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Pre-Op Complications
Many of the commercial and indeed independent cosmetic surgery providers will only undertake an operation on you if you are considered to be fit and healthy to proceed. This is determined by reviewing your medical history. The following problems will more than likely result in you being declined for a cosmetic surgery operation;
- Previous Heart Attacks.
- Strokes.
- Any individual suffering from Transient Ischaemic Attacks (TIA). A Transient Ischaemic Attack causes symptoms similar to a stroke - but symptoms last less than 24 hours. The most common cause is due to a tiny blood clot. [View NHS description here].
- Any individual who suffers from Angina.
- Any patient who has a Haemoglobin count of less that 10 g/dl. Haemoglobin levels in the blood are measured in grammes per 100 millilitres, which is abbreviated to g/dl. The normal range of haemoglobin for a man is 13.5 to 17.5 g/dl and for a woman is 11.5 to 15.5 g/dl. Anything less than these numbers is called anaemia.
- Any individual suffering from uncontrolled hyper tension.
- Any individual who suffers from Cystic Fibrosis.
- Any individual who suffers from Clotting Abnormalities.
- Any individual who suffers from Sickle Cell Disease.
- Any individual who suffers from Addisons Disease. Addison's disease is an endocrine or hormonal disorder that occurs in all age groups and afflicts men and women equally. The disease is characterised by weight loss, muscle weakness, fatigue, low blood pressure, and sometimes darkening of the skin in both exposed and non-exposed parts of the body. Addison's disease occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases, the hormone aldosterone. [View NHS description here].
- Any individual who suffers from Myasthenia Gravis. Myasthenia Gravis is a neuromuscular disease leading to fluctuating muscle weakness and fatiguability. [View NHS description here].
- Any individual who suffers from Diabetes.
- Any individual who suffers from Behcet's Disease. Behcet's disease is a chronic condition in which the body’s immune system, which normally protects the body against infections, becomes over-active. [View NHS description here].
- Any individual who has had a history of Anaphylactic Shock that requires them to carry an epipen.
The Anaesthesia
There are three types of anaesthesia, General, Regional & Local. When having an operation for a cosmetic surgery treatment the vast majority of major operations (Facelifts, Tummy Tucks) are done using a General Anaesthetic while standard operations (Otoplasty, Blepharoplasty) can normally be done with a Local Anaesthetic. Regional Anaesthetic is not regularly used.
General Anaesthetic
During general anaesthesia you will be put into a state of unconsciousness and you will be unaware of anything during your operation. The anaesthetist accomplishes this by administering a combination of drugs. Usually the first step is to inject medication intravenously (i.e. into a vein) through a small plastic tube, placed usually into the arm or hand ( known as induction of anaesthesia). Induction is occasionally achieved by breathing gases (also known as Twilight Anaesthesia). To maintain you in this state of unconsciousness, you will breathe a mixture of anaesthetic gases or vapours with oxygen. If you are having an abdominopalsty, then a muscle relaxant drug is also given and a tube is inserted into your throat and down your windpipe to help you breathe more effectively.
While you are unconscious the anaesthetist will remain with you at all times, monitoring your condition and controlling your anaesthetic and if necessary replacing fluid or blood. At the end of the operation, the anaesthetist will reverse the anaesthetic and you will regain awareness and consciousness in the recovery room, or as you leave the operating theatre.
Local Anaesthetic
In local anaesthesia the local anaesthetic drug is injected into the skin and tissues at the site of the operation. The area of numbness will be restricted and some sensation of pressure may be present, but there should be no pain.
Regional Anaesthetic
For regional anaesthesia a local anaesthetic drug is injected around a bundle of nerves so that a part of the body, such as an arm or a leg, is made numb. In addition, the muscles in the limb are paralysed whilst the drug is acting so that the limb becomes floppy. Obviously you will still be awake and know that the operation is taking place, but often the anaesthetist will administer a sedative drug so that you drift off to sleep during the operation. Even if this is not the case, you will not be able to see the operation because a screen will be placed in the way.
Just as with having a General Anaesthesia, the anaesthetist will remain with you throughout the operation under regional anaesthesia, monitoring and controlling your anaesthetic state throughout in the same way.
Post-Op Complications
There are a number a complications that can arise from having any type of surgery, not just cosmetic surgery. Please select the following;
Infections | Blood Clots | Haematoma | Seroma | Scarring | Numbness | Necrosis
Infections – Wound & Chest Infection
- Wound:- Whilst every effort is made by the hospital to ensure that all the surgery is performed under the strictest clinical and aseptic conditions, an infection can occur at the point of incision and/or when a foreign material (a breast implant for example) is inserted into the body. Symptoms can include raised body temperature, pain in and around the incision point and around the implant, inflammation and possible discharge (that smells offensive) from the wound. These may all indicate the formation of an infection and you should seek immediate medical advice. Many infections can be cured by antibiotics and you will be told to keep the wound clean and dry
- Chest:- Is uncommon in healthy patients but if you suffered from a cold just before your operation then the surgeon may not wish to proceed until all indications point to the non-existence of the cold.
