Aesthetic surgery, like any medical intervention, involves certain risks and potential complications. These range from general systemic issues such as anesthesia and clotting to procedure-specific concerns like hematoma (blood accumulation), infection, tissue healing problems, or implant-related conditions. A successful aesthetic surgery process requires meticulous planning, personalized risk assessment, and the implementation of evidence-based safety protocols to minimize the likelihood of these potential complications. This modern and informed approach forms the foundation for safely achieving aesthetic goals by managing possible issues, placing patient safety at the center of everything.

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What Should You Expect During the Anesthesia Process and What Are Its Risks?

The vast majority of aesthetic surgeries are performed under general anesthesia. This is a controlled and deep sleep state designed to ensure that you feel nothing, remember nothing, and remain completely comfortable throughout the operation. Thanks to modern anesthesia methods and medications, this process has become quite safe. However, the most important link in the safety chain is you. For your anesthesiologist to do their job in the best possible way depends on the information you provide—namely, complete honesty.

This is a team effort, and you are the most important player. There are certain conditions that can affect how your body responds to anesthesia. Providing incomplete or incorrect information can jeopardize the entire process. For example, if you regularly consume alcohol or use different substances, your body’s requirement for anesthetic drugs changes. Failure to share this information may result in inadequate anesthesia depth and unwanted situations.

Similarly, even seemingly harmless herbal supplements or simple painkillers can interact dangerously with anesthetic drugs. A seemingly simple detail like when you last ate before surgery directly affects the life-threatening risk of stomach contents entering your lungs. Therefore, sharing every detail during your consultation with the anesthesiologist is of vital importance.

The most essential information you should share includes:

All past or current health problems
Your previous surgeries and anesthesia experiences
Whether there is any known anesthesia-related issue in your family
All prescription and over-the-counter medications you use
Vitamins, herbal teas, and all other supplements
Your allergies (medication, food, latex, etc.)
Your habits regarding smoking, alcohol, or other substances
When and what you last ate and drank

Remember, this information serves as a shield for your safety. Thanks to modern approaches such as Enhanced Recovery After Surgery (ERAS) protocols, surgical stress is minimized, fewer narcotic painkillers are used, and you recover much faster. The success of these protocols also relies on the honest and transparent relationship we establish with you before surgery.

What Is the Risk of “Blood Clots” (Thrombosis) After Surgery and How Is It Prevented?

One of the most concerning yet largely preventable serious risks in the postoperative period is Venous Thromboembolism (VTE). This usually involves a blood clot forming in the deep veins of the legs (Deep Vein Thrombosis—DVT) dislodging and traveling through the bloodstream to the lungs, where it blocks a vessel (Pulmonary Embolism—PE). This is a life-threatening emergency.

Not every patient has the same clotting risk. To determine this risk on an individual basis, we use a scientifically validated risk assessment system called the “Caprini Score.” This system calculates a risk score by considering both your personal factors and the characteristics of the planned surgery.

Some key risk factors considered in the scoring include:

Your age
Your Body Mass Index (BMI)
Your smoking status
Use of birth control pills or hormone therapy
A personal or family history of clotting disorders
Previous DVT or PE
The type and duration of the surgery

Based on the score, a personalized prevention plan is created. This is a completely individualized safety approach, far from a “one-size-fits-all” mentality.

Very Low-Risk Patients: In this group, simply beginning to walk as soon as possible after surgery is usually sufficient.
Low-Risk Patients: In addition to early ambulation, special compression stockings or intermittent pneumatic compression (IPC) devices that massage the legs intermittently to support blood circulation are used until discharge.
Moderate-Risk Patients: Use of IPC devices is mandatory. Additionally, low-dose blood-thinning injections may be considered (typically starting 12 hours after surgery).
High-Risk Patients: In this group, both IPC devices and blood-thinning injections are mandatory. Anticoagulant therapy usually starts 6–8 hours after surgery and continues for at least a week, sometimes longer.

Thanks to this scientific and systematic approach, we can largely keep serious risks such as clotting under control.

What Is the Most Common Complication in Facelift Surgery?

Although facelift surgeries deliver wonderful rejuvenation results, they have their own specific risks. The foremost among these is hematoma, that is, blood accumulation in the surgical area.

