Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Complications

My primary concern when operating is patient safety. Nevertheless all surgery carries the risk of complications. However, this risk is low. Complications tend to be rare and most complications are minor and resolve without the need for further surgery. If complications occur then I will manage the treatment of them.

I believe that my personal philosophy of keeping procedures simple, safe and conventional and my natural tendency to be a conservative surgeon helps to minimise the risk of complications and problems. I do not operate on patients who are unsuitable or who are high risk. Careful patient selection is important.

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, called a haematoma, and to control the bleed. Late bleeding can manifest as a seroma, a collection of fluid which may require repeated drainage with a needle and syringe.

Infection

Infections may be minor, presenting with redness, tenderness, pain and warmth, or they may be more severe with throbbing pain, swelling, pus collections, and high fever. Treatment options may include local wound care, surgical drainage, removal of implants, antibiotics or other secondary surgery. Where indicated prophylactic antibiotics (antibiotics to prevent infection) are given during your surgery but usually not continued in the recovery period as this has not been shown to be beneficial.

Wound Healing Issues

Wounds dehiscence is splitting open of the wound or wound breakdown. This may be caused by infection, tension in the wound, foreign body in the wound, smoking, poor nutrition and so on. Once it has occurred, secondary suture is usually not advised as the wound is in a poor state to receive sutures. Usually wound breakdown is treated with keeping the wound clean and applying a daily dressing with an antiseptic. Antibiotics are not usually required. Later scar revision later is rarely required.

Suture abscesses appear initially as little irritable bumps in the scar. What you are feeling is the stitch. Suture abscesses are relatively common with buried dissolving sutures because an inflammatory response is necessary to cause the suture to dissolve. This process happens usually a few months after surgery. These bumps can progress to a small pustule which can breakdown and discharge. Sometimes suture material can be seen or felt. If suture material is evident then this should be removed as it causes inflammation and interferes with healing. Otherwise suture abscesses are treated as a wound dehiscence. Antibiotics are not usually required.

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. Bruising and swelling tend to descend following surgery. For example patients who undergo facelift surgery may get bruised on their neck and chest, and 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 developing 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 becomes 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.

Weakness or 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

During anaesthesia fluids, gases and drugs will be administered, and lines inserted. Although anaesthesia is much safer these days than it used to be in the past, anaesthesia still carries risks. The risk is probably equivalent to flying.

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 Tourism which lists advice to travellers. 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 beforehand, it is often difficult to adjust to 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.

Testimonials

I think Dirk is really great – the kind of attention which he paid Ethan was really moving and one which I will not forget.