1. Healing Issues – Certain medical conditions, dietary supplements, and medications may delay and interfere with healing. Patients with massive weight loss may have a healing delay that could result in the incisions coming apart, infection, and tissue changes resulting in the need for additional medical care, surgery, and prolonged hospitalisations. Patients with diabetes or those taking medications such as steroids on an extended basis may have prolonged healing issues. Smoking will cause a delay in the healing process, often resulting in the need for additional surgery. There are general risks associated with healing such as swelling, bleeding, and possibility of additional surgery, prolonged recovery, colour changes, shape changes, infection, not meeting patient goals and expectations, and added expense to the patient. There may also be a longer recovery due to the length of surgery and anaesthesia. Should you experience healing issues, your scar revision could fail. Wound separation may occur. Should this occur, additional treatment, including surgery, may be necessary. There are nerve endings that may become involved with healing scars from surgery. While there may not be a major nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. Often, massage and early non-surgical intervention resolves this. It is important to discuss postsurgical pain with your Consultant.
2. Bleeding – It is possible, though unusual, to experience bleeding during or after surgery. If postoperative bleeding occurs, it may require emergency treatment to drain accumulated blood (haematoma). Blood transfusion is rarely required. Increased activity too soon after surgery can increase the risk of bleeding. It is important to follow all postoperative instructions and avoid strenuous activity for the advised period. I have stopped taking aspirin, anti-inflammatory medications, and any herbal or dietary supplements that may increase the risk of bleeding, as advised by my Consultant.
3. Infection – Infection, although uncommon, can occur after surgery. Should an infection occur, additional treatment, including antibiotics, hospitalisation, or additional surgery, may be necessary. It is important to tell your Consultant of any other infections, such as a history of Methicillin Resistant Staphylococcus Aureus (MRSA) infections, an open wound, recent upper respiratory infection/pneumonia, ingrown toenail, insect bite, tooth abscess, or urinary tract infection. Infections in other parts of the body may lead to an infection in the operated area. Postoperative infections often result in more extensive scarring and predispose to revision surgery.
4. Ileus – The return of bowel function following surgery is important. An ileus is a disruption in bowel function caused by the failure of peristalsis or hypomobility of your bowels/gut, resulting in a lack of defecation and, possibly, repeated vomiting. Anaesthetics and medications like pain medications given to you at the time of surgery can contribute to the development of an ileus in the postoperative period. An ileus can result in abdominal distention, vomiting, inability to absorb oral medications and possibly hospitalisation. Repeated vomiting could result in an aspiration pneumonia and respiratory failure. It may be essential to have regular bowel function after your surgery before being discharged.
5. Scarring – All surgery results in scars. Although good wound healing is expected, scars may be wider, thicker, or more prominent than anticipated. Scar colour and texture may differ from surrounding skin, and scars may appear different on each side of the body. Hypertrophic or keloid scarring may occur, particularly in patients of Asian or Afro-Caribbean descent. Visible suture marks are possible. In some cases, further treatment such as steroid injections, silicone products, or surgical scar revision may be required.
6. Asymmetry – Symmetrical body appearance may not result after surgery. Factors such as skin tone, fatty deposits, skeletal prominence, and muscle tone may contribute to normal asymmetry in body features. Most patients have differences between the right and left side of their bodies before any surgery is performed. Additional surgery may be necessary to attempt to diminish asymmetry.
7. Staged Reconstruction – Some reconstructive procedures require more than one surgery to revise your scar. Your Consultant may advise you that in the long term it may be in your best interest to have staged reconstruction to obtain the best possible functional or aesthetic result.
8. Damage to Deeper Structures – In the process of scar revision, deeper structures such as nerves and muscles may have to be sacrificed. Reconstruction of your scar could include nerve repair or grafting. Your Consultant will advise you if such a procedure may be required. Further, there is the potential for injury to deeper structures, including nerves, blood vessels, and muscles, during any surgical procedure. The potential for this to occur varies according to the type of procedure being performed. Injury to deeper structures may be temporary or permanent.
