Multiple Procedures: How Much Is Safe To Do At Once?

Why consider combining procedures?

There are scenarios that naturally favor this approach. For example, facial aging typically affects both the eyes and face by a certain age. Treating just one area may produce a disharmonious appearance. Therefore blepharoplasty (eyelid surgery) and facelifts are commonly done at the same time. Similarly, changes in both the breasts and abdomen from multiple pregnancies favor simultaneous treatment (Figure 1). Combining procedures is advantageous because it entails only one recovery period and is economically more efficient.

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Figure 1: Before views (left) and after views (right) following a combined breast lift and
abdominoplasty.

Are results better when multiple procedures are performed at the same time?

Some individuals cannot commit to having multiple procedures done together. They may be more comfortable starting with a smaller scope of surgery. In any event the results will be the same if two or more procedures are done simultaneously or separately, spread out over time.

How many procedures can be safely done at one time?

This depends on the procedure characteristics, the method of anesthesia, and the total surgery time. It is usually safe to combine two procedures that are not more than two hours each, such as eyelid surgery and a breast augmentation. Individuals interested in three or more procedures should prioritize and generally pick no more than two to start with.

Besides individual procedure time what other factors influence the safety of combining procedures?

The type of anesthesia is very influential. Deep intravenous sedation has less potential adverse effects on the body than does general anesthesia. Most facial procedures can be done this way and often abdominoplasty too. Total operating time is less constrained with this method of anesthesia. On the other hand most breast procedures, rhinoplasty, and liposuction procedures require general anesthesia. Shorter total operating time is more desirable when general anesthesia is used.

What is the relative risk of different procedures?

Procedures that involved superficial structures only, such as blepharoplasty and facelifts, are safe to combine. Procedures that involve large body areas such as abdominoplasty and extensive liposuction pose a greater risk when combined. Abdominoplasty itself poses a higher safety risk than most other procedures because of its more common association with leg vein clots. Therefore the latter in particular should be cautiously combined with other procedures.

Who decides how many procedures should be done together?

Your surgeon will propose a scope of surgery based on experience that is both maximally efficient and safe. It is best not to press for more than the doctor recommends.

Can multiple simultaneous procedures be performed in an outpatient setting?

Combined plastic surgical procedures can be safely performed in an outpatient setting. One exception is for those having multiple body contouring procedures following weight loss surgery. This is commonly done in a hospital by a team of surgeons. An alternative is to do them as separate procedures over time in an outpatient setting.

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A new drawing continuing in the American flag theme!

#flag #American #girls
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Reverse abdominoplasty is appealing but only applys to those who have all of the following:

1. Loose skin in the middle
2. A perfect lower abdomen
3. Tight muscles
4. Breasts that will hide the scars or existing surgical scars in the breast crease

 Unlike traditional abdominoplasty, done for a different purpose, there is almost no swelling, little discomfort (no muscle work), and the scars are hidden. As indicated above though, true candidates for this procedure are uncommon. 

For the surgeons: this procedure is conceptually simple but challenging to execute. Enough skin has to be removed (4 cm or so) to get the job done yet avoid midline bunching. The inframammary crease has to be re-established and this is most effectively done sitting up, a tedious process!

#abdomen #tummy #wrinkles

Reverse abdominoplasty is appealing but only applys to those who have all of the following:

1. Loose skin in the middle
2. A perfect lower abdomen
3. Tight muscles
4. Breasts that will hide the scars or existing surgical scars in the breast crease

Unlike traditional abdominoplasty, done for a different purpose, there is almost no swelling, little discomfort (no muscle work), and the scars are hidden. As indicated above though, true candidates for this procedure are uncommon.

For the surgeons: this procedure is conceptually simple but challenging to execute. Enough skin has to be removed (4 cm or so) to get the job done yet avoid midline bunching. The inframammary crease has to be re-established and this is most effectively done sitting up, a tedious process!

#abdomen #tummy #wrinkles
...

Breast feeding results in atrophy of the gland, often manifesting as a deflated appearance. In these cases, the most common type, breast implants alone will re-establish pre-pregnancy aesthetics by simply replacing lost volume. More complex cases, like this one, also require removal of stretched skin to provide a simultaneous lift. When skin is removed it only takes a small implant to restore upper breast fullness. 

For the surgeons: Since implant size is small in these cases it typically represents less than 40% of total breast volume. Therefore the “feel” advantage of silicone implants typically becomes moot. Saline implants in this  setting are reliably stable for 20 years or more and are therefore preferred (125cc saline implants in this case).

#breast #lift #restore

Breast feeding results in atrophy of the gland, often manifesting as a deflated appearance. In these cases, the most common type, breast implants alone will re-establish pre-pregnancy aesthetics by simply replacing lost volume. More complex cases, like this one, also require removal of stretched skin to provide a simultaneous lift. When skin is removed it only takes a small implant to restore upper breast fullness.

For the surgeons: Since implant size is small in these cases it typically represents less than 40% of total breast volume. Therefore the “feel” advantage of silicone implants typically becomes moot. Saline implants in this setting are reliably stable for 20 years or more and are therefore preferred (125cc saline implants in this case).

#breast #lift #restore
...

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