Combining Surgical Procedures – Is it a good idea?
I am not a fan of the “extreme makeover” approach to plastic surgery, which has been popularized on television, in which multiple unrelated procedures are performed over many hours in a single day. I think that the most important principle in cosmetic surgery is patient safety. A patient should come in to the operating room healthy and leave the operating room healthy. However, there are many times when combination surgery is both advantageous and safe. Two classic examples of common multiple procedure cases are a facelift combined with a brow lift and/or a blepharoplasty (eyelid surgery) or an abdominoplasty (tummy tuck) combined with breast surgery (augmentation/lift/reduction) and/or liposuction.
Surgery has many parallels to aviation. In flying, the most dangerous time is taking off and landing. Similarly, in surgery, the most dangerous time is going to sleep and waking up. Whether a flight is one hour or four hours the risk is essentially the same. The same holds true for surgery, the risk for a one hour case is essentially the same as that for a four hour procedure. Following this logic, flying Miami to New York nonstop is safer than flying Miami to Atlanta and then Atlanta to New York. There is only one take-off and one landing rather than two. Similarly with surgery, a combined procedure, may in certain cases, be safer in the sense that that there is only one anesthetic induction and emergence (going to sleep and waking up) versus two or three. Of course, as the surgery time lengthens beyond four hours, other safety considerations can come into play.
Additional advantages in combining procedures in a single surgery include a single period of discomfort, a single recuperation and less time away from work. There is also a financial advantage. The two or more cosmetic surgery procedures that are done together are usually hundreds of dollars less than doing the same procedures separately.
Another type of combining surgical procedures that is extremely common in my practice is combining a cosmetic plastic surgery with some type of medically necessary procedure. At Memorial West and Memorial Miramar Hospitals I routinely work with the OB/Gyns, the Urologists and the General Surgeons. Typical combination cases with these physicians may include a tummy tuck and/or breast surgery with a tubal ligation or myomectomy or hysterectomy with the Ob/Gyn, or a bladder suspension with the Urologist, or a hernia repair with the General Surgeon. The same advantages that exist with combining cosmetic plastic surgical procedures apply to these types of combination cases as well. There is even an additional advantage in some of these procedures, in that many of the steps of the cosmetic surgery procedure and the medically necessary procedure are the same (i.e., abdominoplasty and hysterectomy). Therefore, the surgical time of the combination procedure is significantly less than if each procedure was done separately. Finally, there is also a financial advantage when surgeries are combined in this manner. The cosmetic procedure(s) that is (are) done in conjunction with the medically necessary procedure is (are) also typically hundreds of dollars less when done with the medically necessary procedure than when the cosmetic procedure is done alone.
Of course, combining procedures may not be appropriate for every patient. However, in the right circumstances, it can be a welcome option.
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