Facelift, necklift, liplift and lower blepharoplasty - shall I do it at the same time or separately? (Photo)

I am interested in all the above but can't decide whether to do it all at once or separately. All together, it will require 6 hours of surgery. Would I be under for all that time? Is that dangerous? Is the trauma to the face too much and likely to lead to complications? I'm a 47 yrs old female - my friends say "you look great, you don't need it". I've already decided to go ahead with all the procedures, its just that the push back is causing me to be more concerned. I appreciate your feedback.

Doctor Answers 41

Facelift, Neck Lift, Lip Lift, and Lower Bleph?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It is very common to perform all of these procedures in a single setting. While it sounds like a lot of surgery, it is limited just to the facial area and is actually a very small amount of trauma to your body as a whole. For instance, a tummy tuck inflicts far more trauma to your body yet is routinely done with other body procedures without hesitation. You also have the benefit of one combined surgery, one anesthetic, and one recovery. There are also usually cost savings. 

Push back from friends and acquaintances is not unusual. People are very casual about projecting their fears, uncertainties, and anxieties onto others. They may also have similar concerns about their appearance, yet for many reasons may not be able to consider having this surgery, so they are uncomfortable when you tell them that you are going ahead with it. Just make sure that you choose a surgeon who is certified by the Canadian equivalent of the American Board of Plastic Surgery and can demonstrate significant experience in all areas of facial rejuvenation. When your friends see the benefits they may change their attitude. 

Possible to Have Them Concurrently, With Doctor Approval

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It's not uncommon to perform these procedures all at once, because it consolidates the recovery period and makes for a more dramatic result. If you decide that's what you want to do, you'll need clearance from your primary care physician, which may include lab work and cardiovascular testing to make sure you're well enough for a surgery of this duration. Be sure you've found a highly qualified plastic surgeon with ample experience performing a combination of procedures such as this one. Best of luck as you move forward!

Marc DuPéré, MD
Toronto Plastic Surgeon
4.8 out of 5 stars 71 reviews

Facelift, necklift, liplift and lower blepharoplasty - shall I do it at the same time or separately?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Moving forward with facial rejuvenation surgery is a personal choice, ideally supported by your spouse, family and friends.

Performing the surgeries you mentioned can be performed separately or all at once.  The decision can be based on the amount of downtime you have, what you're willing to go through, cost, and overall your aesthetic goals.  

If the proper medical history review/clearance, physical exam, and studies (labs, EKG) are performed, and the surgeries are scheduled in an accredited surgery center (with the pre-operative instructions followed), doing all the procedures is generally safe to perform during the same time.

I hope this helps. 

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 74 reviews

Multiple Procedures at the Same Time or Separately

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

While each area from the brow to the neck can be targeted as a distinct area, it is the smooth and seamless blend from one area to the next that helps define a youthful appearance. In my opinion, addressing all the areas you mentioned at the same time results in a more unified look. As an additional benefit, a combination procedure only requires one recovery. The face/neck procedures will be the most involved in terms of recovery; adding the lower lids and lip lift likely won't add any noticeable time or complexity.

Various risk factors that can increase complications during long surgeries include patient body temperature, blood loss, body fluid shifts and positioning.  While six hours is a long time to be under anesthesia, management of these risk factors is often more straightforward with procedures focused on the head and neck.  A thorough health evaluation and the appropriate pre-operative clearance required by your surgeon will further identify your personal fitness and ability to tolerate a longer surgery. 

It sounds like you have some great friends who really care about you and it will be that support system along with regular physician follow-up that helps you get through the recovery process. Remember, the day of surgery is only part of the process in achieving your desired look. Choose a surgeon who will work closely with you and be personally available to you before, during and long after the day of surgery. 

Daniel Beck, MD
Dallas Plastic Surgeon
4.8 out of 5 stars 31 reviews

You can get all the facial surgeries you mention at the same time without going under general anesthesia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question. I understand you’re 47-years-old and considering having multiple surgeries that will include a facelift, neck lift, lip lift, and lower blepharoplasty. You are estimating the surgeries will take about six hours and you’re concerned about the safety of being under for that length of time. You also want to know whether it is better to do all the surgeries at once or do them separately.

I can certainly give you some guidance on this matter. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. All of the procedures you mentioned make up big parts of my practice, and I certainly have a lot of experience and opinions about the safety and relative risk of these procedures. Please keep in mind these are based on my own personal preference, and are not meant to disparage the methods of other doctors who prefer to do things differently.

In addition to the opinions of your friends, if you visit 5 to 10 more doctors, you will certainly get a plethora of opinions and perspectives on what you need and what you should do, and the question of whether or not this is the right time to do the procedures will always be at the forefront of your mind. The key, however, is what your desired outcome is, and whether the approaches recommended by these doctors can achieve that desired outcome.

