Complications In Cosmetic Surgery Research Articles

Cosmetic Tourism: a Costly Filler Within the National Health Service Budget or a Missed Financial Opportunity? A Local Cost Analysis and Examination of the Literature.

Cosmetic tourism is a global commodity, but patients seeking treatment for complications of international cosmetic tourism appear to be on the rise. We calculate the financial burden to a single NHS trust and summarise the literature, reviewing the implications of cosmetic tourism and summarising available guidance to assist surgeons in this ethically challenging, but expanding, field. Hospital episodes for patients with complications from cosmetic tourism between January 2016 and March 2017 were retrieved using the patient management system. The coding department provided the episode costs. A literature search was conducted using Medline, EMBASE and HBE identifying 273 English abstracts. The abstracts were reviewed for relevance followed by assessment of the 48 selected full articles by all authors and 17 papers contained relevant, new information. Eleven patients underwent management for complications of cosmetic surgery, most commonly infection, with a sum of 29 inpatient episodes and total cost of £259,732. Our study illustrates the management of complications of cosmetic surgery carries a high cost. This is not an experience limited to just this trust in the UK. Internationally, healthcare systems are evolving to raise the safety profile for cosmetic tourists, some going the extra mile to accommodate healthcare tourists, reaping the financial reward. Following the examination of the literature, we query whether NHS trusts should heighten their presence as providers of private services on the international market, eliminating numerous medical-ethic concerns associated with substandard cosmetic tourism. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Evaluating the Safety of Cosmetic Surgery Procedures Over 6 Hours: Lessons Learned After a 3-Year Retrospective Review and Cohort Comparison

The safety of performing cosmetic surgery procedures longer than 6 hours continues to be debated. A single board-certified cosmetic surgeon’s 3-year experience with all abdominoplasty procedures was retrospectively analyzed. Combined hysterectomy and abdominoplasty procedures were excluded from this analysis. All procedures were performed in a certified ambulatory surgery center or hospital, and under general anesthesia with additional local and tumescence. Two cohorts were identified (long vs short) consisting of procedures lasting greater than or less than 6 hours. Two-sample equal variance, 2-tailed, t-test statistical analysis was performed to compare the groups and differences in complications. A total of 116 consecutive abdominoplasty procedures were performed between June 2012 and July 2015; of them, 62 cases were “long” (>6 hours) and 54 cases were “short” (<6 hours). Age was similar for both groups (40 ± 9 vs 39 ± 10, P = .44). The longer group had a slightly higher body mass index (BMI: 28 ± 4.8 vs 26.1 ± 4.1 kg/m2, P = .02). The average time for the long procedures was 7.6 ± 1.1 vs 4.0 ± 1.1 hours for the short cases ( P < .01). As expected, more procedures were performed in the longer cases (5.3 ± 1.4 vs 2.9 ± 1.1, P < .01). There were no deep vein thromboses (DVTs), pulmonary embolisms (PEs), or deaths. Incidence of major complications for all 116 cases was 8.6% (5 hematomas, 2 flap necrosis, 1 chronic seroma, 1 unplanned admission, and 1 retained laparotomy sponge). Overall, incidence of minor complications was 3.4% (2 localized infections, 1 partial thickness skin slough, and 1 acute seroma). There was no statistically significant difference in the incidence of major (9.6% vs 7.4%, P = .67) or minor (5% vs 4%, P = .77) complications between the long (>6 hours) and short (<6 hours) procedure groups. The average BMI of patients who experienced major complications was significantly higher in both the long and short procedure groups (30 ± 2.4 kg/m2, P < .05). Our data do not support the theory that there is a correlation between length of surgery and the incidence of major or minor complications, specifically as it relates to cosmetic surgery patients. Instead, our data suggest that a BMI > 30 kg/m2 is a significant predictor for complications in cosmetic surgery, both in short and long cases. The incidence of wound dehiscence, seroma, hematoma, and DVT in this series is less than that previously reported in the plastic surgery literature and consistent with more recent abdominoplasty literature.

