Complications and poor results in plastic surgery

As with all surgical operations, complications can occur after a cosmetic procedure. Every surgeon strives to reduce the number and severity of complications, but none can claim never to have any.

In theory, the number and variety of complications is very large. Among the less rare ones:

• A haematoma caused by post-operative bleeding may require drainage by needle aspiration or partial opening of the suture, or even reopening in the operating theatre for complete drainage and control of the bleeding. Such bleeding and the occurrence of a haematoma are encouraged by a rise in blood pressure, agitation, vomiting and coughing. A bruise will remain for some time, along with some thickening, but everything settles with time and there will be no trace if the haematoma has been treated correctly.
• A haematoma sometimes develops gradually, but quite often suddenly, sometimes after physical exertion. Pain, marked swelling or a deformity should raise the alarm. A haematoma should not be confused with a simple bruise, which involves a change of colour but no deformity or significant one-sided swelling.
• Infection can also occur after a cosmetic procedure. Fortunately it is rare on the face. The signs of infection are redness, heat and pain. A rise in temperature is also a sign. You must then react quickly and do what is needed: sometimes aspiration, irrigation or antibiotics, and everything generally settles quickly, usually without leaving any trace.
• The scar may become hypertrophic or keloid. It is then red, widened and raised, and often itches. These reactions peak at 6 weeks and then gradually subside with the help of massage, compression or even cortisone injections. The final scar will be white and flat after 6 to 18 months, but wider than a normal scar.

These abnormal scar reactions are mainly seen on the body and are rare on the face. Some people are prone to these excessive scar reactions, in particular those with pigmented or, conversely, very fair skin.
Even if all these complications have been avoided or have resolved without leaving any trace, the result may be judged insufficient or poor by the patient. There are sometimes imperfections, a slightly irregular nasal bridge, a fold or an unsightly bump. If these imperfections persist after a reasonable period, generally six months, a touch-up can in most cases correct them perfectly.

I would also like to mention the cases where the procedure went well and where I consider the result to be correct and in line with my surgical plan, but where the patient is not satisfied. This is essentially because the patient was hoping for more, sometimes dreaming of a miracle or a transformation that the operation, even when successful, could not deliver. To avoid these painful disappointments, both for the patient and for the surgeon who feels he has done his job well, understanding the objectives and limitations of the procedure is fundamental, and if in doubt, do not hesitate to talk to me again to make sure you have fully understood what I can achieve and what is not possible or not advisable in your particular case.

With the help of these explanations, and after a reflection period between the first and second pre-operative consultations, this kind of situation should not arise.
In all cases, I have asked you to come back and see me after the procedure as well, following a schedule that depends on the specific operation, in order to check that everything is going well.