| Although fortunately quite uncommon, complications can occur
with any surgery, and cosmetic or plastic surgery procedures are
no exception. Most complications are relatively minor, and tend
to settle without the need for further surgery, but occasionally,
secondary surgery may be necessary.
Patient selection is paramount, as I tell all
my patients that a successful outcome is really a partnership:
I will be the best plastic surgeon I can be, but then the patient
also needs to be the best patient they can be! In this regard,
I do not operate on patients who are significantly overweight
for their height, or who are in poor general health. Smoking is
a major potential cause of complications, and indeed, I will not
perform facelifts or tummy tucks on patients who continue to smoke around the time
of the surgery – a minimum complete abstinence from smoking
of 4 weeks before and 4 weeks after the surgery are required for
these surgeries, in order to be considered a suitable candidate.
Some potential complications are discussed below. Please also
refer to the ADVICE page
Scarring: This may be good, bad or ugly! It is
really a “material” issue, rather than an “operator”
issue. Every incision will leave a scar, which, in most cases,
will be well sited (relatively “hidden” in natural
body creases etc) and will tend to fade over time to become barely
visible. Some patients do not react well to incisions, and may
form thickened scars (called hypertrophic scars
or keloid scars). These are relatively unusual,
but can occur in certain people after surgery (more often in darker
skinned races). It is important to note that scars undergo several
changes until maturation (usually takes at least 1 year) and I
encourage all patients to use external taping (micropore tape
or silicone tape) to support the scar for the first 3 months to
give the best chance of a good final scar. Smokers tend to make
poorer scars.
Bleeding: Cosmetic surgery operations are very
controlled, and under normal circumstances, operative bleeding
is kept to a minimum. Occasionally, however, in the hours that
follow the surgery, some bleeding may occur, and if small, this
will result in a bruise. If the bleeding is more substantial,
it may form a collection called a haematoma,
and should this occur, one may have to return to the operating
room, and have this evacuated, and the bleeding stopped. This
is never to such an extent that a blood transfusion
is needed. To minimize the risk of bleeding, it is vital that
you AVOID all of the following for at least 2
weeks prior to the surgery:
- Aspirin or any aspirin containing medication (many cold & flu medication have aspirin)
- NSAIDS e.g. Ibuprofen, voltaren, indocid
- Arnica, herbal tablets, supplements of any sort, vitamins, minerals, omega oils, ginseng etc etc. If unsure,
please email me and check. All these supplements may be beneficial AFTER the surgery, but all increase your
likelihood of bleeding intra-operatively.
Infection: Uncommon after most plastic surgery
operations, and most often simply treated with oral antibiotics.
To minimize your risk, it is advisable to use an anti-septic body
wash and shampoo for 2-3 days pre-operatively (e.g. Bioscrub,
Hibiscrub, Betadine shampoo etc). Infection can be a real problem
if prostheses of any sort become infected, as this may result
in the need to remove the implants for 3-6 months.
Wound problems: Most wounds heal by “primary
intention” – e.g. all the incisions heal perfectly.
Occasionally however, the wounds may not heal perfectly, and may
even open slightly. The reasons for this are multiple (smoking
for one!). When this does occur, it tends to be minor, and most
often may require some topical ointment for a couple of weeks
post op. Major wound breakdown is fortunately very uncommon indeed,
and would necessitate further surgical intervention. Vitamins
(taken after the surgery) are useful to assist
the body in healing, as is a balanced diet in the post operative
period. Most wounds are stitched using slow absorbing material
(6 months to complete absorption) placed in the deep layer of
the skin. This is to support the wound as it heals. However, occasionally,
these sutures may “work their way” to the skin surface,
and if this happens, they will need to be removed. They may become
obvious as a little pimple / red area on the skin, or feel like
a little hair sticking through the skin – removal is then
needed.
Bruising & Swelling: Rather than a complication
per se, these represent a consequence of surgery. Everyone should
expect some swelling and variable bruising after any surgery,
the extent of which will vary from person to person and procedure
to procedure. Arnica is useful help with resolution
of bruising if taken AFTER the surgery, NOT
BEFORE!!
Damage to local structures: Nerves, blood vessels,
organs, muscles etc may all be inadvertently injured during the
surgery. This is most uncommon, but nevertheless can result from
aberrant anatomy and other factors related to the specific nature
of the surgery.
Nerve Injury: Both motor and sensory nerves can
be damaged during surgery. To actually cut the nerve (which, if
not corrected, would result in permanent loss of sensation or
movement in an area supplied by that nerve) is distinctly rare,
but occasionally, nerves may be bruised during the surgery, and
will “malfunction” for a period of a few weeks. Bruised
nerves should regain full function after some weeks. After liposuction,
the skin may take several months to regain normal sensation, and
similarly, after facelifts, the cheeks may be quite numb for some
months – this will return to normal.
Anaesthetic related complications: The anaesthetist
will be looking after you in this regard, and although some risk
is present with any anaesthetic, modern anaesthetics of the sort
that is in common practice in plastic surgery procedures, are
extremely safe.
Systemic complications: Although fortunately
VERY RARE indeed, they are worthy of mention,
as they can be potentially dangerous, and even life-threatening.
