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Columns : Plastic Surgery Trends Last Updated: Feb 6, 2017 - 2:32:04 PM

What should you know about the safety of outpatient plastic surgery?
By Dr. Kenneth Dickie
Mar 17, 2008 - 7:16:35 PM

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When considering plastic surgery, it’s natural to focus more on the expected result than on the surgical process. However, to be fully informed, it’s important to learn about the safety of the procedure as well as the expected outcome. Although thousands of people have plastic surgery every year without complications, no surgical procedure is risk-free. To maximize safety, ensure that:



·    Your physician is an ASPS Member Surgeon - which ensures at least five years of surgical training - with a minimum of two years specifically in plastic surgery, and is board certified by the American Board of Plastic Surgery;

  • The facility where your surgery will be performed conforms to strict safety standards - ASPS Member Surgeons only operate in accredited facilities;
  • Your surgeon is informed of any drugs you are taking and your full medical history, especially if you have had any circulation disorders, heart or lung ailments or problems with blood clots;
  • The surgical facility will use skilled, licensed personnel to administer and monitor your anesthesia and your recovery immediately following the procedure

How can I be sure that my surgeon has adequate training?

Good credentials can’t guarantee a successful outcome; however, they can significantly increase the likelihood of it. Patients are advised to find a doctor who is certified by the American Board of Plastic Surgery (ABPS), or the Royal College of Physicians & Surgeons of Canada. Certification by the ABPS is "the gold standard" for plastic surgeons because it signifies that the surgeon has had formal training in an accredited plastic surgery residency program. If your surgeon is ABPS-certified, you can be assured that your doctor:

·          Has completed at least five years of surgical residency training after medical school, including at least two years in plastic surgery

·          Has passed comprehensive cosmetic and reconstructive surgery exams

·          Is qualified to perform cosmetic and reconstructive procedures – everything from liposuction and facelifts to intricate wound repair.

How can I determine if my plastic surgeon’s surgical facility meets acceptable safety standards?

The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have issued a statement to their members that by July 1, 2002 all plastic surgery performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, must be performed in a surgical facility that meets government standards.

Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A 1997 survey 1 based on more than 400,000 operations performed in accredited facilities found that:

·    The rate of serious complications was less than half of 1 percent.

·    The mortality rate was extremely low – only one in 57,000 cases.

·    The overall risk of serious complications in an accredited office surgical facility is comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility


Why is it so important for my plastic surgeon to know detailed information about my personal and family health history, even if I am only having a simple cosmetic procedure?


There is always risk with any surgical procedure. However, as a patient, you can play an important role in reducing your risk by providing a full and complete health history to your surgeon.

Although rare, one of the most serious complications associated with surgery is the development of blood clots in the large veins of the abdomen and legs. This complication can lead to a potentially fatal pulmonary embolism (blocked lung artery). Therefore, it is extremely important to tell your plastic surgeon if you or any of your family members have a history of blood clots or if you have had a family member who died suddenly, shortly after surgery or childbirth.

You will also be evaluated for other factors that may increase the risk of blood clots. These include:

·    Being extremely overweight

  • Having recent traumatic injury
  • Any disorder of the heart, lungs or central nervous system

      A history of cancer, recurrent severe infection or genetic problems that affect blood clotting

For women, additional risk factors include:                               

·    Taking oral contraceptives or having recently ceased taking them

  • Undergoing hormone-replacement therapy

Safety measures to prevent blood clots will be determined by your individual degree of risk. If you are considered low risk, your doctor may simply ensure that you are positioned on the operating table in a way that allows for adequate blood circulation to the legs. If you are of moderate or high risk for developing blood clots, you may also be advised to wear elastic stockings before, during and after your procedure, or to take special anti-clotting medications. Compression devices on the legs may be used during surgery to support your normal circulation.

How can I be sure that the anesthesia care I receive in my plastic surgeon’s surgical facility is adequate?

Anesthesia care in an accredited or licensed facility has reached a level of sophistication that is absolutely comparable to the care received in the hospital. For maximum safety, ASPS recommends that:

·    Any planned anesthesia should be administered by skilled, licensed personnel acting under the direction of an anesthesiologist or the operating surgeon.

·    Before any type of anesthesia is used, the surgeon or anesthetist must take a full medical history. A physical examination and appropriate lab tests may also be performed. Your surgeon needs to know if you have any serious medical problems or have had previous adverse reaction to any other type of anesthesia. Also, you must let the anesthetist know about any medications you are taking (including herbal supplements), any known drug allergies, when you last ate and whether you smoke cigarettes or use alcohol or illegal drugs.

·    You should be assured that you will receive individual monitoring by skilled, licensed personnel before, during and after the procedure. Staff who are familiar with the warning signs of cardiac or respiratory distress and are trained in advanced cardiac life support (ACLS), should be on hand to monitor your procedure and recovery following your surgery.

·    If you are told that you will be kept overnight at the surgical facility while you recuperate, make sure that the facility is accredited. In an accredited facility you will receive around-the-clock care and monitoring by two or more skilled and licensed staff members with at least one trained in ACLS. You will also be assured that the facility has the necessary equipment and medications to handle complications that may arise and an emergency plan in case you need to be transferred to the hospital.

Safety is a team effort

Quality patient care, safety and successful surgical outcomes are the result of the patient, the surgeon and the surgical staff working together. The ASPS has supported this concept by establishing task forces on liposuction, deep vein thrombosis prophylaxis and outpatient surgical safety. These professional groups have thoroughly investigated the surgical techniques, equipment and medications commonly used in outpatient plastic surgery and have set safety guidelines for use by all plastic surgeons, their staffs and their facilities.

 Patients are encouraged to learn everything they can about the procedures they are considering and to ask a lot of questions. Your concerns about safety should be discussed in detail with your plastic surgeon. This will help promote a safe outpatient surgery experience as well as fulfilling your surgical expectations.



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