Plastic Surgery
Complications

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

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

CHIN IMPLANT

1. Bleeding
2. Infection
3. Poor scarring
4. Displacement of implant
5. Malposition of implant
6. Sensory nerve damage (temporary and permanent)
7. Capsular contracture
8. “Bath tub” deformity with loss of projection

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

LABIAPLASTY

1. Bleeding
2. Infection
3. Prolonged swelling
4. Wound healing problems / wound breakdown (smokers)
5. Thrush / candida infection

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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Member |  International Society of Aesthetic Plastic Surgery (ISAPS)
Fellow  |  College of Surgeons of South Africa (Plastic Surgery)
Member |  International Member of THE American Society of Plastic Surgeons
Fellow  |  Royal College of Surgeons
Member |  Association of Plastic & Reconstructive Surgeons of SA