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Facial Plastic and Reconstructive Surgery |
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Complications
The complication rate for most elective procedures in facial plastic and reconstructive surgery is low. Major complications from this kind of surgery include severe problems with your heart or lungs, certain kinds of nerve damage, and major bleeding or infection. While all of the above are possible, the chance of these problems occurring is small. There are a variety of much smaller problems which do occur to some extent in many cases. It is common to have a little bit of bleeding from some wounds. There often is a little bit of infection at some of the incision sites; there always is some scar that is left behind. Anytime the skin is cut, nerves are cut as well, and there can be areas of numbness or tingling around the incision sites.
The most common problem in all elective facial surgery is that the patient's expectations are greater than the surgeon's realistic abilities. If it was your expectation that the surgery would turn out perfect and that you would be dramatically improved, you will be dissatisfied. If your expectations for physical improvement are realistic, then there is a very high chance that you will be satisfied.
Several case examples may make this last point clearer. The first is the story of a junior high school student who came in with her mother and asked to have her nose made smaller. After an appropriate consultation and discussion of all the pros and cons, risks and benefits, the surgery was performed. The girl was average in appearance, albeit with a slightly large nose. Postoperatively, her appearance remained average, albeit with a smaller nose than before, and one which perhaps was in better balance with the rest of her face. Nonetheless, the overall general appearance was not remarkably changed. I did not see this young lady for several months postoperatively, and when she finally came in, I asked how she was doing and how she liked her new nose. She had very little to say but her mother commented that prior to the surgery this girl had not had a single date. She had now been elected queen of the Junior Prom and was booked for dates two months in advance. In retrospect, what happened was that following surgery this patient felt substantially better about her own self image; she carried herself in a different manner, and this different mental attitude was perceived by her friends. She literally blossomed into an outgoing, social, popular human being. The surgery was not responsible for this change. The surgery only helped this girl's self esteem. It was her own personality that blossomed and resulted in these changes.
Contrast this with the case of a young man who appeared with a very large, unsightly nose, and requested improvement. Surgery in this case made a dramatic improvement in this young man's appearance, but when he came in several weeks postoperatively and was asked how he liked his nose, he complained bitterly about the changes and said that this made absolutely no difference in his appearance or his well being. He was disappointed that he had ever had the surgery and was disappointed in the surgeon for failing to achieve a reasonable result. After a long discussion, this patient agreed to see a psychiatrist. In fact, what had happened was that this young man was having fairly severe marital difficulties, and he had felt that an improvement in his appearance would result in an improvement in his marriage. When the marriage failed to improve, rather than blaming himself, he chose to blame the surgeon. This is a good example of an unrealistic expectation from facial plastic surgery.
Terence Davidson, M.D., F.A.C.S.
UCSD Otolaryngology Division
200 West Arbor Drive
San Diego, CA 92103-8895
(619) 543-6631 |