Risks of Surgery

General Risks and Complications of Plastic and Cosmetic Surgery

All invasive surgery has risks and possible complications. The key is to understand what the risks are and what you can do to minimise or prevent them. However, it’s important to state that some complications and surgery risks may occur randomly, despite having chosen the best surgeon, a top hospital and best practice procedure and wound care. Despite evidence-based medicine, all surgery carries risks.

• Cosmetic Surgery is invasive.
• Your skin is surgically incised and the tissue is either re-adjusted or removed.
• Some risks can be mitigated, but others can occur randomly.
• Ask your Surgeon for details of your specific surgical procedure risks or visit the procedure page you are interested in.

Understand these surgery risks by reading the materials provided and be sure you read everything before you sign the surgery consent form. Statistics indicate that the healthiest patients tolerate plastic surgery well, but a small number of patients may experience reactions to surgery or incur higher surgery risk rates or problems during their recovery.

Ask Mr Gittos for a detailed list of Surgery Risks which MAY include but are NOT limited to:

General Anaesthesia

• Most healthy patients are able to tolerate modern general anaesthesia quite well.
• Our team will provide you with the details of your anaesthetists prior to your surgery to discuss any specific concerns.

Bleeding (Hematoma)

• If this occurs, this may require another visit(s) to the operating theatre to remove the blood clot.

Fluid Build-up (Seroma)

• reoperation may be needed.

Infection

• Your Surgeon will prescribe you with antibiotics and monitor you closely.

Delayed Wound Healing

• Your Surgeon and Nurse coordinator will manage the healing process. This usually occurs within patients who are overweight, smokers or who have an infection.

Deep Vein Thrombosis (DVT)

• If circulation is impeded a blood clot may form.  There are other contributing factors.

Scarring

• Initially, there is almost always some contour issues or puckers. These settle over the months but sometimes may require a small revision often under local anaesthetic. Scars continue to mature and improve for up to 18 months after surgery. Stretch marks may not all be removed or new ones may be created.  Dermal treatments may help improve your scars.  (Every effort is made to place the scar within the areas covered by high cut swimwear or underwear).

Numbness

• This will occur 100% of the time and mostly settles over the months and up to 1-2 years.

Asymmetry

• There may be irregular ridges and crease to both sides. Scars may be slightly different on your right compared to your left side.

Umbilical Malposition/Loss

• This is a very rare complication and may require further surgery.

Pain

• This will be managed appropriately with pain medications and prompt aftercare.
• All successful surgical outcomes are the result of realistic expectations of the patient, realistic surgical goals and the knowledge of possible risks and complications. Nothing is ever guaranteed in science and medicine.
• Risks are minimised through careful patient screening and planning, high standards of surgical training, meticulous surgical technique and vigilant post-operative care.
• Small, less serious issues are common and every effort is made to resolve them quickly.
• These rarely have long term effect on an excellent final result.

Risks of General Surgery – An Overview

Swelling, Bruising and Skin Discolouration

• Discolouration from bruising may take several weeks to resolve.
• Moderate swelling and bruising are normal after surgery
• Severe swelling and bruising may indicate bleeding and should be investigated by your Surgeon or medical team
• Severe swelling or elevated temperature can also indicate a possible infection
• Expect to swell and bruising to settle more quickly with your post-op support or ‘compression’ garment
• You can also apply Arnica ointment to the treated areas (ask your Surgeon) – typically for the first several weeks following the operation
• Our Rapid Recovery packages can aid your recovery process – be sure to find out how to best use the products for optimal healing after Liposuction
• Don’t be surprised that some intermittent swelling or discolouration may persist for up to 12 months after you have your surgery.

Haematoma and Bleeding

• Bleeding can occur during or after ANY operation; some bleeding will result in skin discolouration or skin bruising.
• Continued bleeding may result in a collection of blood under your skin; be sure to notify your Surgeon if bleeding after surgery persists.
• Smaller collections of blood that occur under your skin will typically absorb somewhat spontaneously.
• But a LARGE collection of blood under the skin (haematoma), whilst uncommon after liposuction, CAN impede healing or cause complications including pressure under the skin.
• Haematomas tend to occur in the first 24 hours after surgery
• They require aspiration or surgical drainage in an operating room
• Usually, they’d also require you to under a General Anaesthetic for draining of the accumulated blood.
• The presence of a haematoma, even if evacuated, may predispose you to potential infections
• Antibiotics are typically recommended if you have had a Haematoma or are at risk
• Haemorrhage risks can also be increased
• Bruising can occur for several weeks following your liposuction.
• Bruising or late bleeding with bruising (skin discolouration) might indicate an infection, physical exertion (overdoing it), aspirin ingestion or an unrecognized bleeding disorder.

