Preoperative Considerations

All patients are strongly encouraged to stop smoking. Smoking is not only a recognised health hazard in its own right but is responsible for a number of post operative problems and complications in patients who have a general anaesthetic. Heavy smokers are more likely to develop a chest infection postoperatively, particularly after major procedures. They are also more liable to suffer the consequences of impaired circulation. This can lead to flap necrosis (loss of the skin resulting in bad scars) following a facelift or abdominoplasty. Alcohol and aspirin should be avoided for two weeks before and after any significant operation. Both impair clotting and hence the patient is more likely to bleed during and after the operation. Abstinence from food and drink from early morning or the previous midnight is essential depending on the time of the operation and the orders of the anaesthetist.

All surgery and anaesthesia are associated with a small risk. Complications that can be extremely serious, even fatal, can arise in any operation. Elective cosmetic surgery however on healthy patients is not considered to be a high risk.

Postoperative events that can occur after any surgical operation

Pain and Discomfort

Surgical procedures result in discomfort for the patient. The degree and duration of this will depend on the nature of the operation and the patient's pain threshold. Tablets or injections are usually given in the immediate postoperative period. Patients are discharged when they are comfortable.

Scars

All surgical incisions heal with a scar. The surgeon tries to place incisions where they are not easily seen, such as in natural skin folds or behind the hairline. It is wrong to think that scars will be invisible or that they will fade to nothing in time. Wound healing is a complex process and scarring can be very variable. Most scars will look worse (red and raised) for some time after the operation before they mature and become pale. In general scars take 6-18 months to mature and there will always be a permanent mark, no matter how inconspicuous, where an incision has been made. Scars can occasionally be bad for no apparent reason and may require further treatment at a later stage. Complications such as infection or stretching of the wound can lead to bad scars. Some areas of the body and some skin types are notorious for producing worse scars than others.

This is the body's natural response to injury. Every surgical procedure is followed by a period of bruising and swelling, depending on the nature and extent of the surgery.

Sometimes bleeding can continue after the end of the operation or restart after an interval. It can either track to the surface, or more commonly, collect beneath the skin. Such a collection of blood is called a haematoma and if it becomes large enough it may require treatment.

A wound can become infected for a variety of reasons. Prompt and effective treatment is necessary to prevent further complications. Infections can also occur as a result of surgery in areas quite distant from the operation such as in the chest or urinary system.

This is the situation in which blood has clotted in the deep veins of the calf. It is rare in patients undergoing elective cosmetic surgery. If the clot becomes dislodged and travels to the lungs it can have very serious, possibly fatal, consequences. Patients with a previous history of postoperative deep vein thrombosis should warn the surgeon and the anaesthetist before the operation. Oral contraceptives increase the risk of deep vein thrombosis and there is some controversy about the benefit of stopping such treatment before surgery. It is thought wise to stop oral contraceptives prior to certain operations.

Various drugs are administered during the course of an operation particularly if there is a general anaesthetic. It is important to avoid giving any drug to a patient who might be allergic to it. Any known allergy must be reported to the surgeon and the anaesthetist before the operation. Severe allergic responses have to be dealt with promptly and effectively to avoid serious consequences.

This is seldom required in cosmetic surgery. All blood is carefully screened by the blood transfusion service for any infectious agent before it is released for use. It is quite common for patients to be given some fluid with a drip during and after operations.

Sometimes small flexible tubes are used to let out collections of blood or other fluids from a wound. They are removed a day or two after the operation.