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

As the year ends it is time to reflect, ruminate, review, and retrospect in our quest for rejuvenation. Are we heading in the right direction? Or are our patients paying the price for being too aggressive and too ambitious to achieve perfection? Are our techniques risk-free or can they be better?

The trend in aesthetics is clearly toward minimally invasive surgeries and techniques as can be seen from the statistics of the American Association of Plastic Surgeons.[1] Cosmetic surgical procedures showed an average decline by 12% from 2000 to 2014 as compared to minimally invasive procedures, which showed a dramatic rise of 154% in the same period. The top five minimally invasive cosmetic procedures performed were botulinum toxin injection, soft tissue fillers, chemical peels, laser hair removal, and microdermabrasion. However, with the rise in numbers and longer follow-up periods, we are more frequently seeing complications, particularly with soft tissue fillers.[2] Long-term adverse events such as persistent granulomas and infections are being reported. These may be due to laxity in aseptic procedures or formation of biofilms. In this issue, Haneke reviews the complications with soft tissue fillers and cautions against taking fillers lightly.[3] Adverse events with fillers can not only be persistent but can also lead to serious complications such as permanent blindness.[45] Blindness can occur due to inadvertent arterial injection or if it is injected forcefully. The trend is now to use cannulas instead of sharp needles that can make injecting safer.

Sisti et al.[6] reviewed the complications associated with medial thigh lift, a procedure undertaken to rejuvenate the medial thigh after massive weight loss or as part of the aging process. In a literature review of overall 447 patients treated surgically by various methods, complications were observed in 191 (42.72%) patients; that is very common indeed. Most authors report their best results, which are published while there are very few publications highlighting adverse events and complications. This gives a false erroneous impression that most cosmetic procedures are safe with few or minor complications. Even a simple procedure such as a skin biopsy may lead to complications, if not performed meticulously. Kumar highlights the adverse events, which can occur in skin biopsies.[7] There is no minor procedure or minor surgery if there is a complication! Though generally safe, complications can occur even in the best of hands. Hematoma and bruises, seroma formation, nerve damage causing sensory or motor loss, infection, scarring, blood loss and complications of anesthesia can occur in any surgery. More serious complications such as deep vein thrombosis and pulmonary embolism can cause death.

It is essential to minimize risks by careful patient selection by taking a detailed history and examination. Chronic smokers, immunocompromised patients, and patients with cardiovascular and pulmonary diseases are at particular risk.

The incidence of complications is higher when the procedures are performed in salons, spas, and by untrained persons. Most of these are not even reported and swept under the carpet, with patients at the suffering end. The highlighting and analyzing of adverse events in the published literature will definitely help in making cosmetic procedures less risky, assist in introducing newer and safer techniques, and force physicians and the industry to introduce game-changing risk-free trends for the future.

Let us never forget: Primum non nocere