Thank you for your question. In your question you submitted, you are asking will most plastic
surgeons perform facelift, neck lift, tummy tuck and breast lift in one operation. It
seems like you wanted to try to get almost everything you possibly want to get done all
in one operations and I can understand a lot of reasoning behind for you as the patient.
I can give you my opinion. I’m a Board-certified cosmetic surgeon and a fellowship trained
oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for
over 21 years and I do all these procedures you mentioned. And I would share with you
simply my perspective on the role of multiple surgeries and how I see as more of a function
of time and stress to the body rather than multiple operations.
So to begin with, when I was in training back in the early mid 90’s, it was not unusual
for plastic surgeons to book surgeries for one patient for the whole day. And so basically,
an 8-hour operation or in some case a 12-hour operation and I always wondered about the
safety of such a long procedure when it comes to the physical well being of the patient
after the surgery. I think enough time has passed and we have learned about the relative
risks of complications of surgery and basically risk factors such as general anesthesia and
prolonged operating time are very high risk factors for problems such as deep vein thrombosis
or blood clots. So understanding that there is one major issue and the other issue of
course is it is important to understand that surgeries don’t always go exactly in terms
of the time anticipated as planned. Things can happen such as bleeding, such as complexity
in the actual procedure and can it add time.
So, I think most of my colleagues would probably not do all those procedures all at once and
in my own practice, I don’t do general anesthesia for the surgeries I do. I do everything under
local anesthesia with LITE™ sedation and this includes breast augmentation as well
as liposuction and tummy tucks. And because of the knowledge gained by the use of tumescent
anesthesia which is invented by dermatologist back in the mid 80’s, we are able to minimize
the risk and even if the surgeries are long, the patient is not under general anesthesia,
they can actually move their body. They can get up and take a bathroom break but there
is a lot of safety in terms of the blood clot issue kind of build into that scenario. I
would say that the reason why a lot of people like you ask this type of situation is that
they want to avoid going under general anesthesia for more than one sitting And so in our practice,
essentially what I explain to my patients is you can have your eyes done, you can do
your face and neck lift, you can do anything you want separately because everything is
under local anesthesia. So there is really not a disincentive. It is a big deal to be
intubated and have a tube in your throat and being put in a respirator more times than
it is appropriate but in our situation, we are able to do under local sedation.
I generally advise, what I do for my facial aging procedures, if we are going to do eyelids
and facelifts, we will do that together. Sometimes we will put in a chin implant, cheek implants
but essentially I try to keep the surgery time down to under 4 hours and that’s even
people with under local anesthesia with LITE™ sedation, given all of the other things we
can do. I think that, when it comes to body procedures and a breast lifting procedure
surgery itself, it is technically a demanding procedure and takes time. Tummy tuck surgery
can be a little bit shorter but at the same time does require a lot of technical execution
and as well as immediate after care. I know that some of colleagues will do combination
of breast lifting surgery and tummy tuck or combination breast augmentation and tummy
tuck and that’s to the individual doctor and experience but I think that you should
separate the face and body procedures if you are anticipating in doing all of those together.
And again, this is my personal style of practice and I can say we had an excellent safety records
for decades now being conservative and helpful. Basically, I treat my patients like my own
family and I would not want someone in my family to go through all those procedures
at once. And I’m not saying that other doctors are being reckless but that is my personal
bias.
So, I think that you should get several opinions. Meet with different doctors who perform these
operations. I think that it will be of your best interest to divide these procedures out
and see what can be done under local sedation and if possible see what requires general
anesthesia. And I know that a lot of my colleagues especially for traditional tummy tucks perform
general anesthesia and understandably why even though it is certainly possible to do
traditional tummy tucks under local sedation. So again, meet with doctors until you are
comfortable with someone you feel will be able to do these things and I would also add
a little editorializing that there is still probably some doctors who will do a lot of
more face than body and I know that also it is a certain perspective that you may want
to keep in mind when you are choosing a specialist and this is just again a personal bias as
a specialist.
So I hope that was helpful, I wish you the best of luck and thank you for your question!