Dr. Dirk Lazarus
Plastic Surgeon

Tel: 021 424 1112
Fax: 021 424 1118

86 New Church St
Tamboerskloof
Cape Town, 8001
South Africa

My primary concern when operating is patient safety. Nevertheless all surgery carries the risk of complications. This risk, however, is low. Complications tend to be rare and most complications are minor and resolve without the need for further surgery. I believe that my personal philosophy of keeping procedures simple, safe and conventional and that my natural tendency to be a conservative surgeon further helps to minimise the risk of complications and problems. I do not operate on patients who are unsuitable or who are high risk. Patients for plastic surgery are generally fit and healthy, further minimising the risk. To avoid complications I try to operate with an awareness of the potential for problems. Careful patient selection is important so that the great majority of patients can undergo uneventful surgery, a quick recovery and a happy outcome. Some of the potential problems are discussed below.

Bleeding: All surgery entails incisions which can bleed. Bleeding may be early or late, minor or major and may require a return to theatre to eradicate a collection of blood (haematoma) and to control the bleed. In most cases this does not affect outcome, but costs for the theatre have to be borne by the patient. Late bleeding can manifest as a seroma - a collection of fluid which may require repeated drainage with a needle and syringe.

Infection: The skin is a barrier to infection and by cutting it, that barrier is breached. Although the risk of infection is small, it can occur. Infections may be minor - just some redness,tenderness or fever - which usually responds to antibiotics. More severe infections - throbbing pain, swelling, pus collections, high fever, etc. - may require surgical drainage, removal of implants, or other secondary surgery.

Delayed healing: Wounds require adequate blood supply, nutrients and oxygen to heal. Your body requires rest, metabolites and a positive mental state. Wound healing is a complex process influenced by a myriad of factors. Delayed wound healing can occur for any one of a number of different reasons. It can result in skin loss, fat necrosis, wound breakdown, or other problems, most of which simply require time and patience, but some of which may require secondary surgery. Smoking will adversely affect wound healing and the risk of wound related complications in facelift patients who smoke is 12 times greater than in those that do not. Similarly for other operations smoking is ill advised or contra indicated.

Bruising and swelling: Bruising and swelling is normal following surgery and tends to resolve 2-4 weeks after an operation. In some patients or procedures this can be prolonged. Also, bruising and swelling tend to descend following surgery: patients who undergo facelift may get bruised on their neck and chest, tummy liposuction patients may experience bruised and swollen genitalia.

Stitch abscesses: Dissolving sutures are frequently used for many surgical procedures. These sutures dissolve by the body forming an inflammatory reaction against the sutures. Cells called phagocytes then literally eat the sutures away. Sometimes this inflammatory reaction can be close to the surface of the skin and manifest as a pimple. Removal of the suture usually causes the problem to resolve.

Scarring: Every incision leaves a scar. Part of the art of plastic surgery is knowing where and how to place that scar so that it is well camouflaged and becomes inconspicuous. It should be borne in mind that scars take over a year to mature. During the maturation process there is a phase when the scar become red and raised, usually from about 3 weeks after surgery to about 4 months. Sometimes hypertrophic or keloid scars can become excessively red and raised beyond this period necessitating further treatment.

Numbness: Nerves which carry sensory impulses from your skin may be cut, stretched, bruised or otherwise traumatised, thus causing numbness in the area operated on. Usually this is a transient phenomenon and sensation returns rapidly. One can expect most of the sensory recovery to occur within 6 weeks of surgery, although some degree of improvement may occur for up to 2 years.

Paralysis: Nerves also carry signals to the muscles instructing muscles to move. Trauma to the nerves can result in paralysis of the muscles supplied. In most cases, as for sensory problems, this is transient and recovery occurs, but this can take up to 2 years after surgery. Permanent paralysis is rare after surgery.

Damage to other structures in the area: Salivary ducts, arteries, veins, etc., can all be inadvertently damaged during surgery. Although the utmost care will be taken, aberrant anatomy and other factors can lead to injury.

Anaesthetic related complications: Although anaesthesia is very much safer these days than it used to be in the past, anaesthesia does still carry risks. The risk is probably equivalent to flying. During anaesthesia fluids, gases and drugs will be administered, lines inserted, etc.

Systemic complications: Lung infections, collapsed lungs, fluid imbalances, kidney problems, strokes, heart attacks and other events can occur or manifest as a consequence of surgery. Deep vein thrombosis is also a risk and is further discussed under advice to travelers. These problems are all rare, but are part of the risk of surgery.

Mood changes: Cosmetic surgery usually converts a fit healthy individual into a patient who has had surgery and requires time for recovery. In other words, you become sick. Although you may realise this before hand, it is often difficult to adjust to this and it is not unusual for patients to feel depressed, even tearful after surgery. Usually one's mood improves as the swelling and bruising subside. Also, It is not unusual for an initial satisfaction with surgery to be followed by a period of nit picking and fault finding. This usually passes with time.

Unsatisfactory cosmetic result: Part of the difficulty of cosmetic surgery is for the surgeon to understand what it is that bothers you so that a proper correction can be attained. In this regard it is important for you to find a plastic surgeon with whom you can communicate. You should understand that no person has an absolutely symmetrical body, that the face is different on the two sides, that the left breast tends to be broad and squat while the right breast is usually longer and thinner. Also, there is always the risk of too much, too little, too big, too small, irregularities, dents, bulges, etc. Human beings are not lumps of clay or bronze which can be moulded, but living tissue which can sometimes heal unpredictably.

It should be emphasized that on the whole, complications tend to be rare and most patients get through surgery without problems.