How to Avoid Excess Bleeding After Surgery

• Hypertension (high blood pressure) that is not fully controlled, or which is volatile, may sometimes cause excess bleeding during or after your surgery.
• Aspirin, anti-inflammatory tablets and mega doses of certain vitamins (particularly vitamin E) can impact on your blood’s ability to clot.
  • These can also lead to excessive bleeding.
  • Thereby it is often recommended by your Surgeon that you do NOT take any aspirin or non-steroidal anti-inflammatory medications for at least 10 days PRIOR to your surgery date
  • These medications and similar supplements can lead to greater risks of infection, bruising, bleeding or swelling.
  • You should also discuss any and all drugs, medications and even vitamin supplements that you take, so as to learn how to prepare best for your Liposuction surgery and minimise your medication-related bleeding risks.
  • Your Surgeon will give you more details about what you CAN or SHOULDN’T take or which you should ADAPT your intake of, prior to your surgery (examples include anticoagulant medications such as heparin or warfarin, which can lead to more bleeding).
  • You’ll need specific guidance from your Surgeon and medical care team.

Seroma – Fluid build-up

• A seroma (yellow fluid) can accumulate under the skin after liposuction, usually in the first month following surgery.
• A seroma may increase your risks of infection.
• The accumulated fluid will often cause swelling and/or pain in the affected areas.
• Sometimes the body absorbs a smaller seroma but larger ones often need drainage using a needle, or via additional surgery, in order to drain the fluid from under your skin.
• Itching is common as the skin and body heal from a surgical procedure.  Sometimes this can feel like small electrical sensations within the skin. This is common as nerve endings are healing.  How it’s best managed is often with topical treatments, including ice, quality moisturisers or even massages – ask your Surgeon what’s best.

Necrosis – Dead Tissue and Higher Risks of all Complications if you Smoke

• Necrosis means the formation of dead tissue under the skin (Fat necrosis).  Fat necrosis may occur more commonly with the ultrasonic liposuction methods; it can prevent wound healing and require revisional or corrective surgery. Scarring can also occur after necrosis, and the risk factors associated with necrosis include infection and smoking. Smoking should be avoided for best results and optimal healing processes.
• Smokers have a higher chance of complications with any surgery. These include poor wound healing as well as infection, necrosis or skin loss and other problems relating to decreased circulation. Bleeding and haematoma formation are more common in smokers than non-smokers. Smoking also increases all of your risks; it predisposes you to life-threatening surgery complications such as DVT (deep vein thrombosis), pulmonary embolism, massive infections and pneumonia.  You should cease all smoking 4 weeks prior to and for at least 4 to 10 weeks after your surgery.

Wound Separation or Delayed Healing

• Issues such as an infection, inflammation, skin tension around the healing wound, decreased circulation or even pressure (external pressure on the skin or wound) can sometimes delay healing or impede your recovery. If you have other medical conditions or chronic conditions impacting your immunity system, such as smoking or diabetes, then you’ll have a far greater risk of skin loss or wound healing complications.

Wound Separation May also Occur after Suture Removal

• Wound separation is an issue for some patients, and requires diligent post-op care, potentially for several weeks or months after your surgery.  Additional surgery sessions and even skin grafting may be required to help remove any non-healed tissue or to obtain proper wound closure if the wound separates. Scar revisions may also be called for in the event of this complication.

Skin Sensitivity or Allergy to your Dressings or Post-op Tape

• Skin or localised allergies can relate to sensitivity or allergic reactions to various products or solutions. Allergies that are not uncommon include sensitivities to antiseptic solutions, ointments, sutures, soaps, tapes and dressings that are commonly used during or after your surgery.
• Such problems are unusual and for most people, are often mild and easily remedied by your Surgeon’s advice. But it’s still important to make sure your Surgeon is aware of any skin irritations, itchiness, blisters or redness that develop beneath your dressings or anywhere else on your body during the healing period.

