Howard A. Tobin, MD, of Abilene, Tex, reported at the recent meeting of the American Academy of Facial Plastic and Reconstructive Surgery held in Denver his recommendation for combining multiple plastic surgical procedures. He noted that only rarely do patients request all those procedures that will enhance their overall appearance. Dr Tobin believes that the consultant has an obligation to raise the patient's level of sophistication to know that multiple ancillary plastic surgical procedures are available. Dr Tobin often combines three or four procedures, which may include all or various combinations of face lift, blepharoplasty, nasal surgery, chin implant, liposuction, coronal lift, or malar implant. He is particularly enthusiastic about recommending the use of malar implants. Dr Tobin cites the economy of time and expense as major reasons for combining multiple procedures.