Ask Charlotte: How Safe Is Cosmetic Surgery?

A reader asked us about the risks and potential complications of cosmetic surgery. This is, of course, a complex question that deserves a nuanced, thoughtful answer. So we asked CB expert plastic surgeon Dr. Sophie Bartsich for her thoughts.

Q—CHARLOTTE'S BOOK READER

How safe is cosmetic surgery? What are the risks of complication? With so many new cosmetic procedures coming out, have complications increased or decreased?

A—DR. SOPHIE BARTSICH, PLASTIC SURGEON

As a starting point, Dr. Bartsich shares some statistics about the safety of cosmetic procedures: "While it's impossible to quantify the exact overall risk involved in aesthetic procedures, current estimates range anywhere from 1-10% risk of complication. The right procedure in a carefully chosen patient and with adequate anesthesia has an overall complication rate closer to 2%, with major complications around 1% overall. The verdict? Cosmetic surgery is safe, when properly planned and performed."

Am I a good candidate?

Of course, it's important to look beyond the numbers and think about surgery on an individualized level. Candidacy is one of the most important factors to consider. Dr. Bartsich wisely told us, "The highest risks in aesthetics come from performing the wrong procedure on the wrong patient. Not all patients are candidates for their desired procedures. Your surgeon should guide you through the decision-making process, evaluate you thoroughly for each possible intervention, and design a treatment plan with the big picture in mind." One of the components of reducing risk is knowing when to say no. "The key to elective cosmetic surgery is to maximize benefit while minimizing risk, weighing the likely result with the possible complications. In cases where potential complications outweigh the desired outcome, or where the aesthetic goal is unlikely to be met, the desired procedure should be deferred." Dr. Bartsich adds.

What is "high risk"?

When your doctor evaluates you for surgery, he or she will determine your risk level. Dr. Bartsich makes sure to let each patient know that there is no such thing as "no risk"—most elective cosmetic surgery occurs at a low risk to the patient. "Low-risk patients are generally healthy, non-smokers, with no major cardiac or respiratory issues," Dr. Bartsich tells us. "Low risk can also mean that the patient has no history of complications with similar procedures, and no bleeding or infectious concerns." Dr. Bartsich adds that as a general rule, risk increases with: age, the number of procedures performed simultaneously, longer surgical times (notably over 6 hours), and in male patients with a high BMI. She also notes that "smokers in particular are at high risk of wound-healing problems, and diabetic patients are at a higher risk of infection. In rare cases, the risk profile of the patient outweighs the potential cosmetic benefit, and they are therefore not a good candidate for the surgery."

New technology isn't always better (or safer).

You might get excited about the newest treatment or surgery on the market. But it's important to remember that just because it's newer, doesn't mean it's safer or more effective. Dr. Bartsich tells us, "Every year, countless new machines and devices hit the market, promising to deliver the simplest, fastest, and most short-cut route to aesthetic happiness. But most of these machines are technologies rather than healthcare tools. They are aggressively marketed to patients, who then request the treatments from their doctors. While many of these new inventions have promise, not all are really what they are cracked up to be."

Easy fixes aren't always easy, or even fixes.

Each year there are new treatments that claim to be non-invasive replacements for procedures like liposuction. Everyone likes the idea of less downtime, no scarring, and quick results, so patients ask doctors requesting these new technologies. The truth, however, as Dr. Bartsich tells us, is that while all of those things are alluring and desirable, "if they were truly achievable as presented, surgery would no longer exist. If you could get the result of liposuction by waving a magic wand, all of those suction cannulas would be tossed in the trash by now. But liposuction continues to be one of the most popular and widely performed procedures in all of aesthetics—because it is tried and true, safe and reliable, and in the right hands, delivers predictable results." One of the most frequent and frustrating experiences for patients in today's high-tech world is the repeated failure of shortcut procedures. Patients who are hesitant to undergo anesthesia are lured to getting non-invasive alternatives, with the promise that multiple treatments will get them to the same endpoint. In some cases, the magic wand works, but in many cases it's just not enough. Multiple treatments and many payments later, they regretfully find that the results are just not there—and neither is their wallet.

So, what's the bottom line?

"Every patient and every problem is different," Dr. Bartsich reminds us. "There is no one solution that fits all molds. Your surgeon's job is to analyze and identify the problems and potential solutions, and help you find the tailored treatment that is right for you. It is their job to give you realistic expectations, and to let you know if your preferred procedure is likely or not to get you to your goal. Your surgeon will let you know if a little filler is the right method for resolving your laugh lines, or if a facelift is unavoidable." The question should be "Which procedure is right for me?" and your surgeon should guide you to that end. "The curved TV and 3D imaging may be sleek and cool (and most importantly, new!), but that doesn't mean that they will automatically deliver a better experience than your old-school HD flat screen."

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