Frequently Asked Questions | David O. Smith, MD, FACS

Frequently Asked Questions

Why the "plastic" in plastic surgery?

The word "plastic" comes from the Greek word plastikos, meaning "to mold or shape." Many of the first plastic surgeries were developed to close a difficult wound or replace tissue lost due to injury or cancer. These procedures often involved the formation of a skin flap to reshape or mold the defect so as to approximate the original shape.

What is the difference between cosmetic and reconstructive surgery?

Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Cosmetic surgery is usually not covered by health insurance because it is elective.Reconstructive surgery is performed on abnormal structures of the body, caused by congential defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance. Reconstructive surgery is generally covered by most health insurance policies although coverage for specific procedures and levels of coverage may vary greatly.There are a number of "gray areas" in coverage for plastic surgery that sometimes require special consideration by an insurance carrier. These areas usually involved surgical operations which may be reconstructive or cosmetic, depending on each patient's situation. For example, eyelid surgery (blepharoplasty) - a procedure normally performed to achieve cosmetic improvement may be covered if the eyelids are drooping severely and obscuring a patient's vision.

What is recovery from plastic surgery like?

Will I be able to tolerate the pain post-operatively?

Each patient will tolerate pain post-operatively in a different way, and we consider this. While some patients may describe the pain as an ache, others experience greater discomfort. Appropriate pain medications are prescribed for the post-operative patients, and these help minimize discomfort. Most facial cosmetic operations have minimal discomfort post- operatively. Liposuction is slightly more uncomfortable, and operations that require elevation or tightening of the muscles-such as an abdominoplasty or breast augmentation have discomfort equal to that of a C-section.

How long is the recuperative period and when can I return to work?

The length of time it takes to recuperate after plastic surgery varies depending on the procedure performed and the person operated on. Most patients will require assistance for the first two days. Then most patients are able to care for themselves, but may still need assistance if they have small children to care for. The specific lengths of disability are outlined below by procedure. These are approximations, and do not include return to exercise.

Eyelid Surgery - Usually can get around independently by the second day. With the use of sunglasses, may feel comfortable going to the store by day 3-4, and with makeup could return to work by 5-7 days.

Facelift Surgery - Usually can get around independently by the second day. Usually do not feel comfortable going out in public for 5-7 days. Requires 10-14 days before returning to work if in the public eye.

Breast Surgery - Usually can get around independently by the second day. May return to work at 5-7 days if not required to lift more than 15 pounds.

Liposuction - Usually can get around independently by the second day, earlier if smaller number of areas treated. One can return to work and normal activities in 5-7 days.

Abdominoplasty - Patients may take between 2-4 days before getting around independently. The recovery is almost identical to C-section. One can return to a desk job at 5-7 days, other jobs 10-14 days.

When can I resume regular exercise?

The time a patient resumes regular exercises varies based on the operation performed. All patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting and contact sports are allowed at 1 month in most cases.

What should you know about the safety of outpatient surgery?

When considering plastic surgery, it’s natural to focus more on the expected result than on the surgical process. However, to be fully informed, it’s important to learn about the safety of the procedure as well as the expected outcome. Although thousands of people have plastic surgery every year without complications, no surgical procedure is risk-free. To maximize safety, ensure that:

• Your physician is an ASPS Member Surgeon - which ensures at least five years of surgical training - with a minimum of two years specifically in plastic surgery, and is board certified by the American Board of Plastic Surgery;
• The facility where your surgery will be performed conforms to strict safety standards - ASPS Member Surgeons only operate in accredited facilities;
• Your surgeon is informed of any drugs you are taking and your full medical history, especially if you have had any circulation disorders, heart or lung ailments or problems with blood clots;
• The surgical facility will use skilled, licensed personnel to administer and monitor your anesthesia and your recovery immediately following the procedure
• Extra safety measures are taken if you are having a more extensive liposuction procedure.