Iranians' Perspective to Cosmetic Surgery: A Thematic Content Analysis for the Reasons.

BACKGROUNDCurrently, becoming beautiful is a value among Iranian society, although experts have suggested several complications of cosmetic surgery, but decision to have these surgeries has been dramatically increased in recent years. This increase has imposed high workload and costs on the health care system of the country. This study was conducted to explore the reasons why people perform cosmetic surgery in an Iranian context.METHODSTwenty-one subjects from both sexes who were 22-52 year-old and had undergone face plastic surgery between 1-5 years ago were enrolled and semi-structured data was collected via open interviews, while qualitative content were analyzed utilizing conventional analysis methods. Data analysis considered the theme “my face, my destiny” which contained 2 subcategories of “obtaining a chance for a better life “and” obtaining acceptance in society”.RESULTSThe participants considered cosmetic surgery as a blessing from God that played a major role in their future, so they accepted the risks of the surgery.CONCLUSIONUnderstanding experiences of these individuals may help health care team particularly nurses to consult them and other individuals who might think about doing cosmetic surgery through education to help them make a better decision for to do cosmetic surgery.

Boerhaave syndrome: A rare complication of cosmetic surgery

Boerhaave syndrome: A rare complication of cosmetic surgery

Aesthetic journeys: a review of cosmetic surgery tourism.

Medical tourism has witnessed significant growth in recent years. The emerging trend towards international travel for cosmetic surgical interventions has not previously been reviewed. The current review aims to critically address the scale and impact of cosmetic surgical tourism and to delineate the complication profile of this form of medical tourism. Articles published in the English language on the PubMed database that were relevant to surgical tourism and the complications of elective surgical procedures abroad were examined. Reference lists of articles identified were further scrutinized. The search terms used included combinations of 'surgery abroad', 'cosmetic surgery abroad', 'cosmetic surgery tourism', 'cosmetic surgery complications' and 'aesthetic tourism'. This article critically reviews the epidemiology of cosmetic surgical tourism and its associated economic factors. Surgical complications of selected procedures, including perioperative complications, are described. The implications for travel medicine practice are considered and recommendations for further research are proposed. This narrative literature review focuses on the issues affecting travellers who obtain cosmetic surgical treatment overseas. There is a lack of focus in the travel medicine literature on the non-surgery-related morbidity of this special group of travellers. Original research exploring the motivation and pre-travel preparation, including the psychological counselling, of cosmetic surgical tourists is indicated.

Venous Thromboembolism in the Cosmetic Patient: Analysis of 129,007 Patients.

Venous thromboembolism (VTE) is one of the most feared postoperative complications in cosmetic surgery. The true rate of VTE in this patient population remains largely unknown with current American Society of Plastic Surgeons (ASPS) prophylaxis recommendations partially extrapolated from other surgical specialties. This study analyzed the risk factors for VTE in cosmetic surgical procedures. A prospective cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of a clinically significant VTE within 30 days of surgery. Risk factors analyzed included age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. A total of 129,007 patients were identified, of which 116 (0.09%) had a confirmed VTE. Combined procedures had a significantly higher overall rate of VTE compared to solitary procedures (0.20% vs 0.04%, P < .01). On multivariate logistic regression, significant risk factors for VTE (P < .05) included body procedures (RR 13.47), combined procedures (RR 2.4), increasing BMI (RR 1.06), and age (RR 1.02). Gender, smoking, diabetes, and type of surgical facility were not found to be significant risk factors. Face procedures (0.01%) and breast procedures (0.01%) had the lowest VTE rates, followed by combined face/body (0.16%), body procedures (0.21%), and combined body/breast procedures (0.28%). The incidence of VTE after cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably trunk and extremities. Equally, significant patient risk factors exist, including BMI and age.

