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Here are the answers to some of the most frequently
asked questions about plastic surgery. Be sure to check back
periodically as more questions and answers are added. When
reviewing information about specific plastic surgery procedures,
it is important to understand that the circumstances and experience
of every individual are unique. If you are considering plastic
surgery, please ask your plastic surgeon for further information
about the particular procedure and what you can expect.
What You Should
Know About the Safety of Outpatient Plastic Surgery?
Why the "plastic" in
plastic surgery?
What is plastic surgery?
What is the difference between
cosmetic and reconstructive surgery?
What is recovery from plastic
surgery like?
When considering plastic surgery, it’s natural to focus
more on the expected result than on the surgical process.
However, to be fully informed, it’s important to learn
about the safety of the procedure as well as the expected
outcome. Although thousands of people have plastic surgery
every year without complications, no surgical procedure is
risk-free. To maximize safety, ensure that:
- your surgeon is adequately trained and is
board certified by the American Board of Plastic Surgery;
- the facility where your surgery will be
performed conforms to strict safety standards;
- your surgeon is informed of any drugs you
are taking and your full medical history, especially if
you have had any circulation disorders, heart or lung ailments
or problems with blood clots;
- the surgical facility will use skilled,
licensed personnel to administer and monitor your anesthesia
and your recovery immediately following the procedure;
- extra safety measures are taken if you are
having a more extensive liposuction procedure.
The American Society of Plastic Surgeons (ASPS),
an organization of board-certified plastic surgeons who are
dedicated to the highest standards of patient care, has prepared
this document to help you get the safety information you need.
It contains recommendations developed by the society’s
expert task forces, whose members have consulted the most
recent research available. If you have questions about these
guidelines or any specific concerns not covered in this document,
talk with your board-certified plastic surgeon. Only ASPS
members are entitled to display the logo above.
How can I be sure that my surgeon
has adequate training?
Good credentials can’t guarantee a successful outcome;
however, they can significantly increase the likelihood of
it. Patients are advised to find a doctor who is certified
by the American Board of Plastic Surgery (ABPS), the only
board recognized by the American Board of Medical Specialties
to certify a surgeon in plastic surgery of the face and of
the entire body. Certification by the ABPS is "the gold
standard" for plastic surgeons because it signifies that
the surgeon has had formal training in an accredited plastic
surgery residency program. If your surgeon is ABPS-certified,
you can be assured that your doctor:
- has completed at least five years of surgical
residency training after medical school, including at least
two years in plastic surgery
- has passed comprehensive cosmetic and reconstructive
surgery exams
- is qualified to perform cosmetic and
reconstructive procedures – everything from liposuction
and facelifts to intricate wound repair.
To verify a surgeon’s certification
status, contact the American Board of Plastic Surgery at 215-587-9322
or visit the board’s web site at www.abplsurg.org
or the American Board of Medical Specialties at www.abms.org
or by phoning 1-800-776-2378.
How can I determine if my plastic
surgeon’s surgical facility meets acceptable safety
standards?
The American Society of Plastic Surgeons and the American
Society for Aesthetic Plastic Surgery have issued a statement
to their members that by July 1, 2002 all plastic surgery
performed under anesthesia, other than minor local anesthesia
and/or minimal oral tranquilization, must be performed in
a surgical facility that meets at least one of the following
criteria:
- Accredited by a national or state recognized
accrediting agency/organization such as the American Association
for Accreditation of Ambulatory Surgery Facilities (AAAASF),
Accreditation Association for Ambulatory Health Care (AAAHC),
or Joint Commission on Accreditation of Healthcare Organizations
(JCAHO)
- Certified to participate in the Medicare
program under Title XVIII
- Licensed by the state in which the facility
is located
Patients should ensure that the facility
is accredited or is in the process of being accredited. To
find out about a facility's accreditation status, contact
the AAAASF at 1-888-545-5222 or www.aaaasf.org
the AAAHC at 847-853-6060 or www.aaahc.org
the JCAHO at 630-792-5005 or www.jcaho.org.
Plastic surgery procedures performed
in accredited surgical facilities by board-certified plastic
surgeons have an excellent safety record. A 1997 survey 1
based on more than 400,000 operations performed in accredited
facilities found that:
- The rate of serious complications was less
than half of 1 percent.
- The mortality rate was extremely low –
only one in 57,000 cases.
- The overall risk of serious complications
in an accredited office surgical facility is comparable
with the risk in a freestanding surgical center or hospital
ambulatory surgical facility.
Why is it so important for my
plastic surgeon to know detailed information about my personal
and family health history, even if I am only having a simple
cosmetic procedure?
