It is not uncommon for patients, when finally deciding to undergo plastic surgery, to realize that this is the time to do all of the things that they have been thinking about at once. In some cases, the two or three things they are considering actually go together, and it just makes sense to have them done and recover all in one go. But with multiple procedures comes increased time, expense, and sometimes risk. So when is one more too many?
As a general rule, there is a difference between procedures performed on the face and the body. The face absorbs local anesthesia faster, bleeds more, but loses less heat. The wounds are usually smaller, and the procedures often quick. There is a lot of swelling, but also usually not as much pain, so in the end it is – as is everything – a trade off. For facial plastic surgery, it often makes a lot of sense to have things like eyelids and browlifts performed at the same time as the facelift. The wounds are nearby, the bandages and recovery are localized, and it all goes together. Furthermore, if you are a good candidate for rejuvenation of the eyelids and the neck, making one of them smooth and leaving the other wrinkly can create an imbalance that actually makes the overall face look worse in the end.
For body procedures, this is a bit more complex. While many areas of the body are near each other, they are sometimes treated separately. The breasts and the belly for example, tend to be considered as separate entities, although how one looks very much affects the other. In many cases, they can be operated on at the same time, with a few caveats.
For one, combining breast and body procedures usually leads to a long surgery. But every surgeon is different, and it is important to get a sense of how long your surgeon thinks the overall procedure will take. As a general rule, once you go over 6 hours, the risks increase to some extent. For many surgeons, this is their personal limit for elective surgery, while others do not have one. I personally believe that a patient is either a good candidate for plastic surgery or not. If they are not safe for general anesthesia, whether or not it will be used, or if they are judged to be unsafe for a long procedure, then I believe that she should not have anything elective done in the first place. That being said, I still limit my aesthetic cases to 6 hours, because it feels safest to work this issue from both ends.
The baseline risks of a long or complex surgery include blood loss, electrolyte changes, loss of heat, metabolic demand, recovery stress, wound healing, blood clotting, and general exhaustion. All of these things should be considered on a case by cases basis, and a surgeon by surgeon basis. There is no absolute answer to whether or not cases should be combined; but combining is, under the right circumstances, considered safe. Given that the combination also generally means a shorter combined anesthetic time compared with two separate procedures, and a single recovery period, one could even argue that this is an advantage. For self-pay patients this also usually means lower cost in addition to less disruption of their daily lives. If you are thinking about finally having your rhinoplasty at the same time as your planned breast augmentation, you should discuss all of these issues with your surgeon. There is a very good chance that you would be able to do both at once, and emerge transformed and recovered after a few weeks of down time. And that can be a beautiful thing.