General Risks & Complications of Surgery
Every surgical procedure has its own specific risks. During a comprehensive consultation, Dr Perkins will explain the specific risks of your procedure, and your risk profile in the context of your general health and the complexity of the proposed procedure. This enables patients to understand and weigh the risks and benefits of their proposed surgery, to be able to make an informed decision about whether to proceed.
Cosmetic surgical procedures are the same as surgery carried out for a medical indication. They are real operations and should be carried out by a real surgeon (FRACS), in a real operating theatre (accredited appropriately), with a real anaesthetist and given all the same due care, diligence and respect as any surgical procedure. As such cosmetic surgery carries all the potential complications, pitfalls and limitations of all other surgical procedures.
Some general risks that can potentially occur across a number of procedures include:
Scarring
All wounds heal by definition by way of a scar and thus scarring is inherent to all surgery. Plastic Surgeons strive to design incisions so that scars are hidden from sight, and if the nature of the surgery mandates they must be in a visible area, then the craft of the Plastic Surgeon is to minimise the scar’s visibility. A scar is always there, even if it is not visible.
Factors that contribute to a less than optimal scar are poor healing, due to poor blood supply or infection. Genetics are always a powerful force, and the patients inherent genetic healing capabilities can predispose then to adverse healing such as hypertrophic and keloid scarring. It is important for a patient to inform the surgeon of any adverse healing and scars in themselves, and their family.
Scars can be affected in the post-operative period with such things as taping, massage, silicone sheeting and intra-scar steroids. Instruction will be given for these ways to optimize potentials scars. Scars will improve naturally for many years.
Infection
Any surgical procedure has the risk of infection. Surgeons take precautions to minimise this risk, such as sterile operating environments and proper wound care, but infections can still occur. The bacteria are usually from the patient’s own skin. There are guidelines as to who is appropriate to be prescribed prophylactic antibiotics, which is not everyone.
Pain
Plastic surgery involves incisions and tissue manipulation, which can lead to post-operative pain and discomfort. Appropriate analgesia will be prescribed based on prior experience, and the nature of the surgery. Pain is a very subjective and personal experience, and the level of pain perceived varies depending on the procedure and the individual’s pain tolerance.
Undesirable Cosmetic Outcome
Plastic surgery outcomes may not meet the patient’s expectations or desires. It’s important for individuals to have realistic expectations and to communicate clearly with their surgeon about their goals and desired outcomes, prior to the operation. In some cases, additional surgery may be required to achieve the desired results or to correct any complications or unsatisfactory outcomes, which can increase the financial and emotional burden on the patient.
Nerve Damage
Nerves can be damaged during surgery, leading to temporary or permanent numbness, tingling, pain or diminished sensation in the affected area. In some operations, this is not a complication of the surgery, but an inevitable consequence inherent to the procedure e.g. abdominoplasty and facelift. Damage to deep motor nerves can also cause muscle weakness or paralysis. Nerves may recover function for up to 2 years.
Bruising and swelling
A degree of bruising and swelling is to be expected following surgery. The amount of bruising and swelling, and length of time to subside will depend on the procedure performed and the patient’s individual healing.
Haematoma
Haematomas are collections of blood that can form under the skin, wounds or flaps after surgery and may require drainage in the office or operating theatre.
Seroma
Seromas are collections of clear serous fluid (like in a blister). This excess fluid is a natural response to trauma (surgery) and is one reason a drain may be used as part of an operation. These seromas can form after surgery and may require, most commonly, simple aspiration with a needle and syringe in the office. This may need to be repeated until the volume diminishes. Rarely a drain may need to be inserted (usually under ultrasound guidance). Seromas are not intrinsically dangerous, and are more a nuisance, unless they become infected, which is not common.
Blood clots
There are many generalised responses, in the whole body, that accompany surgery. In major surgery, one response is the blood is more likely to clot or become sticky. This accompanied with the site of the surgery, and the degree of immobilisation, can predispose patients to clots in the deep veins of the legs and pelvis called deep vein thrombosis (DVT) (economy class syndrome). If these break off and go to the lung this is called a pulmonary embolus (PE) and can be serious, an emergency and life threatening.
Different operations carry proportionate risks. Measures to minimise risk will be used as specified in guidelines. These risk reduction measures used in the peri-operative period, include graded compression stockings, calf compressors and blood thinning injections and tablets as indicated.
It is imperative that if you have had a DVT or PE in the past, or if a family member has had a DVT or PE in past, you inform your surgeon. A significant number of patients with a history of DVT/PE will have an inherited clotting tendency, which will need managing.
Anaesthetic Complications
Plastic surgery usually requires the use of anaesthesia, which carries its own set of risks. These include adverse reactions to anaesthesia, breathing difficulties, and, in rare cases, life-threatening complications. If you require sedation or general anaesthetic, for your safety, this will be administered in a credentialed operating theatre, with a fully qualified anaesthetist. If you have had past issues with anaesthetics, allergic reactions, or significant medical issues, fully disclose these. Appropriate pre-operative investigation, medical review and anaesthetic consultation can be arranged.
Death
All activities we carry out in life have inherent risk. Crossing the road, swimming at a beach and driving a car all have potentially fatal outcomes. As such, a complication of all surgeries is death, albeit very small for elective cosmetic surgery. It is inherent when planning elective cosmetic surgery, to control and optimize variable factors, which include the number of procedures carried out under the one anaesthetic.
