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Can I Have More than One Plastic Surgery Procedure at a Time?
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Can I Have More than One Plastic Surgery Procedure at a Time?

Episode 23: Can I Have More than One Plastic Surgery Procedure at a Time?

Can I have more than one plastic surgery procedure at once? This is something we talk about with a lot of our patients when they have several different goals to achieve, and there may not be one operation to satisfy all of their needs. So there are several different questions that we really need to answer to get a clear picture of whether or not you can have more than one operation at a time. First we'll ask, what are the benefits of having more than one plastic surgery procedure at a time? Then we'll ask, what are the downsides of having more than one plastic surgery procedure at a time? Then we'll look at some popular combinations of plastic surgery procedures, and talk about who they may or may not be a good idea for.

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What are the benefits of combining plastic surgery procedures?

So let's jump right in with the benefits of having several plastic surgery procedures at once. First of all, and maybe the most exciting thing is you get to see a big change all at one time. This is something that frankly, can just be very satisfying. It's exciting to see a big change all at once, and it may be a drag to have to wait to see a bunch of small incremental changes. The next thing that is a little bit more of a practical reason why it might be appealing to have multiple procedures at the same time is it may actually be less expensive overall. Because if you are combining multiple procedures, you will only have to pay for one time in the operating room, one time with an anesthesiologist, one surgeon's fee.

If you need to stay in a hotel, or if you're from out of town, you only need to do that once. If you need nursing care afterwards, you only have to pay for that once. While it's certainly true that you'll be spending a longer time in the operating room if you're having two procedures at once, rather than if you're just having that one procedure, the way the operating room fees work, and a lot of these fees work is they often get less expensive proportionately with time. For instance, the first hour that you spend in the operating room is always more expensive than the second hour that you spend in the operating room. That's simply an issue of economy of scale. Once you're in the operating room, the cost has already been incurred of mobilizing the team, of opening the central supplies that you need, and of just getting set up and going, and getting that momentum for the case started.

So in terms of time, it really does work out in your favor, from a cost perspective, to have several procedures at the same time. The same thing goes for the recovery. If you're having multiple procedures at once, you've only got to recover once. Now, that recovery may be a bit more difficult than if you were having more than one procedure at a time, but that's a personal decision. If you're someone who can take the recovery in stride, maybe you have a lot of help lined up, it can be a very reasonable choice to decide to have your procedures all at once. So you can just have that downtime once instead of doing it for each individual procedure. This also can have an effect on the economics of your plastic surgery procedures.

By this, I mean, if you're combining your operations and you only have one recovery, you only have to miss work once. Whereas if you were to have these procedures separately, you may have several different recoveries and have to miss out on work several times. So to sum up the advantages of having multiple plastic surgery procedures at the same time, you'll get to see a really nice change all at once. You will have only one recovery, and the combined procedures will almost always end up costing less than having those operations in separate trips to the operating room.

What are the downsides of combining plastic surgery procedures?

There are two sides to every coin, so we have to mention the downsides of combining multiple procedures into one trip to the operating room. The first one, as you can imagine, it is simply more complicated to perform multiple procedures at once than to perform just one operation. Some of the things that can get more complicated are position changes. Maybe you're having part of your operation on your back. Maybe it's a Brazilian buttock lift, or maybe it's a liposuction on your back. Maybe part of the operation is on your front. Maybe it's an abdominoplasty. So that means that you have to be turned over in the operating room, which can be a complicated procedure.

There can be more technical variables that have to be accounted for. For instance, in the example of a breast augmentation performed at the same time as a breast lift, we have to now account not only for the change in size of your breasts, but also really for the change in shape and position. You'll also be spending a longer time in the operating room if you're having multiple procedures at once, and longer operating room times can be associated with higher chances of certain risks associated with plastic surgery procedures. The one risk that we have to be especially careful about in this context is that of VTE or venous thromboembolism. VTE or venous thromboembolism is a condition that occurs when a blood clot forms, usually in the legs or in the calf area.

That is called a DVT or a deep venous thrombosis. Then that blood clot can travel through the circulatory system, to the lungs. Once it gets to the lungs, it's called a pulmonary embolism or PE, and that can be very dangerous. This is an event that we take great precautions to prevent. Fortunately, with modern procedures and protocols in place, it is very unlikely, but by spending a longer time in the operating room, we do have data to suggest that the risk of pulmonary embolism or VTE does go up. So it is important when combining multiple procedures, that we are cognizant of the amount of time that we're operating, and we need to move quickly and efficiently, but also make sure we're doing an excellent job at the same time.

So the moral of the story here is that it is very reasonable to combine multiple procedures, but you need to do this with a surgeon who is truly expert in doing several plastic surgery procedures at a time. The reason for that is that they're going to have experience with each of these variables, and help get all of these moving parts working together efficiently to ensure that your operation is performed in a safe manner. Speaking now from personal experience, I do perform a great deal of combined plastic surgery procedures. So I just want to take a few minutes to speak about popular combinations and who they can benefit.

