In order to get the best possible result for a particular patient it is extremely important to strive to attain the best possible conditions in which to operate. It is our opinion that the pre-operative consultation is the most important part of the entire cosmetic procedure, and has been discussed in more detail in the previous section. This section deals with the physical and medical aspects of the fitness of a patient for surgery.
Because cosmetic surgery is entirely elective, it is of paramount importance for the surgeon to ensure that you are physically fit to withstand the operation safely and without undue risk. It would be extremely foolhardy for a surgeon to operate on any patient who has an increased risk of a serious medical complication following a procedure, which may endanger her well-being.
A carefully devised pre-consultation questionnaire is a useful tool to screen a patient from a purely medical perspective. This will usually give the surgeon all the information he requires in order to ascertain if you are physically fit for surgery, or if there are any factors that may preclude proceeding. Any grey areas can then be investigated in more detail.
In addition, the surgeon will go through his own, thorough screening routine to ensure that it is safe to operate on you. Some of the more important points to consider are as follows.
Your Current General Health
Any significant history of current problems with medical fitness will immediately alert the surgeon to take appropriate action and make an informed decision regarding proceeding with surgery. You should report any recently encountered symptoms, eg. excessive thirst, frequency of passing urine, unexplained weight loss, as these may signify the onset of an illness that has previously been undiagnosed, such as diabetes.
Past Medical History
A detailed past medical history should help uncover any contraindications to proceeding with surgery or alert the surgeon to any possible post-operative problems eg. previous post-operative deep vein thrombosis, or a history of heart or chest problems.
You should declare any past psychiatric history, with accurate details of any hospital admissions and medications prescribed. A past history of depression or anxiety can be very relevant to how you react to the stress of having an operation.
Family Medical History
And you most Any significant family history of illness should be declared, especially a family history of anaesthetic problems. A condition known as Malignant Hyperthermia is a familial disorder, whereby the sufferer's metabolic rate is grossly enhanced when under a general anaesthetic leading to a grossly exaggerated and rapid rise in body temperature, which, if not promptly and expertly treated, can lead to the rapid demise of the patient. Thankfully, this condition is extremely rare.
In fact, you should declare any disease or illness that you know runs in your family, no matter how insignificant you think it to be.
Allergies
By the time a person reaches puberty, she should be aware of any allergies she may be suffering from, especially to conventional drugs. The commonest, most important and pertinent allergen in surgery is Penicillin. Obviously an allergy to any other drug or medication is also important, especially to a particular anaesthetic agent or post anaesthetic drug, but this is less common. All allergies should therefore be declared prior to surgery.
Current Medications
It is important to inform your surgeon of any oral medications you may be taking, in case they are likely to react with any medication likely to be given during an anaesthetic or at any time in hospital. Of particular importance is the oral contraceptive pill and hormone-replacement therapy, as in some situations it will be necessary to take extra steps to protect the patient against the possibility of post-operative deep vein thrombosis.
You should also declare any homeopathic, alternative or other medicines or preparations to the surgeon and anaesthetist before surgery. These too can interact with conventional medicines, especially anaesthetic drugs, which could have disastrous consequences.
Abnormal Healing/Scarring
A history of abnormal scarring or healing should prepare you and your surgeon for the possibility of an unfavourable result. Everything possible should be done in an attempt to minimise this complication eg. your strict adherence to post-operative instructions, and measures for the prevention of infection.
Vitamins
The taking of vitamins is encouraged in order to enhance healing. The homeopathic preparation arnica is recommended by many surgeons as an aid to healing, although some scientific reports have cast doubt over its effectiveness.
Bleeding/Clotting Disorders
Any bleeding tendency or abnormal clotting disorder in you or your family must be fully investigated before surgery. Prior to surgery, many patients complain of 'bruising easily'. This is usually a harmless disorder, often referred to as 'devil's pinch', and is not significant.
If you or your relatives have previously experienced deep vein thrombosis following surgery, you should be treated with the utmost care and given prophylactic preventative therapy prior to surgery.
An increasing number of patients are travelling long distances by air to undergo cosmetic surgery. There is an increasing number of fatalities from pulmonary embolus in patients who have recently stepped off a plane and gone straight into an operating theatre for surgery. Extreme caution should always be exercised in these circumstances.
