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.
The complications worth understanding
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. Lower with modern textured surfaces, smaller pockets, and meticulous theatre technique.
- 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.
Patient-side factors that materially reduce risk
Stop smoking and all nicotine products
The single highest-impact intervention available to most patients. Nicotine constricts blood vessels, reducing tissue oxygenation by 30 to 40%. The downstream effects are substantially higher rates of wound dehiscence, skin necrosis, infection, and impaired scar quality.
Centre for Surgery requires complete cessation of smoking, vaping, and nicotine replacement products for at least six weeks before surgery and six 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. The largest published aesthetic surgery dataset (127,961 patients, Gupta et al., 2016, Aesthetic Surgery Journal) found that overweight (BMI 25-29.9) and obesity (BMI ≥ 30) are both independent risk factors after controlling for other variables. 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. Abstinence for two weeks before and two weeks after surgery is the appropriate baseline; longer for major body procedures. 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 with inadequate support consistently have more complications and worse satisfaction. See essential preparations before your plastic surgery.
Surgeon and facility factors that reduce risk
Choose a properly qualified surgeon
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 are not vanity credentials — they correlate directly with complication rates. 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
Operating time over 6 hours is associated with materially higher complication rates — VTE risk doubles, infection risk rises, and anaesthetic complications accumulate. 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.
Specific procedure-related risk reduction
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.
Sun protection — the long-tail factor
UV exposure on immature scars produces hyperpigmentation that does not fade. 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.
Attending follow-ups
Centre for Surgery’s standard follow-up schedule is day 1, week 1, week 3, week 6, three months, six months, and twelve months for most procedures. 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 — our 24/7 nurse-led aftercare line covers the first six weeks, and patient coordinators can arrange a clinical review at any point thereafter.
Warning signs that warrant immediate contact
- 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. The 24/7 aftercare line is for exactly this purpose.
Booking a consultation
To book a consultation, call 0207 993 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
Centre for Surgery · CQC-regulated · GMC specialist-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 0207 993 4849 · Book a consultation · Finance from 0% APR
