Combining Multiple Plastic Surgery Procedures – Is it Safe?

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


July 29 2008

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Multiple Plastic Surgeries

Perhaps you've seen them on reality TV shows like Extreme Makeover, The Swan, and I Want A Famous Face: people who undergo three, four, five, or more cosmetic plastic surgery procedures at the same time. Ever wondered why anyone would do such a thing?

For an increasing number of plastic surgery patients, one procedure is just not enough. According to statistics from the American Society of Plastic Surgeons (ASPS), 42% of all U.S. cosmetic plastic surgery patients in 2007 had two or more procedures performed at the same time. That's up from 34% just 3 years earlier.

"Combining a few minor procedures is certainly safe when there's a time limit that's appropriate on anesthesia, when the patient is a healthy candidate, and when there is the correct decision on which procedures to combine," says Philip Haeck, MD, a board-certified plastic surgeon in Seattle and chairman of the ASPS Patient Safety Committee.

Why is the so-called "one stop chop" so popular? It comes down to three basic reasons: patients may need multiple procedures to achieve their desired results, stacking those procedures reduces total time in surgery, and there's money to be saved on anesthesia and facility fees. In short, a comprehensive treatment plan can result in a complete transformation in a shorter time for less money.

Pros of Combining Multiple Plastic Surgeries

Like all surgeries, plastic surgery costs break down into three categories: anesthesia fees, facility fees, and surgeon's fees. By combining two or more procedures into one surgical session, the patient is billed for one anesthesia fee and one facility fee. And, in some cases, plastic surgeons may package certain procedures at a discounted rate, so the patient realizes a trifecta of savings.

Some of the most commonly combined surgical plastic surgeries are brow or forehead lift, face lift and neck lift; breast augmentation, breast lift, and tummy tuck (the mommy makeover); tummy tuck and liposuction; tummy tuck and face lift; face lifts and fat grafting; and certain noninvasive or minimally invasive procedures (injectable soft tissue fillers, Botox® Cosmetic) and a surgical procedure.

Cons of Combining Multiple Plastic Surgeries

All surgery carries risks, and extreme plastic surgery ups the ante. One of the biggest concerns is that the cumulative effect of multiple procedures performed during a single operation may increase the potential for complications. Another is the risk associated with extended time under general anesthesia because the longer a patient is under, the greater the risk for cardiovascular complications and the longer the recovery period.

Dr. Haeck notes that while there isn't a time limit per se, being under anesthesia for more than 5 to 7 hours can bring on increased risk for recovery. This is a particular issue when two major invasive procedures are combined, like liposuction and abdominoplasty. "There are always issues of correct monitoring – should that patient go home, should that patient be monitored overnight – but that's especially true when it's combined with liposuction because of the amount of local anesthesia that gets used," he explains. "If there is a lot of liposuction performed in conjunction with another major surgery, the lidocaine that's used during liposuction sometimes doesn't peak in the blood stream until several hours after the procedure is over. So the potential to have cardiac side effects occurs after the patient has been sent home."

"The really dangerous time limits are up to 10 to 12 hours of surgery that combine major procedures like abdominoplasty, breast surgery, and a face lift. That goes beyond common sense," concludes Dr. Haeck, adding that some states are beginning to set time limits of 4 to 6 hours for surgery done outside of a hospital setting, such as office-based or ambulatory surgery procedures.

However, a study involving 248 patients over a 10-year period and released in 2005 concluded that there was no statistically significant increase in minor or major complications in patients who underwent prolonged anesthesia. The patients were divided into four groups according to their surgeries: abdominoplasty only, abdominoplasty with breast surgery, abdominoplasty with face lift, and abdominoplasty with both breast and face lift surgery.

"No significant difference in morbidity or complications rates was found in the four different groups studied," reports Grant Stevens, MD, the board-certified plastic surgeon who conducted the study in California. He adds that combined procedures may yield higher patient satisfaction because they allow patients to see their results more quickly with less time off from work. Dr. Stevens says the minimum requirement for a surgery involving multiple procedures should be an experienced, board-certified plastic surgeon with hospital privileges and a board-certified anesthesiologist.

If you are considering having multiple plastic surgeries at the same time, consult with a board-certified plastic surgeon who's experienced in the combination of procedures you're seeking. Verify that he or she has successfully performed many of these lengthy procedures, and ask to speak to some patients, if possible. You should also check on the certification of the surgery site, if it is not a hospital.

You must also understand that if you have any underlying health condition such as high blood pressure or diabetes all bets are off as far as multiple surgery. You may need to have each procedure separately.

As rewarding as a complete transformation may be, it's critical that you know all the risks and benefits going in.