Excessive Alcohol Intake
Excessive alcohol intake will impair liver function and therefore the production of the essential clotting factors in the blood. This can sometimes cause a problem if the clotting time is increased after the operation. This can in turn lead to excessive post-operative bleeding with the increased likelihood of developing a post-operative haematoma.
Aspirin, a common drug taken for a variety of reasons, has a similar effect on bleeding, and should be avoided for two weeks prior to elective surgery if at all possible.
Smoking
All patients are strongly encouraged to stop smoking. Smoking is not only a recognised health hazard in its own right, but is responsible for a number of post-operative problems and complications in patients who have a general anaesthetic for elective cosmetic surgery.
1. Impaired circulation
It is a known fact that heavy smokers are more liable to suffer the consequences of impaired circulation. This can lead to flap necrosis (loss of the skin resulting in noticeable scars) eg. following a facelift or abdominoplasty. The rate of healing will also be affected. In addition, a smokers cough immediately following facelift surgery can easily precipitate a haemorrhage and an expanding haematoma.
2. Chest infections
Heavy smokers are more likely to develop a chest infection post-operatively, particularly after major procedures such as abdominoplasty.
Anaesthetic Reactions
This has already been mentioned above. Individual patients react differently to a general anaesthetic. Some suffer excessive vomiting, some find it difficult to wake up afterwards, some wake up very tearful, but luckily most get no side effects at all.
In many cases you will be aware of a particular reaction you have to an anaesthetic agent from previous experience. Any untoward reaction to an anaesthetic agent must be dealt with promptly and, thankfully, serious complications are rare. Any known anaesthetic reaction must therefore be declared prior to surgery.
Most local anaesthetics contain adrenaline. The function of the adrenaline is to cause vasoconstriction (narrowing of the local blood vessels) thereby reducing bleeding at the operation site. This makes it a lot easier for the surgeon to operate.
In the main, allergies to local anaesthetics are extremely rare. However, some people can occasionally develop an unpleasant feeling immediately following the injection of a local anaesthetic, which is attributable to the adrenaline. This reaction is usually short lived.
Urinary Problems
Urinary tract infections are a common post-operative complication, especially in patients who are prone to them.
Abstinence from Food and Drink
Every patient undergoing a general anaesthetic must abstain from food and drink for several hours beforehand. This is to ensure that the stomach is empty in order to prevent the inhalation of vomit during the administration and duration of the anaesthetic. Each patient will be advised accordingly.
Employment and Social History
One of the commonest questions patients ask after surgery is, 'When can I go back to work?' The surgeon will need to know what your work commitments and circumstances entail in order to answer this question accurately. Depending on the scale of the procedure you are considering, you may need to arrange to have some considerable time off work. Only you will know if this is feasible. Your relationship with your work colleagues — whether you get on well with them or not, whether they know about and are sympathetic towards your having surgery — can also have an important bearing on how successfully you view the result.
Ideally you will have a loyal and supportive partner or close friend who will help you through the inevitable stress of having surgery and coping with the immediate effects. Often the result of surgery initially is quite disappointing. At first the patient just sees the effect of an injury: bruising, swelling, scars and stitches. It is only later that the beneficial effects of the operation become apparent. It is very helpful to have personal support through these early stages after an operation.
The second best situation is to be left alone to recover quietly without having to look after anyone else except yourself. The worst situation is to live with a partner who is antagonistic to the whole idea of the operation. Every little bruise could be the focus of an 'I told you so' type of remark, and an operation that would have been a success with a supportive partner can be turned into a failure.
It is a good idea for a husband and wife to attend the pre-operative consultation together if possible, so that the events in the post-operative phase and all the complications and risks can be explained to them both at the same time. This is particularly pertinent to breast surgery and skin resurfacing procedures of the face.
Your Hopes and Expectations
One of the most important questions the surgeon should ask you is, 'What are you trying to achieve?' He then has to compare your answer to what you are actually likely to get. If you are hoping for rather more than the procedure is generally capable of achieving, then disappointment is very likely.
The ideal patients for cosmetic surgery are physically healthy, emotionally sound and want what the operation can usually provide. A supportive home and work environment also make a big difference.
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