The American Society of Plastic Surgeons (ASPS), an organization of board-certified plastic surgeons who are dedicated to the highest standards of patient care, has prepared this document to help you get the safety information you need. It contains recommendations developed by the society’s expert task forces, whose members have consulted the most recent research available. If you have questions about these guidelines or any specific concerns not covered in this document, talk with your board-certified plastic surgeon. Only ASPS members are entitled to display the logo above.

How can I be sure that my surgeon has adequate training?

Good credentials can’t guarantee a successful outcome; however, they can significantly increase the likelihood of it. Patients are advised to find a doctor who is certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties to certify a surgeon in plastic surgery of the face and of the entire body. Certification by the ABPS is "the gold standard" for plastic surgeons because it signifies that the surgeon has had formal training in an accredited plastic surgery residency program. If your surgeon is ABPS-certified, you can be assured that your doctor:

• Has completed at least five years of surgical residency training after medical school, including at least two years in plastic surgery
• Has passed comprehensive cosmetic and reconstructive surgery exams
• Is qualified to perform cosmetic and reconstructive procedures – everything from liposuction and facelifts to intricate wound repair.

To verify a surgeon’s certification status, contact the American Board of Plastic Surgery at 215-587-9322 or visit the board’s web site at www.abplsurg.org or the American Board of Medical Specialties at www.abms.org or by phoning 1-800-776-2378

How can I determine if my plastic surgeon’s surgical facility meets acceptable safety standards?

For members of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery, all plastic surgery performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, must be performed in a surgical facility that meets at least one of the following criteria:

• Accredited by a national or state recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• Certified to participate in the Medicare program under Title XVIII
• Licensed by the state in which the facility is located

Patients should ensure that the facility is accredited or is in the process of being accredited. To find out about a facility's accreditation status, contact the AAAASF at 1-888-545-5222 or www.aaaasf.org the AAAHC at 847-853-6060 or www.aaahc.org the JCAHO at 630-792-5005 or www.jcaho.org.

Plastic surgery procedures performed in accredited surgical facilities by board-certified plastic surgeons have an excellent safety record. A 1997 survey 1 based on more than 400,000 operations performed in accredited facilities found that:

• The rate of serious complications was less than half of 1 percent.
• The mortality rate was extremely low – only one in 57,000 cases.
• The overall risk of serious complications in an accredited office surgical facility is comparable with the risk in a freestanding surgical center or hospital ambulatory surgical facility.

Why is it so important for my plastic surgeon to know detailed information about my personal and family health history, even if I am only having a simple cosmetic procedure?

There is always risk with any surgical procedure. However, as a patient, you can play an important role in reducing your risk by providing a full and complete health history to your surgeon.

Although rare, one of the most serious complications associated with surgery is the development of blood clots in the large veins of the abdomen and legs. This complication can lead to a potentially fatal pulmonary embolism (blocked lung artery). Therefore, it is extremely important to tell your plastic surgeon if you or any of your family members have a history of blood clots or if you have had a family member who died suddenly, shortly after surgery or childbirth.

You will also be evaluated for other factors that may increase the risk of blood clots. These include:

• Being extremely overweight
• Having recent traumatic injury
• Any disorder of the heart, lungs or central nervous system
• A history of cancer, recurrent severe infection or genetic problems that affect blood clotting

For women, additional risk factors include:

• Taking oral contraceptives or having recently ceased taking them
• Undergoing hormone-replacement therapy

Safety measures to prevent blood clots will be determined by your individual degree of risk. If you are considered low risk, your doctor may simply ensure that you are positioned on the operating table in a way that allows for adequate blood circulation to the legs. If you are of moderate or high risk for developing blood clots, you may also be advised to wear elastic stockings before, during and after your procedure, or to take special anti-clotting medications. Compression devices on the legs may be used during surgery to support your normal circulation.

How can I be sure that the anesthesia care I receive in my plastic surgeon’s surgical facility is adequate?

