This Plastic Surgeon Says ‘Combo’ Procedures Are Trending, and Here’s Exactly What That Means


Like a lot of his colleagues in the field, Eugene, OR plastic surgeon Lee B. Daniel, MD says, even though his specialty is aesthetic surgery, he’s seen a solid surge in patients coming in who want to couple a “bigger” procedure with something nonsurgical—so much so that he’s experiencing a bit of a backlog at his practice and corresponding med-spa. Here’s what Dr. Daniel counts as the most popular combo treatments consumers are calling for this summer, and how they often segue between one and the other:

Are these combo procedures something you’ve seen gain popularity during the past year?

“When I came to Eugene 20 years ago, I think I was really the first person to start a full-on medi-spa. And, in those early years, it was loss leader!  I used it to generate traffic in my practice, because for a patient to come in for a surgical consultation, it’s a big deal, but for a patient to come in and have a facial, and run into the surgeon in the hallway, that’s less intimidating.

I’d like to consider myself a human being first, someone who is approachable, and a doctor second. As people have a chance to initially meet me through my spa side, they realize that I’m not some plastic surgeon to be put on a pedestal. Connecting on that the spa side has generated a large amount of traffic to the practice, and now it’s a huge part of the practice.

We currently have four aestheticians, and a couple of nurse injectors, and it’s just a normal segue to have patients come in and to feel comfortable with the office, the staff and then me, in general, and then maybe go further and proceed with surgical interventions. Of course, the other side is true as well—some patients come in first for surgical interventions, then we do some of the maintenance over at the spa after their facelift.”

Was there anything that was popular at the spa during the last year that surprised you?

“I’m the penultimate rule follower, and, at the beginning of the pandemic, we went into full-on lockdown and I shut my practice. We’re an elective cosmetic practice and it just didn’t make sense in the early days of quarantine to try to see if we could still do anything in the office, so we shut down for two-plus months. Then, as we started feeding back into it, I think that there were a lot of people who needed something to make themselves feel better about life.

Over the last year, as far as procedures go, we extended a lot of the surgery with what we have on the spa side with some of the machines—the electromagnetic technology like Emsculpt and Emsella, the DiamondGlow facials and some of the various skin-resurfacing treatments and such.

It’s been crazy busy—I’ve never been busier than I am with my surgical procedures now. I’m booking about 4 months out for the next available consult time…and that’s great, but I need another one of me to magically appear right now. If you ever saw the Michael Keaton movie, Multiplicity where he kept cloning himself, or Xeroxing himself, I wish I could do that!

The spa side does still feed me patients, and likewise, I do for them, but as far as a single procedure that picked up, when we first started coming back, people could wear their mask and I could inject their foreheads with Botox Cosmetic without taking off that mask, so that’s been consistently popular.

That was the first little inroads, but, again, being a rule follower, even doing facials was something we held off on—mainly because you’re right in somebody’s face, and you can’t wear a mask while you get one. Then, as we started looking at all the many Zoom conferences on how to manage your practice through COVID, we did all the right things but, and, at the same time, realized some of the nonsurgical stuff, like CoolSculpting, you could safely and accurately do and still wear a mask. The same goes for the electromagnetic muscle-stimulating machines. Those were things that we could still do while patients were masked up.

I got back into the operating room once we realized we had enough PPEs to do elective cosmetic surgery—because a facelift doesn’t equate to when someone has a hot gallbladder that needs to be removed right away—but the backlog that that created is something that I’m still dealing with, and that’s why I’m so busy with surgical procedures and consults right now.

I’m not arguing, but I typically have always tried to have Wednesday off. Mainly for my mental health, and I’ve got a neurosurgery buddy, and he and I go fishing. We like to do the fishing thing, and typically Wednesday is a sacred day. It’s also been a buffer day for me too. If I had the need to put somebody in on a Wednesday, maybe we’d fish half a day, or something like that, and now I’m working a lot of Wednesdays, so I’m having to fish on weekends, which is just a horrible problem to have, but it’s all right!”

Is there anything that you’re surprised has become popular as summer approaches?

“I don’t know that it’s any single thing that has become popular. Certainly, the nonsurgical stuff has been a boom, but the surgical stuff has as well. I think almost globally, my whole cosmetic practice has been a place for a lot of patients to go who were maybe only “thinking” about getting something done before. Now, they have some time to do a procedure like a mommy makeover—a combined breast and tummy, the mommy makeover thing, and it’s not uncommon to see three or four people per day for that procedure. But I think it’s safe to say every procedure has increased—it’s kind of crazy, but it’s a good problem for a surgeon to have!”