine Procedures or Not to Combine?

This week’s focus will be on a dilemma many patients with multiple concerns face. When should procedures be combined or when should they be done individually? The answer to this issue depends on a number of factors. First and foremost, safety comes first. Your surgeon will tell you how long it would take to do your desired procedures, and if the total predicted time exceeds six hours, for elective surgery, it would be safer to stage some of the procedures into multiple shorter sessions. Next, the patient must be a good candidate for the desired procedures.

This means that the patient must have a rational reason for wishing the procedure and that the procedure can be performed safely. Some procedures on adjacent body parts should not be combined for fear of compromising blood flow to the areas between incisions. For example, we do not think it is a good idea to combine a tummy tuck and a thigh lift at the same time as this would leave a narrow bridge of tissue with incisions on multiple sides and compromise blood supply. But there are many combinations that do make sense for a number of reasons.

30 year old female before and after a breast augmentation and abdominal liposuction procedure, all done during a single surgical procedure (actual patient of Dr. Ekstrom)

For example, combining a breast procedure and an abdominal liposuction, or eyelids and a chin implantation at the time of a facelift, will leave the patient with decreased overall costs and less recovery time. With the first example, patients undergoing a breast augmentation usually are too uncomfortable to return to desk work for 3-5 days, and likewise following an abdominal liposuction. Combining the two procedures still leads to a 3-5 day recovery time, but you’d only have to do so once instead of twice. Cost wise, we usually give the patients a discount for a second procedure within the same surgical field, because putting someone to sleep one time and doing one surgical prep will lead to less surgical time than doing the two procedures separately.

The surgery centers and anesthesiologists calculate their charges based on time, with the first hour being the most expensive (they put into the first hour’s charges the cost of disposable supplies, resterilizing instruments, etc) and the cost for subsequent hours is decreased. Thus a three hour operation costs less than two one and a half hour procedures. So, if you have multiple concerns, discuss them with Drs. Ekstrom or Bunkis and your surgeon will go over your many options with you to come up with a customized plan that is just right for you.

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