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. 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