A significant number of dermatocosmetic procedures are associated with primary damage to the epidermis, dermis. Most of the complications that develop as a result of cosmetic interventions are non-specific and are formed both as a result of direct damage to the integrity of the skin, and as a result of the development of an inflammatory reaction.
In the article estet-portal.com you can read in detail the interview on the topic of the hottest questions regarding the occurrence of complications in the aesthetic field from objection specialist, facial plastic surgeon, neck lift specialist, humanitarian mission in Uganda (Africa) Robert Kesmarszky, Hungary-France.
What are the causes of complications in aesthetic medicine
R.K.: In fact, when it comes to the complications of fillers or other injectable products used in the middle third of the face, the key factors are of course the surgeon, surgical skills, training, which is extremely important, but also the product you use must be safe, non-carcinogenic, non-allergic, and the result of your procedure should be predictable with it.
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The role of the patient is also important, the quality of his skin and tissues, his psychological characteristics, smoking, physical activity and some external factors such as temperature must be taken into account.
The role of the media is an external factor, because the Internet, newspapers, TV channels push some people towards the operation.
What is your personal experience with complications
R.K.: Fortunately, I haven't had any complications so far and I hope I won't have any. But, of course, it depends not only on luck, but also on skills. Personally, I did anatomical studies to learn the skills of finding the right points, structures, nerve processes, vessels, and how to avoid fragile structures.
I also attend case presentation events, which is very important for a medical practitioner.
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In fact, in case of complications, the most important — it is a frank communication with patients, you should tell them what happened, what you are going to do, how to help them, and if there is no way to help them, you should inform the patients about it in a very humane way.
And if the communication with the patient is decent, he will understand the procedure, the situation, and this is very important for the quality of life and adaptation to this new situation. Apart from surgery, the role of the medical practitioner is to provide psychological care to the patient, which may require a network of specialists such as general surgeons, plastic surgeons, psychologists, and others.
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What complications should the specialists pay attention to
R.K.: Complications can be classified as acute or chronic, immediate or late, and also depending on localization: local, regional, remote and general. Complications are not so frequent, they are rare, but they can be very serious, such as blindness, stroke, necrosis, and others.
Blindness and neurological complications are very acute and unforeseen complications. Statistically, they are very rare, but if this happens, you must be vigilant and act immediately.
So you should have some products in your office near you, such as hyaluronidase, and also have contacts with a neurologist, an ophthalmologist. And colleagues should be able to come almost immediately, because in case of blindness, a delay of up to 1 hour can lead to losing the chance of saving vision.
Is it possible for a doctor to insure against a mistake
R.K.: I wouldn't say we should call it a "mistake" because the anatomy of the — it's something special, and the rule is that "there are no rules in anatomy." So the vessels can be in different regions, closer to the skin or deeper. This is not necessarily a surgical error, it could be an unforeseen accident.
This is why you must inform the patient of the risk of complications using written consent before acting.
A detailed medical history of the patient should be taken prior to intervention, including pregnancy, breastfeeding, allergies, smoking, medication (some medications may increase the chance of bleeding).
Thank you for staying with estet-portal.com. Read other interesting articles in the "Experts" section. You might be interested in Tracking the Mistakes: Complications of Contouring
What are the reasons for the occurrence of complications in aesthetic medicine
RK: Actually when speaking about complications of fillers or other injecting products in the middle face, several factors must be considered, such as the surgeon, surgical skills, training that are very important, but also the product that you use must be safe and respond to several criteria like not being cancerogenic, not provoking allergy and having an estimable result of the procedure.
Also, the patient related factors, like the quality of the skin and the tissues, the psychological characteristics, smoking, physical activity; and some of external factors like temperature must be considered. The role of the media is also an external factor because the internet, papers, TV channels push some people to the surgery.
What is your personal experience of complications
RK: Luckily, I did not have any complications till now and I hope I will not have any. But of course, it depends not just on the chance but on the training. Personally, I used to do anatomical dissections to coach the skills how to find the right points, structures, branches of the nerves and vessels, how to avoid damageable structures. Also, I attend events providing up-to-date knowledge with a clinical approach which is very important for a practitioner. Also, when you are selecting the products and instruments, choose the best from the reliable resources.
Actually in the case of a complication the most important thing is a communication, to be honest with patients, to tell them what has happened, what you intend to do, how can you help them in a very humanistic way. And if the communication with the patient is good, he will understand the procedure, situation, which is very important for the quality of life and adaptation to this new situation.
Besides of the surgery, the role of the practitioner is to provide psychological assistance to the patient, which may require a network of specialists like general surgeons, plastic surgeons, psychologists and others.
What complications should be focused on
RK: The complications can be categorized at acute or chronic, immediate or late, also according to the localization: local, regional, distant and general.
The complications are not so frequent, they are rare, but they can be very serious like blindness, stroke, cutaneous necrosis and other.
Blindness and neurological complication are very acute and unforeseen complications. Statistically they are very rare but if it happened, you must be vigilante and act immediately. So, you must have some products in your office by your side, like hyaluronidase and also have contacts with neurologist, ophthalmologist. And these colleagues should be able to come almost immediately, because in case of blindness a delay can lead to loosing of chance to protect the vision.
Is it possible for a doctor to insure against a mistake
RK: I would not say that we should call it "mistake", because anatomy is something very special and the rule of the facial anatomy is that "There is is no rule", meaning that the structures can be in different regions, close to the skin or deeper.
So, it is not necessarily a surgical mistake, it can be an unforeseen accident. That is why the physician must be well trained, foresee the anatomical variations and complications and be able to act promptly and correctly if they occur. As well, before acting, you must inform the patient about the risk of complication using a written consent.
Before the intervention you must take a detailed history of the patient, including pregnancy, breast feeding, allergies, smoking, medications (some medical products may raise the chance of hemorrhages).
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