Safety and Risks of Outpatient Plastic Surgery

When considering plastic surgery, either reconstructive or cosmetic, it’s normal to focus more on the expected results of the surgery rather than the surgical process itself. However, it is always a smart idea to be fully informed on all aspects of the surgical process before making any final decisions and knowing the safety and/or potential risks of whatever procedure one is contemplating is essential to making an informed decision. Even though thousands of individuals undergo plastic surgery procedures every year free of unwanted complications, there is no such thing as a risk free surgery. In order to maximize safety ensure that:

1. Your chosen surgeon is fully and adequately trained and is certified by a reputable board such as the ABPS
2. The facility where your surgery is going to be performed is accredited and that it conforms to strict safety standards
3. You have informed your chosen surgeon of any medications you are taking-both over the counter and prescriptions (including any herbal supplements) -along with your full medical history, especially any known drug allergies. Be sure to inform your surgeon if you have any circulation disorders, heart or lung ailments, or problems with blood clots
4. The surgical facility should use skilled and licensed personnel to administer and monitor your anesthesia and recovery immediately following the surgery
5. If you are having your surgery performed in a clinic rather than a hospital, make sure that there is quick and easy access to emergency facilities either in the clinic or at a nearby hospital in case of major complications
6. Extra safety measures should be taken if you are having an extensive liposuction procedure.

If the facility or surgeon you are considering does not meet these basic safety requirements, you probably should consider another surgeon or facility.

Plastic surgery procedures performed in accredited facilities by surgeons who are certified by a reputable board have excellent safety records. An extensive survey in 1997, that was based on over 400,000 plastic surgery procedures performed in such facilities found that:

1. The rate of serious complications was less than half of 1 percent (<.5%)
2. There was an exceptionally low mortality rate – Only one death per 57,000 cases
3. Overall risks in an accredited surgical office facility are comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility

There is always risk during any surgical procedure. However, patients can minimize their risk by making sure safety standards at a chosen facility are strictly adhered to by the surgeon and staff.

Although rare, one of the most serious complications associated with any surgery, including plastic procedures, is blood clot development in the large veins of the abdomen and legs. This complication can lead to what is called pulmonary embolism (blocked lung artery) and is a highly dangerous and potentially fatal condition. Therefore it is extremely important to tell your plastic surgeon if there is any history of blood clots in your own medical history or in your family’s medical history especially if you have ever had a family member who died shortly after childbirth or shortly after any surgical procedure.

You will also be evaluated for other conditions that put you at risk for developing blood clots such as obesity, recent traumatic injury, having a disorder of the heart, lungs, or central nervous system, cancer history, severe recurrent infections, or genetic problems that affect blood clotting. Additional risk factors for women include taking oral contraceptives, having recently stopped taking oral contraceptives, and women who are currently undergoing hormone replacement therapy.

Safety measures to avoid blood clots will be determined by your individual degree of risk. If you are considered low risk, your surgeon may simply ensure that you are placed and positioned on the operating table in a way that ensures adequate blood flow to the abdomen and lower extremities. If you are high risk, your surgeon might recommend that you wear elastic stockings before, during, and after your procedure, or that you take special anti-clotting medications. Compression devices are sometimes used during surgery to promote and support normal circulation.

Anesthesia care in a plastic surgery facility should be comparable to that of any accredited hospital. Maximum safety recommendations are:

1. 1.Any anesthesia, planned or otherwise, should be administered by licensed, skilled, and certified staff acting under the direction and supervision of a qualified anesthesiologist or the operating surgeon
2. An anesthesiologist must take a full medical history before the surgical procedure takes place, including a physical exam and blood tests. The anesthesiologist should be advised of any serious medical problems, drug allergies, any medications you are taking (including herbal supplements), and whether or not you use alcohol on a regular basis, or engage in the use of any illegal street drugs.
3. You should be assured that you will receive monitoring by licensed and skilled staff before, during, and after the surgery. Staff members who are trained in advanced cardiac life support (ACLS) should also be on hand to monitor the procedure and recovery afterwards in case of complications.
4. If you are told that you must stay overnight in recovery, be sure that you will be staying in an accredited facility where you will be able to receive care around-the-clock. Also make sure that the facility has access to the proper equipment and medications to handle any complications that may arise during the course of your stay.

Other risk factors that increase the risk of serious complications include:

1. Excessive amounts of local anesthesia or excessive amounts of fluid administered intravenously or within the tissues of the surgical site
2. Multiple, unrelated procedures being performed during the same surgery
3. Poor health prior to the surgery
4. Personal or family history of breathing or bronchial disorders or other lung problems

Successful surgical outcomes are often the result of the patient, surgeon, and staff all working together to ensure maximum safety. All your safety concerns should be discussed with your surgeon and you should not be afraid to ask too many questions about your procedure. This will help promote the safest outpatient procedure as possible in addition to meeting your expectations.