Sutures and Reactions or Complications to Suture Materials

• Suture reactions or skin infection can occur when sutures are used, including under the skin.
• There’s a possibility that suture marks (indentations/scars) may occur in your skin where the sutures or staples are used to close your surgical incision.
• Skin sutures have been known to become buried under the skin during healing and recovery; and subcutaneous sutures may not always dissolve (resulting in a stitch granuloma). Sometimes, additional procedures may be necessary to help remove buried sutures or granulomas.

Scars and Long-term Scar Management after your Surgery: Fraxel can help

• All surgical incisions produce scarring. Some people are more prone to scarring than others.
• The quality and visibility of the final scars are somewhat unpredictable but can often be helped. That noted, scarring is not entirely under the control of you or your Surgeon. Some areas on your body may scar more readily than other areas; some people – such as people with a lot of pigment in their skin – may also find they are prone to Keloid scars.  Scars can also be made worse if there has been an infection or if the wound has broken down.  Ask your Surgeon about Fraxel scar minimisation and other scar minimisation strategies.

How Scars Tend to Heal and What to Expect

• Scars are permanent marks that indicate injury to the underlying skin or structures.  Scars will remain permanently visible to a lesser or greater extent, depending on the outcome and how they are treated, but mostly dependent on how your body deals with injury or trauma to the skin. Some people scar more readily than others.
• The appearance of your surgical scars will change significantly over your recovery time. Some scars become red or raised and visible, usually between about 6 weeks to about 3 to 4 months.  After 6 to 7 months, scars begin to fade a bit. But scars don’t fully settle for a few years, for most people. Scars on the lower body (legs and thighs) or arms can also take up to 2 years to get to their final ‘this is as good as it can get’ state.
• Brown or darker discolourations in scars tend to settle and blend a bit more with the non-scarred skin, but this can take time. They are permanent but can fade.
• Light or ‘whitish” scars are permanent and the colour will tend to stay lighter than the rest of the skin.
• Please ask your surgeon about scar management techniques

Abnormal Heavy Scars Such as Keloids

Abnormal scars occur more commonly in certain skin types as well as in younger patients. They can also occur where there has been a delay in healing due to complications such as an infection or a wound breakdown. Abnormal scars can be;

• raised
• thick (hypertrophic or keloid)
• stretched (wide)
• depressed/indented
• or a very noticeably different colour to surrounding tissues.
• Some scars may also involve visible suture marks
• or may occur within the skin as well as the deeper tissues.

Scars do often tend to improve with time, but not all do, and some scars benefit from additional treatment including scar revision as a possibility for some patients.  Thicker scars sometimes respond to taping, or the placement of a silicone sheet onto the area of the scars. Serial injections of steroids into the scars is also an option as is a surgical or laser scar revision procedure.  Very wide scars can sometimes require scar revision surgery to help improve their appearance.

Asymmetry

• As noted above, the human body is asymmetrical.
• The normal variation from one side of your body to the other is rarely resolved after surgery.
• You may notice asymmetry more because you are simply paying closer attention to your body.
• Perfect symmetry is simply not attainable.
• whether it’s from liposuction or any other procedure or recovery process
• keep your expectations realistic.

Post-operative Fatigue & Depression Can Sometimes Occur

• Many patients occasionally experience feelings of depression during the first few days or week after their surgery, especially when;
  • they are feeling uncomfortable
  • when there is pain
  • swelling
  • or bruising.
• Fatigue or depression can be aggravated if you don’t get a good night’s sleep.
• There are some sleeping positions you may need to adapt your sleeping style to so as to get rest whilst healing.
• Or, you may find you get very little rest (and become tired and irritable) in the weeks after your surgery.
• This does ease, so be patient and give it time.
• Be gentle with yourself and do all you can to rest and nurture yourself as you recover from your procedure.

Deep Vein Thrombosis (DVT)

• Deep vein thrombosis is a blood clot in the deep veins of the legs or calves.
• It causes pain, swelling and sometimes heat in the affected leg.
• It is potentially life-threatening.
• Prompt treatment is essential and often involves blood-thinning agents/medications.
• Ask your Surgeon about other complications of a deep venous thrombosis including that the clot could spread from the legs to the lungs or even to your heart, potentially causing breathing difficulties, chest pain or even death.
• If you are undergoing surgery, the risk of deep vein thrombosis relates to the type of surgery and the duration of the procedure.
• certain conditions or habits can increase your risks.
• For example, smoking or even possibly increased by being on HRT or using oral contraceptives.
• However, there are preventive treatments for deep vein thrombosis (DVT) and these may be recommended.
• These might consist of compression stockings, early movement of the body after surgery (early ambulation) or even the use of blood-thinning agents.

