Surgery complications – Risks of Plastic and Cosmetic Surgery
What Complications Can Occur during surgery?
Although every endeavour is made to avoid complications, sometimes they do occur and it does not necessarily imply an error has occurred.
General surgical complications can include:
- Anaesthetic reactions/complications: always inherent risks with all surgeries. Complications can relate to blood pressure issues, intubation risks, allergic reactions, respiratory issues;
- Blood clots (rare but serious risks like pulmonary embolism or stroke);
- Infection (is a potential complication for all surgical procedures. Early detection and treatment paramount for resolving/managing infections);
- Skin and fat necrosis (necrosis is the death of tissue caused by limited blood supply);
- Pain (duration and intensity based on surgery type and individuals pain threshold. Your surgeon and anaesthetist can provide advice on pain management);
- Scarring (part of the body’s natural healing process. Dependent on individuals skin type, location of the scar, genetics and size of scar) and abnormal scar formation (hypertrophic, keloid, widespread, hypo and hyper pigmented);
- Asymmetry (especially if unevenness prior to surgery);
- Skin discolouration or sensitivity changes (often temporary, but occasionally permanent)
- Swelling, bleeding and bruising;
- Nerve damage (may result in numbness, tingling, changes in sensation and paralysis of muscles);
- Haematoma (may require drainage or treatment to resolve);
- Poor wound healing (delayed healing or wound reopening);
- Seroma (collection of yellowish lymph fluid developing post operatively that may require drainage or treatments to resolve);
- Unsatisfactory results (outcome may differ from expectations, sometimes requiring revision);
- Prolonged pain (pain that lasts beyond the expected recovery timeline) and pain syndromes;
- Psychologic Impact (emotional responses post-surgery, including anxiety or disappointment); and
- death (extremely rare but remains a recognised surgical risk).
When undertaking surgery to the breasts (Augmentations, mastopexy (breast lift) and breast reductions):
- Change in nipple sensation (including complete loss) both temporary and permanent and the psychosexual consequences thereof and risk of hypersensitivity. Nipple necrosis may also occur;
- Scars can become abnormal and they may become thick, especially in the central area of the chest;
- Residual asymmetry can occur especially if there is unevenness prior to the surgery – different amounts can be removed from each breast to try and correct this;
- Breast-feeding is possible following surgery, however, supplementary feeding will be needed;
- In vertical methods of breast reduction and lift, there is no horizontal scar;
- The blood supply to the nipple can be compromised, which may necessitate the nipple being removed from the body and then reattached back to the skin. This is a rare occurrence and would only be indicated in a massive breast reduction that is extremely ptotic/droopy.
Specific risks for liposuction:
- Increased sensitivity;
- Skin looseness; and
- Indentations and irregularities.
Specific risks for Breast Augmentations:
- Capsule formation occurs as the body’s response to the implant being utilised for a Breast Augmentation. It is only if the capsule becomes particularly thick and constricted that this becomes a capsular contracture. Capsular contracture can result over time, with the implant becoming harder and smaller, and maybe a reason for repeat surgery. For textured implants, the risk of a bad capsule is 1.7 % (Bronz 1999);
- Palpable and visible implant edges;
- Implant rupture;
- Malrotation of an implant can occur in non-round implants. In my experience, this is an uncommon event but is the reason shaped implants are used only when they offer an advantage to the specific patient; and
- If you are not symmetrical, to begin with, and most women are not, then subtle differences are likely to persist after.
Specific risks for Eyelid reductions:
- Surgical complications can include excessive scar tissue inside the lower eyelid which can cause the eyelid to be pulled down (called scleral show or ectropion).; and
- Eyesight impairment and Blindness.
Specific risks for Facelift and browlift surgery:
- Damage to motor and sensory nerves both temporary and permanent and clinical consequences thereof;
- Subdermal scar tissue and banding in the neck; and
- There is the risk of bruising and swelling in all patients which is normal and will vary from patient to patient based on the extent of the surgery. Most patients returning to work after about two weeks.
Specific risks for Rhinoplasty surgery:
- Temporary altered sensation can occur in the skin of the nose;
- For someone with a deviated nose, some residual asymmetry is possible; and
- Minor secondary procedures may be required.
Specific risks for lip augmentation:
- The development of small cysts with dermal grafts, and initial swelling with fat grafts.
This list indicates some examples of the surgery complications. Surgery should not be undertaken until these have been discussed fully with Dr Mark Duncan-Smith.
Dr Duncan-Smith does take precautions to limit your surgical risks such as:
- Being a Specialist Plastic surgeon who is trained, qualified and an accredited Plastic surgeon, trained and qualified to perform invasive reconstructive and cosmetic plastic surgery. Dr Duncan-Smith also undertakes ongoing continuing professional development. Refer to Dr Duncan-Smith’s qualifications;
- Undergoing surgery at an accredited facility with an accredited anaesthetist (if being anaesthetised);
- Obtaining your medical history (it is important that you are transparent about your medical history and medications);
- Requiring you to quit smoking and avoid alcohol before and after surgery;
- Providing pre and post operative care instructions (these should be followed by all patients);
- Educating you on the procedure and encouraging you to ask questions to ensure you fully understand the procedure and its implications; and
- Encouraging you to attend follow up appointments and to report any unusual symptoms promptly.
