FACTORS COMMON TO ALL SURGICAL PROCEDURES
Every surgical procedure carries a risk. This section deals with those postoperative complications that can occur with any surgical operation.
Scars: All surgical incisions heal with a scar. It is wrong to think that scars will be invisible or that they will completely fade to nothing in time. Wound healing is a complex process involving many variables and for this reason results cannot be accurately predicted.
In general scars take six to eighteen months (or even longer) to mature and there will always remain a permanent mark, no matter how inconspicuous, where an incision has been made.
On some occasions scars can heal unfavourably in certain people. Scars may become infected, stretched or thickened ( hypertrophic or keloid ) and may necessitate further treatment. Some areas of the body and some skin types are notorious for producing worse scars than others e.g. over the breastbone.
Pain and Discomfort: Surgical procedures result in discomfort for the patient. The degree and duration of this will depend on the nature of the operation and the patient's pain threshold. Tablets or injections for pain and discomfort are usually given in the immediate postoperative period and to take home on discharge from hospital.
Bruising and Swelling: This is the body's natural response to injury. Every surgical procedure is followed by a period of bruising and swelling, depending on the nature and extent of the surgery. Although there has been much controversy about its effectiveness, many surgeons recommend a course of arnica tablets before and after surgery.
Bleeding and Haematoma: Sometimes bleeding can continue after the end of the operation or restart after an interval. It can either track to the surface or, more commonly, collect in a space or pocket deep to the skin. Such a collection of blood is called a haematoma and if it becomes large enough it will be necessary to remove or evacuate it requiring a further procedure.
Infection : Infection can occur after any surgical procedure. Most commonly the wound (incision site) is affected. If the infection progresses, the adjacent and surrounding tissues can become affected. This condition is known as cellulitis . Further progression of the infection may lead to formation of a localised deep pocket of pus or abscess formation. Serious infection in cosmetic surgery is very rare.
Deep Vein Thrombosis: This results when a blood clot develops in one or more deep veins in the calf. This complication is rare in patients undergoing elective cosmetic surgery. It is possible for the clot to become dislodged from its origin in the calf and be transported by the bloodstream to the lungs (pulmonary embolus) where it can have very serious consequences. Females taking oral contraceptives may run a slightly increased risk of developing a deep vein thrombosis after some operations.
Allergic Reactions to Drugs and Dressings: Various drugs are given during a hospital stay in the ward or injected during the course of a general anaesthetic. It is important to avoid giving any drug to a patient who might be allergic to it.
Blood Transfusion: This is seldom required in cosmetic surgery. All blood is carefully screened by the blood transfusion service for any infectious agent before it is released for use.
Drains: Sometimes small flexible tubes are used to let out collections of blood or other fluids from a wound. They are removed a day or two after the operation.
PREOPERATIVE CONSIDERATIONS
Smoking All patients are strongly encouraged to stop smoking. Smoking is not only a recognised health hazard in its own right but is responsible for a number of postoperative problems and complications in patients who have a general anaesthetic
a. Chest: Heavy smokers are more likely to develop a chest infection post operatively, particularly after major procedures such as abdominoplasty.
b. Circulation: It is a known fact that heavy smokers are more liable to suffer the consequences of impaired circulation. This can lead to flap necrosis (loss of the skin resulting in noticeable scars) eg following a facelift or abdominoplasty. The rate of healing will also be affected.
Alcohol and aspirin should be avoided for two weeks before and after any operation. Both impair clotting and hence the patient is more likely to bleed during and after the operation.
Abstinence from food and drink for several hours before a general anaesthetic is essential. Every patient will be advised accordingly.
Vitamins are encouraged to enhance healing. The homeopathic preparation arnica is recommended by many surgeons as an aid to healing although some scientific reports have cast doubt over its effectiveness.
POST OPERATIVE CONSIDERATIONS
Many patients prefer not to tell anyone about undergoing cosmetic surgery. They are extremely concerned that their friends or peers will ridicule them for undergoing what appears to be a trivial and frivolous procedure.
In reality, the average onlooker, (including close friends and relatives) will rarely notice an alteration in someone's appearance. This is not because a result is less than acceptable but purely because the brain cannot remember exactly what the preoperative appearance was without reference to a photograph.
In the main, patients need not be apprehensive about undergoing surgery as very few if any of their closest friends will notice.