How to Reduce Complications After Plastic Surgery

Most complications after cosmetic surgery are not random events. They cluster around recognisable risk factors, several of which the patient can influence directly and several of which are determined by the surgeon and facility. This guide sets out the complications that materially affect outcomes — what they are, what raises and lowers the risk of each, and the specific actions that reduce them.

The realistic standard is not zero complications. Every surgeon has complications. The differentiator is rate, recognition, and management. The same standard applies to patients: full elimination of risk is not possible, but the risk profile of an elective cosmetic procedure is substantially modifiable by what happens around the operation. Our guides to smoking, BMI and preparing for surgery cover the biggest patient-side factors in more detail.

What Are the Most Common Complications of Plastic Surgery?

Serious complications are uncommon. In a prospective study of 129,007 aesthetic surgery patients, major complications (those needing emergency care, hospital admission or further surgery within 30 days) occurred in around 2% of patients.^[1] The main categories are:

• Bleeding and haematoma. Blood collection within the surgical site. Usually presents in the first 24 to 72 hours. Small haematomas resolve; large ones require return to theatre for evacuation.
• Surgical site infection. Local infection of the wound or surgical bed. Presents usually between days 3 and 14 with increasing redness, warmth, swelling, and sometimes discharge. Managed with antibiotics; significant infection occasionally requires surgical drainage.
• Seroma. Collection of clear fluid within a surgical space, most common after abdominoplasty and large-volume liposuction. Often managed with aspiration in clinic; persistent seromas may need drainage or, rarely, surgical intervention.
• Wound dehiscence. Partial or complete opening of a healing wound, more common where wound tension is high (abdominoplasty, breast reduction) or wound healing is impaired (smoking, diabetes, obesity).
• Skin necrosis. Loss of skin viability due to compromised blood supply. Highest risk after facelift, abdominoplasty, and breast lift, particularly in smokers.
• Venous thromboembolism (VTE). Deep vein thrombosis or pulmonary embolism. Rare but serious. Risk rises with longer operative time, immobility, elevated BMI, oestrogen-containing contraception, and certain procedures (BBL, abdominoplasty, mummy makeover).
• Capsular contracture. Specific to breast implants — thickening of the scar capsule around the implant, distorting shape and producing firmness. Risk is reduced by meticulous theatre technique that minimises bacterial contamination of the implant. Where it develops, treatment usually means breast implant removal or replacement, depending on whether you want implants again afterwards.
• Fat necrosis. Specific to fat transfer procedures (BBL, breast fat transfer, facial fat grafting) — death of grafted fat cells producing firm, sometimes tender lumps. Usually resolves; rarely requires removal.
• Sensory changes. Numbness or altered sensation around the surgical area, usually temporary but occasionally permanent.
• Aesthetic complications. Asymmetry, contour irregularities, scar quality issues, results that don’t match expectation. These are the most common reason for revision surgery — see our guide on whether it’s possible to have smaller scars after breast augmentation for how incision choice and technique affect the outcome.

How Can You Reduce Your Risk of Complications?

Stop smoking and all nicotine products

The single highest-impact intervention available to most patients. Smoking reduces the oxygen reaching healing tissue. Across 140 studies and nearly half a million patients, smokers had 3.6 times the odds of tissue necrosis, around twice the odds of wound breakdown and 1.8 times the odds of infection compared with non-smokers.^[2]

Centre for Surgery requires complete cessation of smoking, vaping, and nicotine replacement products for at least four weeks before surgery and four weeks after. This is not negotiable, and we will test where indicated. Patients who continue to smoke during the cessation window are deferred until they have demonstrated genuine abstinence. See the impact of smoking and does vaping affect cosmetic surgery results.

Optimise BMI

Elevated BMI is an independent risk factor for surgical infection, venous thromboembolism, wound healing complications, and anaesthetic complications. A 2016 analysis of 127,961 aesthetic surgery patients in Aesthetic Surgery Journal found that being overweight (BMI 25–29.9) or obese (BMI 30 and above) were both independent risk factors for major complications after controlling for other variables.^[3] For most body procedures the appropriate ceiling is BMI 30, with limited flexibility for selected cases. See BMI and cosmetic surgery eligibility.

