How to Have Multiple Plastic Surgery Procedures Safely?

I am having Smart Lipo with suction done on my upper back and flanks in a few days. I also plan to have a Tummy tuck, Breast augmentation with Lift and possibly Brazilian butt lift with Fat grafting.

I almost forgot that I will also be having a Bladder lift soon. How long should I wait between surgeries and in what order should I have them?

Doctor Answers 11

Safely and logically combine multiple procedures

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The most important factor is your safety. Board-certified plastic surgeons and accredited surgical facilities have expertise to help you achieve your changes safely. Discuss your concerns with your surgeon, and expect pre-op, intra-op and post-op measures to minimize the risks.

I would not generally recommend having all those procedures at once. The tummy tuck (abdominoplasty) would be a logical match with the bladder tack procedure. Breast augmentation can be combined with tummy tuck.

If you are going to have fat graft (the Brazilian buttock procedure), you should not have ultrasonic or laser-assisted liposuction. You should consider tumescent lipo combined with fat graft. This gives you more healthy fat tissue to transfer / graft. Fat removal from the flanks and back combines well with fat graft to the buttocks. The buttock fat graft results will be better if you do not have to be positioned face-up for additional procedures at the same operation. I would minimize lying on the recently treated buttocks.

Greenville Plastic Surgeon

Procedures can be combined, it has to be safe and logical in sequence..

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The procedures that you wish to have need to be staged into two operations. Looking at your included photo, you would benefit from a Brazilian butt lift. You do not seem like a large person, so I would collect all the fat of which about 1/2 is usable for grafting. Smart lipo or ultrasonic lipo done first will destroy the fat. If you want buttock augmentation afterwards, you are only left with the choice of buttock implants. To me this is a distant second choice after fat injections. You would also need to lie on your abdomen or stand after a Brazilian butt lift for about 10-12 days. You would not want to crush the newly grafted fat cells and give yourself a less than perfect result. A tummy tuck and breast augmentation can be done together and I often do this in my certified office surgical suite under intravenous sedation and epidural anesthesia. A bladder suspension procedure done by your urogynecologist or urologist can present a logistical issue. These surgeons operate out of a hospital or ambulatory surgery center. Although your insurance might cover their part of the operation, these institutions are much more costly than a plastic surgeon's office surgical suite. People often combine procedures so they can save money, but that should never be your primary goal. Your main objective should be to find a board certified plastic surgeon with lots of experience in these procedures and who can deliver good results safely. Best of luck.

How to plan multiple procedures safely

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Safety is the bottom line when considering any plastic surgery, so your question is a very important one. The length of surgery, particularly if it is to be done as an outpatient, is a primary consideration. My own preference is to limit surgery time to less than 6 hours, which is typically enough for an abdominoplasty and a breast procedure with some lipo.

You mention that you are having smart lipo and possibly fat grafting to the buttocks. Since the smart lipo uses a laser to break up the fat, it cannot be used for grafting so that combination doesn't make sense to me.

My other advice would be to do the bladder suspension before the tummy tuck so that your final scar will be from your plastic surgeon.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

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Just because you can do it doesn't mean you should.

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As other physicians have mentioned there are certain logistics to planning a surgery that make it unwise to do it all at once.

On top of that we generally know that the risks of certain complications increase the length and combinations of procedures including problems such as deep venous thrombosis, blood loss with need for transfusion, atelectasis, hypothermia, etc.

It would be wise to discuss this with your surgeon and plan the procedures with probably a 3-4 month period between surgeries although there may be great variation in these recommendations.

For example, as one physician has stated SmartLipo or ultrasound destroy fat and make it useless for fat injection for the Brazilian Butt lift. Therefore you want to plan all your suction removed fat and inject it into your buttocks prior to using SmartLipo.

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

Multiple procedures can be done safely, but need to be staged

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Consider two things: Positioning and Type of anesthesia.

1. As Dr. Canales stated, positioning is key. For example, breast procedures and fat grafting to the buttocks. Because preserving the fat grafts requires avoiding any pressure on the buttocks, you have to lay on your stomach. But laying on your stomach all the time may affect the result of the breast surgery. So from this point of view staging is recommended for certain types of procedures.

2. The risks of long surgery are mainly related to general anesthesia. After 4 hours the risks of blood clot to the legs, or worse yet, the lungs, increase rapidly. Respiratory complications also increase. The good news is you can largely avoid these by choosing Intravenous anesthesia. Because you are breathing on your own and you are using more local anesthetic you are using less general suppression medications. This is good.

The concern about blood loss, especially in outpatient surgical facilities, where by law you cannot give transfusions, is also a concern. Luckily, use of Tumescent anesthesia can vastly decrease this risk.

For sure, see more than one Board Certified Plastic Surgeon before you make your decision.

Ricardo L. Rodriguez, MD
Baltimore Plastic Surgeon
4.5 out of 5 stars 98 reviews

Multiple procedures

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 The procedures that you desire probably should be staged.Depending on what is needed for your bladder, you  may want to combine that with one of the others,  If it has to be done laparascopically, it may be nice to combine it with the tummy tuck?

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

More is not necessarily better

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The main determinants are usually:

1. length of all procedures

2. amount of blood loss

3. positioning issues

Let's say you want a breast augmentation, tummy tuck, liposuction and fat grafting to the buttocks. Just strictly from a time standpoint, all those procedures may exceed what is generally accepted as "safe". Remember that these are elective procedures and, while TV shows tend to glorify complete makeovers, your risk of complications is much higher.

Positioning on your back for augmentation and tummy tuck, is completely opposite of what you want for a buttock lift or fat grafting to the buttock. I would advise you to split the procedures in to two sessions.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

Multiple procedures require coordination and good medical advice

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It seems that you need to prepare your future surgeries very well. First, a general medical clearance with medical history, exam, and labs.

Second a coordination between the different physicians taking care of you is essential. A smart lipo first followed later on by a fat transfer could be counter productive, as you will need this fat in the future for the transfer.

It is not uncommon to allow 3-6 months between surgeries if you are healthy to allow proper recovery.

Best of luck!

Hisham Seify, MD, PhD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 19 reviews

How to have multiple [plastic surgery procedures safely?

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Hello!  Thank you for your question!  I would consult with a plastic surgeon who would examine you and discuss the various options and assist you to decide if you wish to undergo all of the procedures at once or at smaller staged procedures - for those listed, it would be wisest to have these performed at separate settings.  Your safety is of utmost importanceH.  An examination of the amount of work to do with each will also make the decision.  There would obviously be a cost saving and recovery benefit for a one-stage procedure.  However, your safety should not be sacrificed for these reasons.

If it was deemed wisest to stage these procedures, you will have to decide which procedure(s) are most important to you.  You should devise a priority list and discuss this with your surgeon and several of these procedures will still likely to be combined at the same procedure.  Thank you for your question!  Hope that his helps and best wishes for a superb result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Safe multiple plastic surgery procedures

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Without a complete history and physical examination I could not even give an accurate operation plan. I feel you most likely will need 2 to 3 operations for ALL those areas. Go see 3 boarded plastic surgeons, see who you feel comfortable with than develope a game plan for operations. 

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.