A hematoma typically occurs within the first 24 hours after surgery and is a surgical emergency. It presents with sudden swelling, pain, and bruising. If not controlled, it can impair blood supply to the stretched skin, leading to tissue damage, and in rare cases, serious problems that may even press on the airway.

Some important factors that increase the risk of hematoma include:

Uncontrolled high blood pressure
Male sex (male tissue tends to be more vascular)
Use of blood-thinning medications or supplements such as aspirin or fish oil
Smoking and nicotine use
High body mass index

To minimize this risk, we implement a multi-layered prevention strategy. We monitor and control your blood pressure very closely before, during, and after surgery. During the operation, we use special methods—such as the “second-look” technique—to identify and control even small vessels that may bleed after the vasoconstrictive effect of local anesthesia wears off. This is akin to a master chef giving everything a final check before serving. When necessary, we also use medications that support coagulation to reduce this risk to a minimum.

Other potential risks in facelift surgery include nerve injury (usually temporary sensory or motor deficits) and skin necrosis (tissue death). The biggest and most preventable cause of skin necrosis is nicotine. A patient who uses nicotine has a 12.6-fold higher risk of this complication compared to a non-user. Therefore, nicotine use is an absolute contraindication for this surgery.

What Complications Can Occur in Rhinoplasty?

Rhinoplasty is perhaps the most delicate and complex operation in aesthetic surgery, because the goal is not only to beautify the nose but also to preserve—and even improve—healthy breathing function. Complications often arise from disruption of the structural integrity—the “roof” or “skeleton” system—of the nose.

You can liken this surgery to constructing a building. Just as a building with a weak foundation and load-bearing columns will crack and collapse over time, a nose with weakened structural supports can deform over time.

The most common structural issues include:

Tip ptosis (drooping of the nasal tip)
“Pollybeak” deformity
Inverted-V deformity on the nasal dorsum
Saddle nose deformity (collapse of the nasal bridge)

In addition to these aesthetic concerns, functional problems such as difficulty breathing may occur. Sometimes the desired outcome may not be achieved after the first surgery, or minor irregularities may appear over time. In such cases, a second corrective procedure—revision surgery—may be necessary. Revision rates range from 5% to 15%, most commonly due to aesthetic concerns related to the nasal tip. Therefore, the fundamental philosophy in rhinoplasty is to achieve a long-lasting, aesthetic, and functional result by preserving and strengthening the structural integrity of the nose.

Are There Implant-Related Complications in Breast Augmentation?

Breast augmentation is one of the most commonly performed aesthetic surgeries worldwide. However, the presence of an implant—a foreign body—confers a unique complication profile. These issues may require a secondary surgery (revision) during the patient’s lifetime.

The most frequent implant-related problems are:

Capsular Contracture
Implant Rupture
Implant Malposition (Displacement)

Capsular contracture is the most common cause of revision surgeries. Our bodies naturally form a thin, soft membrane (capsule) around every implanted foreign object. Capsular contracture is, in a sense, an “exaggerated” response of this normal healing process. The capsule thickens pathologically, hardens, and compresses the implant, leading to distortion in breast shape, firmness, and pain.

Implant malposition is when the implant shifts from its intended location.

This can present in different ways:

Implant descent (bottoming out)
Implants meeting in the midline (symmastia)
Upward migration of the implant
Lateral displacement of the implants

The surgical plane in which the implant is placed (submuscular or subglandular) directly affects these risks. This is not a “good or bad” choice but a trade-off decision. For example, the submuscular plane reduces the risks of capsular contracture and implant visibility/palpability, but increases the risks of postoperative bleeding (hematoma) and animation deformity (breast shape distortion with muscle movement). The subglandular plane reduces the risks of hematoma and animation deformity but increases the risks of capsular contracture and, especially in thin patients, rippling (palpable/visible implant edges). The decision is made together after discussing all these pros and cons, taking into account your body type, expectations, and lifestyle.

Do Body Contouring Surgeries (Liposuction, Abdominoplasty) Have Risks?

Liposuction and abdominoplasty are highly effective for defining body contours and achieving a fitter appearance. However, because large areas are treated, these procedures also carry their own specific risks:

The most common aesthetic issue after liposuction is contour irregularities. Waves, depressions, or asymmetries may appear on the skin surface. This risk is more pronounced in individuals with poor skin elasticity.

