Between the first consultation and the day of surgery there's a process that at most clinics is opaque: you receive a quote, sign a consent form and turn up at theatre. At ARQÉA that process is deliberate and explained. This article describes exactly what happens from the end of the initial consultation until you enter the operating theatre, who is involved at each step, and why things are done in that order.
The diagnosis: how your case is analysed
The initial consultation is the starting point, but the real diagnostic work happens in the hours and days that follow. With the clinical photographs, the video record, the facial analysis and the information you shared at the consultation, Dr Gutiérrez works through the surgical plan in detail.
Photographic, video and 3D analysis
The clinical photographs taken at the consultation (front, right and left profile, three-quarter and from below) are a fundamental working tool. But a photograph captures a static moment, and the face isn't static: it's expression, movement, conversation. That's why at ARQÉA we also use video recording as a primary diagnostic element. How a jaw moves, how the profile changes when speaking or smiling, or how the skin behaves in motion provides information no photograph can capture.
We also carry out real-time 3D diagnosis during the consultation using advanced facial capture technology (Arbrea Lab). With an iPad and the right software, we generate a three-dimensional model of your face in the consultation itself, with no need to wait days or refer you to an external centre. This makes it possible to visualise proportions, asymmetries and the realistic possibilities of your case immediately, before any decision is made.
Diagnostic imaging: when it's needed and when it isn't
Not every procedure requires additional imaging. It depends directly on the type of operation:
- Lip lift, tracheal shave: not in most cases (soft-tissue procedures with no bone work)
- Forehead, jaw, chin: clinical photographs plus case-by-case assessment (moderate bone work, photographs are usually sufficient)
- Orthognathic surgery: CBCT (3D scan) mandatory (requires virtual surgical planning of the bone movement)
- PEEK implants: CBCT or CT scan mandatory (the implant is custom-made on the patient's 3D model)
- Rhinoplasty (with Dr Ramón Tarragona): photographs plus case-by-case assessment (may require imaging if there's a functional component)
If your case requires additional imaging, we tell you before the consultation so you can provide it or arrange it in advance. These tests are currently carried out at external diagnostic centres. When ARQÉA opens its own clinic, we will have an integrated CT scanner.
Virtual planning and cutting guides
At ARQÉA, every surgery involving bone work is planned on three-dimensional imaging. From the CT or CBCT scan we build a virtual model of your bone structure, on which Dr Gutiérrez plans the surgical movements precisely before entering the theatre. This applies to orthognathic surgery (double-jaw, single-jaw, SARPE) as well as to PEEK implants and forehead feminisation.
This virtual planning isn't just diagnostic: it generates custom cutting guides used during surgery to guarantee millimetre precision in every osteotomy. Dr Gutiérrez doesn't operate on approximate references: he operates on a three-dimensional plan executed and documented before touching the patient.
About morphs: many patients arrive at the consultation with reference images or morphs they've generated themselves. We use them as a starting point to understand the aesthetic direction you want, and at ARQÉA we also have our own simulation software to generate morphs during the consultation. A morph is a tool for visualising how changes take shape and exploring possibilities, not a guarantee of result. It doesn't account for anatomical limitations, bone thickness or how your individual tissues respond. If the morph is realistic, good. If it isn't, Dr Gutiérrez will tell you honestly.
The surgical plan: what it includes and how decisions are made
The surgical plan isn't a list of procedures. It's a reasoned proposal that explains what to do, in what order, why that and not something else, and what the realistic expectation of result is. At ARQÉA that plan reaches the patient in writing, always.
Single or combined procedure: how it's decided
One of the most important planning decisions is whether to operate in one session or several. Three factors mainly determine this:
- Total surgical time: there is a reasonable limit to hours under general anaesthesia. Going beyond 9–10 hours in a single session increases the anaesthetic risk and the risk of complications. Above that threshold, splitting into two sessions is safer even though it means two recoveries.
- Technical compatibility between procedures: some procedures combine well in the same session (forehead and tracheal shave, for example). Others can interfere with each other or require incompatible surgical positions.
- Clinical and aesthetic priority: if one procedure conditions the result of the others, it goes first. For example, it makes no sense to perform a facelift before modifying the jaw structure, since the later bone change would directly affect the soft-tissue result.
What Dr Gutiérrez does not do: bundle procedures into a single session to maximise the bill. If splitting into two sessions is safer or gives a better result, that's what he recommends, even if it means less revenue from a single surgery.
When Dr Gutiérrez says no
There are situations where the answer to a request is no, or not yet:
- When the requested procedure has no clear clinical indication for that case
- When the patient's general health advises against surgery at that time
- When the expected result cannot be achieved with surgery (what can't be achieved is said before, not after)
- When a necessary prior procedure hasn't been done, because the final result would depend on it
This doesn't mean the patient has no voice in the plan. It means the plan is a conversation between what the patient wants and what the surgeon considers indicated, and when they don't match, it's discussed honestly.
The quote: what it includes and what it can never include
ARQÉA's quote is all-inclusive. That isn't a slogan, it's an operating policy. What appears on the quote is what you pay. There are no later add-ons for anaesthesia, materials, check-ups or minor complications that fall within the standard protocol.
