Swelling: How much is normal?
June 10th, 2010
Swelling is normal part of surgery. In fact, it is a normal part of most situations where the body is injured, whether it is trauma from a fall or a medical disease like pneumonia.
The process of tissue swelling begins to occur immediately when surgery is started. It can initially be seen next to the edge of the incised skin. The tissues adjacent to the incision also begin to swell. These are the first steps in the stages of normal healing. Swelling continues as tissues are dissected to allow implant placement (breast enlargement), to allow fat removal (liposuction), or to allow skin and muscle tightening (facelift). As I complete surgery, allowances must be made for swelling as the final sculpting is completed.
The process of swelling continues as patients recover. Maximum swelling is usually between 48 and 72 hours after surgery. This swelling will extend beyond the surgery site to involve adjacent areas. In the case of breast enlargement, swelling will extend onto the chest, back and abdomen. Patients may also notice swelling in distant areas, such as hands and feet, areas well removed from the surgical site. The most distressing to some patients, is the aspect of temporary weight gain due to the extra fluid. This temporary fluid is normal and passes with time.
The question I am often asked, “When will this go away?” Swelling will begin to pass out of your body following 2 to 3 days after surgery. It is naturally excreted in your urine. Initial resolution is rapid, with the vast majority of swelling gone in four to six weeks. Complete resolution of any remaining swelling may take as long as six to twelve months. Although waiting this long to see a final result is frustrating to many patients, this is simply part of scar maturation and the physiology of internal healing. So once again, patience is a virtue!
Mirror, Mirror. Unrealistic Expectations?
May 24th, 2010
There is an old saying among general surgeons, “If you don’t operate, you will not have complications.”
The same can be said of cosmetic surgical results. On occasion, the results of surgery do not go according to plan. All surgeons have surgical results that are less than optimal. Occasionally some surgery may benefit from a secondary surgery to improve the result.
The causes of less than optimum results are complex. Complications such as unwanted bleeding or infection may occur, compromising recovery and healing. Sometimes patients do not follow after care instructions as carefully as they could, which can lead to problems. Pre-existing medical conditions may also interfere with healing and scarring. The surgical design may just not work out for a particular patient. Generally, the final outcome is a combination due to some or all of these factors.
Revision surgery is often difficult. Changes in anatomy are normal following surgery, so that must be taken into account when planning revised surgery. Feelings of disappointment and possible misgivings by the patient are not to be over-looked. Expectations of perfection may present undue anxiety during recovery, as a result of unrealistic goals. It is necessary to understand the limitations of the procedure. Even the most talented surgeon is unlikely to transform prospective patients into their Hollywood idols. Communication between patient and physician is key to maintaining healthy expectations of having surgery.
Surgical results are rarely perfect. The decision to perform revisional surgery is generally based on the likelihood of improvement, weighed against the risk of making things worse.
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