One of the most frequent complications after abdominoplasty is seroma, that is, fluid accumulation in the surgical field. This is the accumulation of inflammatory fluid in the space between the abdominal muscles and the elevated skin flap. Seroma management is based on a principle of graduated intervention.

The steps followed in seroma management are:

Prevention: Placing drains during surgery to close this potential space and using compression garments postoperatively are the most important preventive steps.
Observation: Small, asymptomatic seromas are often reabsorbed by the body over time and are simply monitored.
Needle Aspiration: If the fluid volume is high or causing discomfort, it can be simply aspirated under sterile conditions with a needle. This may be repeated several times.
Surgical Intervention: Very rarely, recurrent seromas that form a thick capsule around them or become infected may require a minor surgical procedure.

What Personal Risk Factors Affect Surgical Success?

Even a technically flawless surgery can lead to undesirable outcomes if the patient is not the right candidate or has certain risk factors. Therefore, risk management begins the moment we first meet you. While some risk factors are non-modifiable, many can be controlled with your effort.

Chief among these is nicotine use. Nicotine does not only mean cigarette smoke. All forms—such as e-cigarettes, nicotine patches, and nicotine gum—are the number one enemies of plastic surgery. By causing intense vasoconstriction, nicotine critically reduces the amount of blood and oxygen reaching the surgical site. Tissues that need oxygen and nutrients to heal are effectively “starved.” Nicotine is also toxic to cells involved in wound healing and triggers the formation of small clots. A patient who uses nicotine and undergoes a facelift has a 12.6-fold higher risk of tissue death (necrosis) than a non-user. Therefore, completely eliminating all nicotine products at least 4–6 weeks before surgery and for at least 4 weeks after surgery is a non-negotiable rule for the safety of your operation.

Other important risk factors include obesity (high Body Mass Index). Obesity slows wound healing, increases the risk of infection, and raises the risk of clotting. It should be remembered that procedures such as liposuction or abdominoplasty are not weight-loss methods but body-contouring surgeries. For ideal results, the goal is to undergo these surgeries at or near your ideal weight.

Finally, combined surgeries—performing more than one procedure at the same time—offer advantages such as a single anesthesia and a single recovery period, but they also increase risks due to longer anesthesia time and the additional physiological stress on the body. Not every patient is a suitable candidate for combined surgeries. This decision is made after a detailed evaluation of your overall health status.

Why Are Psychological State and Expectations So Important in Aesthetic Surgeries?

Success in aesthetic surgery is not measured solely by the result you see in the mirror. How satisfied you are with that result and how you feel are at least as important as technical success—sometimes even more so. Therefore, one of the most critical parts of the preoperative evaluation is understanding your psychological state and expectations.

Sometimes individuals may experience a condition called Body Dysmorphic Disorder (BDD). This is when a person becomes fixated on a very minor flaw—or an imagined one—that is not noticeable to others, shaping their entire life around it. The prevalence of this condition is quite high among those seeking aesthetic surgery. Surgery is not a solution for someone experiencing BDD, because the problem lies not in the body but in perception. Even if they undergo surgery, such individuals are almost never satisfied with the result, and their fixation shifts to another body area.

As surgeons, our duty is to detect this condition and guide the person appropriately. There are some signs that may raise suspicion for BDD:

Excessive focus on a very minor or imagined flaw
Unrealistic expectations that surgery will solve all life problems
A history of numerous aesthetic procedures that consistently end in dissatisfaction
Repeatedly rejecting the surgeon’s professional opinions and recommendations

In such cases, halting the surgical plan and referring the individual to a mental health professional is the best approach for both patient and physician.

For psychologically healthy and suitable candidates, setting expectations on a realistic foundation is crucial. Remember, aesthetic surgery is not a magic wand. It aims for “better,” not “perfect.” You should know that swelling, bruising, and discomfort in the first days after surgery are temporary, and patience is required to see the final result. Sometimes this temporary feeling of “buyer’s remorse” occurs—and when you are prepared for it, it is easier to get through. The open and honest communication we establish with you will allow us to set realistic expectations and achieve the highest level of satisfaction with the outcome.

Dr. Erman Ak

Op. Dr. Erman Ak who is one of the best cosmetic and plastic surgeon in Turkey, completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.