Plastic Surgery is a complex and very personal procedure for most people to consider.
There are nay questions that will be asked of surgical team, here are a few of the more common questions answered.
What is the difference between cosmetic and reconstructive surgery?
What can I expect during an initial consultation?
Is surgery painful?
What are the common complications of surgery?
Are there any possible major complications of surgery I need to know about?
We practice safe, meticulous surgery in which risk factors are recognised and carefully controlled. Despite taking all precautions, complications can and do occur, albeit rarely, so you need to be aware of them. A full discussion of all the risks of surgery, both general and specific, will form part of your surgical consultation.
There are three potentially significant general complications that can occur following any surgical procedure:
The face has excellent blood supply and unless there are significant risk factors such as uncontrolled diabetes mellitus, smoking or compromised immunity, infection is very unlikely. Apart from occasional, minor wound healing problems such as easily managed stitch abscesses, significant infections of face-and neck-lift wounds are almost unheard of. Other areas of the body have different risks, and factors such as peripheral vascular disease, previous surgery or trauma, compromised immunity, diabetes and smoking can increase the risk of post-operative infections.
Excellent blood supply to the tissues is also the reason why there is some risk of bleeding during and after surgery. Meticulous, careful surgery that includes pinpoint cauterization of any bleeding points greatly reduces the risks of post operative bleeding. Close cooperation with our highly skilled anaesthetic team ensures that each patient’s wellbeing is carefully monitored and controlled during surgery, minimising the risks of hypothermia and uncontrolled raised blood pressure two factors that are known to significantly increase the risk of bleeding during and immediately after surgery. Almost every procedure will cause at least some bruising, but blood clots/ haematomas are very rare.
Every incision in the tissues will create a scar. While scarring is dependent on each patient’s genetics and physiology, surgical technique can greatly influence the final outcome. Careful selection and placement of incisions in areas that are shadowed or naturally hidden, or in the hair greatly reduces the visibility of scars. Gentle tissue handling during surgery, followed by precise, meticulous closure with non-inflammatory materials also improves healing. Post-operative care with techniques such as support taping, the use of silicon gel treatments and massage with high-dose vitamin A and C containing emollients will generally speed up natural scar healing to fine, flat, smooth mature scars which are, ideally, almost invisible. Rarely, some people are prone to make thick red scars. If you or a family member has scars like this, you may be at risk of further thick scars. Specific Risks are related to certain procedures, and a full discussion will form part of your surgical consultation. As a general rule, these complications are very rare. What follows are examples only.
The most feared complication of facial rejuvenation procedures is injury to the local nerves. There are two kinds of nerves which are potentially at risk, the sensory nerves, responsible for supplying touch sensation and feeling in the region and motor nerves, which animate the muscles of facial expression lifting the eyebrows, smiling, frowning and so on.
i. Sensory Nerve Damage
Whenever skin is cut, there will be injury to small nerve branches. In the face and neck, this feels like a slight numbness around the incisions. This is normal, expected and in almost every case, virtually complete sensory recovery is expected in 6-12 months. More significant are injuries to bigger nerve branches and trunks, such as the Great Auricular Nerve, which supplies about 70% of the sensation to the ear. Injury to this nerve results in altered sensation on the ear, which may not resolve completely. During a browlift, the supra-orbital nerve is at risk and during a midface-lift, the infra-orbital nerve trunk and the zygomatico-facial nerves must be protected. [KH1] Our expert surgeons clearly understand the location and significance of these nerves, taking great care to protect them during surgery. The likelihood of significant injury is very low, though they may occasionally be bruised or stretched by retractors causing a temporary numbness, which usually resolves over days to weeks.
ii. Motor Nerve Damage
The muscles of facial expression are supplied by branches of the seventh cranial nerve, the facial nerve. These small muscles are responsible for moving the eyebrows, tightening and closing the eyelids, smiling, frowning, pursing the lips and altering the shape of the mouth, chin and neck. Because the nerve is fairly deeply located around the ear, it is rarely injured here injury usually involves a branch closer to the middle of the face, or neck. The commonest branch to sustain injury, usually in browlifting or temporoplasty work, is the frontal branch of the facial nerve that powers the frontalis muscle responsible for raising the eyebrow. A branch to the lower lip sometimes gets stretched in necklift surgery, producing a temporary lower lip weakness.
