Patients who tend to form keloids or hypertrophic scars
All forms of cosmetic surgery carry a degree of risk and a potential for complications. Therefore, you should consider it as seriously as you would any major surgery. Also note that augmentation with implants carries a much higher rate of complications as compared to a fat injection. The risks for having implants placed in your buttocks include infection and bleeding, which are common risks for any surgical procedure. Risks of infection are even higher when incisions are made in the gluteal crease. Another potential complication is the possibility of the implants shifting and causing the results to appear asymmetrical. It is rare, though possible, that the implants may also rupture or break.
Surgical Anesthesia: On the day of surgery, your anesthesiologist will discuss with you the risks of both local and general anesthesia.
Unfavorable Scarring: If the sutured area doesn’t heal properly or takes too long to heal, the scars may be thicker than normal. If the patient heals relatively quickly, minimal scarring will result. Scars will take years to fade, but they are long-lasting. Despite Dr. Agha’s best effort, scar appearance and healing are not fully predictable. The scars may be uneven, excessively wide, and/or asymmetrical. Scars may be unattractive and of a different color than the surrounding skin. Excessive, hypertrophic, and keloid scarring are uncommon. Additional treatments, including surgery, may be necessary to treat abnormal scarring.
Bleeding/Hematoma: Bleeding may result if the sutured areas do not heal correctly or if there is improper coagulation after the procedure. A hematoma is a blood collection that can form under the skin and enlarges as a tender bulge. If a patient notices any unusual bleeding after surgery, they need to contact Dr. Agha immediately. Do not take any aspirin or anti-inflammatory medications for ten days before surgery as this will increase the risk of bleeding. Non-prescription “herbs” and dietary supplements can also increase the risk of surgical bleeding.
Fluid Accumulation (Seroma): After fat grafting or implant placement, body fluids (serum) occasionally accumulate underneath the skin as a seroma. If the fluid collection is significant, Dr. Agha may elect to aspirate the fluid with a small needle in an office procedure. For buttock lifts, drains may be placed at the surgical site at the end of the operation to collect seepage of the fluid. After their removal in five to seven days, seroma may occasionally accumulate underneath the skin, requiring aspirations. If that fails to cure the seroma, then the patient will need to be seen either in the office or in operating room for insertion of new drainage tubes and the removal of seroma cavities. This is very rarely necessarily.
Poor Wound Healing: Individuals that have a slower than average healing rate or are smokers may find that they do not heal properly, that the sutured areas reopen easily, or that they are more prone to infection. Patients should avoid smoking three weeks prior to and after the procedure so that their body’s natural healing process is not hindered.
Wound Dehiscence: In general, your skin closure is in multiple layers. Separation of the superficial, deep and/or both layers may occur any time during your first post-operative month. Suture breakage, knots untying, sutures tearing through an excessively tight closure, too much movement or bending, and skin necrosis (death) are some of the recognized causes of dehiscence. Breakage of the sutures in the superficial layer of skin may be sutured closed or allowed to heal secondarily, at the judgment of Dr. Agha.
Deep dehiscence may require a return to the operating room for closure under anesthesia. These healing problems may require frequent dressing changes, extra office visits, and further surgery to remove the non-healed tissue. Open wounds may take weeks to heal or a secondary closure may be appropriate. Wounds allowed to heal on their own usually benefit from secondary scar revision.
Smokers have a high risk of skin loss and wound healing complications. Do not smoke for three weeks before and after your surgery.
Suture Granuloma: Some surgical techniques use deep sutures. These items may be noticed by the patient following surgery. Sutures may spontaneously poke through the skin, be visible, or produce irritation that requires removal.
Numbness in Skin Sensation: This is a normal consequence that occurs at the site of surgery in everyone to a different extent. You may experience “paresthesia,” which is an altered sensation at the site of the liposuction. This may either be in the form of an increased sensitivity (pain) in the area or loss of any feeling (numbness) in the area. In most patients, numbness goes away within the first four to sixth months after surgery. Massaging the surgical area helps increase circulation, and facilitates the return of normal skin sensation. Numbness is long-lasting in very rare cases.
Fat Absorption and Sclerosis: Approximately 20-30% of the injected fat does not survive and gets absorbed. If this happens unevenly, there could be areas were you feel or see asymmetry due to fat resorption. Gentle massage over the buttock area helps even out and smooth these areas during the recovery phase.
Skin Irregularities or Dimples: Contour irregularities and depressions in the skin may occur after liposuction. Also, the areas of injected fat can occasionally develop contour irregularities, including bumps and dimples, depending on your skin elasticity. Usually, post-operative massage can be helpful in smoothing these areas. On occasion, asymmetrical fullness, bulges, and depressions may be present.
Skin Discoloration/Swelling – Some skin discoloration and swelling can occur following liposuction. In rare situations, swelling and skin discoloration may persist for long periods of time. Permanent skin discoloration is rare.
Depression, Emotional, or Sexual Changes: There have been reports of depression after liposuction similar to postpartum depression.
Asymmetry in Scar Placement or Contour: No two halves of the body are identical. Therefore, following buttock augmentation, these asymmetries may persist and appear as differences between the contour and size of the two sides. Scoliosis or other spine disorders can magnify body asymmetry. On occasion, asymmetry may occur after a buttock lift. Although this is not typical, it is a risk associated with the procedure.