What are some frequently combined plastic surgery procedures?

Maybe the most popular combined procedure that we're performing in our practice is liposuction of multiple areas. By performing liposuction on multiple areas at the same time, we can really achieve dramatic full body transformations. Remember that liposuction is not a weight loss procedure, it's a shape change procedure. So I'm not here discussing doing large volumes of liposuction on every body part to take someone who's larger and make them overall smaller. The goal of a combined liposuction procedure, where we're doing multiple body parts at the same time, is to achieve meaningful changes of shape of each of those body parts so that as a whole, they add up to be a dramatic, often full body, transformation.

Another very popular combined procedure is the mommy makeover. We've discussed this in another recent episode, but essentially, the goal of the mommy makeover is to address areas that have changed the most during pregnancy, often the abdomen and the breasts, and perform various combinations of procedures to return a woman back to her pre-pregnancy state. It's also very common to combine liposuction with fat grafting procedures. In fact, you almost have to because when you're performing fat grafting, and we talked about that in our previous episode, you need to get that fat from somewhere. The way we do this is with performing targeted liposuction. So we can actually do large volumes of liposuction and at the same time, harvest that fat and use it for grafting to different areas of the body.

This can commonly be done in the context of fat grafting to the buttocks, and that would be something like a Brazilian buttock lift. In fact, this combination of procedures, fat grafting to the buttocks at the same time as a liposuction to several areas of the body, has gotten so popular that this has gotten a name of its own. That's lipo 360 and a BBL. The 360 there refers to the fact that liposuction is being performed on 360 degrees of the torso, and that usually means the abdomen, the flanks and the back. But as we've mentioned in another episode, you have to be very careful when you're talking about lipo 360 to make sure that both you and your surgeon are on the same page in terms of exactly what areas are included with that liposuction.

Liposuction is also very frequently combined with fat grafting to the breasts. This is a good option for people that are looking to increase their breast size or enhance their breast shape with natural fat. But probably isn't the best option if they're looking for a very large increase in breast size, as there is a limit to how much fat we can harvest during liposuction and how much of it is actually useful in increasing the breast size. That's something we also went into in a little bit more depth in our previous episode on fat grafting.

Another extremely common operation that we're doing a lot of in terms of combining procedures is a breast augmentation and mastopexy, or breast lift. That's something we referenced a little earlier in the episode. But for a lot of people that are looking to increase the volume of their breasts, they also may be looking to improve the shape of their breasts. By this, I mean with time or often after pregnancy or breastfeeding, the breasts can become droopy, or we call this ptotic. To really address this, a breast lift of some form is often necessary. While we can get a subtle lift by putting in an implant, you really can't rely on a breast implant to significantly lift the breast. So for these people who are looking for both an increase in breast size and an improvement in the shape of their breasts, a breast augmentation combined with a mastopexy might be a good option.

Another very popular combination procedure that we're performing on the face is a combined rhinoplasty and chin augmentation. This is a fantastic operation for people who want to refine their overall facial profile. So instead of having a rhinoplasty or nose job, and just addressing that one issue in isolation, they can, at the same time, have a procedure performed to address the shape of their chin. This will most frequently take the form of either a chin implant or fat grafting to the chin, but it could even take the form of bone surgery to the chin with something called an osseous genioplasty. That's where we actually create a controlled fracture in the mandible, the lower jawbone, and move the chin bone around and plate it back into place in an ideal position. So by combining a rhinoplasty with some kind of chin reshaping procedure, we can really refine the face's balance as a whole. This is a very powerful combination of operations.

While there are several other ways to combine procedures, the last one that I'll specifically mention here is body contouring operations for people that have had massive weight loss. For people that have had very high degrees of weight loss, they may have a lot of extra skin on various parts of their body, because when the fat goes away, the skin can only contract so much. So very commonly, these folks have extra skin on their abdomen, on their arms, on their legs, their necks. We can combine several skin removal operations together to help these folks achieve really stunning transformations a little more rapidly and efficiently than if we were to do each of these operations separately. But again, you really need to go to someone who specialized in this sort of thing to make sure that your operations are being performed efficiently, safely, and efficaciously.

Conclusion

So my overall verdict here is that combined plastic surgery operations can be a great option. But you need to go about this carefully, and do your research, and speak to your board certified plastic surgeon and ask them if they're comfortable combining operations. Because there are some surgeons that just prefer not to do this, and if they aren't comfortable combining operations, is the set of things that you're hoping to achieve compatible with combining operations? So like so many other things with plastic surgery, this really comes down to taking a team approach with your surgeon, and discussing your goals, and having an in-depth conversation to make sure that you can be on the right track to achieve excellent results that you're going to love.

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  • Darren M. Smith MD
  • Darren M. Smith MD
  • Darren M. Smith MD

All photos are of models except before and after images.

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