Can You Combine Plastic Surgery Procedures? A Surgeon’s Perspective

Typical examples of combinations that are often clinically necessary

1. Facelift and lip lift
2. Lower eyelids and mid-face/cheek lift
3. Tummy tuck and groin lift
4. Liposuction to back and arms
5. Upper eyelids and browlifting
6. Rhinoplasty and chin augmentation

In essence, every time we target a specific anatomical unit to operate on, we shall consider what would be the impact on the segments immediately contiguous to it, or associated with overall proportions (such as nose and chin, or nose and ears).

I find it necessary at this point to clarify the difference between facial plastic surgery and body contouring: the implications of combining procedures are very different between these two fields, and more detail follows in the relevant sections below.

When Can Procedures Be Combined?

The most fundamental principle is anatomical. Procedures can generally be combined when they are applied to the same body surface and are compatible with the same recovery position. For example, operating on the breast and the abdomen together is a natural combination, because a patient recovering from both will be resting on their back throughout. Operating on the face and the breast together follows the same logic.

This compatibility matters more than many patients realise. If two procedures require different or conflicting recovery positions, combining them creates a practical problem that can compromise both the outcome and the healing process.

When Combining Becomes a Clinical Recommendation

Sometimes the case for combining procedures becomes stronger than the patient’s original request. It arises from clinical assessment rather than from what the patient initially came to discuss.

I recently consulted a patient who had inquired about face and neck lifting. She had advanced skin laxity, collapse of the cheeks and jowls, and clear skin excess on the neck. As we discussed the “deep-plane face and neck lift” in detail, something became apparent. As I lifted the face upward and considered where the soft tissues would reposition, it became clear that her upper lip was going to look proportionally longer and longer as the face lifted. At that point, it was obvious to both of us that if we were proceeding with the face and neck lifting, we should also address the length of the upper lip. A lip lift was added to the plan, not simply at my request, but as she accepted a genuine suggestion I felt I owed her.

This is an important distinction. Combining procedures is not only about saving time or reducing the number of anaesthetic episodes. In certain cases, it is about achieving a result that is internally coherent, where every part of the face, or the body, reads as belonging to the same person after surgery.

Put simply: while it is crucial that I address the concerns a patient raises, I also feel compelled to avoid producing a disharmonious result, which would otherwise push a patient towards further surgery that we could have carried out at the same time.

The Combinations I Perform Most Often

Lower blepharoplasty and mid-face lift

This is probably the combination I perform most frequently in facial surgery, and the reason for it is clinical rather than logistical. I do not see how it is possible to operate properly on the lower eyelids without at least partially lifting the malar fat pad, the soft tissue of the mid-face, at the same time.

This concept is generally approved amongst specialists in facial plastic surgery as “treatment of the lid-to-cheek junction”.

There are two reasons for this. First, lifting the malar fat pad provides better structural support to the lower eyelid after surgery. Second, and more importantly from a long-term perspective, it produces a significantly better and more durable correction of the tear trough, the shadowed groove that often appears between the lower eyelid and the cheek. If the mid-face is not addressed when operating on the lower eyelid, the long-term result is compromised.

This is not a combination I offer because it is convenient. It is one I recommend because, in my clinical view, operating on the lower eyelid in isolation produces an inferior outcome.

The main advantage is that both procedures can be completed through the same incision: no additional concerns.

Face and neck lifting with lip lift

As described above, this combination arises from careful assessment at consultation rather than from the patient’s initial request. When planning a deep plane face and neck lift, it is worth examining what happens to the surrounding structures as the face is lifted. The upper lip is one area that can change in apparent proportion as the mid and lower face rises. Where this is the case, a lip lift is a natural addition to the plan.

BBL and 360 liposuction

By definition, a Brazilian butt lift is a combined procedure. We use VASER and power-assisted liposuction instruments to remove fat from the areas the patient wishes to reduce, most commonly the waist, flanks, and back in a 360-degree approach, and then transfer that fat to the buttocks and/or hips. This combination is, in practice, the most commonly performed combined procedure in my practice overall.

 

Those combinations are explored in detail below, but they are only examples. The principle applies across the full range of facial and body procedures: whenever I operate on one area, I consider its effect on the regions next to it and on the overall proportions.

The Advantages of Combining Procedures

The practical benefits are clear.

1. A single recovery period is considerably more manageable than two or three separate ones.
2. Time away from work and from normal life happens once.
3. Anaesthesia is administered once.
4. The logistical burden on the patient is substantially reduced.

But as the examples above illustrate, the more significant advantage is often clinical. When procedures interact with one another, when lifting one area of the face changes the proportions of another, or when operating on the lower eyelid creates a dependency on the mid-face, addressing them together produces a more coherent and longer-lasting result than treating each in isolation.

This is the distinction that matters most in my practice. Convenience is a benefit. A better outcome is the primary justification.

Safety and Pre-Operative Assessment

Where combining procedures requires more careful consideration is when the total body surface area involved is greater. Operating on the abdomen and the breast simultaneously, for example, involves approximately 20 to 30 percent of the body surface area. In these situations, the pre-operative medical assessment becomes correspondingly more thorough.

Before any extensive combined procedure, I want to confirm that a full blood count is satisfactory, that liver and kidney function are within normal range, and that coagulation parameters are correct. These checks are not optional. If any values fall outside the acceptable range, we work to restore them before proceeding. Where that is not possible within a reasonable timeframe, we proceed in separate stages.

The safety of the patient is the governing principle. The advantages of combining procedures are genuine, but they are never a reason to accept elevated risk.