What the price includes
- Dr Gutiérrez's fees
- General anaesthesia and the anaesthetist's fees
- Use of the operating theatre and hospital centre (IM Clinic and Gournay, Barcelona)
- Surgical materials, implants where applicable, and sutures
- One night in hospital if the procedure requires it
- Postoperative check-ups included in the standard schedule
What may involve an additional cost
- Prior imaging tests if you don't have them (CBCT, CT scan), until ARQÉA has its own in-clinic equipment
- Postoperative medication (prescribed at discharge and purchased at a pharmacy)
- Revision surgeries for causes unrelated to the initial procedure
Revision surgery insurance: ARQÉA offers the option of taking out revision cover for a symbolic cost of €250. In the event of a complication requiring a second operation or corrective treatment, the costs would be covered. It's an option, not an obligation, but it's one of the few real guarantees a surgical clinic can offer.
About our prices: ARQÉA's prices are roughly 50% lower than those of other specialist centres in the Spanish market for the same procedures. That difference doesn't come from reducing clinical quality but from removing layers of corporate structure. The surgeon who sees you at the consultation is the same one who operates, in a leading surgical centre, without intermediaries who raise the price without improving the result.
From decision to booking: how surgery is confirmed
When you decide to go ahead, confirmation is straightforward. There's no time pressure and no small print.
The booking process
- You tell the coordination team your decision through whichever channel you prefer (WhatsApp, email or phone)
- Available theatre dates are proposed around your availability
- Your date is booked with a deposit of 20% of the total quote. The remaining balance must be paid at least two weeks before the operation
- You receive written confirmation of the date, procedure and total price
- Your coordinator will contact you to request the necessary documentation: ID or passport, blood tests, medical letter and travel details where applicable
- Don't book flights until you receive schedule confirmation. We want to make sure everything is in order before you take on travel commitments
- If you've had a Covid infection in the 2–3 weeks before your scheduled date, surgery must be postponed as a safety measure
Cancellation policy
The deposit is non-refundable if you cancel surgery less than 60 days in advance, except in duly justified cases of force majeure (in which case €350 is retained as an administrative fee). If you need to change your surgery date, let us know at least 60 days in advance to keep your deposit. Date changes carry an administrative fee of €350.
Informed consent
Informed consent is not a quick-signature formality. It's a document that precisely describes the procedure, its real risks, the possible alternatives and the reasonable expectations of result. At ARQÉA it's given to you well in advance so you can read it calmly, ask questions and sign it once you've understood it.
Alongside the written document, ARQÉA has a YouTube channel where Dr Gutiérrez explains each of the procedures we perform on video, including their real risks. It's content no other clinic has produced at this level of detail, and we recommend watching it before your consultation. The videos don't replace the conversation with the surgeon, but they prepare that conversation better.
If anything in the consent form or the videos isn't clear, ask before signing. That's exactly what it's for.
Coordination and logistics: what the team handles for you
From the moment surgery is confirmed until the day of the operation, the team takes care of:
- Coordinating dates between theatre, anaesthetist and surgeon
- Arranging the preoperative consultation and any necessary tests
- Written preoperative reminders and instructions
- Availability to answer questions on WhatsApp during working hours, with replies within 24 hours
- Coordinating your hospital stay where applicable, and postoperative discharge
- Postoperative follow-up and management of your check-ups
How long does it take from consultation to surgery?
The full process from first consultation to surgery usually takes between 4 and 10 weeks in most cases:
- Initial consultation and delivery of the plan: 1–3 days after the consultation
- Your decision time: variable, with no pressure
- Date booking and documentation: 1–2 weeks
- Preoperative tests if needed: 1–3 weeks depending on availability
- Preoperative preparation (no smoking, stopping medication, dental clean): up to 8 weeks depending on the case
- Preoperative consultation: the week before surgery
If you have a target date (for work, travel or other reasons), tell us from the start. The team plans the process backwards from that date to see whether it's feasible and what needs to be brought forward.
Frequently asked questions about surgical planning
Can I ask for a second procedure that wasn't in the initial plan?
Yes, but there's a right moment to do it. If a new question arises before surgery is confirmed, it's discussed during preoperative coordination and the plan is updated if it makes sense. Adding a procedure on the day of surgery isn't possible: it requires planning, additional theatre time and, in some cases, specific materials.
How long do I have to decide after the consultation?
As long as you need. The plan and the quote don't expire in the short term. If a long time passes and there are relevant changes in your case or in prices, we tell you before anything is confirmed.
Can I change procedures after booking?
It depends on the change and how much time remains before surgery. Minor changes within the same surgical plan can be managed up to a point. Significant changes involving different theatre time, materials or planning require reviewing the date and the quote. Talk to the coordination team as soon as possible if you're unsure.
Can I have several procedures in the same session?
In many cases, yes. The decision depends on total surgical time, technical compatibility between procedures and the anaesthetist's assessment. As a general rule, we don't exceed 9–10 hours of surgery in a single session. If your case requires more time, splitting it into two sessions is safer and usually gives a better result.
Can the quote change between the consultation and surgery?
The quote you receive in writing is the confirmed price for that surgical plan. It only changes if the plan changes (if you add or remove procedures, or if new information emerges in the preoperative assessment that alters the scope of surgery). In that case we tell you beforehand, not on the day of the operation.
In summary
Between the first consultation and the operating theatre there's a deliberate process: photographic, video and 3D analysis at the consultation, virtual planning with cutting guides for every case, a reasoned surgical plan in writing, an all-inclusive quote with no surprises, and date confirmation with preoperative documentation. At ARQÉA that process is run by a team that replies within 24 hours and handles the logistics so that your only job is to prepare.
If you have questions about any part of the process, write to us. We're here to resolve them before they become a source of uncertainty.
→ Book your free consultation now
