Medical & Trade Publications

June 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

Plastic Surgery: Is it Safe?

This is a question I am often asked: "Isn't it dangerous?"

"I heard about ... " and "I saw it on TV ... " are often next, followed with a recount of some kind of plastic-surgery-patient horror story. Usually, many people harbor underlying feelings that this patient was harmed because of some minor nonmedical procedure that is not risky. And since then, that patient had a complication ... therefore many come to a conclusion that this plastic surgery thing must be terrible and harmful.

The first thing I can tell you for certain is that if I thought I was likely to harm people, I wouldn't perform any elective surgery!

It is surgery, after all.

The keyword here is surgery. Many people have seen TV segments on quick, easy, extensive procedures that produce a happy, attractive patient with beautiful results, who is obviously not in any pain.

In addition to that portrayal, the fact that plastic surgery is mainly elective leads people to place it in a "lesser" risk category than actual "surgery" i.e., a procedure that is required to save one's life.

Plastic surgery is as 'safe' as any other surgical procedure when a qualified surgeon performs the procedure on the appropriate patient, with the appropriate monitoring, in the appropriate setting.

Surgery is surgery

The presumption that cosmetic plastic surgery is a less serious procedure than other types of surgery is silly. The same sequence of events occurs as with any other surgery, such as the removal of an appendix or gallbladder.

Think about it. There is a consultation with the surgeon for a recommendation, a consultation with the primary care doctor for a preoperative medical evaluation, preoperative laboratory studies, a visit to the hospital or surgical center, the regular outfit of a spiffy gown guaranteed not to cover one's backside, the insertion of an IV, some narcotic medication in the IV, then a general anesthetic in the IV.

While the patient is under anesthesia, a breathing tube is put into the throat, then the patient is placed on a breathing machine, and the vital signs are monitored. After surgery, the patient wakes up in a recovery room, possibly stays overnight, and then goes home.

But wait, that's not all! Next, the patient goes through a recovery period of swelling, bruising, and pain before finally enjoying the results several weeks or months later.

Be realistic

This all sounds pretty serious to me, yet many people talk about cosmetic plastic surgery as if it were as convenient and easy as getting a haircut. Needless to say, it's more than a trip to the salon! Patients must view cosmetic surgery as seriously as any other surgical procedure in order to have realistic expectations about risks, the possibility of complications, and recovery.

Everyone is told about, and expects, risks during a procedure like a hernia operation—potential for bleeding, infection, hematoma (blood collection under the skin), seroma (fluid under the skin), healing problems, and even serious complications that could result in death.

Cosmetic plastic surgery carries all the same risks, plus the risk of complications specific to the procedure, and at about the same rate of risk. For example, it is said that there is a 3 to 5 percent chance that anyone having any surgical procedure will get an infection. Patients hope it doesn't occur, but it could happen, and they accept this risk during any surgical procedure, e.g., appendix or gallbladder.

Well, guess what? Cosmetic surgery carries the same risk. Therefore hearing that someone may have had an infection after plastic surgery should be no surprise, because of course there is a 3 to 5 percent chance of that happening even under the best of circumstances, which means that 3 to 5 percent of all cosmetic surgery patients may have some level of infection, even if it is minor.

That doesn't make plastic surgery any more risky or particularly unsafe or terrible compared to any other type of surgery. It just brings home the fact that this is real surgery, with real risks. From minor to major, all the same complications can and do occur.

It is imperative that patients ask if a surgeon is board-certified by the American Board of Plastic Surgery.

That being said, the risk is low enough, and conversely the success rate high enough, that most people choose to accept the risks and proceed. For example, you get in your car in the morning knowing that you could die in an accident and never make it to work, yet we all get in the car and drive every day because the risk of injury is fairly low and the benefit of going to work is very high.

I have heard many times that, statistically speaking, there is a much greater chance that on any given day, a plastic surgery patient will be injured in a car accident on the way to surgery, than during surgery that day. Interesting!

So ... is it safe?

No procedure is "100-percent safe", cosmetic or not. Everything has risk. The answer is that cosmetic plastic surgery is as "safe" as any other surgical procedure when a qualified surgeon performs a procedure on the appropriate patient, with the appropriate monitoring, in the appropriate setting.

The appropriate patient is someone who is healthy with no major medical problems, or with minor medical problems that are under control and have the approval of the doctor managing those problems. The qualified surgeon is a board certified plastic surgeon. An anesthesiologist or anesthesia provider should perform the monitoring. The appropriate setting is a certified operating room.

Note that some of the scary plastic surgery stories in the news are a result of an unqualified individual performing the surgery in an inappropriate setting. To take a chance on these things, often to save money, is to invite problems!

It is imperative that patients ask whether a surgeon is board-certified by the American Board of Plastic Surgery, which is the only accredited plastic surgery board (visit www.abplsurg.org and www.plasticsurgery.org). Patients should ask who will provide the anesthesia, and whether an anesthesiologist (medical doctor) will be available. Patients should also ask whether the room where the procedure is to take place is certified by the same criteria as the operating room at a hospital.

All these things will cost patients extra, but remind them that making poor choices when planning their procedures could cost them much more.

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.