1 + 2 = 5?
Many patients who desire plastic surgery are interested in more than just one procedure. For example, the massive weight loss andmommy makeover patients often request multiple cosmetic procedures.
Patients who have lost a lot of weight often find that their reward for hard work is loose skin. These patients often desire a face lift, arm lift (brachioplasty), breast lift/ augmentation, tummy tuck, and thigh lift.
Mothers often find that after pregnancy their breasts droop and deflate and their abdomen is loose with new stretch marks and bulges.
These patients just want their bodies BACK. This can be viewed as reconstructive as much as cosmetic.
When combining multiple plastic surgery procedures the risks are more than additive. In other words if the risk of a breast augmentation is a 1 (arbitrary) and the risk of a tummy tuck is a 2, the combined risk is not a 3. The combined risk is more like a 5.
The most feared complication after any surgery is a DVT (blood clot) going to the lungs (pulmonary embolism). A large percentage of these patients do not make it to the hospital with the presenting sign being “sudden death”.
Not the kind of thing you want to think about when researching plastic surgery, I know. It is something that I am scared to death of and take every precaution to reduce this risk as close to zero as I can. I plan on never seeing this complication in my practice. (knock on wood…I have never even had a close call).
There are several well known risk factors for DVT
- Long procedures
- General anesthesia
- Genetic mutations (caution for the patient with a bleeding disorder or multiple miscarriages)
- Liposuction combined with other large procedures
- Oral contraceptives
- Patients with cancer
The duration of a procedure is a risk factor for almost every possible complication after plastic surgery, including infection, scarring and anesthetic complications.
This brings me back to the point of this post. The length of a procedure and type of anesthesia are two very important variables that I have a lot of control over. When a patient presents desiring multiple cosmetic procedures, I prefer to stage them. My general rule (and one that keeps my patients out of harms way and allows me to sleep well at night), is that I will usually do in one operation only what can be done under sedation with local anesthesia (without general anesthesia). There are procedures which have to be done under general anesthesia, but these are the exception.
In the massive weight loss patient, this may mean 4 – 6 operations. Many of these can be done within a few days of each other to allow for one period of recovery. A common sequence may be:
- Facelift (day 0)
- Breast lift/ augmentation (day 2)
- Arm lift (day 7)
- Tummy tuck (day 9)
- Inner thigh lift (day 14)
- Posterior thigh lift (1-3 months later)
By two weeks, the makeover is nearly complete. At this point the recovery is much easier and quicker than a large combined procedure. The risks of each procedure are minimized significantly.
For the mommy makeover patient this may involve two or three operations
- Breast augmentation/ lift (day 0)
- Tummy tuck (day 2)
- Liposuction (can be combined with the other procedures for a couple of small areas or separated)
But what about the costs of staging the procedures, isn’t it a lot more expensive?
The costs can actually be less with a staged approach, if the surgeon has his own operating room and does not charge a facility fee for its use. Our AAAASF certified outpatient operating room is where most of our cosmetic plastic surgery procedures are performed. There is not an additional facility fee or the high costs/ risks associated with a several day hospital admission.
How about the pain?
The pain associated with a staged approach is less. Kind of like getting hit in the stomach 6 times by a child vs. once by an adult.
It is certainly more difficult for the patient, as well as me and my staff, to separate the procedures. It is definitely worth it in this plastic surgeons opinion. I am not a surgical risk taker… I don’t do well with even minor complications after elective cosmetic surgery, it tears at me. It is worth the extra effort to avoid ever dealing with a major complication.