Complications can occur despite the most careful medical work. For a plastic surgeon, ensuring a successful procedure is just as important as it is for the patient, as dissatisfaction can severely damage the doctor's reputation—something that may take 20-30 satisfied patients to restore.
Nonetheless, every colleague in this field has faced some form of complication during their career. However, by strictly adhering to professional guidelines and maintaining up-to-date knowledge, the rate of complications can be reduced. The most common complications in plastic surgery are similar to those encountered in other surgical fields.
While an infection following a hernia operation may only cause temporary discomfort, a similar complication during breast implantation could result in the complete failure of the procedure. Many aesthetic surgeries have their own specific risks, such as capsular contracture in breast augmentation.
Beyond the major types of complications, each surgery may have unique risks, which will be detailed in the relevant sections.
Bleeding is a complication that typically occurs within the first 24-48 hours. During tissue separation, blood vessels must be cut. These are first cauterized using a special electric device (a process called coagulation, which effectively "seals" the vessel) before being severed to prevent bleeding. However, in some cases, these vessels may reopen later, even after the wound has been closed, leading to hematoma formation.
If the bleeding is minor, the vessel clots and closes on its own, and the hematoma is small enough to be reabsorbed naturally. However, if the bleeding is significant, it may cause swelling and tension, making spontaneous reabsorption unlikely. In such cases, the wound must be reopened, the surgical site re-explored, the clot removed, and the source of bleeding identified and stopped.
Hematomas can lead to multiple complications. If bleeding occurs in a confined space, the increasing pressure on surrounding tissues can slow circulation, reducing oxygen and nutrient supply to cells while allowing toxic waste to accumulate. This process can lead to skin and tissue necrosis.
Even a small hematoma that does not require removal can pose risks, as it provides an ideal breeding ground for bacteria, potentially leading to infection. In the case of a breast implant, it may also increase the risk of capsular contracture. If a second surgery is required to remove the hematoma, the risk of infection doubles due to the additional operation.
In borderline cases, it can be challenging to determine the best course of action—whether to remove the clot, accepting the risk of another surgery, or to allow natural absorption, which also carries risks. The decision must be carefully weighed to choose the option with the least risk, which is often difficult.
Infections typically appear between days 5 and 14, though in some cases, they may occur as late as 4-5 weeks post-surgery. The severity can range from mild redness around the wound to severe infections causing tissue necrosis.
Two primary causes of infection exist:
In most cases, reopening the wound and draining the infection is sufficient to resolve the issue, though healing may take longer, sometimes leaving a wider scar. However, in certain procedures—such as breast augmentation—this type of infection can compromise the entire surgery, often necessitating implant removal.
The skin in the surgical area is supplied by a network of sensory nerves, which may be injured during surgery, leading to temporary numbness. In most cases, sensation returns within 2-3 months as the nerves regenerate. However, in rare cases, the affected area may remain permanently numb.
The most problematic situation arises when the nipple loses sensation, but the most serious nerve injuries occur during facelift surgeries, where damage to facial nerves can lead to facial paralysis with severe consequences.
Under optimal conditions, scars heal as thin, barely visible lines. The quality of wound healing depends on factors such as the wound’s location, closure technique, and individual healing tendencies.
The thickness of the skin and underlying dermal layer significantly affects scarring. The thinnest skin on the body covers the eyelids, where scars from surgery (e.g., facelifts) become almost invisible over time. However, surgeries on the back, décolletage, or lower legs tend to heal with thicker, more noticeable scars, even with meticulous surgical techniques.
Using an atraumatic surgical approach is crucial, meaning the incision is made with a very sharp scalpel in a single, perpendicular motion to minimize trauma, and the wound is handled as little as possible using delicate instruments and special sutures. Complete scar maturation can take up to two years. While various treatments, including creams, ointments, and laser therapy, can accelerate healing, they do not necessarily improve the final result.
The most significant aesthetic concern is keloid scarring, which appears as raised, red, itchy, and often painful overgrowths of scar tissue. Keloids are more common in individuals with darker skin tones and frequently develop on the shoulders, sternum, and behind the ears.
Treating keloids is challenging because they often recur despite surgical removal, even when combined with radiation therapy. As a result, conservative treatment is preferred, with surgical intervention considered only as a last resort. Initial treatments include scar gels, silicone sheets, or direct steroid injections into the keloid, which can sometimes improve the condition.
In most cases, necrosis occurs due to venous circulation problems, as mentioned in the bleeding section. In rare cases, severe bacterial infections can also cause tissue death. This is most commonly seen after abdominoplasty, breast reduction, and breast lift procedures.
If necrosis occurs, it is crucial to wait until the nonviable tissue is fully separated from healthy tissue before removal, as some areas may recover over time. This process can take several weeks, allowing some tissue to survive. Secondary procedures, such as tissue grafting or scar revision, may be necessary to improve the outcome.
