Can I combine multiple plastic surgery procedures in one surgery?

Plastic surgery procedures may be combined in the same surgery, however many factors are first considered to ensure patient safety.  Combining procedures is often appealing to patients given that overall recovery time is shortened.  It may be more cost effective by decreasing operating room expenses and facility fees.  The post-operative results may also appear more dramatic when plastic surgery procedures are combined in the same surgery.

Certain combinations are frequently performed, for example, the so-called mommy makeover (tummy tuck and breast augmentation +/- lift) and procedures which address facial aging (for example, facelift and brow or eyelift).  Patients often ask how many procedures may be performed safely during one surgery session.  There is no strict cut-off relating to the number of plastic surgery procedures that may safely combined.  Limitations are based on the following criteria:

Length of general anesthetic

The estimated time under general anesthetic is an important consideration when combining plastic surgery procedures.  Strict guidelines do not exist with respect to the maximum number of hours permitted under general anesthetic for elective cosmetic surgery.  Most plastic surgeons generally recommend limiting surgery under general anesthetic to 5-6 hours.  The longer the anesthetic, the greater the risk of systemic complications, in particular venous thromboembolism (deep venous thromboembolism or pulmonary embolism).  Given that surgery is elective and often performed in out-of-hospital facilities, safety is paramount.

Positioning considerations during recovery

Positioning restrictions and activity modifications are recommended following many surgeries.  It is important to ensure that these recommendations do not conflict when combining plastic surgery procedures.  For example, following Brazilian buttock lift it is recommended to avoid sitting or sleeping on one’s back for one month.  This will reduce the pressure applied to the buttocks during early healing as the blood supply is re-established to the injected fat.  Following mommy makeover surgery, sleeping on one’s back is encouraged over the first month.  This will avoid pressure on the surgical sites and lower the risk of developing asymmetric swelling from sleeping on one side.  A Brazilian buttock lift and mommy makeover therefore would not be recommended during the same surgery based on conflicts with respect to recovery positioning.  Combining these procedures would also not be recommended based on the estimated length of general anesthetic, greater than 6 hours.  In my opinion it is safer with more predictable aesthetic outcomes if these procedures are staged to allow adequate recovery before undergoing the second surgery.

Blood supply at the surgical site

Certain surgeries if combined may increase the risk of surgical complications relating to compromised blood supply.  For example, liposuction of the upper abdomen may increase risk of wound healing complications when combined with abdominoplasty.  Liposuction of the flanks however, may be safely performed in combination with abdominoplasty given that the blood supply of the skin flap is not further compromised.  Augmentation-mastopexy (breast lift with implants) may be performed in appropriately selected cases, however may increase risk of healing complications in certain cases.  A pocket is created to place the breast implant while skin flaps are also elevated to tighten the skin envelope.  This undermining reduces the blood supply of the breast while the breast implant places additional tension on the incisions during early healing.  It is important to consider the blood supply at the surgical site relating to extent of undermining, size of implant, and other medical conditions which may affect healing.

Please contact us if considering plastic surgery in the Toronto area.  Dr. Power will listen to your concerns and recommend a surgical plan that meets your aesthetic goals while maximizing patient safety.

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