Fluid imbalances, severe infections, heart attacks, strokes etc
may all follow surgery – hence the need for fit, healthy
patients to begin with!! Deep vein thrombosis (DVT) and
pulmonary embolus (PE) are clots that may form in the
leg veins and may travel to the heart and lungs and make one very
sick indeed, and can even be fatal. We take every precaution to
minimize the patient’s risk and this may include special
stockings (T.E.D.) and sometimes calf pump machines to keep the
circulation moving in the legs. Having the procedure done under
regional anaesthetic blocks and sedation (as opposed to a full
general anaesthetic) is also protective. These complications are
not specifically related to plastic surgery at all – they
are common to all surgery procedures lasting longer than an hour.
Mood changes: It is very common to feel a bit
down shortly after any cosmetic procedure, notably facial aesthetic
surgery. This is a consequence of hormonal changes that occur
with surgery, and invariably passes as things start to settle,
swelling subsides etc.
Cosmetic Complications: Aside from the “medical”
complications above, and unique to cosmetic surgery patients,
is the possibility that despite no medical complications having
occurred, the patient can be dissatisfied with the cosmetic result
of the surgery. This can largely be avoided by the patient being
realistic about their expectations, and the surgeon being realistic
about what can or cannot be achieved surgically! If perfection
is what you are after, you are likely to be disappointed. If an
overall improvement is desired, this can often be achieved. I
prefer, where possible, to meet with prospective patients several
times in the pre-operative phase, to ensure that I understand
what they want to achieve, and perhaps more importantly, that
they understand what I can offer, both the advantages and disadvantages
of the procedure. I NEVER recommend surgery; I prefer that a patient
relates to me what bothers them, and I then provide information
(pros & cons) about a possible procedure that may improve
the area of concern. It is also important to appreciate that we
are all a bit asymmetrical (I will usually point this out to the
patient pre-op!), and that we cannot be “sculpted”
with as much predictability as clay!
Having said all of this, it is important to note that most patients
do not suffer any complications, and recover quickly without any
problems.
COSTS: Surgery costs, when quoted, include all
costs related to the primary surgery (unless specified), and all
normal aftercare. Should you be unfortunate enough to suffer a
complication that requires a return to the operating room (like
bleeding, infection etc) the hospital will levy additional fees
(for the use of the theatre, consumables etc) for which you, the
patient, would be liable. First Health Finance
offers insurance for those patients wishing to “cover”
themselves – I have no specific affiliation to this company,
but feel free to check out their website, and see if this appeals
to you.
Below is a list of some specific potential complications related
to the various surgeries – these will be discussed in detail
at consultation
SPECIFICS:
BREAST AUGMENTATION:
1. Anaesthetic related
2. Scarring
3. Bleeding / fluid collections
4. Infection – leading to loss of implant
5. Changes in nipple sensation – temporary vs permanent
6. Being able to feel the implant / see the implant
7. Asymmetry
8. Capsular contracture / hardening of the scar tissue around
the implant
9. Submuscle – pneumothorax
10. Implant displacement (submuscle)
BREAST REDUCTION / LIFT:
1. Anaesthetic related, including DVT / PE
2. Scarring
3. Bleeding
4. Infection
5. Changes in nipple sensation – may be permanent
6. Wound healing problems – notably at “T” -
dressings
7. Nipple / areola loss – partial or total
8. Breast feeding implications
9. Asymmetry - of breast / nipple height
ABDOMINOPLASTY
1. Anaesthetic related – DVT / PE and consequences
2. Scarring – dog ears, broad / hypertrophic scar
3. Bleeding / seroma / fluid collections
4. Infection
5. Wound healing problems
6. Numbness above scar
7. Tissue loss above scar
8. Asymmetry of tummy / scar
9. Need for revision / liposuction
10. Liposuction deformities: contour irregularities
11. Umbilical scarring / retraction / loss / position
LIPOSUCTION:
1. Anaesthetic related – DVT / PE
2. Bleeding / seroma / fluid collections
3. Infection
4. Numbness
5. Damage to local structures – muscles, tummy contents
6. Fat necrosis
7. Contour irregularities
8. Poor skin retraction / redraping
9. Inadequate fat removal
10. Excess fat removal
BLEPHAROPLASTY
1. Anaesthetic related
2. Scarring
3. Bleeding – hematoma – blindness (NB: Aspirin)
4. Damage to local structures – levator, extra-ocular muscles,
globe
5. Excess skin resection – scleral show / ectropion
6. Dry eyes
7. Asymmetry
FACELIFT
1. Anaesthetic related, including DVT /PE
2. Scarring, wound healing problems, skin slough, asymmetry
3. Bleeding – haematoma - ? Surgery
4. Infection
5. Damage to local structures:
1. Parotid gland / submandibular gland
2. Sensory nerves: numb earlobe
3. Motor nerves: facial nerve – eyebrow elevator / lip depressor
RHINOPLASTY
1. Anaesthetic related
2. Bleeding
3. Infection
4. Prolonged swelling – 1 year
5. Poor breathing
6. Cosmetic - shape, size
7. Deviation – if previous fracture
8. 12% revision rate
Please consult the page with ADVICE to
see what you can do in the pre-operative period to minimize your
risk of complications.
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