Perhaps most importantly, a single operation means a single recovery period. After a facelift, there will be swelling. It will take at least two weeks before patients feel presentable in public, and in many cases it can take a month. Adding an endoscopic forehead lift adds virtually no discomfort. Adding eyelid surgery adds swelling around the eyes but very little additional discomfort. Adding fat injection means that there will be some minor swelling and bruising at the donor site and slightly more facial swelling.
Laser skin resurfacing usually sets the pace of recovery. This is because laser resurfacing causes swelling, redness and oozing of the facial skin which are all very visible changes, and it takes about a week for the appearance to get much better, when the oozing has stopped. In fact, there may not be a great deal of difference in appearance between a patient after laser skin resurfacing alone and after laser skin resurfacing with a facelift, eyelid surgery, forehead lift, etc. So the rationale for combining techniques is that if a patient is going to commit to two weeks to recover from cosmetic surgery, why not add additional techniques that do not substantially extend the recovery time but optimize the result?
The stereotype of the socialite having cosmetic surgery procedures every year or two is a thing of the past. Most of us do not have the luxury of unlimited time off work. It is difficult to be off work for two weeks or more, and most of us would choose to do something more enjoyable with vacation time than have cosmetic surgery. Few of us have the spare time or inclination to have multiple operations and recovery periods. One regular speaker at plastic surgery meetings is fond of saying, "We (plastic surgeons) enjoy surgery much more than our patients." For most patients, it makes sense to commit to getting the work done at one setting and the next year go on a cruise rather than recover from another cosmetic operation.
The final rationale for combined procedures is price. Plastic surgeons typically discount the price of additional procedures when done simultaneously. This reflects the fact that we are making use of one visit to the operating room, one set of supplies and one anesthetic. There is one recovery period because the patient recovers from more than one procedure simultaneously. This means there is a cost savings. The cost-benefit ratio is optimized. Not surprisingly, combined procedures are becoming more prevalent. Today, the majority of plastic surgical operations for facial rejuvenation involve more than one procedure. In fact, our thinking and pricing which has been traditionally procedure-specific, is becoming more goal-specific. We think in terms of facial rejuvenation as the goal rather than a forehead lift, or a facelift, which are simply tools that are put to use to achieve facial rejuvenation.
Operations are customized to the desires and time constraints of patients. Of course, some patients prefer to start out with a small procedure and return for other procedures incrementally because they simply want to start with baby steps. They may be nervous and need to develop a trust level with their surgeon, or they may simply have to prioritize financially. Some things will just have to wait.
