When considering having an aesthetic procedure – be it surgical or non-surgical – risks and complications can feel like a daunting topic to explore. Whether you’re an avid researcher or processing the information your provider shares with you, calculating whether the reward is greater than the risk can be difficult to compute. While the treatments offered by reputable, board certified dermatologists and plastic surgeons are largely considered safe and effective, no procedure is without risk and it’s important that patients understand that before booking an appointment.
Look no further than Linda Evangelista sharing her experience with paradoxical adipose hyperplasia (PAH) after CoolSculpting® or Amy Schumer talking about getting filler dissolved to see that it is possible to have suboptimal results. In some cases, the suboptimal veers to the dangerous. Late last year, Shahs of Sunset star Lilly Ghalichi opened about a scary brush with vascular occlusion and the threat of skin necrosis after getting filler. And then there are surgeries that don’t go as planned.
We certainly appreciate that people have become more transparent about their nips and tucks (here’s looking at you, Marc Jacobs), but the pitfall of normalization is that conversations around safety, efficacy, cost, and recovery are often lost in the shuffle. “Plastic surgery carries similar complications as other surgical specialties,” says Jules Walters III, MD, a board certified plastic and reconstructive surgeon in Metairie, LA. “Patients must realize this and not just be caught up on the glamorous side of plastic surgery shown on social media.”
This article is not to dissuade you from getting a procedure but rather to ensure you make the best decision for your health and aesthetic goals. With the help of top plastic surgeons, we’re exploring the most common cosmetic surgery complications, how severe they can be, and what steps patients can take to minimize the risk.
Side Effects vs. Complications
Before we dive into complications, it’s important to understand how they differ from side effects. Side effects refer to undesired or negative consequences that are expected when a drug or treatment is administered. For example, nausea is a common side effect of general anesthesia, while redness, swelling, and tenderness are all side effects of injectables. Complications, meanwhile, are uncommon consequences that, however rare, can occur. While side effects tend to resolve on their own, complications usually require medical intervention and possible revision. In this article, we are focusing on complications.
Both the side effects and potential complications of a procedure should be discussed during the consultation process and should certainly be considered before deciding on a procedure. The two vary in severity, but complications are the more serious – and rarer – of the bunch. “In general, the most common complications in plastic surgery are bleeding (hematoma), bruising (ecchymosis), fluid collection (seroma), infection, or poor scarring,” says Olivia MaDan, MD, a board eligible plastic and reconstructive surgeon in Nashville. In the case of the latter, “poor” can include widened, atrophic, hypertrophic, keloid scars, and more. “Some procedures can also lead to sensory changes, contour deformities, delayed wound healing, and need for revision,” she continues. “Less common complications include blood clot, fat embolism, and cardiac arrhythmia.”
The likelihood of these complications depends on a range of factors inclusive of both the patient and provider. The type of surgery you are undergoing, your medical history, and the surgeon’s level of expertise can all play a role in how smooth your recovery from surgery will be.
As it relates to the relationship between procedure type and complications, the Brazilian butt lift (BBL) is perhaps the most infamous. For the uninitiated, the procedure involves harvesting fat from a donor site via liposuction, purifying that fat, and then injecting into the buttocks. A 2017 survey from the Aesthetic Surgery Education and Research Foundation (ASERF) determined the BBL mortality rate to be one in 3,448. It decreased to one in 14,952 in 2019. The 2019 figure indicates mortality has reached an ‘acceptable’ level that is similar to that of abdominoplasty (one in 13,193). This is thanks in large part to changes in technique that have led to a safer result.
Despite the progress, many surgeons do not perform the procedure. Barry Weintraub, MD, a board certified plastic and reconstructive surgeon in New York City, says he doesn’t offer BBL at his practice because of the risks associated with it. And Dr. MaDan says it’s not just the butt enhancer. “Fat transfer procedures – BBL, facial fat grafting – are more likely to carry risks of contour deformity and fat embolism,” she notes.
As a reminder, trendy surgeries aren’t the only ones that carry risk. “Tummy tuck (abdominoplasty) procedures are more likely to have complications like hematoma and seroma,” Dr. MaDan shares. Breast surgeries, including breast lifts and breast implants, meanwhile, “are more likely to have complications like sensory changes, implant malposition, and poor scarring,” she adds.
How to Mitigate the Risk of Complication
In some ways, plastic surgery complications are a numbers game. Even in the best hands, there is always a possibility that something can happen. With that said, there is much that can be done pre- and post-op to mitigate risk.
1. Prioritize Your Health
The best way to prepare for surgery? Seeing to it that you’re in good overall health, says Martin Benjamin, MD, a board certified plastic and reconstructive surgeon in Scottsdale, AZ. “Maintaining a healthy weight, exercising, and having good nutrition will help to optimize your recovery,” he says. In some cases, a surgeon may even recommend committing to certain healthy lifestyle changes before undergoing treatment. Body mass index (BMI), for example, plays a role in whether or not someone is a candidate for surgery because of its impact on recovery and wound healing, while smoking can adversely affect results, too.