Bowel Injury following Liposuction. A rare Complication of Cosmetic Surgery

Liposuction is one of the most commonly performed surgical procedures for aesthetic reasons. It is often performed as day-case surgery and is thought to be a low-risk ‘minor’ procedure. We present a rare case of necrotising abdominal wall infection due to small bowel injury resulting in extensive abdominal wall debridement and the development of an enteric fistula.

Venous Thromboembolism in the Cosmetic Patient

PURPOSE: Venous thromboembolism (VTE) is one of the most feared post-operative complications in cosmetic surgery. The true rate of VTE in this patient population remains largely unknown and current ASPS recommendations for prophylaxis are partially extrapolated from Orthopedic and General Surgery literature. Furthermore, although there are provider surveys suggesting a high incidence of deep venous thromboses in certain plastic surgeon communities in the United States, there still is a dearth of data establishing the number of these complications on a population level and quantifying concrete risk factors. This study analyzed the risk factors for VTE in cosmetic surgical procedures, alone and in combined procedures. METHODS/MATERIALS: All patients who had a clinically significant VTE complication in cosmetic surgery procedures between May 2008 and May 2013 were identified from the CosmetAssure database. CosmetAssure is an insurance program that provides coverage for treatment of significant complications following aesthetic surgery. Univariate and multivariate analysis was performed on identified risk factors for venous thromboembolism, including age, smoking, BMI, gender, diabetes, type of facility where performed, and if the procedure was combined or alone. RESULTS: A total of 129,007 patients were identified from 183,914 procedures in the database. An overall complication rate of 1.9% was established. A total of 116 confirmed VTE complications were encountered (0.09% incidence). Combined procedures had a significantly higher overall rate of VTE compared to solitary procedures (0.20% vs. 0.04%, p<0.01). On multivariate logistic regression significant risk factors (p<0.05) included body procedures (RR 12.9), combined procedures (RR 2.3), BMI ≥ 25 (RR 2.0) and age ≥ 40 (RR 1.8). Diabetes, smoking, gender and the facility in which the procedure was performed were not found to be significant risk factors (Table 1). Face procedures (0.01%) and breast procedures (0.01%) had the lowest VTE rates, followed by combined face/body (0.16%), body procedures (0.21%), and combined body/breast procedures (0.28%). The most common single procedures reporting confirmed VTE were thigh lift (0.25%), lower body lift (0.23%), abdominoplasty (0.20%), brachioplasty (0.13%), liposuction (0.06%), breast reduction (0.03%), and rhinoplasty (0.03%).Table 1: Risk Factor multivariate logistic regression.BMI, body mass index. ASC, accredited surgical center. OBSS, office-based surgical suites. CONCLUSION: The complication rate for VTE in cosmetic procedures is relatively low. However, the risk increases with combined procedures as well as with particular body areas, most notably body. Equally, significant patient risk factors exist including BMI and age.

Complications in Cosmetic Surgery: A Time to Reflect and Review and not Sweep Them Under the Carpet.

Complications in Cosmetic Surgery: A Time to Reflect and Review and not Sweep Them Under the Carpet.

Venous Thromboembolism After Facelift Surgery Under Local Anesthesia: Results of a Multicenter Survey

