Can You Have Two Surgeries (Example: Rhinoplasty and Bbl) a Day Apart when the Doctors Use Local?

I am having 2 different surgeries a day apart by 2 different doctors. I am having rhinoplasty on the 1st day then bbl with lipo to chin arms and inner thighs the next day. both doctors will be using local anesthesia. Can this be done? What are the effects of the anesthesia on me? The 2nd doctor says it ok as long as its local anesthesia, but I want opinions from other doctors before I have this done. thanks!

Doctor Answers 7

Rhinoplasty and BBL

 Rhinoplasty should not be done under local anesthesia. First of all, it is very difficult  and painful to get the nose  completely numb with local anesthetic while you're awake. Secondly, blood will be going down the back of  your throat and you could potentially aspirate blood and secretions  while undergoing surgery. Thirdly, you will have conscious awareness of your nasal bones being broken which will be  quite unpleasant. It is best to have both procedures done on the same anesthetic at the same time, or separate them out month apart if both are being performed under general anesthesia. We perform all rhinoplasty surgeries under the direction of a board-certified anesthesiologist  for patient safety.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 146 reviews

Combining plastic surgery procedures

Combining plastic surgery procedures is relatively common, such as rhinoplasty and septoplasty, or a face lift and eyelid surgery. Sometimes facial surgery is performed at similar time as breast or body surgery. Coordination is required between the surgeons, if the same surgeon is not performing all of the procedures.

However, as other cosmetic surgeons have stated, typically rhinoplasty and breast or body plastic surgery is not performed under local anesthesia. Most cosmetic surgery is performed via IV sedation (MAC) or general anesthesia. Minor procedures can be performed via local anesthesia. In addition, there are many variables in your planned procedures, and plastic surgeons want to minimize variables and maximize safety. Only after a comprehensive evaluation can your plastic surgeons can best guide you and coordinate care. Best of luck.

Dr. Chaboki

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 85 reviews

Operations can be safely done on subsequent days.

In general there is no particular contraindication to doing to operations on separate days. What is described in your situation is unorthodox. I have no problem doing operations under local anesthesia but there are instances where it certainly is not best for the patient – rhinoplasty.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 36 reviews

Can You Have Two Surgeries (Example: Rhinoplasty and Bbl) a Day Apart when the Doctors Use Local?

 There are two problems with this scenario in my opinion:

 1. Rhinoplasty under local infiltration does not allow adequate protection of the airway from bleeding...which can be quite significant during the surgery.  This blood would be free to go down the back of the throat and may be aspirated resulting in a pneumonia at worst and you being misrable at best.  In my opinion, Rhinoplasty should not be done with this type of anesthesia.

 2. The BBL will require you to be positioned face down and no matter how the nose is surely will be exposed to an increase in pressure and most likely bleeding...again with you awake.  Even if you had the BBL first, you'd have to be psoitioned on your back (and butt) for the Rhinoplasty again...not a good idea.

 That this is being considered gives me pause as it should you as to why this is even being entertained by either or both plastic and cosmetic surgeons.


Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Two consecutive surgeries under local anesthesia

There is a maximal allowed dose of a local anesthetic, which mainly depends on the type of the anesthetic and the weight of the patient.  The duration of the anesthetic is several hours, so as long as this maximum dose is not met during each surgery you should be ok from the toxicity standpoint.  But there are other issues to consider: having two surgeries as opposed to combining two procedures into one setting, discomfiort associated with having procedures done under local anesthesia, positioning issue (as brought up below) after rhinoplasty, etc.  So, the overall situation of two consecutive surgeries is far from the ideal.

Alexander Ovchinsky, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

How to separate two procedures on different days- safety is the key issue

Combining these two surgical procedures under local would not be a good idea due to the real possibility of lidocaine overdose.  Personally I would not consider a BBL under local anesthesia since you will require a fair dose of lidocaine just to harvest enough fat to perform the surgery.  A rhinoploasty, if at all extensive is also difficult under local anesthesia.  You may want to consider a single surgeon who could perform both operations at one time under a general anesthesia.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Can You Have Two Surgeries (Example: Rhinoplasty and Bbl) a Day Apart when the Doctors Use Local?

 A Brazilian buttlift one day after a rhinoplasty will involve a host of considerations, including care when positioning prone for the Brazilian buttlift to protect your nose.  The anesthesiologists and plastic surgeons need to all be involved in the decision.  You should also consider whether local anesthesia will be enough for both procedures.  There may be a possibility that one or both could be converted to general anesthesia.  Just have a frank discussion with all members involved.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 496 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.