Almost every case of facial nerve weakness that we see is a temporary phenomenon, usually caused by stretching rather than cutting a nerve branch. As such, it seldom persists for more than a few weeks before the affected muscle returns to full strength. In extremely rare cases a facial nerve injury may be permanent.
When adjusting the shape and size of the eyelids, precise, meticulous surgery is of paramount importance. Over-resection of skin in the lower eyelid can lead to the lid margin being pulled down (rounding of the eye) or, in severe cases, pulled away from contact with the globe, a condition called ectropion. While prevention is ideal, these conditions can be cured by further surgery.
In some cases of Blepharoplasty, patients may complain of dry eyes. If this is severe, they may develop a chemosis, (swelling and redness of the conjunctival membrane on the eyeball). The condition usually improves with conservative management, with cool packs and steroid eye drops etc.
Tightening of the anterior abdominal wall, a key component of abdominal reshaping procedures, reduces the space available for the internal organs and raises the intra-abdominal pressure. Without proper care, this can have two particular adverse effects.
Firstly, without being prepared and carefully monitored after surgery, a patient’s diaphragm will not move fully, causing a tendency to take only small, shallow breaths, which can lead to fluid in the lung bases and increased risk of pneumonia. This is easily overcome by concentrating on taking deep, long breaths, aided by blowing up balloons or using an incentive spirometer (a device that helps patients improve lung function).
Raised intra-abdominal pressure reduces the flow of blood back to the heart from the lower limbs. Sluggish blood flow in the legs raises the risk of deep vein clotting. The risk can be managed by support hose, calf-compression devices, and most importantly, by early mobilisation.
Both risks reduce as normal activity and function is resumed in the first days and weeks after surgery.
I love my sport. How much time off will I need after surgery?
Healing (as measured by the regaining of tissue strength) should be considered a process rather than an event. The strength of a surgical wound (its resistance to being physically pulled apart), increases steadily to a maximum of about 85%, when compared with unoperated tissue, over about six weeks and full strength by about 3 months. We advise patients to avoid physical activity for about two weeks. Rehabilitative activity should continue from weeks two to six, gradually increasing in intensity. Fitness training can begin at about six weeks, with precautions (if you’ve had a breast operation, you might be comfortable on a bicycle at six weeks, but would want to re-introduce running cautiously and only when wearing a well-fitted sports bra). We recommend a three-month recovery period before resuming contact sport, especially after surgery such as rhinoplasty or reconstructive hand or facial surgery. If you have concerns, our staff will be happy to discuss these with you.
What care will I receive after surgery?
Even when your surgery ends, our care doesn’t. It’s vital that you feel supported every step of the way even when you’ve been discharged. All post-operative nursing care is included in the cost of treatment, including visits to your surgeon up to one year following treatment. For your added reassurance, our support staff can be reached by phone, day or night, should you have any concerns.
General tips for post-operative care
During the first two weeks after surgery (even minor procedures under local anaesthetic), physical exertion leading to raised blood pressure can provoke bleeding in a surgical wound. So we recommend reduced activity, with rest and elevation of the surgical site. We will give you printed guidelines for post-operative dos and do nots, but if you’re unsure, please call and ask.
Intra-operative bleeding and bruising can be made worse by use of blood thinners such as aspirin, so pre-operatively, we will ensure these medications have been temporarily stopped for the week before surgery. Post-operatively, cold packs and elevation of the surgical site help reduce swelling and bruising. In the great majority of cases, bruising is gone by 10-14 days post surgery