An Unspoken Concern

While most plastic surgeons will outline the risks of having an elective surgical procedure performed, very few tend to speak directly to the issues regarding safety and post operative complications. Often, a surgeon will make a general statement regarding the risks of surgery, such as, "All surgery carries risks which includes, bleeding, infection, difficulty breathing, swelling, clotting, and other illnesses in a small percentage of patients," and then move directly into talking about the benefits of the procedure. Patients need to inform themselves of the actual risks associated with cosmetic surgical procedures, especially the risk of a stroke or cerebral vascular accident (CVA). As a physician, I understand that there is no value in frightening our patients without cause. Yet I still firmly believe that patients should never be too quick to decide on an elective surgical procedure without fully realizing the potential for devastating complications.

Patients and physicians alike need to recognize that most patients who are receiving some sort of cosmetic care are generally considered to be healthy individuals. Thus, neither patient nor physician is necessarily ready for the onset of a complication. This fact alone can make a complication much more serious than if the very same complication arose during a medically necessary procedure. For instance, even during a routine knee surgery, physicians do not see their patients as completely healthy, and are more guarded against the onset of blood clots or other risk factors for stroke.

While the approximated one to two percent of cosmetic surgery patients who will experience a stroke seems like a very limited number of patients, the effects of these strokes can be devastating

Who is at Risk?

Few patients really consider themselves at risk for a possible stroke because they associate the condition as an event that occurs to people over the age of 55. While in some cases age does bear a factor, it is far from the determining factor of a stroke. In fact, a healthy 65-year-old woman can be less likely to have a stroke than a 35-year-old woman who is undergoing invasive cosmetic surgery. Patients should understand the causes of a stroke in a post operative environment in order to assess more realistically their level of risk. However, as a physician I can testify to the fact that sometimes there simply is no way to ascertain why a stroke occurred for one individual and not for another with the same health history, the same risk factors, and the same surgical procedure.

Most post operative strokes occur when a blood clot dislodges, which typically occurs in the lower section of the body. This blood clot then travels through the body and may lodge itself in the brain or more commonly the lungs. This action of a blood clot traveling through the body post surgically is commonly referred to as an embolism and usually arises from a larger blood clot that usually forms in the lower body known as a deep venous thrombosis or "DVT". DVT is a prime concern for surgeons, and can be considered a precursor to a stroke.

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