Surgeon working alone without second assist?

In general, the vast majority of cosmetic procedures do not require a second assistant. In my practice, I will use second assistants to help with closure of extensive incisions. This is common in large body contouring procedures, especially when multiple procedures are being down such as in massive weight loss patients. The second assist generally has extensive experience closing incisions. This will cut down on operative times which can lead to easier/better recoveries. However, second assists are not necessary or customary for many procedures, and their presence or absence doesn't alter or affect the procedure that is performed. 

 I am sorry to hear about your concerns. No, it is not necessarily "customary" to have a plastic surgeon assistant. In my practice, for example, I do not have a plastic surgeon assistant for the vast majority of cases performed. I hope this clarifies. Best wishes.

I feel it is the reverse. It is more normal for a plastic
surgeon to work alone and it has nothing to do with how tight you may or may
not have been pulled. The assistant usually only helps with sewing anyway. They
do not do the actual surgery. So it is not usual and customary to have a
surgical assistant in the operating room, it is up to the surgeon and it
usually is a cost to the patient to have an assistant.