CHRONIC PAIN IS SOMETIMES AN ISSUE AFTER SURGERY FOR SOME PATIENTS

• Following surgery, abnormal scarring in the skin and deeper tissues can sometimes trap nerves, impinging on nerve endings or producing pain.  Chronic, persistent pain of an unknown or ambiguous origin can develop for some patients. This type of chronic pain can be extremely difficult, or impossible, to fully correct.

Anaesthetic Related Risks

WHAT RISKS ARE THERE IN HAVING SURGERY OR ANAESTHESIA?

• Anaesthetic complications, although uncommon, can occur.
• And, will be discussed between you and your Anaesthetist prior to Surgery.
• Allergic reactions to drugs used in anaesthesia are, fortunately, quite rare (1 in 10,000 people).
• Systemic reactions may also occur to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
• The tube used to administer anaesthesia can cause a sore throat.
• You may develop a painful or infected intravenous site.
• Anaesthetic complications should be discussed with the anaesthetist.

PAIN OR DISCOMFORT

• Mild to moderate pain is normal and can be expected after tummy surgery.
• If your pain becomes severe and is not relieved by pain medication,  let your Surgeon know immediately. This may mean you have a complication.
• With no drain procedures for most patients, your post-op discomfort should be minimized – but do expect pain as an inherent part of your procedure.

UPSET TUMMY INCLUDING NAUSEA OR VOMITING

• Some people have reactions to Anesthetic
• Nausea or post-op vomiting often relate to your body’s reaction to the Anaesthetic
  • This usually resolves relatively quickly (a few hours).
  • However, some patients might experience ongoing vomiting, especially if they have digestive sensitivities to pain relief medications or post-op antibiotics where these are given.
  • Sometimes infections can also cause an upset stomach or nausea, so be sure to check with your Surgeon.
• Risks of vomiting and nausea: if persisting, you could develop dehydration.
• You should contact your surgeon if nausea and vomiting persist and you may need to become re-hydrated.

CONSTIPATION

• If you normally take medication for bowel problems you will need to bring these medications to hospital with you. It is common to develop constipation after surgery that may require treatment. Prevention of constipation begins on the day of surgery and continues until the bowel returns to “normal” function, which is usually once the need for pain medication ceases. Medications for constipation such as coloxyl and senna or lactulose can be purchased from the local chemist without a prescription. Eat fresh fruit and vegetables, take extra fibre and increase your exercise. Drink plenty of water, providing you are not on restricted fluids for any reason.

Life-threatening complications

• Include pulmonary embolism, cardiac arrhythmia, heart attack, stroke or massive infection These are thankfully very rare but can occur

PULMONARY (LUNG) COMPLICATIONS

• Pulmonary complications are uncommon and may occur secondary to either a blood clot starting in the legs (pulmonary embolism), aspiration of stomach secretions or partial collapse of the lungs after general anaesthesia

What Impacts Long-term Results and Effects?

AGEING, SMOKING, WEIGHT CHANGES AND SUN EXPOSURE (AND, OTHER ILLNESSES)

• There are many variables in terms of your health or your lifestyle that can influence your long-term body-contouring results after liposuction.
• Aging, skin changes, sun damage, weight changes, pregnancy, certain illnesses or other lifestyle factors can impact your short or long-term liposuction outcomes.
• Additional liposuction, surgery or combined treatment may be required in time.
• This may be needed to help maintain or help improve your contours.
• However, if you maintain a healthy lifestyle and stable weight, you should enjoy a good long-term liposuction/body contouring result.

FAQs about Risks of Surgery

WHAT ARE THE POSSIBLE SIDE EFFECTS, COMPLICATIONS AND RISKS OF THE SURGERY?

Surgery is serious business and there are complications. All our operators are experienced, qualified plastic surgeons. In other words, they will explain, in detail ALL the risks and complications related to your surgery. You will be fully informed and consent was given prior to undertaking any surgery.

We always say “The best time to get surgery right is the first time.”  

WHAT IS YOUR SURGERY SUCCESS RATE (SURGICAL COMPLICATIONS STATISTICS)?

