One of the most common plastic surgery risks, and certainly the one that is most recognized by patients, is that of infection. Fortunately in most elective aesthetic plastic surgery that risk is fairly low as the procedures are clean in largely healthy patients. But in certain aesthetic procedures which involve implants or going through the mouth or around the nose or eyes, the infection risk is slightly higher.
Numerous precautions are taken by plastic surgeons when performing procedures to minimize the risk of having a patient get an infection. These include intraoperative and after surgery antibiotics, prepping the surgical field with antimicrobial solutions, and using sterilized instruments and gloves. These efforts combined with a patient’s normally robust immune system account for the often quoted 1% or less occurrence of infection in most cosmetic surgery operations.
But surgical site infections, known as SSIs, do occur and are the result of a complex interaction of factors of which the most important is the natural bacterial flora. When this is allowed to enter the surgical site and proliferates it can create the typical signs of wound infection including redness, warmth, pain and ultimately drainage. But there are several things that patients can do to also help decrease the risk of infection as well.
Avoid Shaving the Surgery Site Before Surgery. While shaving around or over the surgery site the day before or the morning of surgery seems to make sense, it is exactly the opposite of what should be done. Shaving of the skin creates tiny tears in it that lead to growth of skin bacteria in them. Not shaving has been shown by numerous studies to have the lowest risk of SSIs. Any hair removal that needs to be done should occur in surgery by the plastic surgeon just before prepping the surgery site.
Washing with Chlorhexidine before Surgery. Having the patient wash the surgical area immediately before surgery is common practice by many plastic surgeons. If the surgery is going to occur through skin areas that are known to have higher bacterial counts (like armpits, groin creases and breast folds), a chlorhexidine wash or wipe should be done the night before and the morning of surgery.
Timing of Antibiotics is What is Important, not Duration. While most patient’s believe that high and continuous doses of antibiotics are important to prevent infection, it is not that simple. It has been shown that the timing of them, given within one hour of surgery, is the most effective use of antibiotics. Prolong them beyond 24 hours after surgery, with the exception of when implants are placed, has not been proven to be beneficial in reducing SSIs. Many patients will ask to have their antibiotics prolonged thinking it is helpful. But doing so may actually create resistant bacterial growth.
Eat a High Protein Diet. Since surgery by definition creates a catabolic state, particularly in any major body contouring procedure, good nutrition is needed to both heal and resist infection. Patients should consume a high protein diet several weeks before surgery that has at least 100 grams of protein intake per day.
Stop Smoking. The negative effects of smoking on healing have been well chronicled. The carbon monoxide inhibition of the red blood cells and the vasoconstriction caused by the nicotine create a surgical site that is less well vascularized. This also increases the risk of infection as bacteria fighting white cells are also less delivered to the area of injury with the decreased blood flow. One should stop smoking two weeks before and for two weeks after surgery to avoid skin necrosis and wound complications.
Dr. Barry Eppley
Indianapolis, Indiana