Is 7 Hours Under General Anesthesia Standard For Combination Procedures?

   I typically perform upper and lower eyelid surgery, facial fat grafting, and full face and neck lift in about 3 or 3.5 hours.  However, some of the best plastic surgeons with the best results take 6 hours just for the facelift.  I think most plastic surgeons would agree that 6 hours for facial surgery is not unreasonable.  What is the difference between 6 hrs and 7 hrs of general anesthesia?  This may not be unreasonable.  Kenneth Hughes, MD Los Angeles, CA

As long as you are in good health and cleared for surgery by your physician, it is ok to have all of these procedures performed at the same time.  Depending on the patient's age, I will normally recommend the following prior to having any surgery, especially one with multiple procedures:

1) Full physical exam by a board certified physician
2) Complete cardiovascular work-up
3) Stress test performed by board certified cardiologist (Usually for older patients)

 

I would recommend communicating any concerns you have to your surgeon prior to having any procedures performed.  This will ensure you are comfortable and worry-free prior to your surgery. Thanks and I hope this helps!

If you’re going to have prolonged operative procedures usually one shouldn’t do an outpatient procedure if it is longer than 4-6 hours. It also depends on your health status. Any longer than that, you should probably do less combination procedures or consider doing surgeries in a hospital for patient safety.

If you ask this question to 10 surgeons, they will give you 10 different answers depending on their preference and their practices.

General anesthesia for 7 hours should be just fine. Our anesthesia safety has improved over the years. Obviously there are no guarantees in any medical procedure. The longer you are "under", the longer your recovery will be in terms of recovery from the anesthesia, in terms of nausea, etc, but the safety will more than likely be fine, if you are a health individual. If you have a cardiac history, this will certainly be a factor.

Hi Sara,

In my practice, I limit time spent under general anesthesia to no more than 6 hrs. Ofcourse, this is my opinion. I am not one to put my patients at unnecessary risk for elective surgery. There is just no reason to justify it. Please make sure you are dealing with a Board Certified Plastic surgeon and that he actually has the credentials he claims.

Best wishes,

Dr. H 

 

I like to limit my surgery time to about 6 hours for any procedure or combination, but 7 hours should be  okay too. The combination of procedures you have described are typically done at the same setting and there should be no problem as long as the surgeon and anesthesiologist  are board certified and experienced.

As you can tell from the replies so far, there is no standard approach for either the type of anesthesia or length of time for a facelift. My personal view is that outpatient surgery should be limited to 6 hours, and that seems reasonable for the list of things in your plan.

Thank you for your question.

Yes, all of this can be done at the same time and the 7 hours quoted is a reasonable time frame. Anesthesia is safe as long as you are in good health.

Discuss this with your surgeon directly if you have continued concerns.

Best wishes.

Unfortunately the law of large numbers means that your surgeon may routinely perform longer procedures and have never experienced a complication.  This does not make the increase risk reasonable.  To paraphrase the line from Top Gun, is your surgeon writing checks your body can't cash?   If the extra hours under generally anesthesia double the risk of death or significant morbidity, is it safe or reasonable?  That might depend on how you judge risk.  For example, having liposuction under general anesthesia has a risk of death that is between 1 in 5,000 cases to 1 in 40,000 cases depending on whose numbers you believe.  However, doing the same liposuction under local anesthesia is a associated with a risk of death that is less than 1 in 300,00 cases.  Despite this, many people continue to have liposuction under general anesthesia.  Returning to your case, many people are often swayed by the surgeon's argument that you can recover from 3 procedures in the time of 1 procedure and you will save money because the first hour of anesthesia is the most expensive, or that your surgeon has truthfully never experienced an issue doing lengthy surgery.  All of these things may be true.  However, what is extra safety worth to you?  Unfortunately that is not a question that your surgeon can answer for you.  If you are not comfortable, do not allow yourself to be hustled into so much surgery at one time.  Do what feels comfortable.  Don't be bullied by your surgeon.

Every surgeon is different, there isn't a "standard" for the amount of time for a combination of procedures. I do cases of seven hours or more under general anesthesia frequently and maintain the utmost safety for my patients. For the longer procedures, we keep the patient overnight for monitoring and comfort. If the patient is healthy, and has an experienced Board Certified Plastic Surgeon, there should be no reason for concern. I have my own accredited private surgery center which allows me to keep the highest of standards, including a board certified anesthesiolgist and a surgical team of my choosing. If you are healthy and check the credentials of your surgeon, anesthesiolgist and medical facility, you should be fine.