Skin Necrosis (Skin Death): The skin above the site of surgery or at the incision site may become necrotic or “die.” When this happens, skin may change color and slough (fall) off. Necrotic skin may become infected with bacteria or microorganisms. This may require further surgical management.
Pain that Persists: Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue after surgery.
Allergic Reactions: In rare cases, local allergies to tape, suture material, or topical preparations have been reported. More serious systemic reactions may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
Residual Deformity– Despite best efforts to obtain tight buttock contour after a buttock lift, a small degree of residual deformity may persist or develop months after the surgery.
Need for Revisional Surgery: The practice of medicine and surgery is not an exact science. Should complications occur or some aesthetic expectations remain unmet, additional procedures or other treatments may be necessary. Other complications and risks can occur but are even more uncommon.
Suboptimal Aesthetic Result: You may be disappointed with the results of surgery. Under-treatment with residual laxity and looseness or over-treatment with excessive tightness of skin can occur with the flattening of regional contours and the widening or thickening of scars. Considerable judgment is used to achieve the optimum shape, but for a variety of reasons, the ultimate results may be suboptimal. At times, it is desirable to perform additional procedures to improve your results.
Infection: Infection may occur after any surgery and may rarely occur after liposculpture. The rate of infection increases with the increasing amounts of injected fat, but the overall rate still remains very low due to routine use of peri-operative antibiotics. There is a significantly higher risk of infection (about 23-30%) with the use of buttock implants. This is most likely due to the proximity of the incision to the rectum. Milder infections can be treated with antibiotics. More significant infections require implant removal, and the wound must be left open for it to close gradually, which can take several weeks. In extremely rare cases, infections may be serious or life threatening. In cases of a buttock lift, minor wound infections accompanied by exposed and “spitting” sutures can occur and are usually easily dealt with by limited debridement, antibiotics, and dressing care. Major infection with fever and large areas of red skin (cellulitis) is unusual. Should a serious infection occur, treatment, including intravenous antibiotics or additional surgery to remove dead tissue and drain abscesses, may be necessary. There is a greater risk of infection in smokers, those with diabetes, and with multiple procedures.
Deep Vein Thrombosis (DVT) and Pulmonary Complications: Deep vein thrombosis is a rare but worrisome complication of plastic surgery. It represents the formation of blood clots in the deep veins of the legs during anesthesia and surgery. Although a sequential compression device will be used to reduce the risks, few patients may still develop DVTs. This frequency is reduced by early post-operative mobility so that blood does not have time to become stagnant in the calf muscles. Fat embolism during liposuction is an extremely rare condition where loosened fat enters the blood through injured blood vessels during liposuction. Fat fragments can then become trapped in the blood vessels, gather in the lungs, or travel to the brain.
Pulmonary complications may occur secondarily to the migration of blood clots or fat clots into the lungs (pulmonary emboli) or partial collapse of the lungs after general anesthesia. The signs of pulmonary emboli may be shortness of breath or difficulty breathing. If you have the signs or symptoms of pulmonary emboli, it is important for you to seek emergency medical care at once. Should this complication occur, you may require hospitalization and additional treatment. Pulmonary emboli can be life-threatening or fatal in some circumstances.
Nerve Injury: Buttock implants can either press upon or migrate onto the sciatic nerve which travels in the buttock region. This can potentially cause impingement or injury to the nerve. Treatment may include removal of the implants.
Implant Protrusion: It is possible for the buttock implants to migrate and gradually extrude through the incision or other areas of the buttock skin. The risk of this complication increases if there is seroma, hematoma, or infection. Also, excessive pressure over the implants during the early period of healing can increase the risk of implant protrusion.
Visceral Perforations (Puncture Wounds in the Organs): There have been reports of visceral perforations during liposuction that damage internal organs with the liposuction cannula. When organs are damaged, surgery may be required to repair them. Visceral perforations may also be fatal.
Toxicity from Anesthesia: Lidocaine, a drug that numbs the skin, is frequently used as a local anesthetic in the tumescent fluid. Large volumes of tumescent fluid may be injected during liposuction. This may result in high doses of lidocaine, which can be toxic. The symptoms of this toxicity are lightheadedness, restlessness, drowsiness, tinnitis (a ringing in the ears), slurred speech, metallic taste in the mouth, numbness of the lips and tongue, shivering, muscle twitching, and convulsions. Severe lidocaine toxicity may cause the heart to stop, resulting in death. In general, any type of anesthesia may cause complications and is always considered a risk during any surgery. To minimize the potential for lidocaine toxicity, Dr. Agha limits the dose of lidocaine used during general anesthesia.
Fluid Imbalance: The liposuction procedure involves the injection of large amounts of tumescent fluid into the tissues. Although much of the fluid will be suctioned, the remainder will be gradually absorbed and may result in a fluid imbalance. While you are in the surgical center or hospital, the staff will be monitoring you for signs of fluid imbalance. However, this may happen after you go home and can result in serious conditions, such as heart problems, excess fluid collecting in the lungs, or kidney problems as your kidneys try to maintain fluid balance.
Fatalities Related to Liposuction: There are reports of deaths related to the liposuction procedure. Studies conducted to date have not been definitive, so it is difficult to be sure how often death from liposuction occurs. In order to understand the extent of the risk, one study compares the deaths from liposuction to that of deaths from car accidents (16 compared to 100,000). It is important to remember that liposuction is a surgical procedure and that there may be serious complications.