Venous thromboembolism (VTE) is a serious complication of cosmetic surgery, and studies have suggested that the incidence is not insignificant in facelift surgery. Use of local anesthesia over general anesthesia and shorter operative times are probable contributing factors to lower VTE incidence. Because there have been no large-scale assessments of VTE in facelifts as such, we investigated VTE incidence and relevant factors in facelift surgeries performed under local anesthesia only. We conducted a retrospective multicenter survey of facelift surgeons who utilize the American Society of Anesthesiologists level 1 oral anxiolysis and local diluted lidocaine anesthesia technique. Anonymous online surveys were sent to surgeons with questions regarding facelifts performed and VTE incidence over the previous 19months. Seventy-seven surgeons (93% response rate) completed the survey, with 74 eligible surgeons reporting at least one facelift. Respondents reported five VTE events, for an overall VTE incidence of 1 event in 5,844 surgeries. Surgeons who reported performing facelifts at high volumes (>500 facelifts in 19months) had a significantly lower VTE incidence than lower-volume surgeons (p=0.011). High-volume surgeons also reported a significantly lower average operative time (p=0.016), but for surgeries that did or did not result in VTE, there was no significant difference between surgeon-reported average operative times. The low VTE incidence in this facelift series supports prior understanding that there is a low risk of VTE in surgery performed under local anesthesia and in surgery with shorter operative times. Limiting ancillary procedures to the face likely reduces operative time and likely also contributes to a lower VTE rate. The data further suggest that physicians performing facelifts more frequently tend to have shorter average operative times and overall lower VTE incidence. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anaesthetic complications in plastic surgery

Anaesthesia related complications in plastic surgeries are fortunately rare, but potentially catastrophic. Maintaining patient safety in the operating room is a major concern of anaesthesiologists, surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential and pressure to avoid these complications in cosmetic surgery is increasing. Key aspects of patient safety in the operating room are outlined, including patient positioning, airway management and issues related to some specific conditions, essential for minimizing post-operative morbidity. Risks associated with extremes of age in the plastic surgery population, may be minimised by a better understanding of the physiologic changes as well as the pre-operative and post-operative considerations in caring for this special group of patients. An understanding of the anaesthesiologist's concerns during paediatric plastic surgical procedures can facilitate the coordination of efforts between the multiple services involved in the care of these children. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patients’ experience and surgical outcome.

Superficial Temporal Arteriovenous Fistula as a Complication of Rhytidectomy

A 67-year-old woman who had undergone rhytidectomy 5 years before her presentation experienced increasing pulsatile tinnitus on the left side that had begun 2 years earlier. Angiography revealed a direct arteriovenous fistula between the superficial temporal artery and superficial temporal vein in front of her left ear. There was a scar from the earlier cosmetic surgery at the site. The fistula was embolized with N-butyl cyanoacrylate, and her tinnitus disappeared. We posit that the fistula was a complication of rhytidectomy and that a small arteriovenous fistula formed at the time of surgery and enlarged over time. This case indicates that arteriovenous fistulae can occur as a delayed complication of cosmetic surgery.

Thrombin Generation During Abdominal Surgical Procedures: Effect of Prophylactic Anticoagulation Therapy

