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Is It a Good Idea to Combine Surgical Procedures?

Our plastic surgeon—Robert E. Rothfield, MD, FACS—shares his philosophy on combining multiple surgical procedures:

I am not a fan of the “extreme makeover” approach to plastic surgery that has been popularized on television. In this process, multiple unrelated procedures are performed over many hours in a single day, which could potentially be hazardous to the patient. I think that the most important principle in cosmetic surgery is patient safety. I want my patient to come into the operating room healthy and leave the operating room healthy.

There are, however, many times when combination surgery can be both advantageous and safe. Two classic examples of common multiple procedure cases are:

  • Facelift combined with a brow lift and/or a blepharoplasty (eyelid surgery)
  • Abdominoplasty (tummy tuck) combined with breast surgery (augmentation/lift/reduction) and/or liposuction.

Advantages of Combining Multiple Cosmetic Procedures

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 under general anesthesia and waking up after surgery. Whether a flight is one hour or four hours, the risk is essentially the same. This also holds true for surgery: the risk for a one hour case is essentially the same as 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 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 of combining procedures into a single surgery include a single period of discomfort, a single recuperation, and less time away from work. There may also be a financial advantage. Having two or more cosmetic surgery procedures performed together usually costs hundreds of dollars less than having the same procedures done separately.

Benefits of Combining Cosmetic Surgery and Medically Necessary Procedures

Another common way to effectively combine surgical procedures is to perform cosmetic plastic surgery along with a medically necessary procedure. At Memorial West and Memorial Miramar Hospitals, I routinely work with the OB/Gyns, Urologists, and General Surgeons on combination surgeries. Typical combination cases with these physicians may include a tummy tuck and/or breast surgery along with a tubal ligation, myomectomy, or hysterectomy with the Ob/Gyn; 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 can apply to these types of combination cases as well. Furthermore, many of the steps involved in the cosmetic surgery procedure and the medically necessary procedure are the same (i.e. abdominoplasty and hysterectomy). Therefore, the surgical time of the combined procedures may be significantly less than if each procedure was performed separately. Finally, there can be a financial advantage when surgeries are combined in this manner. The cosmetic procedures done in conjunction with medically necessary procedures are typically hundreds of dollars less when performed together.

Of course, combining procedures may not be appropriate for every patient and certain risks may be increased. However, under the right circumstances, combination surgery can be a safe option.

Editor’s note: The original version of this post was published on August 14, 2009.

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