Safety in plastic surgery: care that begins before the operation

The first safety decision is to verify whether there is an indication to operate.

Before defining a technique, it is necessary to understand:

Patients seeking the same surgery may have different needs and risks. That is why planning takes information into account such as:

Deep vein thrombosis happens when a clot forms in a vein, usually in the legs. When part of that clot travels to the lungs, a pulmonary embolism can occur. Although these events are uncommon, they can be serious. That is why prevention holds a central place in planning, especially in abdominoplasty, body contouring surgeries, combined procedures, longer surgeries and patients with individual risk factors.

Every surgical patient undergoes a systematic thrombosis risk assessment using the Caprini score, which guides an individual prevention strategy. Depending on the risk and the type of surgery, prevention may involve compression stockings, early movement, hydration, reduced periods of immobility, responsible planning of surgical time, preventive medication when indicated, and monitoring of mobility after surgery.

See the full content on thrombosis prevention in plastic surgery, covering risk factors, the Caprini score, preventive measures, medication and early walking.

Dr. André encourages all of his patients, in every surgery, to walk early, including on the same day as the procedure.

Walking on the day of surgery does not mean exercising, carrying weight, doing household chores or moving ahead of authorized activities. The intensity and frequency of movement are adjusted according to the surgery and each patient's progress.

Combining procedures can bring benefits, such as concentrating part of the recovery and avoiding a new anesthesia at another time. However, it can also increase surgical duration, the extent of the areas treated, blood loss, difficulty with mobilization, healing demands, thrombosis risk and the complexity of the postoperative period.

For that reason, performing more procedures in a single surgery is not automatically better. The decision considers:

Abdominoplasty is a larger-scope surgery compared to several other aesthetic procedures. It can involve skin removal, fat treatment, tissue undermining, correction of the abdominal wall, muscle plication, a temporary change in posture, and reduced mobility in the first few days.

When combined with other surgeries, planning needs to be even more rigorous. This does not mean abdominoplasty cannot be performed safely. It means it requires:

Surgeries are performed at Hospital Campagnolo, in Toledo. The hospital has complete structure for surgical care, including an operating center, anesthesia team, nursing team, monitoring during the procedure, post-anesthesia recovery, the possibility of hospital stay, and an Intensive Care Unit (ICU) if needed.

Having a complete hospital structure allows care to be adjusted to the scope of the surgery and each patient's clinical course. During the procedure, different professionals take part in care, including the plastic surgeon, surgical team assistants, instrument staff, the anesthesiologist, the nursing team and hospital staff.

Hospital structure is an important part of safety. However, it does not replace:

During surgery, the anesthesiologist continuously monitors the body's response. The parameters monitored include:

The bispectral index monitor, known as BIS, helps the anesthesiologist track brain activity related to anesthetic depth.

A sensor placed on the forehead converts brain activity information into data that helps the anesthesiologist assess, in real time, how the body is responding to anesthetic medications.

This tool allows for more individualized management of anesthesia, especially in longer procedures, such as certain combinations of liposuction, abdominoplasty, breast surgery and other combined procedures.

BIS can help the anesthesiologist to:

During surgery, the body can lose heat. A drop in temperature can interfere with clotting, comfort, anesthetic recovery and the body's response to the procedure.

To help keep body temperature adequate, the following are used:

Bleeding risk is assessed starting in the preoperative period. It is important to report the use of anticoagulants, medications that interfere with clotting, supplements, a history of hematomas or bleeding, blood disorders, hormone use, anabolic steroid use and previous surgical experiences.

During and after surgery, the team watches for signs such as:

Infection prevention depends on several stages:

Nicotine use must be stopped at least 30 days before surgery and remain suspended for at least 30 days after the procedure. This guidance includes cigarettes, e-cigarettes, vapes, hookah, tobacco products, other sources of nicotine, and patches or replacement products, unless specifically advised otherwise by a physician.

Nicotine causes blood vessels to constrict and reduces blood flow to the tissues. This can increase the risk of:

Breast surgeries require attention to bleeding, hematoma, infection, healing, skin quality, areolar circulation, sensitivity, symmetry, tissue adaptation, weight, and tension on the scars.

Risk may be higher when larger-scope procedures are combined or when factors such as the following are present:

When a breast implant is indicated, planning includes choosing the implant, defining size and shape, planning the placement plane, controlling handling, preventing contamination, and record-keeping for traceability.

Tools such as a sterile funnel may be used to reduce direct contact between the implant and the skin, decrease handling during placement, and assist with inserting the implant.

The sterile funnel is a safety tool, not a surgical technique. It does not eliminate the risk of infection or capsular contracture, but it can be part of a strategy to reduce handling and contact.

After surgeries involving implants, the patient receives a card or document with information about the implant used. This record may include manufacturer, model, size, batch number and the identification needed for traceability.

The document should be kept by the patient. It may be needed at future appointments, exams, follow-up visits, communication with other professionals, and identification of the implanted material.

Breast implants require follow-up over time. The patient should seek evaluation if she notices:

The safety of liposuction does not depend only on the amount of fat removed. The following are also considered:

Gluteal fat grafting requires anatomical knowledge, cannula control, continuous attention to the plane of application, planning of the amount and distribution of fat, and adherence to safety criteria.

In Dr. André's practice, ultrasound is used in every case of gluteal fat grafting. During the procedure, it allows visualization of the tissues, tracking of cannula position, assistance with controlling the plane of application, and increased information available during surgery.

Ultrasound is an additional control tool. It does not eliminate the risks of the procedure and does not replace anatomical knowledge, technique, planning, continuous cannula control and surgical experience. Learn more in ultrasound use during procedures.

Technologies can contribute to:

In certain surgeries, hyperbaric oxygen therapy may be planned preventively as part of postoperative care. Its use is considered especially in procedures that involve greater extent, higher healing demands, treatment of areas with more delicate circulation, individual factors deserving additional attention, or that may benefit from this resource within the established plan.

Hyperbaric oxygen therapy is a complementary form of care. It does not replace surgical technique, preserving tissue circulation, controlling risk factors, dressings, follow-up and early identification of changes.

It also does not guarantee healing free of complications. Its indication and the number of sessions depend on the type of surgery, the extent of the procedure, tissue characteristics, risk factors and the patient's progress.

Surgery ends in the operating room, but care continues. Postoperative recovery involves:

Discharge does not happen simply because a certain number of hours have passed. Hospital stay depends mainly on the complexity of the surgery, the patient's clinical picture, anesthetic recovery and the stability of vital signs.

The following are also observed:

After surgery, the patient receives direct contact with the Linhares Plástica nurse. This channel can be used to:

The team is responsible for the indication, the planning, the technique and the follow-up. The patient also plays a part in safety by:

Contact the team if you notice:

Before surgery: listening and indication, clinical assessment, tests, the Caprini score, stopping nicotine, planning of the procedures, and the decision on whether to combine surgeries or split them into stages. Learn about each step at the consultation and in the patient journey.

During surgery: hospital structure, full team, continuous monitoring, BIS, temperature control, bleeding control and careful technique.

After surgery: early walking, pain and swelling control, dressings, direct contact with the nurse, follow-up visits, recognition of warning signs, and progressive clearance of activities.