Operative Information

The goal of surgery is to create the desired appearance and function without complications. Most often the results of surgery are good and both the patient and physician are happy with the result. However, complications occasionally can and do occur. Unlike a carpenter who may remodel pieces of wood and simply glue them together, a plastic surgeon must “work” with living tissue. The human body has been miraculously formed with the ability to coagulate its blood vessels (stop bleeding), to fight infection, and to heal itself (normal wound healing). A medieval surgeon once said, “I care for the patient but God heals.” A surgeon can perform a procedure in the standard way but it is still your body that must heal itself. The surgeon performs an operation to modify living tissue to a more advantageous state, but the body must heal itself. Occasionally unforeseen problems occur. Any complication can slow healing, increase scarring, and occasionally require further surgery for correction or decrease the overall long-term result. If further surgery is needed to treat complications, additional hospital, anesthesia and medical costs may follow. You will be responsible for these additional costs.

Complications which can occur with surgery include:

• Bleeding – Any time an incision is made, bleeding can occur after surgery. This usually occurs within the first day or two and is best avoided by not taking Aspirin, Aspirin containing products, or Ibuprofen products (Advil, Motrin, etc.) for two weeks prior to surgery. These medications interfere with the platelet clotting mechanism of the blood and makes excessive postoperative bleeding more likely. Herbal and vitamin supplements also increase the risk of bleeding and should be avoided for at least 2 weeks prior to any operation. Also, heavy exertion, straining, aerobics and weightlifting or other similar exertions should be avoided for approximately two to three weeks after surgery. Because abnormal amounts of blood can interfere with healing, another unplanned operation may be required to wash out the clotted blood, if excessive bleeding occurs. This will increase the cost of surgery.
• Infection – Any time an incision is made, it can become infected. This is uncommon. If the wound does become infected, it may respond to oral antibiotics which you can take at home or occasionally require intravenous antibiotics and admission to the hospital. If an implant is used (breast augmentation or reconstruction, nasal or chin implant, etc.) the implant must usually be removed. Some months later it can usually be replaced. But the operation must be repeated and the final result may be less than expected.
• Scarring – Any time an incision is made, the wound heals with a scar. Scars are always visible, although they need not be deforming or obvious. All scars become red, raised and lumpy about a month after surgery. Then they become soft, flat, and white over the ensuing six months to a year. Such temporary redness is expected and normal. It is important that you understand that if surgery is performed, there will be a scar that comes with it. Some scars are less attractive than others.
• Decreased sensation – Local nerves of sensation are injured during surgery. Most often the feeling returns and the numbness diminishes over a few months and is sometimes restored almost to its preoperative condition over a year. There is numbness over the lateral face and neck at the time of a facelift, over the brow after a browlift, over the nose after rhinoplasty, over the lower abdomen after an abdominoplasty, on the breast or the nipple after breast surgery (especially breast reduction), and in the area of any incision.
• Decreased motor function – Although quite unusual, motor nerves that go to muscles in the area of any surgery can be injured. This can occur during a facelift or a browlift. If injured, a decrease in facial smiling or the lifting of the brow occurs. Fortunately, it is usually temporary and muscle function returns in a few months. Occasionally, it does not.
• Skin necrosis – Any time we make an incision, skin that is lifted up has a decreased blood supply, can heal poorly and may occasionally die. This is quite uncommon. It occasionally occurs with surgeries which lift large areas of skin (after a facelift, abdominoplasty, or a breast reduction). This is an unusual circumstance. However, it may be associated with slow healing, more scarring, and may require further unplanned surgery to remove the unhealthy skin, improve the scar, or the final result, if possible. It occurs more commonly in smokers and it is important to stop smoking two weeks before and after surgery. Serious necrosis is unusual but can necessitate additional surgery and limit the final result.
• Failure to achieve desired result – Many factors will affect the outcome of surgery. The surgery must be preformed in an appropriate manner to achieve full correction of the deformity and the best possible healing. The body must heal itself without bleeding, infection or excessive scarring. The patient’s own body tissues must be healthy. Obviously, excessive sun exposure may promote the early recurrence of skin cancer or signs of aging. Drinking of alcohol, smoking, or fluctuation in weight also causes more wrinkles, excessive skin, and signs of aging. In most circumstances, the body part on which surgery was performed was neither perfect nor ideal. It is unrealistic to expect that it will perfect after surgery. We can only hope to obtain a significant improvement which makes the surgery worthwhile. However, it is not possible to guarantee the results.
• Limitation of exercise – To allow proper healing and avoid excessive tension on the wound or bleeding, heavy exertion, aerobics and weight lifting or other sports activities should be avoided for two to three weeks after most surgery and for six weeks after abdominal surgery or other muscle surgery.
• Revisional (redo) surgery and complications – Occasionally, further improvement can be obtained by revisional surgery. After the wound is healed and the tissues are in the best possible condition, an additional surgery can sometimes make things look or function better than would otherwise be possible. The cost of such revisions (surgeon’s fee, operating room charges, anesthesia fee) are the responsibility of the patient, as are the costs of dealing with the complications.

Again it is impossible to guarantee the results of surgery. The patient must accept the inconvenience, discomfort and cost of surgery, the risk of surgery and the risk of complications. The consultation is an opportunity for both the patient and the physician to ask questions of one another so that they can each understand the problem and the best way to approach it. They must formulate a plan and decide what surgery (if any) is appropriate, understand the pros and cons of no treatment or of various techniques, and make a decision that both the patient and surgeon can agree upon. They must be comfortable with one another, have confidence in one another, and feel that they can work together to obtain the desired result. If these conditions are not met, surgery should not be preformed. Remember that it is your responsibility to give the risks and gains of surgery careful consideration. You must be willing to follow instructions and take responsibility for your part in your recovery.