News & Features

Doing Several Plastic Operations at Once

“Cosmetic Cocktailing” Staff Report
Medically reviewed by Robert Spies, M.D., and F.A.C.S.

Doing Several Plastic Operations at Once More plastic surgery patients want their time under the knife to really count. So many are showing up at their surgeons’ offices with wish lists of several procedures they want done -- all at once.

“Patients commonly turn up in my office with a list of cosmetic procedures they want done at once,” says Elbert Cheng, M.D., a plastic surgeon at The Center for Facial Rejuvenation in Los Gatos, California.

But how much plastic surgery is too much? For invasive surgery, experts say it can be risky to stay under general anesthesia longer than five or six hours. According to the American Society for Aesthetic Plastic Surgery (ASAPS,) that’s about enough time for a facelift, eyelid surgery and brow lift.

“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 Laser and Skin Center in New York City. (An embolism is the sudden blocking of an artery by a blood clot.)

One common procedure that combines several procedures has been studied. The American Society for Dermatologic Surgery noted many patients were undergoing facelifts and laser surfacing to remove tell-tale signs of aging and sun exposure from their freshly tightened facial skin. Tina Alster, M.D., a Washington, D.C.-based dermatologic surgeon analyzed 34 patients who had both procedures at once.

“Clearly, combining laser resurfacing and facelifts in one procedure maximizes aesthetic outcomes without increasing potential side effects,” Dr. Alster said.

Yet another method to speed things up is by two surgeons joining forces and operating together on one patient, thereby shortening the amount of time the patient spends under general anesthesia. That often happens in
body contouring operations when many feet (or yards) of skin must be removed from a patients. More commonly one plastic surgeon operates on one patient.

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

It’s not only happening in Chicago. Undergoing multiple plastic surgery procedures is a rapidly growing trend, according to the American Society of Plastic Surgeons who records 34 percent of U.S. plastic surgery patients in 2004 having several cosmetic procedures done at once. Those patients are motivated by a chance to cut 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 off the job than racking up several no-shows.

For instance, during one recent operation, Drs. Epstein and Pielet working together, decreased the time one patient spent in surgery 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. Surgeons repeatedly tell their patients those head-to-toe makeovers seen on “The Swan” or “Extreme Makeover” just do not take place in a single 45-minute operation. It only seems that way because many months of aesthetic overhauls are compressed into one show.

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 includes:

  • Breast augmentation and tummy tuck.
  • Breast augmentation and liposuction.
  • Brow, face and neck lift.
  • Hysterectomy and tummy tuck.
  • Hysterectomy and liposuction
  • Hysterectomy and facelift.

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

He also suggests getting some background on the surgeon to make sure he or she has the stamina for an operation that can last eight to 12 hours. However, older patients should stagger, not combine, procedures. Verboten multiple operations include doing an outer thigh lift at the same time as the inner thigh lift because when the leg is lifted, too much pressure is put on the stitches.

“Cosmetic Cocktailing” is what Babak Azizzadeh, M.D., a Beverly Hills facial plastic and reconstructive surgeon recommends for getting the best results from several procedures.

“There are so many new and innovative techniques and products available to surgeons that we can produce unprecedented results when done in combination,” says Dr. Azizzadeh.

One of the most common dual operations is combining an Endoscopic Brow lift with Botox injected into the outer eyes and forehead. (An endoscope is a surgical tool the surgeon inserts under the skin through small holes instead of making a large incision that will accommodate a human hand. The tool allows the surgeon to both see and operate.)

“The brow lift raises the eyebrow arch without an eyelid incision, while the Botox reduces crow’s feet and forehead furrowing,” Dr. Azizzadeh says.

For older patients who have a lot of loose facial skin, Dr. Azizzadeh recommends a facelift to rejuvenate the jowls and jaw line combined with Sculptra to plump up the mid-face. The filler is needed because our faces naturally lose fat pads under the skin as we age. And that allows the skin to sag.

Thomas Barnes, M.D., a Newport Beach, California, plastic surgeon combines liposuction with a high-tech device known as a Polaris to treat patients who have a smaller area of lower tummy “pooch” they want to lose. Normally, the Polaris uses its combination of radio frequency and light to simulate collage formation under the skin and rapidly reduce fine lines and wrinkles on the face.

“My ‘Tummy ShrinkLift’ combines a mini-liposuction with the Polaris to create a loss of several inches in about half an hour,” says Dr. Barnes. “The liposuction removes some fat while the Polaris has a shrinking effect.” He says the Polaris does its work better when the skin has first been loosened from the fat.

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

Among other common combinations, Dr. Capraro says he sees are: Facelifts plus fat transplants and facelifts with soft tissue fillers like Radiance and Restylane.

“Overall, I find patients come to the office very well educated – thanks mostly to the Internet -- about plastic surgery and the list of procedures they want,” says Dr. Capraro.

But, no matter what the level of education, there’s no help for people who carefully make lists, only to lose them.

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