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Key Points
- Realistic expectations, informed consent crucial before elective surgeries
- Surgeons should take care to be conservative depending on the invasiveness of a given procedure
- Thorough history-taking is paramount in preoperative screening process
Though generally considered safer than traditional surgery, cosmetic surgery involves risk, and a multitude of things can go wrong during and after a given procedure. Careful patient selection, an effective informed consent process, meticulous perioperative patient screening and a good dose of surgical and treatment conservatism are all important steps in preventing adverse events from occurring.
Apart from achieving a good aesthetic outcome, the main goal in elective cosmetic surgery is to ensure patient safety and minimize risks. The sober balance between maximizing aesthetic outcomes, risk assessment, patient expectations and physician expertise limitations can be a fine line to walk.
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Dr. McMenamin
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"Elective cosmetic surgery is predicated on realistic expectations as well as informed consent, the latter of which means acceptance of risk," says Patrick G. McMenamin, M.D., a practitioner in Sacramento, Calif. "Though patients accept this risk, it is our responsibility to understand the goals of the patient and carefully weigh this with what we as cosmetic surgeons can offer the patient in terms of our expertise and what can be realistically achieved aesthetically for the patient."
VARIED RISKS Adverse events in cosmetic surgery can vary greatly depending on the nature and invasiveness of the surgical procedure. Whether performing a facelift, browlift, blepharoplasty, rhinoplasty, breast augmentation, abdominoplasty or liposuction, surgeons must be aware that minor and major adverse events can occur, include bruising and bleeding in and around the surgical site as well as wound dehiscence or infection. Rarely, much more serious complications such as pulmonary emboli, necrotizing fasciitis and life-threatening anesthesia-related adverse events can occur. According to Dr. McMenamin, patients need to be thoroughly informed about the potential risk factors of cosmetic surgery. "Fortunately, significant adverse events are exceedingly rare in cosmetic surgery because of the nature of cosmetic surgery and the lesser degree of invasiveness. Furthermore, patients are ASA I or II, meaning they are essentially healthy, and therefore we don't usually expect health-related issues to be major factors," Dr. McMenamin says.
LIPOSUCTION OUTCOMES Liposuction is the most commonly performed outpatient cosmetic surgery procedure. Barring major complications, many of the adverse events encountered with this procedure are correctable. If the surgeon does not remove enough fat from the target area, for example, he or she can always go back and make minor adjustments to achieve a potentially better cosmetic outcome. If a liposuction procedure is performed too aggressively and too much fat is taken out, skin texture changes and other suboptimal aesthetic outcomes can result.
"We all want to make our patients extremely happy. However, it is wise to be more prudent and more conservative when performing cosmetic surgery, for the safety of the patient. For the most part, physicians stay within the confines of their surgical limitations, and it is usually a constellation of events and circumstances that lead to unexpected sequelae," Dr. McMenamin says.
Abdominoplasty is more invasive than liposuction and involves cutting and lifting a flap, which potentially carries the risk of losing skin from compromised blood supply and may result in flap necrosis. One of the most serious complications associated with abdominoplasty is thromboembolus. Therefore, patients need to ambulate early and may need to receive anticoagulant medications.
A major contributory factor to the compromise of flap surgery is smoking. Nicotine is a potent vasoconstrictor and smokers undergoing flap surgery have a 1,200 percent higher complication rate compared to nonsmokers. It is of paramount importance that patients cease smoking before the flap surgery is performed, as this increases the chance of flap viability.
