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.
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.