Safety in Plastic Surgery
Safety is our highest priority. Surgery to improve your appearance cannot be justified unless it can be done safely. While any human endeavor involves some risk, common sense dictates that we do what we can to minimize the risks we are taking. While surgeons are always thinking about safety, recent news reports can serve to remind all of us to think about safety when we are planning to have surgery. So, what can you do to be certain that you are minimizing your risks?
Perhaps the most important thing you can do is to pick your surgeon carefully. Many Arizonans are surprised to hear that any physician licensed as an MD or DO can do any surgical procedure he or she wants, without any surgical training whatsoever! Further, even nurses and other providers, who have never had any plastic surgery residency training, have succeeded in getting the legislature to approve their independent practice, and some of them have decided that they are as good as any plastic surgeon. They argue that, since their courses included the same textbooks and topics as physicians, they should be able to do whatever a physician can do. See Picking A Plastic Surgeon for more information on this most important step.
This is especially important in Arizona because Arizona nurses, nurse practitioners, physician assistants, and even other physicians who are not plastic surgeons are not held to the same legal standard as physician plastic surgeons such as Dr. Nachbar. You can read more about that at A.R.S. § 12-2604 and St. George v. Plimpton, 384 P.3d 1243 (Ariz. Ct App. 2016).
Surgeons who are members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have agreed to include courses in patient safety in their continuing medical education, and have also agreed to abide by a Code of Ethics.
The next most important thing is to consider where your surgery will be done. Some surgeons will do major surgery in their office. Depending on the office, that might be acceptable, but I personally do not think that any doctor's office will be as safe a venue for surgery as a hospital operating room or the operating room of a formal surgery center. Nonetheless, in some areas of the country, especially the east and west coasts, the use of a hospital operating room may be cost prohibitive, and there are some very well respected surgeons who do surgery that way. At a minimum, ensure that such a facility is licensed or accredited. Be aware that some physicians without adequate training, who would not be permitted to do plastic surgery in a hospital, will use their office instead. If your surgeon proposes doing surgery in his office, ensure that he or she has privileges both to do surgery in a hospital, and to do plastic surgery in a hospital. Call the Medical Staff office of the hospital to check. For HonorHealth, the Medical Staff office is at 480-323-3070.
Third, tell your surgeon about your medical conditions, and follow his directions. A good surgeon will give you detailed instructions to help you prepare for surgery. Avoid drugs like aspirin, ibuprofen, Motrin, Aleve, etc., which can cause increased bleeding in surgery. If your doctor has prescribed those medications, discuss this ahead of time so that the appropriate plans can be made.
Avoid smoking and exposure to cigarette smoke, both before and after your surgery. Smoke is always bad for you, and increases your risk of pneumonia and other complications, but is especially problematic for some plastic surgical procedures. Procedures, such as facelift, breast lift, and abdominoplasty (tummy tuck), which involve raising a flap of tissue, have a much higher risk of tissue loss (resulting in delayed healing and wide and depressed scars) in patients with exposure to cigarette smoke.
Finally, ask about any specific safety precautions you may wish to discuss. For longer surgeries, ask about the use of sequential pneumatic compression stockings, which alternately squeeze the blood out of your legs during and after surgery to reduce the risk of blood clot. Dr. Nachbar uses these for all of his surgery performed in a hospital or surgery center. For patients staying at the surgery center overnight, Dr. Nachbar also uses an injectible blood "thinner" to further reduce the risk of a blood clot.
While nobody can guarantee a specific result, modern surgical techniques and precautions have dramatically improved the safety of surgery since the days of our parents. Ensure that you get the benefit of those advances.