American Plastic Surgery and Infections
Infectious agents are always lurking in some corner and watching over a surgeon’s shoulder for a happy place to land and multiply. The eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. (who blogs as Dr. Body) and the equally eminent Robert Kotler, M.D. (a board-certified Beverly Hills cosmetic facial surgeon) tell how and why they lean over backwards and sometimes must be stern to be kind in the face of possible infections.
Even in the most experienced of hands that follow all the sterilization guidelines in the cleanest and most sterile of operating rooms, the standard rate for infection everywhere is about one patient per hundred.
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Dr. Face: (Dr. Kotler) Have you been stern lately, doctor?
Dr. Body: (Dr. Linder) Yes, I had a patient recently to whom I gave an absolutely beautiful breast augmentation that healed nicely. But when she went home, she thought that she – and perhaps others – could see that one breast was a tad larger than the other. And she wanted a redo – she wanted the equivalent of a shot glass worth of silicone (50cc’s) added to the breast implant she perceived as smaller.
Dr. Face: What did you do?
Dr. Body: I explained the risks that attend any plastic surgery and that such a tiny adjustment was not worth risking a possible infection or other complication and thanks for asking but I could not do the procedure. She went elsewhere, had the surgery, got a terrible infection and had to have one implant removed while that breast healed for six months.
Dr. Face: Plastic surgeons are, by nature, perfectionists but that is a perfect case of what we mean by “reasonable expectations.” Most people, including her significant others, only saw a huge, healthy improvement. But any time the surgeon opens a chest or takes a breast implant out of its sterilized package and exposes it to air, the slight risk of an undesirable complication like infections is present.
Dr. Body: Unfortunately, most rejuvenation surgeons are wont to talk about a negative issue like infection. But the truth is: infective agents are floating around in the cleanest, most sterile of operating rooms. Also, human skin is alive with all sorts of flora, including bacteria that can get into an open wound. Of course, the surgical area is painted with germ killers but there are super resistant bugs that can survive and start their own colonies.
Dr. Face: Make that, their own colonies even though every precaution is taken. Implants for the face and body are packed in sterile materials, the implants are soaked in sterile agents after opening and the surgical site of the body or face is irrigated with an antibacterial solution before closing.
Dr. Body: That’s one of the reasons we want to see plastic surgery patients in the morning after the procedure. It’s apparent to us — even before the patients — when an infection is developing so we leap on it as early as possible. Some infections are so powerful, they can digest cartilage. But if the surgical area can go three to six days with no infection, we can be relatively sure we are home free.
Dr. Face: American plastic surgeons and the U.S. medical care system is very concerned about infections and also happens to be very good at tracking down the source.
Dr. Body: I bet you are talking about the case several years ago when the U.S. Centers for Disease Control (CDC) got involved in solving an infection outbreak in New Jersey.
Dr. Face: That’s right. An unusually large number of women were reporting to their doctors with infections in what appeared to be liposuction cases. The CDC interviewed the women and found they all had liposuction in the Dominican Republic at a particular clinic. The source of the infections turned out to be unsterilized liposuction wands.
Dr. Body: So it’s more important than ever to check your surgeon’s website for information about his or her surgery center. Those facilities marked:
- AAAASF (American Association for Accreditation of Ambulatory Surgical Facilities)
- JACHO, (Joint Commission on Accreditation of Healthcare Organizations)
- AAAHC (Accreditation Association for Ambulatory Health Care)
- Medicare certified
and will be following all the the standard sterilization procedures known.
