Plastic Surgery Complications: A Review for EM Clinicians

Abstract and Introduction

Abstract

The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million surgical procedures and over three million nonsurgical procedures were performed in 2015 alone. Of these, the most common procedures included surgeries of the breast and abdominal wall, specifically implants, liposuction, and subcutaneous injections. Emergency clinicians may be tasked with the management of postoperative complications of cosmetic surgeries including postoperative infections, thromboembolic events, skin necrosis, hemorrhage, pulmonary edema, fat embolism syndrome, bowel cavity perforation, intra-abdominal injury, local seroma formation, and local anesthetic systemic toxicity. This review provides several guiding principles for management of acute complications. Understanding these complications and approach to their management is essential to optimizing patient care.

Introduction

The number of aesthetic surgical procedures performed in the United States is increasing rapidly. Over 1.5 million aesthetic surgical procedures were performed in 2015.^[1] Breast augmentation and suction-assisted lipectomy (SAL), also known as liposuction, are the most frequently performed cosmetic procedures in the US with over 600,000 performed annually (Figure 1).^[2–4] Cosmetic procedures are lucrative, and in the absence of legal restrictions, are increasingly being performed in outpatient settings by non-plastic surgeons and even non-physicians.^[5,6] Growing medical tourism has spurred demand for cosmetic surgery in Europe, South America, and Southeast Asia.^[6–8] A survey distributed to 2000 active members of the American Society of Plastic Surgeons (ASPS) showed that 51.6% of respondents noted an increasing trend in the number of patients presenting with complications from surgical tourism.^[9] Public perception of these surgeries as minor procedures contributes to risks for major complications with potentially fatal consequences, with reported mortality of 1 per 5000 procedures.^[5,10–12] Emergency clinicians should be aware of possible complications.

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Figure 1.

Most common cosmetic procedures in the United States in 2017 by gender. Statistics available at https://www.plasticsurgery.org/documents/News/Statistics/2017/plastic-surgery-statistics-full-report-2017.pdf.