Edward H. Davidson, Zoe Diana Draelos, Bridget Harrison, Ibrahim Khansa, Jeffrey E. Janis
Successful outcomes in aesthetic surgery and nonoperative cosmetic procedures demand meticulous preparation and aftercare to ensure optimal results and minimize risk of complications.
Preparation and aftercare regimens are commonly procedure, technique, and practitioner dependent, but general principles and considerations may be applied.
Involving patients in their own management before and after cosmetic interventions promotes understanding, empowers them to invest in their own results, and may help to manage expectations.
Preoperative Measures to Reduce Complications
Comorbidities
Elective aesthetic surgery patients are usually healthy. The presence of chronic disease (including diabetes, hypertension, coronary heart disease, chronic obstructive pulmonary disease, hepatic or renal dysfunction, cancer) necessitates preoperative medical clearance by the patient’s primary care physician or specialist.
Diabetes: Poor glycemic control places diabetic patients at increased risk of surgical site infection and delayed wound healing.1,2
Hypertension: Uncontrolled hypertension increases risk of bleeding and hematoma in all aesthetic procedures, and visual loss after blepharoplasty.3
Coagulopathy: Hematologic consultation should be considered for patients with history of coagulopathy or venous thromboembolism (VTE).
Most elective plastic surgery procedures performed in the United States are performed on white females. Factor V Leiden gene is found as a heterozygous mutation in 3%-7% of white females and results in a sixfold increase in the risk of VTE.
VTE risk is increased if combined with cancer, travel, immobilization, use of oral contraceptives, hormone replacement therapy, and estrogen receptor antagonists.
In low-risk ambulatory plastic surgery patients, preoperative laboratory testing is costly, associated with limited clinical benefit, and may be eliminated with significant cost savings.4
Mental health: A patient’s mental health should be preoperatively assessed and appropriately addressed before proceeding with any elective procedure.5Patients with mental health conditions—whether psychiatric disorders, such as body dysmorphic disorder or substance abuse diagnoses—who undergo outpatient aesthetic surgery seek hospital-based acute care within 30 days postoperatively three times more often than patients without a mental health condition (see Chapter 1).
Medications: Every patient’s medications must be carefully reviewed. Table 10-1, although not exhaustive, lists medications associated with postoperative complications and/or interference with some anesthesia and may require discontinuation or special precautions.
Table 10-1 Medications Requiring Discontinuation or Special Precautions
Medications That Should Not Be Taken the Day of Surgery
Use of herbal medicines and supplements is more prevalent in the cosmetic surgery population than in the population at large (49% versus 42%, respectively).6
Nutritional supplements are not routinely recommended in lieu of a healthy, well-balanced diet.
60%-72% of patients do not report use of supplements.7
Many herbal medicines and supplements are cited for adverse reactions and should not be taken for 2-3 weeks before and after surgery8(Box 10-1), according to the American Society of Anesthesiologists.
Box 10-1 Herbs and Supplements to Avoid Two to Three Weeks Before and After Surgery
