General Risks of Surgery

General Risks and Complications of Plastic and Cosmetic Surgery – An Overview

All invasive surgery has risks and potential 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 note that some complications and surgery risks may occur randomly, despite having chosen an experienced specialist plastic surgeon, an accredited hospital and wound care. Despite evidence-based medicine, all surgery carries risks.

• 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 Dr Doyle for details about the risks of your specific surgical procedure or visit the procedure page you are interested in. Understand your surgery risks by reading the information provided and be sure you read everything before you sign the surgery consent form.

• All surgical outcomes are the result of realistic patient expectations, 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, surgical technique and post-operative care. Small, less serious issues are common and every effort is made to resolve them quickly.

Research Statistics indicate that healthy patients can tolerate plastic surgery, but a small number of patients may experience reactions to surgery or incur higher surgery risk rates or problems during their recovery.

Here is a detailed list of Surgery Risks which may include but are not limited to:

General Anaesthesia

• Most healthy patients can tolerate modern general anaesthesia
• The GCPS Team will provide you with the details of your anaesthetists before your surgery to discuss any specific concerns

Bleeding (Haematoma)

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

Fluid Build-up (Seroma)

• Further reoperation may be required to remove an internal build-up of fluid. The risk of seroma can be minimised by following post-up recovery instructions and wearing your post-op garments.

Infection

• You may get a surgical site infection. In the case of infection, Dr Doyle will prescribe antibiotics and monitor you closely.

Delayed Wound Healing

• Dr Doyle and his team manage your recovery process. Delayed Wound healing may occur in patients who are overweight, smoke or have an infection.

Deep Vein Thrombosis (DVT)

• If your circulation is impeded a blood clot may form. There are other contributing factors including being overweight. It is important to be mobile and move early.

Numbness

• This will generally occur 100% of the time and mostly settles over the months and may continue for up to 1 – 2 years. Occasionally there will be prolonged numbness after surgery.

Scarring

• Initially, there can almost always be some scars issues. These generally settle over the months following surgery, but sometimes may require a scar revision. Scars continue to mature and improve for up to 18 months after surgery. Stretch marks may not all be reduced and new ones may be created. Non-surgical treatments and supplements may help with scarring. Every effort is made to place the scar within the areas covered by high-cut swimwear or underwear.

Asymmetry

• There may be irregular mounds and creases on 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 to correct.

Pain

• This will be managed appropriately with pain medications and prompt aftercare. Please contact the clinic if you are concerned.

Risks of General Surgery – An Overview

Swelling, Bruising and Skin Discolouration

• Discolouration from bruising may take several weeks to months to resolve.
• Moderate swelling and bruising are side effects 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
• Supplements can aid your recovery process – be sure to find out how to best use the products for wound healing after surgery
• Some intermittent swelling or discolouration may persist for up to 12 months after you have your Liposuction 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 surgery, 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 undergo a General Anaesthetic to drain 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 surgery.
• Bruising or late bleeding with bruising (skin discolouration) might indicate an infection, physical exertion (overdoing it), aspirin ingestion or an unrecognised 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 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 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 surgery, usually in the first month following surgery.
• A seroma may increase your risk 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 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 most suitable results and wound 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 6 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 required 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 infections 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

• All surgical incisions produce scarring. Some people are more prone to scarring than others.
• The visibility of the final scars is somewhat unpredictable. 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 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 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 are 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 any  procedure or post-recovery process
• Maintain realistic expectations

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 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 generally 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 can be an issue for some patients but it is rare

• 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 in 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 any 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 minimised – but do expect pain as an inherent part of your procedure.

Stomach Upset including Nausea or Vomiting

• Some patients can have reactions to Anaesthetic
• 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.
• A Risk of vomiting and nausea persisting is that 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 the 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. It is recommended to eat fresh fruit and vegetables, take extra fibre and increase your exercise. Drink plenty of water, provided you are not on restricted fluids for any reason.

Potentially life-threatening complications

• Surgery can threaten your life, Serious Risks include pulmonary embolism (PE), cardiac arrhythmia, heart attack, stroke or massive infection These are very rare but can occur.

Lung Complications

• Lung 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

For more information or questions – please contact Dr Mark Doyle at Gold Coast Plastic Surgery