How Many Cosmetic Procedures Can Be Done at One Time? What Are Things That Affect General Anesthesia?

I'm planning on undergoing a rhinoplasty, otoplasty and two mole removals (most likely via incision), is it safe to do all these under the same general anesthesia. I have a slight fear of going under general anesthesia, due to the hundreds of horror stories that I have come across. This includes patients waking up mid-way through surgery and being unable to speak but hear and feel everything that is going on. I am just wondering what kind of things need to be disclosed and affect general anesthesia i.e Anti-depressants, whether you smoke, herbal supplements?

Doctor Answers 7

Safe to have rhinoplasty and otoplasty done at same time

Rhinoplasty, otoplasty, and 2 mole removals are certainly acceptable procedures to be performed concurrently and will require approximately 2 hours of general anesthesia.  Your anesthesia should be administered by a board certified physician anesthesiologist in a Medicare certified ambulatory surgery center.  You will not wake up during the procedure with general anesthesia.  With twilight anesthesia and conscious sedation, patients do have recollection of the procedure, which we do not recommend.  It is also best to stop smoking for the healing process and to stay off all herbal supplements for 2 weeks before and after the surgery.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 145 reviews

Rhinoplasty and otoplasty together: very reasonable.

Hi Timmy89;

It is not unusual to combine rhinoplasty and otoplasty.  The mole removals are minor players.  And, yes, it is safe to do them under general anesthesia. 

Today, anesthesia is safer than ever.  You may not have heard this, but, remember that you are placed into a light sleep and immediately the surgeon will inject local anesthesia into your nose and ears, so that, in fact, you cannot have any pain during the procedure.  This is similar to an injection you would have in a dental office when you are awake.

Once those tissues are rendered painless, minimal anesthesia, given by the anesthesiologist, is necessary.  You do not have to be in as deep a sleep as you would be if you were having major abdominal or chest surgery.  After all, no major body cavity is being opened.  They are only operating on the skin, cartilage, and bone, and that is considered superficial surgery. 

You certainly should disclose to the plastic surgeon, and to the anesthesiologist, what medications you are taking - both prescription and non-prescription medication.  I am glad that you mention "herbal supplements" because a lot of people do not think they are medicines, but, in fact, they are because they can affect the body.  As a matter of fact, in my book, Secrets of a Beverly Hills Cosmetic Surgeon, we devoted a section to listing all the medicines that people do not think might affect their anesthesia, but might.  You would be well advised to check that out.

It is always short-sighted not to reveal everything about your medical history to your doctor and, particularly, to your anesthesiologist.  Some of the "horror stories" that you heard about regarding anesthesia occurred because the patient was not frank, up front, and honest.  I know of an unfortunate case here where a young woman did not reveal to an anesthesiologist that she was taking a certain illicit drug, and it had a very adverse effect on her anesthesia.  No doctor is a mind reader.  Remember, it is your body.  It is your health.  You owe yourself the wisdom of disclosing any and all factors that the doctor should know about.

Robert Kotler, MD, FACS
Facial Plastic Surgeon

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 87 reviews

How Many Cosmetic Procedures Can Be Done at One Time? What Are Things That Affect General Anesthesia?

  Having multiple plastic and cosmetic surgery procedures like a Rhinoplasty and Otoplasty together is quite common.  The general health, of the patient and a reasonable time to have the patient under general anesthesia have always been the way I make this decision.  Rhinoplasty and Otoplasty should be around 3 hours of surgery time, IMHO and as such should be no issue with a healthy inmdividual.  The other issues are finding a surgeon that understands and follows the proper aesthetics of facial beauty for the creation of a naturally, more attractive face and nose in this case.  The second is experience.  The more experience, the less time it should take to perform the surgery which means less time under general anesthesia.



Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 25 reviews

Otoplasty, rhinoplasty and mole removal can be done safely

Otoplasty, rhinoplasty and mole removal can be done safely and effectively together under general anesthesia. General anesthesia performed in an accredited surgical facility with a well trained and licensed anesthesiologist or nurse anesthetist is safe and you should not be scared. I have worked with the same anesthesiologist in my accredited surgical facility for almost twenty years and we have no nightmare stories. At your preoperative appointment you should disclose all history of allergies or reactions to medications or non medication allergies as well such as adhesive or latex. You should provide a full list of all medications you are currently taking and your anesthesiologist will review with you what medications you should stay on, which medications should be stopped prior to surgery etc. Medications include all things you are taking Including non prescription or over the counter medications like vitamins, herbal remedies, etc. Some of these may increase bleeding and should be stopped two weeks prior to your scheduled procedure. Again your surgeons office and anesthesiologist will review all pertinent information with you. If you are cleared for surgery then you should have a very safe and happy experience. Many patients enjoy the nice rest and recouping time. So relax, don't stress and enjoy! Best regards!

Michael Elam, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 210 reviews

Anesthesia and Surgery Safety

Thank-you for your question as this is something that comes up often in consultations. Many patients consider having more than one procedure done at a time to limit the time they will need help at home or limit the amount of time they take off from work. The number of procedures that can be performed together is determined by the extent of the procedures, the patient's medical and physical condition and the time spent under anesthesia. Procedures with greater areas of dissection and thus possible fluid or blood loss will stress someone with a compromised physical condition and may be dangerous. General anesthesia lasting longer than 5-6 hours has been shown to greatly increase the risk of infection, blood clots in the lower legs, and patient temperature changes.

The rule in our  accredited surgery center is that surgical procedures performed under general anesthesia must be completed in under 5-6 hours, and each patient's medical condition is assessed carefully, often with input by the patient's doctor and/or our anesthesiologists. 

Douglas Leppink, MD
Grand Rapids Plastic Surgeon
4.8 out of 5 stars 26 reviews

Safety of General Anesthesia? Very Safe

Not surprisingly, Anesthesia is the factor that prospective patients fear most when considering cosmetic surgery.   Is this fear of the unknown rational, or is it overblown?  Healthy patients, without active, symptomatic cardiovascular or pulmonary problems are generally very safe under anesthesia in competent hands.  The simple answer to your question is that rhinoplasty, otoplasty, and mole removal can be performed together safely and effectively.  However, recovery from and risks associated from anesthesia increase with the length of the case.  Full disclosure of any medication, supplement, smoking and health history is essential to a good outcome.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 95 reviews

The SAFETY of Your Cosmetic Surgery depends on your Full Disclosure

When you have any medical procedure you are entrusting your health, well-being and life to a surgeon and anesthesiologist. By witholding ANY information from your doctors, even the use of certain supplements, much less medications or previous medical conditions or operations, you are inviting a potential complication, drug interactions or even death. 

Risk increases with duration of the operation. But it is reasonable to combine an Otoplasty and rhinoplasty.

As far as waking up under anesthesia, it is an urban legend. Such cases are seen EXTREMELY rarely and most surgeons cannot think of ever seeing such cases in careers that spen thousands of surgeries.

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 109 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.