AbstractAbstract 3183 Background:One of the most serious complications of cosmetic surgery is a thromboembolic event (TE). Although the incidence of TE in most cosmetic procedures is <1 percent, the rate in massive weight loss patients presenting for circumferential contouring surgery is as high as 9 percent. Little evidence currently exists to determine the biochemical cause of this hypercoagulable process. Furthermore, there is little data to assess whether chemoprophylaxis prevents the hypercoagulable state. In this study, we use thrombin generation to assess activation of the coagulation cascade in patients undergoing excisional abdominal contouring procedures. Thrombin generation is a novel tool for studying the coagulation cascade and may better reflect in vivo coagulation activation than currently available laboratory measurements. Methods:Twenty-one consecutive patients from two surgeons were enrolled prospectively to assess thrombin generation at three time points: baseline/pre-operative, intra-operative after rectus plication or hernia repair, and 24 hours post-operative. Patients' intra-operative and post-operative values were normalized to their baseline value. All patients wore pneumatic compression devices for mechanical prophylaxis against TE. Nine patients received no chemoprophylaxis and 12 patients received pre-operative and post-operative chemoprophylaxis with unfractionated heparin or dalteparin according to surgeon preference based on the patient's risk profile. Results:Nine patients with a median age of 43 (range: 24–64) and BMI of 24.9 (range: 21.1–31.4) underwent abdominoplasty without TE chemoprophylaxis. Twenty percent had massive weight loss. Seventy-seven percent had liposuction and 67 percent had simultaneous procedures (liposuction as well as hernia repair or some other surgical intervention). The average operative time was 3.7 hours. In this group, the total thrombin generation increased by a mean (SD) of 997 (+/− 835) nM intra-operatively and 1404 (+/− 914) nM post-operatively. Twelve patients with a median age of 43 (range: 28–60) and BMI of 29.2 (range: 22.2–39.9) underwent panniculectomy or abdominoplasty with TE chemoprophylaxis. Eighty percent of these patients had massive weight loss. Fifty percent of patients had liposuction and 75 percent had simultaneous procedures. The average operative time was 5 hours. In this group receiving chemoprophylaxis, the total thrombin generation increased by a mean (SD) of 75 (+/− 781) nM intra-operatively and 186 (+/− 510) nM post-operatively. A t test was used to compare these two arms and the increase in thrombin generation was significantly less in patients receiving chemoprophylaxis compared to those who received no prophylaxis (intra-op: p<0.02 and post-op: p<0.004). There were no TEs or bleeding complications in any patient in the immediate post-operative period. Conclusion:Thrombin generation increases in patients undergoing abdominal contouring procedures. The magnitude of change may be decreased by giving peri-operative chemoprophylaxis. Further studies are warranted to determine the clinical relationship between thrombin generation, chemoprophylaxis and risk of thromboembolism and bleeding. Disclosures:No relevant conflicts of interest to declare.

Perioperative Considerations for Patient Safety During Cosmetic Surgery – Preventing Complications

Maintaining patient safety in the operating room is a major concern of surgeons, hospitals and surgical facilities. Circumventing preventable complications is essential, and pressure to avoid these complications in cosmetic surgery is increasing. Traditionally, nursing and anesthesia staff have managed patient positioning and safety issues in the operating room. As the number of office-based procedures in the plastic surgeon's practice increases, understanding and implementing patient safety guidelines by the plastic surgeon is of increasing importance.A review of the Joint Commission's Universal Protocol highlights requirements set forth to prevent perioperative complications. In the present paper, the importance of implementing these guidelines into the cosmetic surgery practice is reviewed. Key aspects of patient safety in the operating room are outlined, including patient positioning, ocular protection and other issues essential for minimization of postoperative morbidity. Additionally, as the demand for body contouring surgery in the cosmetic practice continues to increase, special attention to safety considerations specific to the obese and massive weight loss patients is mandatory.After review of the present paper, the reader should be able to introduce the Joint Commission's Universal Protocol into their daily practice. The reader will understand key aspects of patient positioning, airway management and ocular protection in cosmetic surgery. Finally, the reader will have a better understanding of the perioperative care of unique populations including the morbidly obese, massive weight loss patients and the elderly. Attention to detail in these aspects of patient safety can help avoid unnecessary complication and significantly improve the patient's experience and surgical outcome.

Handling Complications of Cosmetic Surgery

Handling Complications of Cosmetic Surgery

Medical Legal Aspects of Complications in Cosmetic Surgery

Medical Legal Aspects of Complications in Cosmetic Surgery

Management of Blindness in the Practice of Cosmetic Surgery

Blindness (amaurosis) as a complication of cosmetic surgery is not common, but has been reported in cases of blepharoplasty, as well as in connection with facial injection of various substances, including collagen. The anatomic and pathophysiologic basis for embolization of the retinal artery is presented, and the literature regarding thromboembolic, spasmodic, and vaso-obliterative etiologic factors in amaurosis is reviewed. It is recommended that ocular examination be carried out prior to both injection of materials into the face and blepharoplasty. The treatment of this most serious complication is reviewed in detail. Finally, it is suggested that the surgeons who practice cosmetic surgery be aware of this complication and the current treatment modalities.