Anesthesia care in an accredited or licensed facility has reached a level of sophistication that is absolutely comparable to the care received in the hospital. For maximum safety, ASPS recommends that:

• Any planned anesthesia should be administered by skilled, licensed personnel acting under the direction of an anesthesiologist or the operating surgeon.
• Before any type of anesthesia is used, the surgeon or anesthetist must take a full medical history. A physical examination and appropriate lab tests may also be performed. Your surgeon needs to know if you have any serious medical problems or have had previous adverse reaction to any other type of anesthesia. Also, you must let the anesthetist know about any medications you are taking (including herbal supplements), any known drug allergies, when you last ate and whether you smoke cigarettes or use alcohol or illegal drugs.
• You should be assured that you will receive individual monitoring by skilled, licensed personnel before, during and after the procedure. Staff who are familiar with the warning signs of cardiac or respiratory distress and are trained in advanced cardiac life support (ACLS), should be on hand to monitor your procedure and recovery following your surgery.
• If you are told that you will be kept overnight at the surgical facility while you recuperate, make sure that the facility is accredited by a recognized agency. In an accredited facility you will receive around-the-clock care and monitoring by two or more skilled and licensed staff members with at least one trained in ACLS. You will also be assured that the facility has the necessary equipment and medications to handle complications that may arise and an emergency plan in case you need to be transferred to the hospital.

To achieve the cosmetic results I want, my plastic surgeon has recommended "large-volume" liposuction. What types of safety measures should I expect my surgeon to take?

Due to recent advances in technique and technology, serious medical complications in liposuction are quite rare. However, the risk of complications increases with the number of areas treated and the amount of fat removed. A liposuction procedure is classified as "large volume" when 11 pounds (5,000 cc) or more of fat and fluid are removed.

Factors that may increase the risk of complication are:

• Excessive amounts of local anesthesia or excessive amounts of fluid administered intravenously or within the tissues at the surgical site
• Multiple, unrelated procedures performed during the same surgery
• Being in poor health prior to surgery
• Having a personal or family history of blood clots of the legs or a blocked lung artery
• Having a personal or family history of breathing or bronchial disorders or other lung problems
• For women: Current use of oral contraceptives

For maximum safety, a patient planning to have either large-volume liposuction or ultrasound-assisted liposuction (known as UAL) should be aware of the following:

• Large-volume liposuction requires specialized knowledge. Therefore, it’s important for your surgeon to have additional training specifically in UAL or large-volume liposuction.
• Your surgeon should keep track of the amount of fluid that is infused into your body and the amount that is withdrawn from your body. The surgeon should also have systems to record intravenous fluid, the amount of fat removed and urinary output.
• Extended post-operative monitoring of vital signs and urinary output is critical following large-volume liposuction. An overnight stay in a hospital or other overnight-stay-accredited facility may be required.

ASPS believes that in the hands of an appropriately trained specialist, liposuction is a generally safe procedure. Still, ASPS is collecting additional data on the safety and effectiveness of liposuction. The Liposuction Outcomes Study and will yield valuable data in the near future.

Safety is a team effort

Quality patient care, safety and successful surgical outcomes are the result of the patient, the surgeon and the surgical staff working together. The ASPS has supported this concept by establishing task forces on liposuction, deep vein thrombosis prophylaxis and outpatient surgical safety. These professional groups have thoroughly investigated the surgical techniques, equipment and medications commonly used in outpatient plastic surgery and have set safety guidelines for use by all plastic surgeons, their staffs and their facilities. The task forces have also supplied the patient-safety information for this document.

As the ASPS continues to support the safety research being conducted by its Educational Foundation and the National Endowment for Plastic Surgery, patients are encouraged to learn everything they can about the procedures they are considering and to ask a lot of questions. Your concerns about safety should be discussed in detail with your plastic surgeon. This will help promote a safe outpatient surgery experience as well as fulfilling your surgical expectations.

1. Morello, D.C., Colon, G.A., Fredericks, S., Iverson, R., Singer, R. Patient safety in accredited office surgical facilities. Plast. Reconstr. Surg. 99: 1496, 1997.

Statement approved by the ASPS Board of Directors, June 24, 2000