#64 – Zol Kryger, M.D.: Plastic surgery—common procedures, reducing risk, & picking the right doctor

Patients should ask about the surgeon's training background, how long they've performed the specific procedure, where they trained, and their hospital privileges for that procedure. It's also crucial to inquire about their complication rates, how complications are managed, and whether costs for follow-up care are included.

Capsular contracture is the most common long-term complication of breast augmentation, occurring in 2-8% of cases. It happens when the body forms abnormally hard scar tissue around the implant, squeezing it and causing pain or distortion. Bacteria are suspected as a primary cause.

ALCL (Anaplastic Large Cell Lymphoma) is a rare type of cancer linked to textured breast implants. It occurs in the capsule surrounding the implant and can invade breast tissue. Some textured implants carry a risk as high as 1 in 3,000, with no reported cases in smooth implants.

While the incidence of ALCL is low (1 in 3,000 to 1 in 10,000), women with textured implants should see their plastic surgeon at least once a year. They should monitor for signs like significant swelling or hardening of the breast. Regular MRI screenings and monthly self-exams are also advisable.

Smooth, round silicone implants are generally preferred due to a more natural look and feel, and a lower ALCL risk compared to textured implants. An incision underneath the fold of the breast is recommended over approaches through the armpit or nipple due to lower bacterial exposure and reduced risk of pain and numbness.

A tummy tuck removes excess skin and fat below the belly button and tightens stretched abdominal muscles. It's commonly done for postpartum women (95% of cases) to address changes like skin laxity, diastasis recti (muscle separation), or umbilical hernias that result from pregnancy.

The biggest risk is seroma, a fluid accumulation under the skin (10-15% incidence), usually requiring drainage. Bleeding is a smaller risk, especially in patients with larger blood vessels or uncontrolled blood pressure. Long-term, patients may complain about scars, recurrent loose skin, or sometimes a recurrent diastasis.

Liposuction can be dangerous, with severe complications like punctured lungs, liver, or intestines, even in thin patients, due to improper cannula usage. Other risks include electrolyte problems, volume overload, pulmonary edema, and lidocaine toxicity from excessive local anesthetic.

The Brazilian Butt Lift is extremely dangerous due to the high risk of fatal fat embolism. This occurs when fat, liposuctioned from one body part and injected into the butt, inadvertently enters veins and travels to the lungs. Autopsies of fatalities consistently show lungs full of fat.

A good plastic surgeon must discern whether a procedure will genuinely help the patient in a safe and ethical way. They might decline surgery for overweight patients seeking liposuction for weight loss or individuals with body dysmorphic disorder, advising counseling or lifestyle changes instead.

Even 'lunchtime procedures' carry risks. Fillers, particularly when injected near the eyes or eyebrows, can cause blindness if they enter an artery. Lasers and peels can lead to permanent pigment damage. Procedures like 'vampire facials' (PRP) have even been linked to HIV transmission due to unhygienic practices.