Aesthetic Medicine
Aesthetic Medicine


Two become one


Mr Alex Karidis, MD FRCS studied for his medical degree at the Aristotle University of Thessaloniki, then trained in the NHS before developing his specialism in cosmetic surgery. Renowned for his “invisible” scarring techniques, he works solely from his private clinic which is based in the St John & Elizabeth hospital in St John’s Wood, London. The Karidis clinic was founded in 1997.

Since the first national lockdown in the UK last year, we’ve seen a big increase in enquiries in clinic for multiple cosmetic surgery procedures to be combined. There are some patients who simply have one issue that they’re not happy about and want to correct, whereas others have multiple things. So, they figure, “while I’m under, why not try to combine more than one procedure?” From a surgeon’s point of view there is a lot of sense to this because this way you’re effectively subjecting patients to only one anaesthetic rather than multiple anaesthetics. It adds another variable to the success of the outcome of the surgery every time you add a new anaesthetic, whereas, if you do whatever you can during the same anaesthetic, then that’s always a benefit for the patient.

Combination surgery isn’t a new trend, but the pandemic has imposed time and financial restrictions on many people, leading them to think more about the best way to approach cosmetic surgery from both a cost and recovery perspective. The interesting thing is that the body doesn’t mind whether you’re recovering from one operation or three. It recovers at the same rate. For example, say the patient needs two weeks to recover from their breasts, two weeks to recover from their tummy and two weeks from their thighs; this doesn’t mean that they need six weeks. The body will do everything within those two weeks because it all runs concurrently at the same time.

From a financial perspective, by combining surgeries the patient often saves costs on travel, repeat hospital tests, anaesthetists and potentially an overnight stay. Patients can also reduce the time they take off work to recover and the length of a holiday they may wish to take for downtime.

There isn’t a limit to the number of procedures which can be performed in one appointment, but it’s a question of time.

Every surgeon has a certain time frame in which they do every procedure. Some may do one operation in four hours, while others can do two; it depends on expertise and level of skill. As long as the procedures are done strictly within that timeframe, it doesn’t matter if the body has been traumatised in one, two or three areas. The timeframe that I personally always work towards is usually about four and a half to five hours, maximum. In other words, I don’t want a patient to spend longer than that amount of time asleep under anaesthetic because if procedures are too long then this could cause added complications. Things like blood clots and pressure sores can be caused in some situations where patients are lying down in one position for too long.

So, usually, four and a half to five hours is the cut-off that we’re happy to do procedures in. I tell patients that whatever I can do within that timeframe, I’m happy to discuss.


In my practice there are several surgeries that we commonly combine for patients who wish to address those areas. Often, it is the eyelids alongside a face lift. Some patients are concerned with their nose as well, so a rhinoplasty can also be performed at the same time. Another common combination procedure is for men and targets gynaecomastia and the “love handles”.

The “mummy makeover” is also a popular procedure, targeting the stretched skin on the tummy and the breasts that have suffered as the result of breastfeeding and pregnancy. These complaints often go hand in hand, so many women feel they want to combine the two. In general, I start at the top of the body and work my way down. For example, if I’m doing the face and the eyes, I’ll do the eyes first and work my way down to the face. Same with the “mummy makeover”; I’ll do the breasts first and then the tummy.

However, there are certain operations that I won’t combine together, surgeries where the after-effects from the procedure might interfere with the other operation if it’s in too close proximity. For example, I wouldn’t perform a rhinoplasty at the same time as the lower eyelids because the nose operation leads to swelling underneath the eyes. You would be doubling the swelling in the same area by performing lower eyelid surgery straight after. There are also other operations that might interfere with healing and blood supply. If, for example, you perform a tummy tuck and you also do liposuction in close proximity to the thighs, you could interfere with the blood supply and, hence, the healing of the tummy tuck, potentially causing complications down the line for the patient.


Every surgeon has a style, and some are heavier handed than others. All have different abilities and strengths. We have different techniques and those who are more confident are likely to be gentler with the tissue, so they don’t have to search around for the dissection they need to do, reducing pulling or tugging.

There are different ways you can dissect tissue such as using scissors or a knife, and each way has a different traumatic effect.

There are special instruments that can actually cut through the tissue using heat, which separates tissue and at the same time stops any bleeding. We know the blood can cause irritation and subsequent pain, so if you can reduce the amount of bleeding then the patient will have less pain.

“The pandemic has imposed time and financial restrictions on many people, leading them to think more about the best way to approach cosmetic surgery from both a cost and recovery perspective”

I use heat to dissect tissue because it is much easier on patients and they feel much less pain. We go on the basis of what we have been doing the last 23 years at the hospital, and this demonstrates how important it is to assess your patients post-operation. In my practice, post-op appointments are equally as important as pre-operative because we want to get feedback from patients; “How was it?”, “Did you suffer? If so, why?” We want to try to understand whether we can tie in the answers to these questions with something we’ve possibly done, if there’s anything we need to try to avoid or change for future patients. It is all about assessing and auditing your results to benefit the patient and those to come after them.

As surgeons, we cannot become stuck in our ways and continue doing the same thing just because we’ve done it for the past 20 years. Yes, it may work, but you have to continually ask yourself if there’s a better way. It’s not just about the results, it’s about the patient.

This article appears in the March 2021 Issue of Aesthetic Medicine

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This article appears in the March 2021 Issue of Aesthetic Medicine