The following are significant risk factors for the development of complications after any major surgery. All should be identified in advance, and most can be controlled or eliminated.
Smoking. Smokers have a higher risk of complications after facelift and other surgeries where there is significant disruption of tissue blood supply. Many surgeons will not perform any elective surgery on smokers. Smoking impairs healing, and these effects persist for a year after a smoker quits; therefore, a smoker contemplating elective surgery should quit smoking well in advance. Patients using nicotine patches to help them quit smoking also need to get off the patch before surgery because nicotine in any form constricts blood vessels and thereby prevents oxygen and other nutrients from getting to damaged tissues.
Multiple procedures. Patients undergoing multiple simultaneous procedures are thought by many to be at increased risk for complications, although the studies on this issue have been inconclusive. What is certain is that adding procedures often increases anesthesia time, drug requirements (including local anesthetics), and blood loss, and may contribute to surgeon fatigue.
Long anesthesia. Certain surgeries require a patient to be under general anesthesia for many hours. Aside from the possible risks associated with long operative sessions, a lengthy anesthesia often means that the patient will require a prolonged period in the recovery room and is unlikely to be ready for discharge until the next day. Patients contemplating such a scenario should be certain that they will be cared for in an appropriate facility until they are ready to go home.
Unrealistic expectations. Patients who have unrealistic expectations regarding the processcess and results of a cosmetic intervention are guaranteed to experience distress and disappointment. In the short term unprepared patients can be emotionally undone by the pain, swelling, deformity, and incon venience. In the long term these same patients can be intolerant of inevitabilities such as scars, numbness, and imperfect results.
Previous surgery. The most important reason to shop carefully for a cosmetic surgeon before having any surgical procedure is that the physician you choose has, during that first operation, the best opportunity to provide you with a good result. All revision surgeries, whether or not performed by the original surgeon, are carried out on already damaged tissue, may take longer, may require more anesthesia, and may even cost more than the original operation.
Body image problems. Body dysmorphic disorder (BDD), a body image problem that can cause severe anxiety or interfere with psychological or physical functioning, is estimated to occur in approximately 5 percent of the general population and is thought to be more prevalent in the group of people who seek cosmetic interventions. People with known BDD are clearly at high risk for dissatisfaction after cosmetic procedures, and most physicians try to identify and avoid performing cosmetic procedures on people with this condition.
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