Multiple Plastic Surgeries and Reasonable Time Under Anesthesia?

I have recently lost 135 lbs. and have excess skin I want removed. I want to have a 360 degree circumfrontial body lift along with a breast lift (NO implants), and a thigh lift. The one surgeon says he would do all 3 procedures in one setting. Is this reasonable/safe? He said it would take 6.5 hours total. The other surgeon would do the body lift and breast lift and it would take 8 hours. Which is the better choice? How long is too long to be under anesthesia?

Doctor Answers 16

Multiple Plastic surgeries at one time under anesthesia

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This is an obivously controversial issue in the field of Plastic Surgery, especially given the increasing number of bariatric patients that we are seeing.  There are several studies that show that the complication rates with respect to combined surgical procedures increase after 5 hours.   Make sure that you have fully discussed all the potential complications with your prospective surgeon, including the more serious ones such as DVT's and pulmonary embolisms, which can be life-threatening.   There is more and more pressure on surgeons to perform multiple surgeries at one time, given the fact that there is only one recovery, etcetera.  Nonetheless, these are elective procedures, and there is no reason to take on undue risks.   I personally do not perform surgeries that last over 5 to 5 1/2 hours for this reason.   

Orange County Plastic Surgeon
4.7 out of 5 stars 52 reviews

Safety concern on multiple cosmetic surgery at one time

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First of all, congratulations on your successful weight loss.

I usually do not recommend more than 6 hours under general anesthesia for any combination of cosmetic procedures. These are elective procedures and the risk associated with being under general anesthesia for a prolonged time is not worth the risk in my opinion.

I must question the quality of  work being performed for all those procedures in such a short period of time. I hope you have done you homework, looked at before and after pictures and are satisfied with his/her results.

Personally, a well performed breast lift takes an average 3-4hrs alone (no vertical scar, internal bra with upper pole fullness).  Please be careful.

Kind regards,

Dr. H

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Multiple Plastic Surgeries and Reasonable Time Under Anesthesia?

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Thanks for your question. It is an important topic. We are seeing a lot of patients who lose over 100# and usually want some form of abdominoplasty, breast lift with or without implants, and a thigh lift. There are some pretty good statistics showing a significant increase in serious postop complications for surgeries that go over 5 hours under general anesthesia. This is cosmetic surgery and it is not worth taking big risks. We normally do the extended abdominoplasty (or body lift) one day and the breast lit and thigh lift another day in order to minimize these risks.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

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Plastic Surgery After Weight loss

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Thank you for your question and congratulations on your weight loss!
Each surgeon has their own way of doing things.  You could have all procedures performed at the same time but personally, I would probably break things up to reduce the OR time, anesthesia time and make it a little more tolerable during recovery.
Make sure your surgeon has experience working on patients who have had significant weight loss because your skin elasticity may be different than a patient who has not had significant weight loss.
Best wishes.


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Hello, Doing all that surgery is do able , but you need to make sure that its done in a accredditated surgery center. You need to make sure that they have certified anesthesiologist and after care NURSE to take care off you. I would do more research.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Multiple plastic surgeries at one time under anesthesia

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It all depends on the setting the surgery is going to be done. If as an outpatient, 5 to 6 hours of surgery time is the maximum safe time, if a hospital admission is planned, then it can be extended. One has to factor in tiredness of the surgeon and how much help he has during surgery and the ease and comfort of the patient after surgery. There is nothing wrong with doing in two phases. Sometimes, the overall financial saving may not justify the added risk.

M. Vincent Makhlouf, MD, FACS
Chicago Plastic Surgeon

Body contour procedures -How many at once?

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Congratulations on your weight loss. I personally think that a full thigh lift, circumferential body lift and breast lift is a lot of surgery for one day.  It does not mean that the surgery can not be done effectively and safely by others, but depending upon how extensive a thigh lift that is being done really makes a difference. I like to stage some of these because of the length of surgical time and the amount of blood that is lost in the tissue removed.  Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Safety considerations with long surgical procedures

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There are many factors to consider when planning body contouring and breast surgery following massive weight loss.  It is reasonable to assume that the longer you are under anesthesia the greater the risk of post op complications including DVT and Pulmonary Embolism.  I usually take a staged approach to this problem but others may choose to do it with a team of plastic surgeons.   In any event safety is the over ridding consideration.  You should thoroughly evaluate your options and make an educated decision how to move forward.  Congratulations on your weight loss.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Too large time under anesthesie and surgery are not sage for any certified serious plastic surgeon

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it is not advisable to realize  2 or 3 procedures  during  any surgery. any  serious, certified and ethical  surgeon will  surely opposite to this kind of  manegement. by the contrary if someone suggest to do do it take great  carefull because perhaps only is  looking  for  economical benefits

Ramon Navarro, MD
Mexico Plastic Surgeon

Safety of multiple procedures

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The safety of multiple procedures is dependent on many factors. One is the length of anesthesia especially in one position as this can increase the risk of pressure injuries and blood clots. The other is the total surface area involved in the surgery as the large the total area, the more the physiological response to trauma including swelling, loss of intra-vascular volume, shock, and blood loss. Another is the post-op recovering as some surgeries will work against each other because of the opposing tension that might occur as in breast lifts and tummy tucks) or competing need for early ambulation (i.e. abdominoplasty) and need for less (i.e. thigh lifts).


Since different surgeons have different experience, parameters, and techniques, it is something you will have to trust your surgeon on. In general, 6 hours on the operating room table is reasonable but one must have an exit strategy beyond this point. My outside limit is 7-8 hours, not only for the patient's safety, but for surgeon comfort and ease.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

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.