9. Alternative Graft Materials – Alternative grafting materials may be utilised in your case such as Integra or Biobrane. Sometimes these materials are synthetic (man-made) or animal (porcine or bovine), or another part of your body may be required as a graft (auricular or ear cartilage). Even fat grafting can be a component of your scar revision. Your Consultant will advise you when such materials are going to be considered or utilised.
10. Firmness – Excessive firmness can occur after surgery due to internal scarring. The occurrence of this is not predictable. Additional treatment, including surgery, may be necessary.
11. Change in Skin Sensation – It is common to experience diminished (or loss of) skin sensation in areas that have had surgery. Diminished (or complete loss of) skin sensation may not totally resolve.
12. Skin Contour Irregularities – Contour and shape irregularities may occur. Visible and palpable wrinkling of skin may occur. Residual skin irregularities at the ends of the incisions or "dog ears" are always a possibility when there is excessive redundant skin. This may improve with time, or it can be surgically corrected.
13. Skin Discolouration/Swelling – Some bruising and swelling will normally occur. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent.
14. Skin Sensitivity – Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations, it may be chronic.
15. Major Wound Separation – Wounds may separate after surgery. Should this occur, additional treatment, including surgery, may be necessary.
16. Sutures – Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible, or produce irritation that requires suture removal.
17. Delayed Healing – Wound disruption or delayed wound healing is possible. Some areas of the skin may not heal normally and may take a long time to heal. Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Individuals who have decreased blood supply to tissue from past surgery or radiation therapy may be at increased risk for wound healing and poor surgical outcome. Smokers have a greater risk of skin loss and wound healing complications.
18. Fat Necrosis – Fatty tissue found deep in the skin might die. This may produce areas of firmness within the skin. Additional surgery to remove areas of fat necrosis may be necessary. There is a possibility of contour irregularities in the skin that may result from fat necrosis.
19. Shock – In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections, or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment would be necessary.
20. Pain – Some degree of pain and discomfort is expected after surgery, which is usually well controlled with prescribed painkillers. In rare cases, chronic pain may develop due to nerves becoming trapped in scar tissue or tissue stretching. Small nerve endings may become overactive during healing, producing areas of tenderness or heightened sensitivity, which typically resolves with massage and time. If pain persists, I will inform my Consultant.
21. Nerve Endings – Chronic pain may occur very infrequently from nerves becoming trapped in scar tissue or due to tissue stretching. There are nerve endings that may become involved with healing scars from surgery. While there may not be a major nerve injury, the small nerve endings during the healing period may become too active producing a painful or oversensitive area due to the small sensory nerve involved with scar tissue. Often, massage and early non-surgical intervention resolves this. It is important to discuss postsurgical pain with your Consultant.
22. Allergic Reactions – In rare cases, local allergies to tape, suture material and glues, blood products, topical preparations, or injected agents have been reported. Serious systemic reactions, including shock (anaphylaxis), may occur in response to drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment. It is important to notify your Consultant of any previous allergic reactions.
23. Surgical Wetting Solutions – There is a possibility that large volumes of fluid containing dilute local anaesthetic drugs and epinephrine that is injected into fatty deposits during surgery may contribute to fluid overload or systemic reaction to these medications. Additional treatment, including hospitalisation, may be necessary.
24. Fat/Air Embolism – In rare cases, fat particles or air can enter the vascular system and can travel to the heart, lungs, or brain. This can result in significant complications, including death.
25. Persistent Swelling (Lymphedema) – Persistent swelling can occur following surgery.
26. Unsatisfactory Result – Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. The body is not symmetric and almost everyone has some degree of unevenness that may not be recognised in advance. Many such issues cannot be fully corrected with surgery. The more realistic your expectations are as to results the better your results will appear to you. Some patients never achieve their desired goals or results, at no fault of the Consultant or surgery. You may be disappointed with the results of surgery. Asymmetry, unanticipated shape and size, loss of function, wound disruption, poor healing, and loss of sensation may occur after surgery. Unsatisfactory surgical scar location or appearance may occur. It may be necessary to perform additional surgery to improve your results. Unsatisfactory results may NOT improve with each additional treatment.
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