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Patients-to-Docs: “My To-Do List!”


Multiple Procedures in Vogue

Patients-to-Docs: “My To-Do List!” More plastic surgery patients want their time under the knife -- or needle -- to really count. So they are showing up at their surgeons’ offices with wish lists of several procedures they want done at once.

While it can be risky to stay under general anesthesia longer than five or six hours, according to most experts, a few patients are getting more personal rejuvenation work done by going to a pair of plastic surgeons who work as a team. The arrangement shortens the amount of time a patient must spend under anesthesia.

Doctors Michael Epstein and Rodger Pielet, board certified plastic surgeons at Aesthetic Plastic Surgery Associates in Chicago, make their patients’ time under general anesthesia count: one surgeon works on the upper body while the other tackles plastic surgery chores below the belt.

Whether it’s invasive or non-invasive procedures, undergoing multiple procedures is a rapidly growing trend. According to the American Society of Plastic Surgeons, 34 percent of U.S. patients who underwent plastic surgery in 2004 had several procedures done at once. Most of those plastic surgery patients are motivated by cutting expenses on hospital and anesthesiologists’ fees while suffering the woes of a single recovery period instead of several. Moreover, patients say it’s better to take fewer days taken off the job instead of racking up several no-shows.

For instance, during one recent operation, Drs. Epstein and Pielet working together, decreased the time one patient spent under the knife from an estimated six to just under four hours. Their patient underwent a tummy tuck, a knees-to-buttocks liposuction, a face peel and fat grafting to fill hollows under her eyes. To receive the surgeons’ double team service, patients must be in good health, have specific complaints and realistic expectations for their surgical outcomes. For instance, those head-to-toe makeovers seen on “The Swan” or “Extreme Makeover” just do not take place in a single operation. Or, even two or three.

“When a patient is under general anesthesia longer than six hours, the risk of pulmonary embolism increases,” says Michael Bruck, M.D., director of plastic surgery at the JUVA Center in New York City.

According to Dr. Philippe Capraro, M.D., a board certified aesthetic and reconstructive plastic surgeon at Grossman Plastic Surgery in Denver, the list of approved, commonly done multiple procedures among his colleagues is:

  • Breast augmentation and tummy tuck.
  • (Procedures above, plus...) liposuction.
  • Brow, face and neck lift.
  • Hysterectomy and tummy tuck.
  • (Procedures above, plus...) liposuction
  • (Procedures above, plus...) facelift
  • (Procedures above, plus...) liposuction


“It’s not a good idea to do more than one procedure under anesthesia in a surgeon’s office,” says Dr. Capraro. “For a facelift, tummy tuck, breast reduction or lift, body lifts and liposuction that removes over five liters of fat, we recommend having the operations done in a hospital and staying overnight. Not even an emergency room is a safer place to be!”

Before undergoing multiple surgical procedures, Dr. Capraro also recommends having blood and urine screenings, an EKG and -- for women over 30 doing any type of breast surgery -- a mammogram.

People who choose to avoid the knife are also trying to combine several procedures in one visit.

“Patients commonly turn up in my office with a list of cosmetic procedures they want done,” says Elbert Cheng, M.D., a plastic surgeon at The Center for Facial Rejuvenation in Los Gatos, California. “The most common request here is for Botox to smooth wrinkles and some type of filler to erase smile lines, those facial grooves that run from the nose to the corner of the mouth and from the corner of the mouth down to the chin.”

Dr. Capraro says the most commonly done non-surgical combinations are facial treatments with injectables like Botox, Restylane and Radiance.

“Of course, the injectables must be done last because the patient can’t lie down for four hours afterwards,” says Dr. Capraro. “Any facial treatments that require sedation – like a laser treatment – might not be a good idea because the patient will be tired and want to stretch out.”

Among the surgical and non-surgical combinations, Dr. Capraro says he sees:
  • Facelifts and fat transplants.
  • (Procedures above, plus...) soft tissue fillers like Radiance and Restylane.


Adds Dr. Cheng: “Thermage and the fillers are often requested but don’t go together because the heat from Thermage causes reactions that leave the patient’s skin red and itching.”

He also prefers to skip fillers in the frown lines of the forehead because the pressure of the fillers can cause the blood pressure in that area to collapse and the skin to die.

“But I receive many requests for Botox, fillers and Thermage,” says Dr. Cheng. “I can’t do them all at once but must break it up so that Botox and Thermage are given together and then, a week later, the filler.

“Overall, I find patients come in very well educated – thanks to the Internet -- about plastic surgery and the procedures they want.”

But there’s no help for people who carefully make lists, only to lose them.



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