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Top Ten Cosmetic Surgery Complications

June 30th, 2009

The risk of complications are always present when any surgery is performed and cosmetic surgery is no exception.  However, since elective surgery patients are generally healthy at the outset, those complications are somewhat diminished.  It is important for patients to understand the risks of any surgery, so they  can make an informed decision.   In addition, informed patients may recognize problems early  during the post operative period and seek medical advice to correct.  I have made a list of  the top ten complications.

  1. Infection. Even though every precaution is taken to do surgery in a sterile setting, infection  is always a risk.   An IV  dose of antibiotics that is given just before the operation begins reduces the risk.   Antibiotic administration and in rare cases, implant removal becomes necessary to control infection.
  2. Bleeding. It is normal to see bleeding during surgery.    A significant amount of time doing surgery is dedicated to control bleeding.   After surgery some bruising may be seen.   Sometimes blood collections can occur and require removal. Rarely is blood transfusion necessary due to blood loss.
  3. Scarring. A scar in the skin will always be present after surgery.   The key factor for an unnoticed scar is optimal placement, such that it heals within the normal body creases and/or  that it can  be covered by clothing.   Sometimes scars can be raised, red and firm.   These are known as hypertrophic scars and are often a result be part of a person’s predisposition to abnormal scaring and are difficult to control.   Breast firmness or capsular contracture is a form of excessive scarring, as well.
  4. Poor Healing. Cosmetic surgery results are based on anticipated normal healing where scar tissue has an anticipated  strength  and density.   Breast implants can sag from beneath the breast if the normal scar tissue around the implant is not strong enough.   Nose surgery results are less than ideal when scar tissue becomes too thick.
  5. Slow Healing. Normal healing takes approximately six months.   This can be prolonged for secondary surgery where the amount of scar tissue is greater .   Sometimes scars can heal slowly if hair follicles become inflamed or if stitches beneath the skin become exposed.
  6. Skin Loss. Cosmetic surgery and plastic surgery in general carries a risk of skin loss.   Many of the surgeries we do reduces the normal blood flow to the skin as part of the surgical technique.  Skin loss may occur when a portion of skin simply does not survive, becomes part of the scab and falls off.   Fortunately, this is rare.   We know that bleeding beneath the skin may contribute to this condition.   More importantly, smoking and tobacco products can increase the risk of this problem ten fold.
  7. Nerve Injury. There are two kinds of nerves which can be hurt during surgery.   One is the sensory nerve which give feeling to the skin.   A portion of the skin can become numb after surgery.   Women can sometimes experience nipple numbness after breast enlargement, which often resolves.   The other type of nerve injury involves the motor nerves.   These nerves are necessary to have normal muscle function.   Rarely is facial muscle weakness seen after face lift surgery caused by motor nerve damage.
  8. Drug Reactions. Medications are an integral part of medicine.   Allergic reactions to medicines during and after surgery are possible.   Most often simply stopping the offending drug leads to rapid resolution of symptoms.   Emergency care is almost never needed.   Drugs can also react with each other in unpredictable fashions.   Illicit drugs, when combined with anesthetic agents can be very dangerous. It is important to be forthcoming about disclosing their usage.  The most common drug reaction we see in patients is nausea and vomiting after prescribed narcotic pain medicine following surgery.
  9. Deep Venous Blood Clots. Anytime a person remains very still for prolonged periods, there is a risk of forming clots inside the leg veins.   This process can involve the veins in the pelvis as well.   The inactivity or stillness  of a patient during surgery, combined with possible dehydration or fluid depletion always posses a risk for this.   Proper hydration before surgery and early activity as soon as possible after surgery goes a long way to prevent this problem.  Keeping surgical time to a minimum is ideal.
  10. Death. I hesitated to include this because it is so very rare with cosmetic surgery.   Yet it has occurred. Media reports almost all of these sensational occurrences.   This can occur from undiagnosed or undisclosed medical conditions, poorly controlled health problems, anesthetic complications, deep venous thrombosis or severe bleeding following surgery.  It is important to know the qualifications of your surgeon and the accreditation status of the surgical facility.

The risks of having cosmetic surgery are real but manageable.   Following before and after surgery instructions, along with recognizing problems early make it possible to safely do surgery.

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Body Dysmorphic Disorder

June 29th, 2009

Dr. Katharine A. Phillips reported on Body Dysmorphic Syndrome in World Psychiatry in 2004.   The review article describes the behaviors and symptoms of dysmorphophobia.   Generally patients with this problem have the perception that something is wrong with their appearance.   Frequently they focus on their face and head.   They turn to abnormal behaviors, such as excessive grooming (e.g., applying makeup, hair styling), camouflaging (e.g., with a hat, clothes, or makeup), frequent clothing changes, reassurance seeking, skin picking, and/or eating a restricted diet.   These behaviors typically occur for many hours a day and are difficult to resist or control.  Sometimes cosmetic surgery is considered.   It is also reported that this syndrome  is frequently associated with delusional thinking, depression, substance use disorders, and social phobias.

Sadly, the late Michael Jackson expressed many of these symptoms with his bizarre habits of mask wearing, weight loss, prescription drug use, and multiple cosmetic surgery procedures.   Depression and delusional thoughts may have ultimately contributed to his demise.

Patients sometimes come into my office with a history of prior multiple cosmetic surgery procedures.   We interview them carefully with regards to their expectations and motives for surgery.   This is particularly critical when they have had multiple procedures on a single facial feature, such as the nose.   We try to guide these patients to psychiatric care in an effort to rule out serious psychological problems.   Unfortunately, not all offices have this policy.   It seems that determined patients will often find someone willing to perform another cosmetic surgery procedure, when a reputable physician has counseled  against surgery.

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