VII. COMPLICATIONS

A complication—in its most simple form—is any-thing that makes the patient unhappy. If for any rea­son a patient is unhappy with the result, this might be considered a complication. This does not necessarily mean that the surgeon did something wrong, but may simply mean that despite his or her best efforts some undesired result occurred. Most surgeons will undertake any reasonable effort to satisfy a patient in this important surgery.

Surgery is not an exact science and results can-not always be anticipated. Despite the best efforts of a skillful surgeon, complications still occur. Theliterature reports that as many as 10% of patients may require some form of revision surgery.

Patients often wish to know what they can do before surgery to decrease the risk of complica­tions. A discussion of the potential complications is critical, so that the patient understands the small but real risks of a complication. The surgeon will give the patient instructions for before and after surgery, and the patient should be sure to follow them. However, although most complications are relatively minor and correctable, more serious and debilitating complica­tions do occur.

A good surgeon is highly self-critical. There is a story told among rhinoplasty surgeons that a famous master rhinoplasty surgeon was asked, toward the end of a career in which he had performed many thou-sands of rhinoplasties, how many "perfect" rhinoplas­ties he had done. After some thoughtful reflection, he replied, "two."

With this in mind, one can imagine that in many cases the surgeon may notice an imperfection that is amenable to correction, but the patient may not even notice it or may not be concerned by it.

There is no way for a patient to be certain that he or she won't have a complication. Even if the surgeon does things well, a complication can occur. Just as an airplane can encounter unexpected turbulence, unan-ticipated technical problems can occur during surgery that can lead to a complication. Despite careful pre-operative analysis and meticulous attention to surgical detail, unacceptable results may still occur.

Cosmetic surgical procedures have been repeated successfully countless times and are dependable when executed by skillful, experienced surgeons. Plastic sur­gery is a combination of art and science, and as such can be subject to unpredictables—usually (but not always) minor in nature.

No surgical procedure should be taken lightly; a slight but real risk is involved in all surgery. Fortu­nately, the overwhelming majority of plastic surgery results are highly satisfactory and pleasing when ac­companied by careful presurgical planning, meticulous surgery, and full patient cooperation.

FIGURE 34. Revision rhinoplasty (a) preoperative, (b) postoperative.

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