Complications – Following Surgery

1. Pain

Pain is usually well controlled. Early postoperative numbness limits pain. If bone grafts are used from the hip an indwelling catheter infuses local anaesthetic into the hip area and pain should not be severe.

2. Swelling

The degree of swelling is probably genetically determined in facial surgery and as such is not related solely to surgical technique. Intravenous steroid drugs are used to reduce facial swelling; in some patients this works very well with little or no swelling - in others swelling is marked despite steroids and the eyelids may be closed for around 72 hours (rare).

3. Bleeding

Patients undergoing orthognathic surgery will be screened for the common blood disorders associated with bleeding and clotting disorders. On occasion bleeding may be severe enough to return to theatre for an exploratory operation. This is rare circa 0.5% risk. In a potential life threatening situation incisions in the neck may be required to stop bleeding by tying off major blood vessels. If bleeding is associated with major facial swelling a temporary tracheostomy may be required to maintain the airway until swelling subsides.

4. Bruising

Bruising may be marked in some patients and has an association with smoking and drugs such as aspirin. Bruising is more likely in patients who smoke, and persistent smokers should abstain from smoking for a minimum of 1 month prior to surgery. Some bruising tendency runs in families. The amount of bruising is not necessarily related to surgical technique. Rarely bruising may be a manifestation of an underlying undiagnosed blood disorder. Bruising may be visible for 6 weeks following surgery and may travel down the tissue planes from the jaws to the neck and even the chest (rarely).

5. Malocclusion

In jaw operations the teeth are deliberately put into a position so that the incisor teeth meet and the molar teeth are kept apart. This is known as a posterior open bite ensures that the incisor teeth touching for reasons of cosmesis biting, and speech. Following surgery the bones move - especially in the maxilla which may be paper thin. The incisor teeth act like a fulcrum and the molar teeth can be guided into place with elastic bands. In some cases a small gap may persist in the molar region. Generally this is clinically and aesthetically acceptable and requires no additional treatment.

6. Infection

Infection is rare (circa <0.5%). Surgery is carried out under the cover of intravenous antibiotics. Oral hygiene measures are required pre and post surgery, when the teeth are cleaned with sponges soaked in chlorhexidine (Corsodyl) mouthwash. This may temporarily stain the teeth and tongue Teeth may require scaling and polishing to remove the stain. It is important to keep the mouth as clean as possible following surgery.

7. Wound Healing

All wounds heal with a scar; there is no such thing as invisible mending in cosmetic surgery. Scars are hidden by virtue of their positioning in skin creases. Whilst most scars heal well, some scars become large and noticeable (hypertrophic scars) and some scars may thicken abnormally (keloid scars). The ability to form such scars may run in families. Other scars may be related to infection.

It is the remit of the surgeon to make incisions in areas of skin creases (Langers Lines) for the best cosmetic effect. Healing is generally good in the facial area, but may be affected by inherent poor scarring that is not in the control of the surgeon. Healing may also be poor in areas where the scar breaks down in relation to poor blood supply. This may be seen in facelift patients (especially smokers) behind the ear where the scar approaches the hairline. Healing may be adversely affected in patients who bruise excessively (smokers, aspirin, non steroidal anti-inflammatory drugs, garlic, Chinese food etc). Wound breakdown from infection is rare in facial surgery. Revision surgery may be required in cases of poor primary wound healing.

8. Cartilage

A particular problem may occur with cartilage of the ear and nose, and is related to the poor blood supply of cartilage. If cartilage becomes surrounded by excessive bruising, or becomes infected, it may die; this affects the contour and shape – resulting in the cauliflower ear often seen in rugby players or in collapse of the cartilaginous skeleton of the nose. The cartilage may become painful and inflamed (chondritis) in some patients. Treatment may involve further complex surgery and reconstruction of the deficit.

9. Titanium Screws and Plates - Why Titanium Implants?

There are 6 good reasons to utilize this material:

i) Titanium has, as a pure metal, an extraordinary tissue compatibility and resists corrosion from exposure to air and the biological environment. Therefore, Titanium is especially suited for long-term implants and can, according to today’s knowledge, remain indefinitely in the body.

ii) Titanium implants remain chemically inert and corrosion-free. Material-related damage to the tissues is impossible.

iii) Titanium plates can easily be fully adapted to the contour of the bone.

iv) Titanium screws can be anchored tightly into bone and resist loosening.

v) There have been no reports of allergic reaction to titanium.

vi) The use of stainless steel screws and plates interfere with future CT scan and MRI scan images. The use of titanium overcomes many of these problems.

Some titanium screws and plates may be palpable under the skin in some patients. This may be annoying and is more likely to occur where the skin is thin e.g. near the lower eyelids eyebrows and nasal bridge. The problem may often be prevented by using small plates or microplates in the areas of thinnest skin. Collagen sheeting may be placed over the plates in these areas to reduce this complication.

Some patients (circa 3%) may find some irritation in areas of screw placement and may request that the screws and plates be removed as a short procedure under general anaesthetic.

10. Facial Asymmetry

Some degree of facial asymmetry is within normal anatomical boundaries, and is not possible to eliminate. Whilst some asymmetry should be expected following any surgical procedure, this should be compatible with pre-existing anatomy that has not been altered.



Summary


It is an NCAFOS Clinic Philosophy to provide a total care package within a multidisciplinary Expert Team Setting. Patients are treated within the guidelines of Clinical Governance by trained surgeons and staff, who keep up-to-date with advances within their sphere of interest. It is this attention to detail, treatment planning and care that is the cornerstone of the services available. Patient feed back is welcomed and an essential part of our audit process to maintain a standard of excellence within the field of Cosmetic Facial Surgery.

We look forward to seeing you soon…………