Cosmetic surgery will never be completely risk free, and a careful assessment of risks is certainly needed when combining procedures. Bottom line, there is no simple answer yes or no answer. Personally, in addition to being a plastic surgeon in Denver, I am the medical director for our Colorado state-licensed Ambulatory Surgery Center, the Surgery Center of Colorado, and I am always evaluating how we can best maintain a “Culture of Safety” within the surgery center.
Several factors are involved in the safety of performing multiple cosmetic surgery procedures in combination, including:
- Blood clot risk assessment and preventative measures
- Surgeon leadership in fostering and maintaining a culture of safety
- Safety “Habits” of the operating room personnel for the specific procedures being performed
- Pre and postop nursing-staff familiarity with the surgeon and the procedures
- Maintaining body temperature
- Body movement during surgery
- Type of anesthesia, and the time the patient will be under anesthesia
Personally, I routinely perform multiple procedure surgeries, and for every patient I perform a risk assessment in developing a plan for surgery. To say that my practice is “unsafe” by doing so is to not see the whole picture. The steps we go through to assess and improve safety are too numerous to list here, but include:
- Surgeon leadership in maintaining an ongoing “Safety Radar”
- Routine assessment of risk in every patient
- Demanding that all in the O.R. pay attention to the “Time Out” that precedes every surgery
- Vigilant attention to patient warming
For combined procedures that involve body contouring, such as the Mommy Makeover or Post Weight Loss Plastic Surgery Procedures, some additional measures used include:
- Moving patients to different positions during surgery
- Routine use of blood thinning shots
- Routing use of preoperative, intraoperative and postoperative “SCDs” (sequential compression devices)
- Careful teaching and follow-up to ensure that patients are walking (20 minutes total per day by day 7, including giving out a walker as needed to assist with walking)
- Routine use of skilled assistant surgeons or co-surgeons to improve efficiency
In summary, safety is an ongoing, never ending process. There is a limit as to what is safe to do in one day in the operating room. While multiple procedures do increase risk, if they are performed in a surgery setting as I have described, I believe that this increase in risk is often lower than the added risk of performing the surgeries separately. In other words, in the appropriate setting multiple cosmetic surgery procedures performed together may decrease your total risk by decreasing the number of times you are exposed to surgery.
