The Surgeon Minute

Combined Procedures – How Much is Too Much?

Combined Procedures – How Much is Too Much?

In the early 2000’s, reality television shows like Extreme Makeover and The Swan showcased people who underwent multiple plastic surgery procedures at the same time, achieving dramatic results. Today, many patients are gravitating towards similar comprehensive surgical treatment plans in order to achieve complete transformations in less time – and perhaps even for less money. 

The idea of combining several procedures into one operation is attractive to anyone who has more than one feature they would like addressed in the operating room. There are, however, limits to the amount of surgery that can be done safely at one time. “There are very compelling reasons to do combined procedures,” says board certified plastic surgeon Dr. Richard Baxter of Seattle. “It costs less money. It’s only one trip to the operating room and only one recovery time. We just can’t let it influence our judgement as to how much is safe to do in the one session.

Combined Procedures Require Surgeon Expertise

Combined procedures in plastic surgery is an excellent idea when done correctly and safely.  If you are considering a combination approach to your plastic surgery goals, consult with a board certified plastic surgeon who is experienced with the procedures you are interested in.

Before undergoing any type of procedure, it is important to check your surgeon’s credentials and experience. The surgeon should be board certified by the American Board of Plastic Surgery, the gold standard in plastic surgeon certification. It means they have had appropriate training and have passed comprehensive written and oral examinations covering all plastic surgery procedures.

 Combined procedures require expertise.

Your surgeon should also have significant prior experience with the combination of procedures you are specifically interested in. In some cases, surgeons may even be able to put you in touch with prior patients who have undergone a similar surgical treatment plan in order to hear firsthand about their personal experience.

Limiting Time in the Operating Room

The majority of plastic surgery procedures are done as outpatient procedures. This means that the patient leaves the surgery center and goes home for their recovery on the same day the procedure was done. At home, their caregiver is often a family member or a friend. Patients need to be stable and comfortable before they are sent home after surgery.

“There are guidelines as to how much you can do [in one surgery],” explains Baxter. “If the operation itself takes all day, then they are going to be in recovery longer. They’re not going to get home until late in the day, and it’s just not necessarily an optimal situation.”

Which procedures can be safely combined depends primarily on the amount of time that will be required to complete them in the operating room. “If the operation that we’re planning is going to take longer than a certain period of time, then we would recommend breaking it up into two sessions,” says Baxter.  In his practice, Baxter schedules surgeries to go no longer than five hours at a time.

Popular Combined Procedures

Some plastic surgery procedures take much less time than others. Adding a brow lift to a facelift, for example, may add only a fraction of an hour to the total time spent in the operating room. On the other hand, if a patient wants to add liposuction to a breast augmentation, the amount of time that it will take depends largely on the amount of areas that will be addressed. Adding on liposuction of the thighs, abdomen, arms, and back may not be realistic. It’s important for the patient to prioritize their goals so that, together with the surgeon, they can come up with a comprehensive plan that will safely address their top concerns.

Most plastic surgeons offer what is commonly known as the mommy makeover, a combination of surgical procedures that addresses a post-pregnancy woman’s abdomen and breasts during one trip to the operating room. In general, the recovery time for a mommy makeover is less than the recovery time required when undergoing two separate surgeries on the breast and abdomen, making the combination procedure especially popular among busy mothers.

Combined procedures - mommy makeover.

Examples of combined procedures:

  • Breast Surgery + Tummy Tuck (Mommy Makeover)
  • Facelift + Eyelid Surgery
  • Breast Augmentation + Breast Lift
  • Tummy Tuck + Liposuction

For the face undergoing a facelift, eyelid surgery is a common add-on procedure. Most tummy tucks also include the addition of liposuction in the adjacent areas. Patients undergoing a breast lift may consider having an implant added at the same time (breast augmentation) in order to restore lost volume.  

It is up to the surgeon to set limits and stage procedures when necessary. “Sometimes you realize you add all of this up and you’ve got six hours worth of surgery, or more. You have to be willing to say, ‘This is too much. It’s just not going to be safe to do it that way,’” concludes Baxter.

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