One or two procedures?

Hi! I just found out that I am to have LMA anesthesia for my upcoming 5 hour surgery. This will include a SMAS lift, platysmaplasty, quad bleph and lateral temple lift. I am nervous about the length of the procedure although confident in this particular anesthesiologist (very good credentials). Would it be better for me to split the surgery into two pieces to shorten the length of surgery, avoid potential complications etc?

Doctor Answers 10

Better to have endotracheal tube than LMA45 hour involved facial plastic surgery

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During the course of the procedures  which include a SMAS facelift, platysmaplasty and temporal lift as well as 4 lid blepharoplasty I would prefer my patients have an endotracheal tube and not a LMA.  The head is moved side-to-side many times during the course of these procedures and slipping or displacement of the LMA can occur and would require emergency intubation with an endotracheal tube.

Please discuss this in detail with your plastic surgeon.

However the procedures that you're having are often done together and can safely be done in the 4-6 hour timeframe by a very experienced in skilled plastic surgeon.

One 5-hour facial surgery or split into two operations?

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I agree with my colleagues' replies, but would suggest that Dr. Fleming's answer hits the proper perspective here. With an excellent anesthesia provider and plastic surgeon, there are very many but extremely unlikely potential complications. Let's look at complication rates (source: for some facts.

Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A survey based on more than 400,000 operations performed in accredited facilities found that:
  • The rate of serious complications was less than half of 1 percent
  • The mortality rate was extremely low – only one in 57,000 cases
  • The overall risk of serious complications in an accredited office surgical facility is comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility
You will also be evaluated for other factors that may increase the risk of blood clots. These include:
  • being extremely overweight
  • having recent traumatic injury
  • any disorder of the heart, lungs or central nervous system
  • a history of cancer, recurrent severe infection or genetic problems that affect blood clotting
For women, additional risk factors include:
  • taking oral contraceptives or having recently ceased taking them
  • undergoing hormone-replacement therapy
Notice that length of operation is not listed as a risk factor, but understand that most plastic surgeons who operate in their own accredited facility or at a hospital-operated outpatient facility will self-limit outpatient procedures to 6 (or rarely more) hours. Two operations only doubles whatever risks already exist, however low, not to mention increasing the cost and time off work.

My partner and I have performed over 300 lower body lifts in our nationally-accredited (AAAASF) office surgical facility, and these procedure take 4-8 hours. All patients have done well without major complication. We have performed over 16000 office-facility operations in the 27 years I have been in private practice without death, heart attack, or stroke. But these things can and do occur, fortunately rarely. Why double your risk with two operations?

Best wishes and safe recovery! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

One or two procedures?

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A 5 hour procedure is not a particularly long surgery time and should be very safe under the correct circumstances. Personally, I think it's easier for the patient to undergo the procedures you mentioned in one sitting and then you only have to deal with one recovery period as well.

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Facelift with Browlift and Eyelid Surgery: Full Face Rejuvenation

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Full face rejuvenation with a face and neck lift combined with a browlift and eyelid surgery are common combinations that can take upwards of 6 hours. Advantage of combining this procedure is one anesthetic, one recovery, and one harmonious operation to set the clock back on the face.
In a healthy patient with monitored anesthesia, facial procedures are relatively safe because of the ability to maintain proper body temperature, limit blood loss, and avoid fluid shifts. This combined with DVT/VTE prophylaxis makes this effective combination safe in the well prepared patient.

Andrew P. Trussler, MD
Austin Plastic Surgeon
4.9 out of 5 stars 52 reviews

Anesthesia time with facelift and blepharoplasty

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Hi. Blepharopalsty and facelift are commonly combined procedures. Providing you are fit and healthy there is no reason not to perform these together - this has the advantage of only having one recovery (time off work etc) and also less expensive. Sometimes if one area if operated on the looks much better then the adjacent area can look relatively worse, which is another reason to have everything done together. Regards Dr Charles Cope

Charles Cope, MD
Sydney Plastic Surgeon
5.0 out of 5 stars 5 reviews

Anesthesia Time with Facial Rejuvenation Surgery

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For the number of facial procedures that you are going to have 5 hours is reasonable.  This amount of time should not increase your complication rate.

Dr. ES


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If you are healthy and a board certified anesthesiologist will be in attendance at your procedure, doing these procedures at one time is safe. Length of surgery in the 4-6 hour range is not considered risky.

Patti A. Flint, MD
Scottsdale Plastic Surgeon

One procedure

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HI Marcy22. I think the combination you describe can be safely performed in one setting. Good luck!

Lewis Ladocsi, MD, FACS
Richmond Plastic Surgeon

Safety of anesthesia for facial surgery

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Most facelifts and combination facial plastic surgery procedure are longer than 4-5 hours. These procedures are usually very safe, as long as the patient is in good health and there is adequate monitoring by a board certified anesthesiologist.

Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.4 out of 5 stars 51 reviews

Anesthesia Risks

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Although there are risks with any operation a five hour procedure for facial rejuvenation is safe. Actually there would be less anesthetic risk with one five hour procedure than a couple of two and one half hour operations.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

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.