Disclose all medications and supplements

Several common medications and supplements increase bleeding risk and should be paused on medical advice before surgery: aspirin, ibuprofen, naproxen, fish oil, vitamin E, ginkgo, ginseng, garlic supplements, St John’s wort. Prescription anticoagulants (warfarin, apixaban, rivaroxaban, clopidogrel) require structured bridging managed by the prescribing doctor.

Withholding information about medications or supplements at consultation is not in your interest. The surgeon needs the full picture to plan safely, and most issues are manageable with appropriate planning when disclosed.

Manage chronic conditions before surgery

Diabetes, hypertension, hypothyroidism, and other chronic conditions should be well controlled before elective surgery. Tell your GP that surgery is upcoming, ask whether any medications need adjusting, and ensure relevant blood tests are recent. Uncontrolled diabetes in particular materially increases infection and wound healing risk.

Maintain adequate nutrition

Protein intake supports wound healing. Patients on highly restrictive diets, those who have lost significant weight rapidly in the preceding months, and those with eating disorders are at higher risk of poor healing. The target is around 1.2 to 1.6g of protein per kg of bodyweight per day in the pre- and post-operative period. See pre-operative nutrition.

Avoid alcohol around the procedure

Alcohol increases bleeding risk, interferes with anaesthetic metabolism, dehydrates tissues, and impairs healing. Stop at least 48 hours before surgery, ideally 1 to 2 weeks before (4 to 8 weeks for heavy drinkers), and avoid alcohol for at least 2 weeks after. See when you can drink alcohol after cosmetic surgery.

Arrange proper post-operative support

A dedicated adult to accompany you home and stay for 24 hours is a clinical requirement. Time off work, childcare arrangements, and a properly prepared home environment all materially affect how well you recover. Patients who try to power through without enough support tend to find recovery harder. See essential preparations before your plastic surgery.

How Your Surgeon and Clinic Affect Risk

Check your surgeon is properly qualified

Surgeon on the GMC Specialist Register for Plastic Surgery, holding FRCS (Plast) or equivalent, with full membership of BAAPS or BAPRAS. High annual case volume for the specific procedure you are considering. These credentials are the best available indicator of a surgeon’s training and experience. See plastic surgeon vs cosmetic surgeon.

Choose a CQC-regulated facility

Care Quality Commission registration, with a current inspection rating of Good or Outstanding, indicates that the facility has met defined operational and safety standards. CQC-regulated facilities have full theatre standards for sterilisation, infection control, equipment, staffing, and emergency response. Treatment rooms above shops, hotel suites used by visiting surgeons, and non-regulated premises do not.

Consultant anaesthetist throughout

For any procedure beyond minor work under local anaesthetic, a consultant anaesthetist should be present throughout, with full monitoring including ECG, pulse oximetry, blood pressure, and capnography. The surgeon should not be managing anaesthesia themselves while operating. See twilight sedation in cosmetic surgery.

Realistic operative planning

Longer operations carry more risk. A study of 1,753 plastic surgery cases in Aesthetic Surgery Journal found that each extra hour of surgery raised the odds of a complication by 21%, with risk starting to climb after about 3 hours and reaching nearly five times that of operations under 2 hours once surgery passed 6.8 hours.^[4] The clinical decision to combine procedures should be made on risk grounds, not on marketing or discount-stacking grounds. Patients booked for multiple major procedures simultaneously should ask why, and what the alternative staged approach would look like.

How to Avoid Complications After Specific Procedures

After abdominoplasty: compression binder worn 24 hours a day for 6 weeks; gentle mobilisation from day 1 (with mid-flexed posture); careful drain management; adequate protein intake; smoking cessation absolutely.

After breast augmentation: surgical bra continuously for 6 weeks; sleeping on the back propped at 30 degrees; no chest exercise for 6 weeks; monitor for early signs of capsular contracture (firmness, distortion) at follow-up. See how to sleep after cosmetic surgery.

