A Retrospective Observational Study on the Eleganza Protocol: A Standardized Seven-Step Workflow for Combined Aesthetic Surgery

Background Combined aesthetic surgery ("mommy makeover") is increasingly performed to address postpartum body contour deformities; however, prolonged operative time remains associated with increased perioperative morbidity. The Eleganza Protocol was developed as a standardized workflow-oriented approach designed to optimize operative sequencing and operative efficiency during combined aesthetic surgery. Methods A retrospective observational study was conducted including 13 consecutive patients treated at two independent surgical centers using the Eleganza Protocol. The protocol consists of a predefined seven-step operative sequence integrating coordinated team-based execution, neuraxial anesthesia, and an anterior-to-posterior surgical workflow. Combined procedures included mastopexy, breast augmentation, abdominoplasty, and extensive liposuction. Primary outcomes were operative time and 30-day postoperative complications classified according to the Clavien-Dindo system. Secondary outcomes included estimated blood loss and intraoperative transfusion requirements. Results Most procedures were completed within four hours, with nine of 13 patients (69.2%) finishing within this threshold (median operative time: 3.5 hours; q25-q75: 3.0-4.5). The median estimated blood loss was 250 mL (q25-q75: 100-300 mL), and no intraoperative transfusions were required. No major postoperative complications (Clavien-Dindo grade ≥II) occurred during the 30-day follow-up period. Minor self-limited complications included transient edema and ecchymosis. No patient required prolonged hospitalization beyond the planned overnight stay. Conclusions This retrospective observational study describes operative performance and short-term safety in consecutive patients undergoing combined aesthetic surgery using the Eleganza Protocol. Operative times remained within a consistent range despite procedural variability, with low estimated blood loss and no major short-term postoperative complications. Further prospective multicenter studies are warranted to evaluate reproducibility, operative performance, safety, and long-term outcomes.