Tell me your cosmetic secrets

I live and work in Los Angeles, one of the plastic surgery capitals of the world. Quite a few of my patients have “had a little work done” — the blandly euphemistic term you’ll hear for plastic surgery makeovers of all kinds. That’s fine. Plastic surgeons have children to feed too.

The problem is this: many of my patients want to convince everyone that their “look” is entirely natural. They don’t want to admit that they’ve had a tummy tuck, an eyelid lift, or breast implants. One patient tried to tell me that the perfectly matched scars behind her ears were the result of a car accident, not a face lift. In front of family members, patients will even deny having dentures. That’s understandable, but unwise from a medical point of view.

The fact is that plastic surgery has implications for future medical care. Your anesthesiologist needs to know about it, and your surgeon does too. It may be cosmetic, but it’s still a bigger deal than getting your eyebrows waxed.

Here’s why we need to know the cosmetic secrets our patients may NOT want to tell us.

Why does a tummy tuck matter?

One of the worst complications I’ve seen after plastic surgery happened to a lovely patient who, years before, had an abdominoplasty, popularly known as a “tummy tuck”, with a very good cosmetic result. Many women request this procedure once they’ve finished having children, to tighten up the skin and smooth out the appearance of the abdomen. The incision is similar to the one for a cesarean section, across the lower abdomen, though it extends further to each side. Once it’s well healed, it may barely be visible.

Years later, the patient needed major surgery on her liver, and the surgeon made an incision known as a “chevron” or “rooftop” – an incision across the upper abdomen, just below the ribcage. The surgical team didn’t realize she’d had a prior abdominoplasty, and the patient never thought to mention it.

The blood supply to her abdominal wall had been interrupted from below by the abdominoplasty incision, and now was interrupted from above by the chevron incision. The skin and soft tissue of the patient’s whole abdominal wall essentially died and turned black from lack of blood flow and oxygen, a condition called tissue necrosis. The patient needed extensive skin grafting and several surgical procedures for reconstruction.

What about breast implants?

For the most part, breast implants don’t matter much in terms of subsequent surgery – unless you need an operation that involves your chest. Surgery on the lungs or esophagus often is done today with a minimally invasive technique called video-assisted thoracoscopy, where the surgeon inserts slender instruments and a tiny camera through small incisions in the chest wall. It would be easy to rupture a breast implant unless the surgeon knows it’s there and can work around it.

Chin enhancement?

Chin enhancement surgery, or genioplasty, may involve inserting a small plastic implant to improve the appearance of a receding or “weak” chin. It may seem like a trivial procedure, and the tiny scar beneath the chin may be hard to spot. But please tell your anesthesiologist if you have a chin implant! A receding chin is a facial feature that can alert the anesthesiologist to possible trouble inserting a breathing tube. It’s important for us to know if a patient’s chin didn’t always look the way it does today.

(As an aside, it’s not uncommon for men to grow beards as a cheaper, easier way to conceal a receding chin. An experienced anesthesiologist knows to look for this feature when evaluating the patient’s airway prior to surgery.)

Eyelid lifts? False eyelashes?

Eyelid lift, or blepharoplasty, is done to remove excess or sagging skin from the eyelids. It’s also popular among East Asian patients (both men and women) who want to alter the shape of their eyelids for a more “western” look.

After a blepharoplasty, the eyes may not close completely if a patient is sedated or unconscious during another operation. If the eyes aren’t fully shut, they may dry out because the patient isn’t blinking normally. The delicate corneas may develop micro-cracks, which cause pain when the patient wakes up just like any other corneal scratch or injury. Oxygen from a face mask blowing past partially open eyes may also cause the corneas to dry out and become red and painful. If we know that you’ve had a blepharoplasty, we can take extra precautions to protect your eyes and keep them moisturized.

False eyelashes or eyelash extensions can easily be damaged during surgery. This is because the anesthesiologist usually protects the patient’s eyes from corneal scratches by putting tape or a transparent dressing over the eyelids. When the tape comes off at the end of surgery, the eyelashes can come with it. If you’ve just paid $150 or more for a full set of lashes, I can understand why you’d be upset. If you mention that you have them on, we can use goggles to protect your eyes and leave the eyelashes undisturbed.

We promise not to tell

The take-home message to patients? Please tell us your cosmetic secrets. Send your family members off to get coffee before you talk to us if you don’t want them to know. But what we – your anesthesiologist and your surgeon – DON’T know about your cosmetic history, unfortunately, can hurt you. We promise not to tell.

5 COMMENTS

Jean Sprengel, MD

I am also an anesthesiologist in an adjacent cosmetic surgery capitol, Orange County, CA. I recently had a patient whose muscle relaxation I was trying to assess using the peri-oribital muscles. The results were not making sense. I finally realized that the patient had extensive Botox and moved to test other muscles. I then remembered that I had seen this same phenomenon a few years back. We need to know about Botox, too, not just surgical interventions.

[Reply]

karen

Dear Dr. Sprengel,

That’s a great point! Thank you so much for reading and taking the time to comment.

All the best,

Karen Sibert

[Reply]

Adel Bishai,MD

Do you ever worry about Breast implants rupturing during CPR ? Has it ever happened to anyone ? I actually did do CPR one time and it was a huge problem . Luckily nothing happened and we brought her back immediately by a simple Thumb thrust

[Reply]

Thanks for this article because it helps me got an idea on how to deal with a patients that not telling their surgery history. I think it’s good to start appreciating their beauty and telling some story to them and then through that they can have a confident to tell their story. Hope this could help a lot. Thanks anyway!

[Reply]

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