Additionally, it’s imperative to share any information you think may be significant with your surgeon or anesthesiologist during the consultation process, so they can adapt your care accordingly. “Understanding the patient’s medical history, as well as any previous issues with healing and surgery-related issues, can help to prevent future complications,” says Michael Somenek, MD, a double board certified facial plastic and reconstructive surgeon in Washington, DC. Dr. Benjamin agrees. “It will be important to make sure to discuss any of your past medical history and obtain the appropriate surgical clearance and preoperative labs, as well as avoid any tobacco or drug use before your operation,” he shares.
2. Choose a Skilled Surgeon
One of the most crucial steps to prevent possible complications is choosing the right provider. “When it comes to complications, the best prevention is to go with a trained surgeon, who is board certified in plastic surgery,” says Lauren Chmielewski, MD, a NYC-based board certified in plastic and reconstructive surgeon. “While even under the best of circumstances a complication can occur, you can improve your odds by researching the surgeon’s credentials.” This expertise can actually become even more important in case of an emergency, when the extensive training and experience kicks in.
In addition to vetting the credentials of the surgeon, also do your due diligence in scouting their team, facility, and body of work (think: patient testimonials, before and after photos). Dr. Chmielweski recommends asking your surgeon if the surgery center where your procedure will be performed is accredited. You can also inquire about who else will be on the surgical team – including the qualifications of the anesthesiologist.
The consultation process is a good way to get to know potential providers (in addition to learning more about treatment options), which is why we always recommend consulting with at least two surgeons. “Patients should always go with their gut,” Dr. Weintraub says. “In my revision cases where I’m correcting another surgeon’s subpar result, patients always say that they didn’t feel right about going ahead with their prior surgeon but did so anyway.”
We know that there can be a lot of ground to cover during the consultation, but there are some factors not related to treatment that you should pay attention to. “A surgeon should not be in a rush and should answer all questions during a consultation,” Dr. Weintraub shares. “[It] should be up to 60 minutes with thorough explanations of the procedure requested, a tour of the surgical facility, and an in-depth meeting with the practice manager.” His key takeaway: “Surgery is not sales – there should be no pressure and no rush.”
3. Ask Questions
As we’ve started to cover, the most crucial step before surgery is the consultation. It’s your primary opportunity to explore possible treatments, ask questions, learn more about the surgical team, and get a sense of the surgeon’s bedside manner. “Having a thorough discussion with your surgeon regarding your surgical procedure’s risks, benefits, and alternatives are of utmost importance during your consultation,” Dr. Benjamin emphasizes. “It will help guide your decision-making and best prepare you should there be any unanticipated surgical complications.”
A few questions you could ask regarding complications include:
- Am I a suitable candidate for this procedure?
- What are the known side effects and complications of this procedure?
- Are there any lower-risk alternatives I should consider?
- Have any of your patients experienced complications following this procedure?
- What will recovery look like? Are there any signs of complications I should look out for?
If you need more inspiration, we’ve got a full list of consultation questions to consider. At the end of the day, it’s all about fostering a healthy dialogue. “Proper communication between the patient and surgeon is a must,” Dr. Walters says.
4. Stick to Your Post-Op Plan
Just as you invest time and effort into the pre-op process, the post-op recovery period requires the utmost care, patience, and precision. Your surgeon will provide in-depth instructions that detail everything you can expect, everything to keep an eye on, and everything you can (and cannot) do at certain points along the way. Needless to say, compliance plays a big role in how you heal. Dr. MaDan offers these tips for a smooth recovery:
- Move Mindfully: Depending on the procedure, it could be weeks or months before you are cleared to exercise and get your blood pressure up again. While short walks and gentle movement are necessary to prevent clotting and such, slow and steady wins the race.
- Wear Compression: If your recovery calls for compression garments, wear them according to your surgeon’s recommendations. They help minimize bruising and fluid retention.
- Care for Your Scars: Wherever there is an incision, there will be a scar. Minimizing tension on incision sites can help minimize scars, as can silicone gel and massage.
- Be Patient: Even if you are cleared to resume normal activities after six or 12 weeks, know that the body can take up to a year to fully heal and your results may continue to evolve over that period of time. When implants are involved, allow them time to, as Dr. MaDan says, “drop and fluff.”
Preparation alone cannot completely eliminate the risk of complications, but no one has ever regretted going the extra mile to research and understand exactly what they can expect from something that is as expensive and life-changing as cosmetic surgery. This preparation includes being aware of the risks a surgery poses, preparing your body for a procedure by taking good care of yourself, and laying the groundwork for a smooth recovery. As Dr. Somenek reminds us, “following your doctor’s postoperative regimen and allowing time to heal are large factors that can contribute to an optimal result.”
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