With regard to the length of time you will be under for, and this is really a question that you need to ask your surgeon. Before doing surgery, my time estimation always includes time of preparation, the time of the surgery, and the time of recovery. I do have to mention that I don’t use general anesthesia in my practice, with the exception of rhinoplasty surgeries, for which there is an issue with the airway that really does require general anesthesia. Otherwise, I routinely use local anesthesia with LITE™ sedation for all the surgeries you mentioned.
The reasons why I prefer not to use general anesthesia are for safety and ease of recovery. From my experience, local anesthesia with LITE™ sedation is considerably safer than general anesthesia because patients are able to avoid many of the medical stressors associated with general anesthesia, both during and after the procedure. After a facelift, for example, my patients are routinely able to walk out of the office after their procedure, their faces wrapped, smiling and feeling good. This is in sharp contrast to how facelifts were done in the early to mid-90s. Back then, patients were placed under general anesthesia, then usually kept overnight at a hospital or surgery center, and we would place large wraps and drains after the procedure. Certainly, local anesthesia with LITE™ sedation makes it easier on both the patient and the doctor.

In terms of doing the procedures all at once, I don’t think that’s a problem. In our practice, it is not unusual to do a brow lift, upper and lower eyelid blepharoplasty, facelift, and neck lift all at the same time. It’s not so much about the number of procedures, but more about the time it takes to perform them. When working with local anesthesia and LITE™ sedation, I try to keep surgical time under four hours — that’s usually where I draw the line. It’s also not so much about the names of the procedures, because certainly there are different types of facelifts and eyelid surgeries, plus additional procedures like ptosis surgery, canthoplasty, lateral tarsal strip, and laser treatments; however, when you are dealing with a specialist type of approach to any issue, the range of time can vary.

It is difficult to give a more concrete recommendation without a physical exam. Usually, when I examine patients to determine if they are a good candidate for a facelift, I’ll lift up the skin in order to show them what can be done. In some cases, we’ll offer to do their eyelids and then do a procedure like structural volumizing in order to improve volume and definition in the cheeks and jawline in a way that is comparable to a facelift. There are certainly quite a number of options, and I think you should visit more doctors and learn more about these options to get a balanced and fully-informed perspective. If you already have a chosen doctor in mind, and if you trust them and feel comfortable with them, then this is certainly a discussion you need to have with that doctor.
Sometimes, patients will tell me that they only want to have one procedure done this year, and that’s perfectly fine. Because I don’t work with general anesthesia, I won’t feel pressured to tell the patient to have everything done together because they’re going under general anesthesia. In my practice, I could do eyelid surgery now and then a facelift later on, or I could do injectables. There really is a lot of flexibility in my approach and I think this wonderfully complements the reality of today’s modern lifestyle where people just don’t have enough time for prolonged post-surgery recovery periods. Sometimes, many people have pressing deadlines such as weddings, graduations, and birthdays, all of which need to be factored in when considering a cosmetic procedure.

Meet with experienced specialists so you can compare opinions and see if there is some consistency. I think it is important to choose a surgeon who not only treats their concern with technical and medical prowess, but also treats their concern with a sense of artistry and aesthetic awareness, which is what I strive to do in my practice. Aside from treating a patient’s main medical concern, we also offer skin products, skin rejuvenation treatments, in advanced cosmetic surgical procedures so that our patients are not limited in terms of solutions. As such, we are able to customize our approach in a way that will best serve the needs of the patient.
I hope that was helpful and I wish you the best of luck!

This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Facelift, lower eyelids and lip lift at the same time

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
These procedures can safely be performed at one time.  This will save you multiple anesthetic and healing periods, if performed individually.  Your sutures and bruising occur over one period. 

Ernest Robinson, MD
Aliso Viejo Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

It really depends on the individual

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
It really depends on the individual. I typically draw the line at about 6 hours of surgery for my patients but quite honestly if things are done well and balanced, it’s typically better to do everything together providing you have a very experienced surgeon. Sometimes patients will prefer to proceed with one or two things at a time but then are other individuals who prefer to just have everything done and not to be back to have to address another area. I hope you find this information and video useful.

Edwin F. Williams, III, MD
Latham Facial Plastic Surgeon

Undergoing a Facelift, Neck lift, Lip lift, and Blepharoplasty in One Session

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Dear Lellis30, ultimately, the decision to perform all of the procedures at once or separately is up to you or your surgeon. Depending on your age and overall health, it may be more beneficial to perform them separately (so as not to stress the body). However, as long as you are in overall good physical condition, performing these surgeries all in one visit may lead to a more uniform and desirable result, as other surgeons have mentioned. Another perk of having all of these procedures performed in one session is that it generally means less downtime for the patient, and some surgeons will even offer lower rates to those patients who have multiple surgeries performed in one visit.

Combining Procedures for Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
These procedures are done together frequently, as long as the patient is in good health, there should not be a problem. Be sure to choose a Board Certified Plastic Surgeon and view many before and after pictures. Good luck!

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Facelift, necklift, liplift and lower blepharoplasty - shall I do it at the same time or separately?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Facelift and eyelid surgery is very commonly done together.  Another issue is the duration of the surgery.  Ideally elective cosmetic surgery is optimal when the duration of surgery is 3 hours or less.

A well-done facelift will impact the mouth hopefully elevating the corner of the mouth.  My preference would be wait to do the lip lift at a second procedure once you have been able to evaluate the effect of your facelift on your mouth.

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.