Explore Plastic Surgery

I have come to learn over the years of a patient phenomenon of what I call…the unrecognizeable problem. While it is not quite that common in major surgery, it has become more evident in minor plastic surgery procedures and, in particular, with all of the new injectable treatments that now exist. It is when the patient points out some issue on their face and I, quite honestly, can’t seen it. I don’t claim to have microscopic vision but my macroscopic vision is still really quite good in both eyes. (20/40)

When I was younger I would look hard and even if I could not see the facial problem, I would often say I could….just to make the patient happy. That may sound deceptive, and I was not trying to be deliberately so, but I figured if the patient sees it it must be real. Not that I am older, I have come to realize that if I don’t see it, just say so. Even if the patient and I disagree, as unpleasant as that can be with some patients. And the reason is….patients always then want something done to it or a little ‘extra’ tweak to these areas and what we effectively have is……chasing a moving target. It is hard to correct something that I can not see very well or something that I don’t even agree is there. Plus, agreeing with the patients always leads to more treatment as they search for the perfect result. Quite frankly, not every result can be perfect and many results will fall into the category of ….improved….or better than it was.

Being too agreeable at times can encourage a patient to try and improve their result even further….and not every result can or should be improved. I have learned that I usually know best as to when to stop…not the patient.

Dr. Barry Eppley

Indianapolis

Amongst the many adverse effects of smoking on the body is its detrimental impact on wound healing. This phenomenon has been recognized since the late 1970s when a correlation between smoking and an increased risk of wound problems in surgery was established.This is quite important in plastic surgery where large skin flaps area raised, resulting in a decreased blood supply to the raised skin as the circulation is cut off from below and skin survival is dependent on blood flow coming in from raised skin only. Cosmetic plastic surgery procedures such as facelifts, tummy tucks, and breast reductions in particular, are particularly prone to healing problems from smoking.
For this reason, the identification of smoking on a patient’s history is very important. It is often one of the first things that I look for on the intake medical history after allergies and medications. Whether the amount of tobacco use listed is accurate is up for debate. I figure most patients put down what they would like it to be, not necessarily how much tobacco they are exposed to every day. I strongly urge patients that they must refrain from all tobacco use at least three to four weeks before and after surgery. Some plastic surgeons refuse to operate at all on smoking patients for certain procedures such as a tummy tuck. I even know some that get a nicotine level several days before surgery. I don’t go quite that far but I can understand this concern. No plastic surgeon wants to deal with avoidable complications. On the surface, no patient wants to either but the addiction of smoking is quite strong even in the face of making smart decisions when you are venturing thousands of dollars in an investment in your body.
There is little question that smoking affects wound healing. I have seen a disproportionate number of patients who said they stopped smoking, but when they developed wound problems such as a dehiscence (separation of the incision line), they casually admitted that they had not stopped completely or had slipped in a few in the past few days to ‘calm them down’. Although I have no scientific evidence to support it, my feeling is that the effects of smoking probably takes many months (not just 3 or 4 weeks) and even up to a year after quitting to become ‘normal’ from a wound healing standpoint.
A recent journal article in Plastic and Reconstructive Surgery (May 2008) now implicates smoking as a cause of increased infections as well. I must say I am not surprised.
Dr. Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

 Plastic surgery encompasses a wide variety of procedures for the face and body. From nose jobs to breast implants, we perform a broad scope of body changes. While the vast majority of these procedures do very well and patients have an uncomplicated after surgery course, some patients will experience complications. The occurrence of complications in plastic surgery, of the minor variety, are not rare. Major complications in plastic surgery, fortunately, are very rare.

Interestingly, there is a vast difference in the occurrence rate and types of complications between plastic surgery of the face and that of the body. While patients understandably place a greater emphasis on procedures done to their face, the actual rate of significant complications from facial plastic surgery is quite low. There are several reasons for this that include; the tremendous blood supply to facial tissues which is quite resistant to infection and allows most wounds to heal quite quickly (including the clearing of bruising and swelling), cosmetic surgery of the face is really ’superficial’ surgery and does not enter any major body cavities or cause major pain and surgery on the face does not disrupt the body’s physiologic functions (like temperature control and fluid shifts) like body plastic surgery does. For these reasons, facial plastic surgery procedures do not pose the same systemic risks as body plastic surgery such as deep vein thromboses, pulmonary embolisms, and infection. Most complications in the face, short of bleeding and hematomas, are mainly about appearance, symmetry, and scarring. Not that these are not significant, but they rarely are life-threatening or invoke major medical problems.

Body plastic surgery, conversely, carries with it bigger risks in my opinion. First, body plastic surgery is ‘bigger’ and involves more surface area of the body than the face. Whether it be liposuction or a tummy tuck, large body areas are being opened or manipulated. As a result, the issues of blood loss, adverse temperature changes, and fluid shifts are real potential issues and expose the patient to greater medical risks such as fluid collections (seromas) and blood clots. Second, the blood supply below the neck to any one body part is not as great as any part of the face. Therefore, infection rates for body plastic surgery are definitely greater than that of the face. While patients are more tolerant to small differences or asymmetries on the body as opposed to the face, the chances of more significant differences is also likely because the surgery site is much bigger and the changes being made are bigger. No where are these issues more evident than in bariatric plastic surgery, the extreme end of body plastic surgery,  where big skin cutouts, long incisions, and extended operating times test the ability of any patient to heal in an uncomplicated manner.

Potential complications are part of any form of plastic surgery and fortunately most are relatively minor and are often just a bump (aggravating as that is) along the way of recovery. However, body plastic surgery is associated with longer recoveries (for many of the procedures) and higher rates of complications such as wound dehiscences, seromas, and asymmetry between body parts. This is in contrast to plastic surgery of the face where the surgical sites by comparison are smaller and healing is much quicker and less complicated.

 Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis