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Introduction to the Risks
of Plastic Surgery
Bleeding and Hematoma
Infection
Seroma
Suture Reactions
Skin Reactions
Wound Separation
Necrosis
Nerve Damage
Anesthesia
Scarring
Bleeding and Hematoma
Many common medications, herbal supplements, vitamin
E, and even alcohol can contribute to bleeding tendencies,
as can uncontrolled high blood pressure. (see preparing
for surgery and aspirin list) In fact, anything that
increases your blood pressure and heart rate such as
exercise, straining, vomiting, or leaning forward can
increase your risk for bleeding.
Bleeding after surgery is most likely within the first
24 hours and can lead to further complications of hematoma
(blood collection), infection, wound separation, and
in extreme cases, tissue death. A hematoma will begin
as an increasingly painful area of fullness under the
skin. It may feel firm or turn the overlying skin blue
or purple. Usually the bleeding is minimal and it will
stop and reabsorb on its own as your natural blood clotting
mechanism takes over.
If the hematoma gets large enough it compress the tissues,
prevent oxygen from getting to the skin, and cause the
skin to start to die. In this case, you will need to
return to the operating room to have the bleeding stopped,
the excess blood removed, and a drain placed to prevent
any further bleeding from accumulating under the skin.
A large hematoma can increase your risk of other complications
such as infection, wound separation, and necrosis.
Infection
Infection is another possible complication, with the
highest risk 72 hours after surgery. Bacteria can enter
the body during surgery, or after surgery through suture
and drain sites or by way of open wounds. If you have
surgery or skin procedures around the mouth, you may
be given anit-viral medication before surgery to prevent
a viral infection causing a Herpes outbreak.
Antibiotics are frequently given during surgery through
your IV (if you have one), and can be effective in pill
form for systemic infections (in your bloodstream) or
in ointment form for infections of the skin or eye.
Your doctor will usually want you to use antibiotics
after surgery even if you don't have an infection as
a preventative measure.
Patients with mitral valve prolapse or any implants
(including pacemakers, breast implants, facial implants,
or artificial joints) should take antibiotics anytime
the skin or mucous membranes are cut. Consult with your
doctor for more information.
Typical signs of infection are warmth, tenderness,
an increasing area of redness, foul odor, thick yellow
or white discharge, or a fever over 101 degrees Fahrenheit.
If the infection progresses, you may need to switch
to a different antibiotic pill, have IV or IM (in the
muscle) antibiotics, or have another surgery to drain
and clean out the infection.
Seroma
A seroma (fluid collection) is also a possible complication
in surgeries where the tissues have been separated (especially
in tummy tucks). This occurs as your body tries to fill
the empty space created between separated tissue, or
as layers of tissues rub against one another. Once you
get a seroma, you are at increased risk for infection,
and if you have implants in that area, they may need
to be removed for your body to heal (such as a seroma
around a cheek implant).
The risk of seroma can be reduced with compression
garments and limited activity. If a seroma does develop,
you may notice fullness, heaviness, an enlarging area,
sloshing of fluid, and in extreme cases, even weight
gain.
A seroma can be treated with compression or with drainage
with a needle and syringe. Seromas resistant to these
treatments can sometimes be aided by injection into
the seroma cavity of an antibiotic or a solution to
help the tissues stick together. It may take weeks or
months for a seroma to resolve, even after being drained.
To Next Section - Suture
and Skin Reactions, and Wound Separation
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