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Coon, Devin M.D.; Michaels, Joseph V M.D.; Gusenoff, Jeffrey A. M.D.; Rubin, J. Peter M.D.

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Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 683-684
doi: 10.1097/PRS.0b013e3181df7267
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We would like to thank Thommaso Agostini et al. for their thoughtful comments regarding our article on procedure combination and staging in body contouring.1 The writers convey their experience using two teams to facilitate closure and reduce intraoperative time in 15 body contouring patients. We fully agree that a team approach represents a safe and effective way of performing multiple body contouring procedures. As mentioned in the article (on p. 694), our surgical team typically consists of the attending surgeon, a dedicated body contouring fellow, and a physician assistant or plastic surgery resident. This facilitates our ability to execute a complex operative plan efficiently in the operating room.

Our focus on the team approach also extends beyond the operating room. Having staff with years of experience in body contouring allows us to use and continually improve standardized methods for preoperative assessment and postoperative care. We have previously discussed the advantages that can be realized over time with a center-of-excellence approach.2 With the continuing growth in post–bariatric surgery plastic surgery, outcomes analysis and continual process improvement will be valuable in maintaining safety for patients undergoing multiple procedures.


The authors have no financial interest in the content of this communication.

Devin Coon, M.D.

Division of Plastic and Reconstructive Surgery

University of Pittsburgh Medical Center

Pittsburgh, Pa.

Joseph Michaels V, M.D.

Chevy Chase, Md.

Jeffrey A. Gusenoff, M.D.

Division of Plastic and Reconstructive Surgery

University of Rochester Medical Center

Rochester, N.Y.

J. Peter Rubin, M.D.

Division of Plastic and Reconstructive Surgery

University of Pittsburgh Medical Center

Pittsburgh, Pa.


1. Coon D, Michaels J, Gusenoff JA, Purnell C, Friedman T, Rubin JP. Multiple procedures and staging in the massive weight loss population. Plast Reconstr Surg. 2010;125:691–698.
2. Tang L, Song AY, Choi S, Fernstrom M, Rubin JP. Completing the metamorphosis: Building a center of excellence in postbariatric plastic surgery. Ann Plast Surg. 2007;58:54–56.

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