There is always risk with any surgical procedure. However,
as a patient, you can play an important role in reducing your
risk by providing a full and complete health history to your
surgeon.
Although rare, one of the most serious
complications associated with surgery is the development of
blood clots in the large veins of the abdomen and legs. This
complication can lead to a potentially fatal pulmonary embolism
(blocked lung artery). Therefore, it is extremely important
to tell your plastic surgeon if you or any of your family
members have a history of blood clots or if you have had a
family member who died suddenly, shortly after surgery or
childbirth.
You will also be evaluated for other
factors that may increase the risk of blood clots. These include:
- being extremely overweight
- having recent traumatic injury
- any disorder of the heart, lungs or central
nervous system
- a history of cancer, recurrent severe infection
or genetic problems that affect blood clotting
For women, additional risk factors
include:
- taking oral contraceptives or having recently
ceased taking them
- undergoing hormone-replacement therapy
Safety measures to prevent blood clots
will be determined by your individual degree of risk. If you
are considered low risk, your doctor may simply ensure that
you are positioned on the operating table in a way that allows
for adequate blood circulation to the legs. If you are of
moderate or high risk for developing blood clots, you may
also be advised to wear elastic stockings before, during and
after your procedure, or to take special anti-clotting medications.
Compression devices on the legs may be used during surgery
to support your normal circulation.
How can I be sure that the anesthesia
care I receive in my plastic surgeon’s surgical facility
is adequate?
Anesthesia care in an accredited or licensed facility has
reached a level of sophistication that is absolutely comparable
to the care received in the hospital. For maximum safety,
ASPS recommends that:
- Any planned anesthesia should be administered
by skilled, licensed personnel acting under the direction
of an anesthesiologist or the operating surgeon.
- Before any type of anesthesia is used, the
surgeon or anesthetist must take a full medical history.
A physical examination and appropriate lab tests may also
be performed. Your surgeon needs to know if you have any
serious medical problems or have had previous adverse reaction
to any other type of anesthesia. Also, you must let the
anesthetist know about any medications you are taking (including
herbal supplements), any known drug allergies, when you
last ate and whether you smoke cigarettes or use alcohol
or illegal drugs.
- You should be assured that you will receive
individual monitoring by skilled, licensed personnel before,
during and after the procedure. Staff who are familiar with
the warning signs of cardiac or respiratory distress and
are trained in advanced cardiac life support (ACLS), should
be on hand to monitor your procedure and recovery following
your surgery.
- If you are told that you will be kept overnight
at the surgical facility while you recuperate, make sure
that the facility is accredited by a recognized agency.
In an accredited facility you will receive around-the-clock
care and monitoring by two or more skilled and licensed
staff members with at least one trained in ACLS. You will
also be assured that the facility has the necessary equipment
and medications to handle complications that may arise and
an emergency plan in case you need to be transferred to
the hospital.
To achieve the cosmetic results
I want, my plastic surgeon has recommended "large-volume"
liposuction. What types of safety measures should I expect
my surgeon to take?
Due to recent advances in technique and technology, serious
medical complications in liposuction are quite rare. However,
the risk of complications increases with the number of areas
treated and the amount of fat removed. A liposuction procedure
is classified as "large volume" when 11 pounds (5,000
cc) or more of fat and fluid are removed.
Factors that may increase the risk of
complication are:
- excessive amounts of local anesthesia or
excessive amounts of fluid administered intravenously or
within the tissues at the surgical site
- multiple, unrelated procedures performed
during the same surgery
- being in poor health prior to surgery
- having a personal or family history of blood
clots of the legs or a blocked lung artery
- having a personal or family history of breathing
or bronchial disorders or other lung problems
- for women: current use of oral contraceptives
For maximum safety, a patient planning
to have either large-volume liposuction or ultrasound-assisted
liposuction (known as UAL) should be aware of the following:
- Large-volume liposuction requires specialized
knowledge. Therefore, it’s important for your surgeon
to have additional training specifically in UAL or large-volume
liposuction.
- Your surgeon should keep track of the amount
of fluid that is infused into your body and the amount that
is withdrawn from your body. The surgeon should also have
systems to record intravenous fluid, the amount of fat removed
and urinary output.
- Extended post-operative monitoring of vital
signs and urinary output is critical following large-volume
liposuction. An overnight stay in a hospital or other overnight-stay-accredited
facility may be required.
ASPS believes that in the hands of an
appropriately trained specialist, liposuction is a generally
safe procedure. Still, ASPS is collecting additional data
on the safety and effectiveness of liposuction. The Liposuction
Outcomes Study and will yield valuable data in the near future.
