Surgical Risks Overview
General Considerations for Surgery
Being prepared for surgery, both mentally and physically, will make the whole process less anxiety provoking. Please read this section about general issues related to surgery. Specific issues and instructions for each procedure you are considering will be reviewed in the procedure section.
All surgery has associated risks, and understanding these risks will help you feel more comfortable about them. In general, small procedures have small risks, and major procedures have larger risks. It makes sense that if an incision is necessary for a procedure, there will be a scar. Likewise, when the skin is cut, there is a possibility of bleeding. Finally, until the incision is fully healed, there is a possibility of contracting an infection. Many steps are taken to reduce all of these risks, but even if everything is performed perfectly, a small chance remains that something may occur. Other general risks may not immediately jump to mind, but are understandable once you consider them further:
- During the rough and tumble years of childhood, many of us have experienced bumps or scrapes. If you bumped your knee, you probably noticed some swelling. If you scraped it badly, even if there was no bleeding, it could weep fluid for a period of time. Similarly, after any surgery, your body will respond by creating fluid around the operative region. The fluid can be seen as edema (soft swelling of the skin), or, if a potential cavity was created during the surgery, it can manifest as a seroma (a fluid collection under the skin). In surgeries where a seroma is expected to occur, drains may be placed to remove this fluid.
- All incisions made during surgery need to heal, and occasionally delayed healing can occur. Smoking and vascular conditions are known to slow down healing, so please be forthcoming during your preoperative interview and compliant with smoking abstinence in the peri-operative period.
- Variable amounts of bruising are possible, and occasionally there can be significant bleeding after surgery which requires additional operative intervention for treatment. With small surgical procedures, these issues will prolong the visible recovery period (due to more extensive bruising). With very extensive operations, the possibility of a blood transfusion may be entertained if excessive bleeding were to occur.
- It is normal to have some numbness near scars, as skin incisions divide small sensory nerves. Sometimes, larger regions can be affected, depending on how extensively your body tissues are moved to achieve the desired surgical changes. Typically, sensation will return over a period of months as the small nerve endings heal back into their correct locations.
- The life threatening complication of blood clots to the lungs (pulmonary emboli) is well known, and steps will be taken to reduce the chance of this occurring. The risk is higher in procedures with long operative times, and is reduced through the use of compression devices during surgery. Soon after your operation, you will be asked to resume walking, as walking reduces the chance of this occurring.
Know what to expect
The goal of your plastic surgeon and their staff is to make your surgical experience as easy and comfortable as possible. You will be provided with information regarding your specific procedure, all of which is aimed at removing the uncertainties that you would otherwise be facing. There are risks associated with surgery, and some instructions are aimed at reducing these risks. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery.
Day of Surgery
Your surgery will be performed either in a hospital, a free-standing ambulatory facility or an accredited office-based surgical suite. Medications will be administered for your comfort during the surgical procedure. Depending on the procedure being performed and your comfort level, pain relief can be achieved with local anesthesia, intravenous sedation, or sometimes general anesthesia. For your safety during the operation, various monitors will be used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
Once surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. If you had an “outpatient” procedure performed, you will be permitted to go home after a short period of observation. If you have undergone a general anesthetic, you must have a caregiver assist you with daily activities continuously for the first 24 hours. If your procedure requires an overnight stay, you will be transported to an overnight observation room after initially waking up in the recovery area.
Recovery from surgical procedures varies according to the procedure performed, as well as the individual on whom they are performed. The first few days after surgery, you should rest quietly. During the first 48 hours following surgery, patients experience varying degrees of bruising and swelling. Bruising typically disappears within seven to ten days. Remember that you must not take aspirin or certain anti-inflammatory medications as these will make your bruising worse, and could lead to bleeding. Swelling is a normal response of your body after surgery, and keeping the operated region elevated will help reduce the swelling. Cool compresses can help relieve discomfort and decrease swelling, but should only be used as specified by your surgeon. For most procedures, the first 2 to 3 days is when you will experience the most discomfort and you should expect to use oral pain medications on a scheduled basis. The discomfort level then rapidly decreases, and most patients can then reduce their medication to an as-needed basis by the 4th to 7th day after surgery. You will probably benefit from some medication at night to assist with sleep up to 10 days after the operation.
In general, it is good to avoid strenuous activities for the first few weeks after surgery. Specific instructions are tailored to the restrictions of individual procedures, and should be followed to achieve the best outcomes. After any operation, it is important to resume normal activities of daily living as soon as possible. These include going to the dinner table to eat and walking yourself to the rest room. This minimal amount of walking activity is enough to significantly reduce the risk of blood clot formation in your legs. Strenuous activities (such as running or weight lifting) should be avoided until your surgeon feels they are safe to resume.
Maintaining a Relationship with Your Plastic Surgeon
Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon. You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated.
Depending on your surgery, the surgical incisions will be closed either with absorbable sutures (that disappear on their own) or material that need to be removed (such as non-absorbable sutures or staples). The choice of closure material depends on the type of surgery being performed and the tension along the incision. If you need anything removed, this will be performed during a scheduled office visit. The timing for these visits will be discussed by your surgeon. In general, you will be instructed how to keep your incisions clean, and the care regime during the immediate healing phase. After immediate healing is complete (2 to 3 weeks), you will be instructed in scar care, with the use of creams to speed scar maturation, and sun block to avoid scar pigmentation.
All cosmetic surgery is aimed at changing contours of your body. The best way to maintain your surgical results are to protect the elastic properties of your skin (smoking avoidance, sun protection) and maintain a stable weight. Aside from prolonging the desired effects of your surgery, these practices are good for your overall health.