Are Multiple Cosmetic Surgery Procedures Safe?

I am a healthy 47 year old female considering having the following cosmetic surgery procedures performed at once: 1. Gummy bear breast augmentation (from an A cup to a C cup) 2. Macslift and Eyelid surgery (Blepharoplasty) 3. Full body power assisted liposculpture (under chin, upper arms, upper and lower abdominal area, mons area, hips, thighs and knees) How long would the total operating time be for these procedures and is it safe to undergo all these treatments at once?

Doctor Answers 19

S-A-F-E-T-Y. Multiple Cosmetic Surgeries -- What is Safe to do in One Day?

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You ask an excellent question about the safety of performing multiple procedures. Cosmetic surgery will never be completely risk free, and a careful assessment of risks is certainly needed when combining procedures.

Bottom line, there is no simple answer to your question. Personally, I am the medical director for our Colorado- licensed Ambulatory Surgery Center, the Surgery Center of Colorado, and I am always evaluating how we can best maintain a "Culture of Safety."

Several factors are involved in safety when performing multiple procedures, including:

  • Blood clot risk assessment and preventative measures
  • Surgeon leadership in fostering and maintaining a culture of safety
  • Safety "Habits" of the operating room personnel for the specific procedures being performed
  • Pre and postop nursing-staff familiarity with the surgeon and the procedures
  • Maintaining body temperature
  • Body movement during surgery

I routinely perform multiple procedure surgeries, and for every patient I perform a risk assessment in developing a plan for surgery. To say that my practice is "unsafe" by doing so is to not see the whole picture. The steps we go through to assess and improve safety are too numerous to list here, but include:

  • Surgeon leadership in maintaining an ongoing "Safety Radar"
  • Routine assessment of risk in every patient
  • Demanding that all in the O.R. pay attention to the "Time Out" that precedes every surgery
  • Vigilant attention to patient warming
  • For combined procedures involving body contouring, some additional measures used include:
    • Moving patients to different positions during surgery for combined procedures
    • Routine use of blood thinning shots
    • Routing use of preoperative, intraoperative and postoperative "SCDs" (sequential compression devices)
    • Careful teaching and follow-up to ensure that patients are walking (20 minutes total per day by day 7, including giving out a walker as needed to assist with walking)
    • Routine use of skilled assistant surgeons or co-surgeons to improve efficiency

In summary, safety is an ongoing, never ending process. I agree with Dr. Rand's premise that there is a limit as to what is safe to do in one day in the operating room. Combining liposuction of multiple areas with the facial and breast surgeries is likely best done in separate sessions, but without knowing what process was used by your surgeon in making this recommendation, we don't see the full picture.

I agree with Dr. Marosan's suggestions for taking care in selecting a qualified surgeon, and I would recommend asking your surgeon about the items I've listed above.

Multiple procedures do increase risk, however, in a setting such as I describe above, I believe that this increase in risk is often lower than the added risk of performing the surgeries separately. In other words, in the appropriate setting multiple procedures performed together may decrease your total risk by decreasing the number of times you are exposed to surgery.

Hope this helps,

Nick Slenkovich MD, FACS

Multiple Cosmetic Procedures

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I personally would recommend that you stage these procedures.   I think the breast augmentation, chin lipo, and  facelift would be safe together.   I would then recommend the liposuction at a seconds stage 3-6 months down the road.   This would give you the opportunity to touch up any issues from the facelift or chin lipo and offer you the safest recovery.   Remember this is elective cosmetic surgery that is not medically necessary, practice safety first.

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Multipul Cosmetic Surgery Procedures Safe???

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Yes and No, (it depends on the number of procedures, how they are grouped, and the overall time it takes for any individual surgeon to complete them). Most surgeons would agree that complication rates go up the longer someone is under anesthesia and the larger the surgerical insult’s to the body. Anything over six hours tends to get onto the steep part of the complication curve, and that is where I usually limit my surgeries. Large surgeries, with significant body surface area with liposuction done in conjunction with other large surgeries can be overwhelming to the body even though you are below the six-hour liposuction. The six-hour limit is then in violated. Having said that, for example in today’s six-hour surgery involved a facelift, lower lids with midface lift, canthopexy, upper lids blepharoplasty, rhinoplasty, corner mouth lift and fat to various areas of the face. All those procedures were accomplished in less than six hours.

Robert K. Sigal, MD
Reston Plastic Surgeon

Are multiple surgeries at one time safe?

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I feel confident that there are very few of my American colleagues that would perform this amount of surgery at one time, even on a healthy individual let alone recommend it. Many ambulatory facilities limit the amount of time that a patient can undergo general anesthesia to 6 hours which is ours. The amount of surgery you propose, even in the most adept hands, will take longer than this. It would certainly be safer and more reasonable to stage your surgical objectives into two sessions, possibly performing the facelift and blepharoplasty with the augmentation at one sitting and the full body liposuction at another. I know if it very often the patient’s desire to have everything completed at one sitting but sometimes this is not the best or safest way to proceed.        

Multiple procedure risk factors

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The risks of surgery increase with longer length of the procedures. However, many factors go into determining overall risk: Your age, overall health, anesthesia type, etc.

The procedures you describe could take 5 to 8+ hours. If it is 5 hours under sedation and local anesthetic, the risk may less than 8 hours of general anesthesia.

It may be best to discuss your risk with your plastic surgeon and primary care (GP) doctor. If there are any concerns, it would be OK to have your face done at one time and the your breasts and body at another time.

Safety First!

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

Combination plastic surgery procedures

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You have described a marathon string of procedures that, in my opinion, carries too much risk to attempt in one stage.  The length of anesthesia exposure shows an exponential increased risk after 6 hours and your surgeon will be operating under the stress of fatigue beyond that period.  Even with multiple surgeons, the physiological trauma will tax your health unnecessarily.  I suggest doing the head and neck procedures separately under conscious sedation to decrease your anesthetic exposure.  The body work will require general anesthesia, but can be completed with your safety and best interest in mind.  Please consider staging your makeover.

Wisdom of multiple cosmetic procedures in one day

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The number of hours it would take by an experienced solo surgeon performing the lsit of procedures you describe would typically be a minimum of 7 if not 8 hours. The time could be reduced with multiple surgeons inframammary fold approach, simple MACS lift, UL bleph only and limited liposuction.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Safety in Plastic Surgery

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I believe that the amount of procedures you have listed is too many to do in one day.  The length of time in the operating room for elective surgeries should be kept to a minimum (less than 6 hours) and staging procedures is the best way to accomplish this.  Performing the breast and facial surgery together in one day followed by liposuction at another time would be safe.

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 78 reviews

Are Multiple Cosmetic Surgery Procedures Safe?

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From your description I feel too much is being done for your safety. Please stage these operations. From MIAMI Dr. darryl j. Blinski

How much surgery is safe?

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I think the amount of surgery one can tolerate depends on what you are having done.  Certainly the breast augmentation and the facelift/blepharoplasty can be done safely at the same time.  Liposuction is certainly a safe procedure however doing as many areas as you are planning means you are probably removing almost 4000cc of fat.  Combining significant liposuction with other procedures does seem to have a higher complication rate.  The longer the surgery, especially over 6 hours also increases the complication rate.

I would probably recommend dividing the surgery into two segments.  Although it may cost a little more or inconvenience you a little more, how much is a complication worth to you in terms of all those things.  Good luck, Dr. Schuster in Boca Raton.

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.