Safety is a team effort
Quality patient care, safety and successful surgical outcomes
are the result of the patient, the surgeon and the surgical
staff working together. The ASPS has supported this concept
by establishing task forces on liposuction, deep vein thrombosis
prophylaxis and outpatient surgical safety. These professional
groups have thoroughly investigated the surgical techniques,
equipment and medications commonly used in outpatient plastic
surgery and have set safety guidelines for use by all plastic
surgeons, their staffs and their facilities. The task forces
have also supplied the patient-safety information for this
document.
As the ASPS continues to support the
safety research being conducted by its Educational Foundation
and the National Endowment for Plastic Surgery, patients are
encouraged to learn everything they can about the procedures
they are considering and to ask a lot of questions. Your concerns
about safety should be discussed in detail with your plastic
surgeon. This will help promote a safe outpatient surgery
experience as well as fulfilling your surgical expectations.
1. Morello, D.C., Colon, G.A., Fredericks,
S., Iverson, R., Singer, R. Patient safety in accredited office
surgical facilities. Plast. Reconstr. Surg. 99: 1496, 1997.
Statement approved by the ASPS Board of Directors, June 24,
2000
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The word "plastic" comes from the Greek word plastikos,
meaning "to mold or shape." Many of the first plastic
surgeries were developed to close a difficult wound or replace
tissue lost due to injury or cancer. These procedures often
involved the formation of a skin flap to reshape or mold the
defect so as to approximate the original shape.
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Plastic surgery is a surgical specialty dedicated to reconstruction
of facial and body defects due to birth disorders, trauma,
burns, and disease. The art and science of plastic surgery
is also involved with the enhancement of the appearance of
a person through such operations as facelift, rhinoplasty,
breast augmentation, and liposuction.
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Cosmetic surgery is performed to reshape normal structures
of the body in order to improve the patient's appearance and
self-esteem. Cosmetic surgery is usually not covered by health
insurance because it is elective.
Reconstructive surgery is performed on abnormal
structures of the body, caused by congential defects, developmental
abnormalities, trauma, infection, tumors or disease. It is
generally performed to improve function, but may also be done
to approximate a normal appearance. Reconstructive surgery
is generally covered by most health insurance policies although
coverage for specific procedures and levels of coverage may
vary greatly.
There are a number of "gray areas"
in coverage for plastic surgery that sometimes require special
consideration by an insurance carrier. These areas usually
involved surgical operations which may be reconstructive or
cosmetic, depending on each patient's situation. For example,
eyelid surgery (blepharoplasty) - a procedure normally performed
to achieve cosmetic improvement may be covered if the eyelids
are drooping severely and obscuring a patient's vision.
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Will I be able to tolerate the pain post-operatively?
Each patient will tolerate pain post-operatively in a different
way, and we consider this. While some patients may describe
the pain as an ache, others experience greater discomfort.
Appropriate pain medications are prescribed for the post-operative
patients, and these help minimize discomfort. Most facial
cosmetic operations have minimal discomfort post- operatively.
Liposuction is slightly more uncomfortable, and operations
that require elevation or tightening of the muscles-such as
an abdominoplasty or breast augmentation have discomfort equal
to that of a C-section.
How long is the recuperative period
and when can I return to work?
The length of time it takes to recuperate after plastic surgery
varies depending on the procedure performed and the person
operated on. Most patients will require assistance for the
first two days. Then most patients are able to care for themselves,
but may still need assistance if they have small children
to care for. The specific lengths of disability are outlined
below by procedure. These are approximations, and do not include
return to exercise.
Eyelid Surgery-Usually can get around independently
by the second day. With the use of sunglasses, may feel comfortable
going to the store by day 3-4, and with makeup could return
to work by 5-7 days.
Facelift Surgery-Usually can get around independently
by the second day. Usually do not feel comfortable going out
in public for 5-7 days. Requires 10-14 days before returning
to work if in the public eye.
Breast Surgery-Usually can get around independently
by the second day. May return to work at 5-7 days if not required
to lift more than 15 pounds.
Liposuction-Usually can get around independently by the second
day, earlier if smaller number of areas treated. One can return
to work and normal activities in 5-7 days.
Abdominoplasty-Patients may take between 2-4
days before getting around independently. The recovery is
almost identical to C-section. One can return to a desk job
at 5-7 days, other jobs 10-14 days.
When can I resume regular exercise?
The time a patient resumes regular exercises varies based
on the operation performed. All patients are encouraged to
start a slow walking routine on the second postoperative day.
Regular aerobic and more vigorous activities are not allowed
during the first 2 weeks in order to decrease the risks of
bleeding, swelling, and bruising. Weight lifting and contact
sports are allowed at 1 month in most cases.
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Information provided by American
Society of Plastic Surgeons. |
