I was recently interviewed for an article on plastic surgery, and one of the “hot topics” had to do with combining multiple surgical procedures, and the safety and ethics of this approach. Due to the recent media attention to a reality television star who admitted to ten simultaneous surgeries, people are wondering what is safe and where surgeons need to draw the line on combined surgeries.

Combining surgical procedures, such as “Mommy Makeover” surgery, has always been a part of my surgical practice. Combined surgery allows patients to address multiple problem areas with only one trip to the operating room, and one general recovery period from surgery so that there is less time off of work.

In fact, I have contributed to the publication of 5 papers on this topic demonstrating that combined surgery is safe if done properly. Specifically: 1) patients need to be healthy and have proper preoperative medical screening, 2) the total operating time should be kept within a reasonable time-frame, 3) a board-certified MD anesthesiologist should be providing the anesthesia, and 4) multiple precautions should be taken against the formation of blood clots (DVT) during surgery.

This being said, there are a few lines that I am careful not to cross. For example, if a patient legitimately needs many areas of surgery to achieve an ideal appearance (for example, having loose skin all over the face and body after significant weight loss), I explain that I cannot combine all of these surgeries into one giant procedure. In these cases I always group procedures into safe, manageable stages with an appropriate period of healing between each stage. This approach is designed to protect a patient’s physical well-being.

Sometimes, I have to worry more about a patient’s mental well-being. For example, if a patient comes to my Phoenix area medical office asking for many procedures that seem out of proportion to issues with their actual appearance, I would usually be very concerned about body dysmorphic disorder (a negative distortion of self image). For these patients, their well-being would be better served by a therapist who could help them understand and correct the root cause of their distorted view of their appearance.

The bottom line is that performing multiple procedures simultaneously can be a great thing for patients when done safely and for the right reasons. However, careful judgment and moderation must be used to ensure the best surgical outcomes.