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Cosmetic Surgery: What You Should Know

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Dr. Abdollah Malek stresses patient satisfaction. “It’s not like fixing a hernia and my job is done,” he says. “My job is done when the patient is satisfied.” Photograph by Tom NutterWant to look young, trim and attractive? Who doesn’t? Cosmetic surgery offers a world of possibilities. But though the result may be alluring, people need to consider the hazards

All surgeries involve thousands of steps, any of which can cause problems if not planned and executed properly, says Centreville plastic surgeon Dr. Peter R. Coggins. Infection, excessive bleeding, blood clots, abnormal scarring and numbness at the incision site can occur after any procedure. Life-threatening complications include pulmonary emboli, cardiac arrest, and adverse reactions to anesthesia or medications.

Complications specific to cosmetic surgery include unsatisfactory result, skin necrosis, asymmetry, slow healing, and skin and contour irregularities. These risks will vary from patient to patient. “Complications will be different for different age groups and in patients with pre-existing medical conditions,” says Milford plastic surgeon Dr. Dimitrios Danikas.

Such complications are rare in the hands of a skilled surgeon, and if they do occur, they are correctable. Still, an average of 1 percent to 4 percent of all patients experience some sort of problem or negative outcome. If you consider that more than 11 million procedures were performed in 2007, there were at least 110,000 problems. So patients must choose their surgeons carefully.

Cosmetic surgery patients often face psychological issues as well. Depression and second-guessing can result as the person copes with change. This can occur even after a successful outcome. “Sometimes the change is too much for them to handle,” says Dr. Abdollah Malek of The Centre for Cosmetic Surgery in Newark.

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Having realistic expectations is important “A lot of people try to get back to their 20s or they think that if they have a problem, this is going to make a difference,” says Coggins. Yet patient satisfaction is the Holy Grail of cosmetic surgery. “It’s not like fixing a hernia and my job is done,” says Malek. “My job is done when the patient is satisfied.”

• One of the most popular procedures is liposuction, removal of fat tissue through a rigid tube attached to a vacuum device. Though most patients walk away satisfied, complications can occur. These include burns and accidental organ puncture. Irregular contours and dimpling of the skin are common in patients whose skin has lost elasticity. Dehydration and heart failure can occur if fluid levels are not monitored carefully. Fat embolism syndrome can develop when pieces of fat break away and enter the circulatory system, which creates a potentially life-threatening situation. “Intravenous alcohol given in a moderate dose can alleviate a lot of the problem,” says Coggins.

• “Tummy tuck” is an informal term for abdominoplasty, a group of surgeries designed to reduce belly prominence by removing excess skin and fat, then tightening the muscles of the abdominal wall. Abdominal bulging can result from muscle stretching during pregnancy, excess skin from weight loss or large fat deposits. The major complication from abdominoplasty is infection. This can be prevented by having the patient take antibiotics two to three days prior to surgery and continuing for 10 to 14 days after. Skin necrosis can occur if skin is tightened to the point of cutting off blood supply. Women are advised to postpone abdominoplasty until after their last pregnancy to achieve a more permanent result, says Dr. Mehdi Balakhani, chief of plastic and reconstructive surgery for Christiana Care Health System.

• Breast augmentation involves placing bags of saline or silicone gel into the breast to make the breasts appear larger. The implants can develop a condition called capsular contraction, a hardening of the natural scar that forms around the implant. “This can be avoided by selecting an implant that is an appropriate size for the patient, placing most of the implant under the muscle, and being careful to avoid cross-contamination,” says Balakhani. Asymmetries and irregular contours can also occur if precise measurements are not made. Nipples may lose sensitivity if nerves are cut. Implants that are too large will sag as skin stretches with age.

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• Rhinoplasty, or nose reshaping, can significantly alter a person’s appearance, making it the most challenging procedure for any plastic surgeon. An unhappy result is the biggest risk. Most of the time this can be attributed to overcorrecting with too high a nasal bridge that can result in a “ski slope” years later. “The patient has to understand that if you come out of the operating room and your nose is absolutely perfect, in 10 to 15 years an overcorrected nose will begin to show as the fat beneath the nose disappears,” says Coggins. “It’s like steak. It should be just underdone.”

• Eyelid surgery, or blepharoplasty, makes a person look less tired by eliminating wrinkles, slack skin, shifting fat and-or puffy bags under the eyes. Complications fall into two categories: asymmetrical eye contours and damage to the eye. Vision loss is rare, but problems from overaggressive treatment are not, says Malek. Removing too much skin can cause the eyelid to droop. Poor eye closure may compromise the health of the eyeball.

• A well-planned and executed facelift can remove some of the effects of gravity and skin laxity that occur with age. As we mature, production of growth hormone decreases, causing loss of fat under the skin, which causes wrinkles. Old techniques that pulled skin tight did nothing to increase volume, so they often resulted in the face-in-the-wind-tunnel effect. Injecting fat into strategic areas in combination with a mid-face lift produces a more aesthetic effect, says Coggins. “Once you put the volume in and then tighten the skin somewhat, you’ve got a much more natural and a much younger look.” The risk: injecting too much volume, which results in “pillow face.”

Though any of these procedures can shave years off someone’s appearance, surgeons stress that surgery works best when combined with a healthy lifestyle that includes diet, cessation of smoking and exercise.

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