Safety First: Decreasing Cosmetic Surgery Risks

Whether you are considering a breast augmentation, a mommy makeover or a facelift, it’s important to realize that cosmetic surgery is still surgery. There are always risks involved with surgery. Part of any great plastic surgeon’s role as a physician is educating the patient on those risks and reducing risks when possible. After all, surgeons are physicians who consider their top priority patient safety.

“A lot of young, healthy people do have issues that may impact some of the risks of surgery,” shares board certified plastic surgeon Dr. Mark D. Epstein. At the Center for Aesthetic Surgery in Stony Brook, New York, Dr. Epstein ensures his patients have the lowest possible risks for their unique circumstances by properly screening, educating and preparing them for surgery.

Medications, Vitamins & Supplements May Increase Risks

Risks with surgery include excessive bleeding during surgery, hematomas after surgery, blood clots, and infection. Certain medications, herbs, vitamins and supplements can increase the risk of these complications.

Risks During & After Surgery:

• Excessive bleeding
• Hematoma
• Blood clot
• Infection

Dr. Epstein has a very thorough multi-page list of medications, vitamins and supplements that can affect surgery. “Patients will think that when they are on an over-the-counter or supplement, they don’t need to mention it,” says Epstein. “You’d be surprised how some of these little things, such as Ginseng, can affect bleeding after surgery.”

In most cases, Epstein requires patients to stop taking anything that affects bleeding two weeks prior to surgery. Non-steroidal anti-inflammatory drugs – aspirin, Advil, and Motrin, for example – can affect the ability of blood to clot. When blood doesn’t clot properly, it can cause excess bleeding during and after surgery. This may lead to complications such as hematomas, which are collections of blood under the skin at the surgery site.

Even young, otherwise healthy plastic surgery patients are often on prescription medications that may increase the risks of complications during or after surgery. Oral contraceptives, also called birth control pills, can slightly increase the risk of the formation of a dangerous blood clot. When possible, Epstein recommends patients stop taking their oral contraceptives in the weeks leading up to surgery, and then resume taking them again shortly after.  

Some prescription medications for autoimmune or inflammatory bowel disease affect a patient’s immune system.  A compromised immune system is unable to properly prevent or fight infection. In certain cases, pausing these medications around the time of surgery may provide a boost to the patient’s immune system, decreasing the risk of infection at the surgical site.

Surgeons & Doctors Work Together to Reduce Risks

When a patient has a medical condition such as an autoimmune disease or diabetes, Epstein works closely with the physician who manages the condition to ensure they are best prepared for surgery. “We get appropriate consultations from the medical sub-specialties to make sure our patients are in the actual optimum medical condition,” says Epstein. “When I go to the operating room, I know that my patient has the lowest possible risk of that patient. Now, that risk may be higher than someone else who doesn’t have a medical problem, but I still want to make sure that they are in the best condition that they can be.”

When it comes to preparing for surgery, Dr. Epstein walks the patient through his instructions during the preoperative appointment. He also provides each patient with a customized, detailed preoperative handbook. This handbook instructs the patient day-by-day in the days leading up to surgery and also in the days following surgery.  

“Following instructions is very important,” emphasizes Epstein. “The handbook guides them so that they get the best result and the smoothest pre and post-operative course.”

Reducing Risks in the Operating Room

Safety on the day of surgery is largely dependent on the surgical facility, the surgeon and the surgeon’s staff.  The importance of choosing a board certified plastic surgeon who operates in an accredited surgical facility can not be overstated.

Not all surgeons claiming to be plastic surgeons are properly trained as plastic surgeons. Choosing a surgeon who is certified by the American Board of Plastic Surgery means they have met the standards set by the American Board of Medical Specialties (ABMS), the highest standard for medical specialties in the United States.

Surgery may take place in a hospital or an outpatient surgical facility. The process a facility or hospital goes through to certify it as safe is called accreditation. An accredited facility has met the safety standards set by the certifying organization. This ensures that all processes are in place to make sure the patients gets the safest care possible while they are in the operating room. “We are accredited by the Joint Commission,” explains Epstein. “You could also be accredited by AAAASF (American Association of Accredited Ambulatory Surgical Facilities), or AAAHC (Accreditation Association for Ambulatory Healthcare). Any of the three are fine.”

If your procedure requires general anesthesia during surgery, the person responsible for administering the anesthesia plays an important role in reducing risks during surgery. In his practice, Dr. Epstein uses two physician anesthesiologists who he has been working with for nearly twenty five years.

“These anesthesiologists have done anesthesia on me, my family and many of my staff,” shares Epstein. “They are absolutely outstanding. They give me the degree of comfort and confidence to do fairly involved complicated procedures in an office space setting with total assurance that my patients are well cared for and will have a smooth course through the operating room and through the recovery room until they are ready to be discharged.”