It is ironic that many surgeons who claim to have low complication rates never actually see their own patients with the surgical complication – their patients go elsewhere for revision surgery to get it fixed.

Our highly-experienced group of Plastic Surgeons do revision surgeries and attract unhappy patients from all over the country. Other surgeons really know which surgeons do the best work.

There are published plastic surgery industry statistics for rates of infection and complications like Hematoma and Seroma. During your consultation, you will be informed about your risks and you will be asked to sign a consent form. Rest assured that we do everything possible to reduce infection and complication rates.

ARE MY RISKS HIGHER THAN NORMAL?

• Some additional or ELEVATED RISKS from having surgery MAY APPLY to certain patients.
• Risks and potential COMPLICATIONS with HIGHER RISK rates:
  • maybe due to genetics or weight/Body Mass Index
  • might be related to underlying health conditions or allergies and sensitivities
  • can be related to substance use, habits or lifestyle factors, SUCH as smoking, bacteria-laden environments or improper wound care
  • they may occur based on your use or intake of medications, herbs and/or other substances (legal or illicit)
  • or, possibly improper nutrition, disturbed sleep habits or apnea/breathing issues
• SMOKING means you’ll incur higher complication RISKS and health risks at all stages of your procedure
• OBESITY can also increase your risks
• PRIOR reactions to any type of surgical procedure or medications (including allergies) may also mean your particular SURGERY RISKS are higher
• Other factors may increase your risks such as having more than one or two procedures at one time (longer operating times)
• Discuss risks with your Surgeon during a consultation

 HOW CAN I REDUCE MY COSMETIC SURGERY RISKS?

• It’s important to have a healthy lifestyle, NEVER to smoke AND to follow your Surgeon’s specific surgery PREPARATION and surgery RECOVERY protocols.

BE SURE YOU UNDERSTAND THE RISKS BEFORE PROCEEDING WITH COSMETIC PROCEDURES.

• If you’re one of the unlucky patients who experiences a potential complication or health concern after surgery,
• be sure you notify your Surgeon IMMEDIATELY and/or your medical practitioners AND
• Discuss your best treatment options with your Special Plastic Surgeon
• Recognise that having a complication may delay your recovery time and healing

TIP: Discuss Risks with your Surgeon and be sure you understand the surgery consent forms before proceeding.

Disclaimer: This list of cosmetic surgery risks is not fully inclusive nor does this list replace or constitute medical advice.

Plastic Surgeon’s Recommendations

Do your Research!

• Your consultation will cover risks.
• Risks will be listed on the consent form.
• You’re advised to do your own research as well but rely on reputable sources such as Harvard Medical, MAYO clinic or similarly reputable medical sites.
• Ask your Surgeon for the detailed list of potential cosmetic surgery risks or potential complications, including RISKS specific to certain procedures.
• READ all materials and VIDEOS provided to you.
• Follow your Surgeon’s advice carefully to REDUCE RISKS when possible.
• Understand not everything in surgery recovery may go to plan – but choosing an expert Surgeon AND having surgery in an accredited private hospital, you’ll at least be in GOOD HANDS should something not go to plan.
• Complications, however, could delay your recovery.

BIA-ALCL – Associated with Textured Breast Implants

• There is a risk for patients having Breast Implants. Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). A rare type of Lymphoma.

Normal Recovery vs Complications

Learning about your risks and what to expect during normal recovery.

What to Expect

Your Specialist Plastic Surgeons in London will go over surgery risks with you in detail during a confidential consultation for your procedure.

• It’s important to be honest with your Surgeon about prior cosmetic surgeries, lifestyle habits, allergies, medications and supplements as well as emotional health and mental states.
• These can all impact your surgery risks.
• Second opinions about cosmetic surgery from one of our expert Plastic Surgeons may also be of benefit to some patients, especially those shopping on cosmetic surgery price who are unaware of differences in surgeons.

Understanding the risks of surgery is important – Do your research and choose your Surgeon wisely.

• Choosing whether or not to proceed with plastic surgery or cosmetic surgery is a very personal decision and one that should be well-informed.
• Take your time, when asked to review possible complications.
• Consider the implications of surgery (there’s a mandatory waiting period)
• You will need to sign a consent form. This will indicate that you understand the procedure and risks and that you will follow your Surgeon’s advice.