There are hundreds of thousands of cosmetic procedures performed ever year in the U.S. The outcomes of these procedures can be influenced by two factors: how the body responds to the insult of surgery and the unpredictable forces of wound healing. As a result, undesirable complications can occur and the subsequent need for revisional surgery may be necessary.
In plastic surgery, the occurrence of complications presents issues that are different from most other types of surgeries. Unlike more typical postoperative problems such as infection or bleeding, the healing of the surgical site in a cosmetic procedure may be perfect but the desired appearance of the operated area less than anticipated. These two potential postoperative problems, difficulties with wound healing and suboptimal or less than optimal appearance, exposes the cosmetic surgery patient to the potential need for revisional surgery.
While the actual need for revisional surgery varies amongst the type of cosmetic procedure performed and who performs it, it has been estimated that it averages around 15%. Some estimates are even higher. While revisional surgery is often minor, it can be seen with this estimated number that the need for secondary surgery in cosmetic procedures is not rare. Any cosmetic surgery patient needs to understand this risk and be accepting of it.
When postoperative complications develop and the need for revisional surgery becomes apparent, there is unhappiness on the part of both the patient and surgeon. The cosmetic patient is dissatisfied as they never really anticipated that this might happen, no matter how well disclosed this risk was before surgery. Surgical problems are usuallythought of as ‘something that happens to other patients’. The cosmetic patient is usually entirely focused on the benefits of the aesthetic outcome, and not at all focused on the statistical realities of surgery.
This approach, unfortunately, has been fostered by plastic surgeons themselves with the many promotional advertisements promising ‘weekend facelifts’, ‘scarless surgery,’ and other often unrealistic outcomes. As a result, cosmetic surgery is often not perceived as “real” surgery with associated risks.
Like the patient, the surgeon is equally not enthused about the need for revisional surgery. There are many reasons for such a response by the surgeon: from knowing that this is not what the patient expected, a perceived failure of their own skills and expertise, and how this result reflects on their own reputation and image. As a result of these opposing perspectives and even potentially conflicting agendas, a difference in opinion may develop between the patient and surgeon as to the need and advisability of revisional surgery. In these circumstances, patients often seek out other surgeons to undergo their revisional surgery, getting a ‘fresh’ perspective on the problem.
When needed, however, surgical revisions should be done in the proper setting and under the appropriate circumstances. Certain minor revisions can be reasonably performed under local anesthesia in the office. This approach is simple and avoids the use of the operating room. Many times, however, this office approach to revisional surgery is ‘overused’ in an effort to save the patient further expense. As a result, the desired outcome may still be compromised as this environment (lack of good anesthesia, lighting, or equipment) may not permit what really needs to be done. In many cases of revisional surgery, the patient and surgeon needs to be willing to accept the additional arrangement and expense of an operating room to put themselves in a position where the procedure can be carried out properly.
In conclusion, the potential need for revisional surgery is a statistical reality. Revisional surgery from cosmetic procedures carries with it an unfortunate combination of physical, emotional, and often economic consequences. An open and understanding dialogue with your surgeon, preoperative informed consent of the risks and consequences and patience
with the healing process, is the best way to prepare should the need arise for this potential reality from cosmetic surgery.
Dr Barry Eppley
Indianapolis, Indiana