Blood Clots – Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE)
- DVT – This is a blood clot that forms in and around the Calf area of the leg. Symptoms can include, pain from your calf muscle, a raised body temperature (especially of the calf muscle) and localised swelling. These may all indicate DVT and you should seek immediate medical advice.
- PE – This is a more serious blood clot than DVT as it involves a blockage of the pulmonary artery (or one of its branches) by the clot. By far the most common form of pulmonary embolism is a thromboembolism, which occurs when a blood clot, generally a venous thrombus, becomes dislodged from its site of formation and moves to the arterial blood supply of one of the lungs. Symptoms may include difficulty breathing, pain during breathing and a sudden chest pain. These may all indicate PE and you should seek immediate medical advice.
This is a collection of blood that can normally be found near to the wound/incision site which the body is unable to dispose of. Visually there will be a large ‘bruise’ swelling around the site and a localised pain. The wound may also start to ooze a blood red discharge. If left unattended the area will become infected and hence medical advice should be sought immediately.
A Haematoma normally occurs quite soon after surgery, while you are still in hospital and so you will be returned to theatre for further surgery to remove the haematoma.
Similar to a Haematoma but instead of blood there is a collection of a clear to yellow fluid that collects around the wound and as with a Haematoma if left unattended, may develop into an infection.
A Seroma is often associated with major operations (such as an Abdominoplasty) which involve a large wound/incision sites. Symptons are similar to a Haematoma, there will be localised pain and swelling of the affected area and possible oozing of the fluid through the wound site. If necessary a return to theatre may be required so the surgeon can drain the wound.
A scar is a natural part of the healing process. Skin scars occur when the deep, thick layer of skin (the dermis) is damaged. The worse the damage is, the worse the scar will be.
Most skin scars are flat, pale and leave a trace of the original injury which caused them. The redness that often follows an injury to the skin is not a scar, and is generally not permanent. The time it takes for it to go away may, however, range from a few days to, in some serious and rare cases, several years. Various treatments can speed up the process in serious cases.
To mend the damage, the body has to lay down new collagen fibres (a naturally occurring protein which is produced by the body). This process results in a ‘Fortuna Scar’. Because the body cannot re-build the tissue exactly as it was, the new scar tissue will have a different texture and quality than the surrounding normal tissue. An injury does not become a scar until the wound has completely healed.
Two types of scars are the result of the body overproducing collagen, which causes the scar to be raised above the surrounding skin. Hypertrophic scars take the form of a red raised lump on the skin, but do not grow beyond the boundaries of the original wound, and they often improve in appearance after a few years. Keloid scars are a more serious form of scarring, because they can carry on growing indefinitely into a large, tumorous (although benign) growth.
Both hypertrophic and keloid scars are more common on younger and darker-skinned people. They can occur on anyone, but some people have a genetic susceptibility to these types of scarring.
Following surgery the operation site may feel numb. This has been caused by the severing of nerve endings during the operation itself. Over time (in some instances a year) the nerve endings start to heal themselves and a slight tingling sensation may be felt along with hypersensitivity.
However the nerve endings may have been damaged during the surgery and may never repair. If a particular nerve is cut (especially during a facelift) then there may be a resultant paralysis of the area where the nerve has been cut. This is very rare and is possible to have this corrected.
Necrosis is the name given to accidental death of cells and living tissue (a form of Gangrene). It is directly caused by the skin losing its blood supply and requires highly specialised surgery and care to correct it including extensive antibiotic treatment. Symptoms are similar to those of an infection with the added complication that the skin has started to turn black.
All these signs (especially the skin turning black) may all indicate the onset of Necrosis and you should seek immediate medical attention.
Common Ailments Following Surgery
The following are common problems that the vast majority of patients will suffer from following their surgery. They are usually relieved by prescribing drugs or is some cases will naturally cure themselves;
- Nausea & Vomiting – Certain operations, anaesthesia and pain relief drugs can cause nausea and vomiting more than others. The nausea can last for a few hours after surgery or in some cases up to several days following.
- Dizziness – The anaesthesia and loss of fluids may lower the blood pressure of the patient which has the effect of making them feel faint. Drips may be administered to counteract the dizziness.
- Sore Throat – Is usually caused when a patient has a tube inserted into their airway to aid then when breathing. The pain can last for a few hours to a couple of days and can be relieved buy gargling soluble pain killers or using pain relieving lozenges.
- Headaches – Mainly caused by the effect of the anaesthesia, but can also be caused by the effects of the surgery itself, anxiety, or lack of fluids. The headache can relieve itself within a few hours after surgery but can be helped by taking pain killers.
- Aches & Pains – Some patients experience aches and pains in parts of the body where surgery has not taken place. This usually occurs in parts where the patient has suffered from existing aches and pains(especially the back). This is usually caused when lying on the operating table for long periods of time.
- Confusion & Temporary Memory Loss – This is more common in older patients who have undergone an operation under general anaesthetic. Even though it is temporary it can last from several days to several weeks.
- Bruising & Soreness – Can happen around incision, injection and drip sites. It can be caused by a vein bursting, a very minor infection or by the movement of any joints. The bruising and soreness will usually settle without the need for a drugs to be administered.
