Plastic Surgery: 3 Things to Do Before Going Under the Knife

You want liposuction, a nose-job or perhaps a tummy tuck. But don't think that just because it's elective, or not related to a health problem, that it is no big deal. Plastic surgery is no different from other types of operations. There are risks. Here are three things to do before you decide on cosmetic surgery.

1. Research your surgeon
A survey by the American Society of Plastic Surgeons (ASPS) showed that nearly one third of cosmetic surgery patients did not check their doctor's credentials before surgery. Be sure you choose a surgeon who is board-certified. To be board-certified in plastic surgery, a doctor must have an M.D. or D.O. (doctor of medicine or osteopathy) and extensive specialty training. This includes five years of a surgical residency and at least two years of specialty training in plastic surgery. He or she must also have passed the certification exam given by the American Board of Plastic Surgery. Use a board-certified surgeon to reduce your chance of developing complications.

Do your homework when choosing a surgeon:

• Your surgeon's credentials. Check on the physician's:
  • Education
  • Medical license (in which state?)
  • Training (residences, fellowships)
  • Certifications
  • Professional society memberships

Ask your doctor if he or she is certified by the American Board of Plastic Surgery. Also make sure your doctor is on staff and has admitting privileges at the nearest hospital.

• Your surgeon's experience. Ask your doctor about his or her training and comfort level with the procedure you want done. How often has your doctor done the procedure? One special example to ask about is large-volume liposuction (a procedure for removing more than 11 pounds or more of fat). This procedure carries more risk than a typical liposuction. Your surgeon should have special training in this procedure. Ask to see before and after pictures.

2. Inform your doctor about your health history
Any surgical procedure carries a certain amount of risk. You can lower this risk by giving a complete medical and family history.

Be sure to discuss:

• Your medical conditions. If you have heart disease, diabetes or lung problems or you are obese, you are more likely to have complications. Tell your doctor if you have a history of blood clots. Ask if you need any pre-surgery testing such as an EKG (electrocardiogram) or blood tests to make sure you are in good health to undergo surgery.
• Your smoking and/or drinking. Those who smoke or drink to excess also have a greater risk of problems.
• Your medications. Certain herbs and medications may raise the risk of bleeding or may affect how well your blood can clot. Be sure to tell your surgeon all of the medications, prescription and over-the-counter, and any supplements that you are taking.
• You family medical history. Tell your doctor if you have a family member who reacted poorly to anesthesia, has a bleeding problem, had blood clots or died suddenly.

3. Understand the possible problems
According to the ASPS survey, about one third of patients who had plastic surgery had side effects or complications they found to be at least somewhat difficult to manage. Here are just some of the problems that could develop during or right after your surgery:

• Anesthesia-related complications. General anesthesia means you are asleep during the surgery and do not feel any pain. Certain kinds of liposuction, nose reshaping and other kinds of surgery need you to be unconscious. You may have a reaction to the anesthesia or sedation itself, especially if you smoke, have heart or lung disease or are very overweight. Anesthesia risks include breathing, heart and blood pressure problems, and brain or nerve damage.
• Infection. To prevent infections, you will take antibiotics before and after the procedure. You will also be given instructions on how to keep the surgical site clean after you go home. Be on the lookout for slow healing or signs of skin damage or tissue death. Risk is higher in smokers and people with diabetes.
• Fat embolism. A rare but serious complication of liposuction is a fat embolism. During liposuction fat can enter a ruptured blood vessel, then travel to the lungs, where it can block blood flow. This can be fatal. Tell your doctor right away if you have signs of fat embolism, such as sudden shortness of breath after surgery. If you develop symptoms once you are home, call 9-1-1.
• Blood clot. Another risk of surgery is a blood clot in a deep vein of the leg or abdomen. If the clot travels to the lungs (called a pulmonary embolism), it can block blood flow. This can be fatal. Being very overweight, having heart disease or having a recent injury also raises the risk for blood clot. For women, there are also risks from taking oral contraceptives or hormone replacement therapy. Your surgeon will consider your risks and take measures to prevent blood clots. You may take medications to thin the blood (such as coumadin) or wear elastic stockings that improve blood flow in the legs.
• Bleeding, bruising, swelling or numbness. Be sure you understand what's normal to expect and when you should call your doctor.
• Seroma. Fluid that collects under the skin.

You can help lower certain risks by following the advice and the instructions of your surgeon, both before and after your surgery. Further, schedule your surgery at a facility that is accredited by a national or state-recognized organization, such as:

• American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF)
• Accreditation Association for Ambulatory Health Care (AAAHC)
• Joint Commission on Accreditation of Healthcare Organizations (JCAHO)