When Is Doubling (Or Tripling) Up On Plastic Surgery Procedures A Good Idea?

When Heidi Montag had 10 plastic surgery procedures (comprising of a mini brow lift, chin reduction, fat transfer, and butt augmentation to name a few) within 24 hours back in 2010, it was widely considered dangerous. But, just a few years prior, she had doubled up on a rhinoplasty and breast augmentation, which is a relatively common practice.

So, if 10 invasive cosmetic procedures are, understandably, too many but two is (in most cases) just fine, what is the rule of thumb for when it is safe to combine and when it is not? When it comes to doubling or tripling up on plastic surgery procedures, how much is too much?

“More than half of my patients combine procedures,” says Melissa Doft, MD, a Manhattan-based plastic surgeon and clinical assistant professor of surgery at Weill Cornell Medical College. “It is very common for patients to combine a medically-necessary procedure like a septoplasty for a deviated septum with a rhinoplasty or a breast reduction with liposuction.” She will even occasionally partner up with another surgeon and do a tummy tuck after an obstetric surgeon removes a cyst or an IUD.

It is also popular, says Dr. Doft, for patients to combine two or three cosmetic procedures that complement one another — such as breast augmentation and tummy tuck or a rhinoplasty and a chin implant — because it can improve the overall result.

At his plastic surgery practice in Manhattan, David Rapaport, MD, says his patients will often double or triple up on invasive procedures because of the time and cost savings. “It’s very common for a patient to undergo more than one procedure at a time, and, in some cases, this is truly ideal," he says. "For example, combining areas for liposuction takes advantage of a single anesthetic experience and a single recovery period to improve multiple body parts. Similarly, when performing a facelift, I often address the eyelids at the same time. This too allows for more than one area on the face to be treated in a single procedure and allows for just one downtime.”

If bundling procedures saves time and money and can improve the result, when is it not a good idea? "When you double or triple up, the issue is usually not the number of procedures," says Dr. Doft. "It is how long it will take your surgeon to complete everything.”

Her rule of thumb: a six-hour operating maximum. After that time, she says, the risk of complications increases.

Dr. Rapaport concurs, and says he, too, tries to not exceed five to six hours in the OR. “After this period of time, there is a real increase in the risk of deep vein thrombosis (DVT) blood clots, a rare but potentially-fatal complication," he shares. "Furthermore, when patients undergo procedures of extended duration, their body temperature is typically lower, which increases the risk of postoperative infection, nausea, and vomiting.”

In addition to time constraints, Dr. Doft says it is also important to avoid combining procedures that may significantly impact a patient’s mobility post-operation. “You want a patient to be as ambulatory as possible after surgery,” she says, adding that being able to move around minimizes some of the post-op complication risks and accelerates healing.

But it's not just invasive procedures patients wish to combine. Non-surgical procedures and cosmetic treatments like lasers and injectables (think: Botox® and dermal fillers) are also common add-ons when someone is already scheduled for cosmetic surgery.

Thus, the number and types of procedures that can be combined is (a) doctor-dependent (read: how quickly do they operate?) and (b) patient-dependent (i.e. how complex is the rhinoplasty, or how much suturing does the doctor need to do after, say, the neck lift or eyelid surgery?).

“Surgeons must know themselves. I will typically write out a detailed sheet that lists everything a patient wants — breast reduction, lipo, filler, mole removal — to make sure I can realistically keep it under six hours,” says Dr. Doft, who then evaluates how the combination of procedures will impact a patient’s mobility after surgery. Only when she is confident that both considerations are within her safety parameters, will she green light bundling.

Most doctors follow a protocol similar to Dr. Doft and Dr. Rapaport. But, for your own peace of mind, if you are considering multiple surgeries, have your doctor walk you through the total time it will take for all the requested procedures and detail the recovery process. If you are not comfortable with the plan they outline, consider scaling back — or get a second opinion.