After BBL: no sitting directly on the buttocks for 2 weeks; BBL cushion that transfers weight to the thighs for several weeks beyond that; no flights for at least 2 weeks; monitor for fat embolism symptoms.

After facelift: sleeping propped at 30 degrees for 2 weeks; head bandage as instructed; no smoking under any circumstances; minimal facial expression for the first week; ice packs for the first 48 hours.

After rhinoplasty: head elevated for sleep; no glasses on the nose for 6 weeks; nasal saline as instructed; no nose blowing for 2 weeks; sun protection on the nasal skin.

After liposuction: compression garment continuously for 6 weeks; gentle walking from day 2; manual lymphatic drainage massage from week 2 if recommended; adequate hydration; weight stability.

Does Sun Exposure Affect Scars After Surgery?

UV exposure on immature scars can cause darkening that is long-lasting and difficult to treat. For 12 months after any procedure with visible scars, direct sun on the scar should be avoided, with SPF 50 sunscreen used reliably. This applies through autumn and winter too — UV exposure is reduced but not absent.

The longer-term picture also matters. UV exposure is the dominant modifiable contributor to facial skin ageing, and the durability of facial rejuvenation procedures is directly affected by sun habits in the years following surgery. See the effects of tanning on cosmetic surgery scars.

Why Follow-Up Appointments Matter After Surgery

Centre for Surgery arranges a series of follow-up appointments through your recovery, scheduled around your procedure. These appointments are not optional. Their function is to catch complications early — when they are easy to manage — rather than late, when they are not.

Patients who skip follow-ups disproportionately present months later with problems that could have been addressed at the routine appointment. Conversely, patients with concerns between scheduled appointments should not wait: contact the clinic, or use the out-of-hours contact details given to you at discharge.

Signs of Complications After Plastic Surgery

• Sudden increase in pain not controlled by prescribed analgesics.
• Significant swelling, particularly asymmetrical (one side more than the other).
• Bleeding through dressings.
• Fever above 38°C.
• Increasing redness, warmth, or discharge around a wound.
• Calf pain, swelling, or warmth (DVT signs).
• Sudden shortness of breath, chest pain, or coughing up blood (pulmonary embolism signs — call 999).
• Any change in mental state or unusual symptom that doesn’t make sense.

Calling early is always preferable to waiting. Use the clinic number, or the out-of-hours contact details given to you at discharge.

Booking a consultation

To book a consultation, call 020 7993 4849 or use the contact form. We are based at 95–97 Baker Street, Marylebone. The specific risks of your planned procedure, and the strategies for minimising them, will be discussed in detail at consultation.

Related reading

• Essential preparations before your plastic surgery
• How long is recovery after cosmetic surgery?
• Factors that influence your cosmetic surgery results
• Breast Implant Removal vs Replacement
• Is It Possible for a Woman to Have Smaller Scars after Breast Augmentation?

References

Sources identified via PubMed. Each entry links to the original paper.

1. Bamba R, Gupta V, Shack RB, Grotting JC, Higdon KK. Evaluation of diabetes mellitus as a risk factor for major complications in patients undergoing aesthetic surgery. Aesthetic Surgery Journal 2016;36(5):598–608. doi:10.1093/asj/sjv241
2. Sørensen LT. Wound healing and infection in surgery. The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis. Archives of Surgery 2012;147(4):373–383. doi:10.1001/archsurg.2012.5
3. Gupta V, Winocour J, Rodriguez-Feo C, Bamba R, Shack RB, Grotting JC, Higdon KK. Safety of aesthetic surgery in the overweight patient: analysis of 127,961 patients. Aesthetic Surgery Journal 2016;36(6):718–729. doi:10.1093/asj/sjv268
4. Hardy KL, Davis KE, Constantine RS, Chen M, Hein R, Jewell JL, et al. The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases. Aesthetic Surgery Journal 2014;34(4):614–622. doi:10.1177/1090820X14528503

Centre for Surgery · CQC-regulated · GMC-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 020 7993 4849 · Book a consultation · Finance available, subject to status