Part 3: Pain, Anesthesia, Scarring, and Instruments in Cosmetic Surgery

★Is cosmetic surgery very painful?

The mere mention of surgery conjures up images of incisions and pain. However, in cosmetic surgery, even procedures performed without incisions, such as double eyelid surgery (using sutures), dimple creation (using sutures), and correcting protruding ears (using sutures), require anesthesia to ensure optimal results. If the patient is groaning in pain during surgery, it will affect the doctor's mood, and rushing the procedure often leads to adverse consequences. Therefore, the method and effectiveness of anesthesia are key considerations for doctors when designing surgical procedures.

Of course, it's impossible for surgery to be completely painless. There's only a slight pain when the local anesthetic is injected, similar to an intramuscular injection in the buttocks. The pain disappears once the anesthetic is administered. During surgery, sometimes touch and pain sensations are separated; you may feel touch but not pain. After surgery, as the anesthetic gradually wears off, and with the help of bandages, the pain is limited. Sensitive patients can easily get through the pain by taking painkillers.

★Does anesthesia affect the brain during cosmetic surgery?

The vast majority of patients undergoing cosmetic surgery are young and middle-aged women, whose requirements for anesthesia safety are much higher than those for ordinary surgery. Since the surgical sites are mostly on the surface of the body, where sensation is highly sensitive, local anesthesia is more common, and muscle relaxation and deep general anesthesia are generally not required.

The principles for selecting local anesthetics in cosmetic surgery are: safety, high efficacy, and low toxicity. Anesthetics that may cause allergic reactions are generally avoided. Drugs with rapid onset, strong penetration, wide diffusion, and low toxicity are typically used. These drugs are generally metabolized in the liver and, within safe dosage ranges, will not affect the central nervous system, i.e., the brain's memory, thinking, or reaction abilities. Even when intravenous anesthetics are chosen, their effects are rapid and short-lived, selectively inhibiting the brain's association nerves and the thalamus's projections to the neocortex; therefore, consciousness remains partially preserved, and pain sensation is clearly and completely eliminated. The anesthetic effect wears off completely, leaving no sequelae or discomfort.

For major surgeries, an anesthesiologist should be consulted to guide or perform the procedures.

Will cosmetic surgery leave unsightly scars?

In general surgery, the primary focus is on relieving the patient's pain and removing the cause of the disease. The incision must be easy to operate, with maximum exposure of the surgical field to meet the surgical requirements and facilitate postoperative dressing changes. Therefore, the incision location and scar management are not the main concerns, often leading to disagreements with patients. Cosmetic surgery, however, presents the opposite situation. Both doctors and patients are highly concerned about the location and size of the incision and the postoperative scarring. When the surgical requirements permit, incisions are chosen at the hairline, in skin folds, or hidden under clothing. Due to the use of specialized cosmetic surgical instruments, the required incision length is very short, and doctors perform scar-free procedures to minimize surgical traces. Surgical incisions are necessary to ensure surgical results and prevent scarring. Sharp, clean edges and careful suturing minimize scarring. Some surgical incisions are only 3-4 mm in size and designed in concealed locations; these can be called scarless incisions. Because scarless incisions require a high level of skill, not all doctors can achieve this. Some non-incision methods can leave many irregular scars on the body, which are very difficult to repair. Among all surgeries, liposuction has the smallest incision, and the main surgical layer is in the subcutaneous fat layer. With careful handling by the doctor, it generally does not leave unsightly scars after the operation.

★Are there any special features to cosmetic surgery instruments?

The nature of cosmetic surgery dictates that it requires the use of precise, efficient, easy-to-use surgical instruments that cause minimal tissue damage. For example, the sutures used are only a fraction of the thickness of a human hair, and combined with the surgeon's precise suturing techniques, surgical scars can be minimized, and even scarless results can be achieved.

Some imported surgical instruments are suitable for large Caucasians, but not necessarily for smaller Asians. Some imported sutureless tapes allow Caucasians to heal quickly and without noticeable scarring after surgery, eliminating the need for stitches. However, they are not as effective for Asians. It seems that the selection of surgical instruments must be based on specific racial characteristics and racial differences.

★Are the side effects of cosmetic surgery serious?

The term "sequelae" generally refers to irreversible complications that occur after surgery. Due to the highly selective nature of cosmetic surgery, the possibility of serious sequelae is virtually eliminated. Before surgery, the surgical site, organ function, degree of surgical trauma, and possible temporary phenomena during the recovery period, such as the degree of pain after the anesthesia wears off, local motor impairment, minor bleeding, hematoma, numbness, and swelling of the skin, are all predicted and explained truthfully to the patient.

The most common side effect is scar hyperplasia at the incision site, which can usually be resolved with scar excision. As for the loss of facial expression after facelift surgery, surgery must be performed with the patient's consent. Moreover, this loss of expression will not have any serious impact, so there is no need to worry too much about serious side effects when undergoing cosmetic surgery.

★Are there any risks associated with cosmetic surgery?

Many things in daily life involve risks. Cosmetic surgery involves healthy individuals who have undergone all necessary preparations, making the likelihood of risks very small. However, like anything else in the world, cosmetic surgery is no exception; it also carries risks from unforeseen circumstances and human error.

Because cosmetic surgery involves aesthetic sculpting and enhancement on a healthy individual, it is subject to numerous interdependent factors. Besides uncontrollable factors, surgical accidents, anesthesia complications, unsatisfactory postoperative results, and other risks are all part of the risks. Unlike general surgery, where not undergoing surgery during an illness could be life-threatening, the risks of surgery remain the same-the outcome is unimaginable. In such cases, the priority is saving the patient's life; regarding surgical risks, doctors, patients, and their families generally share the same viewpoint. All procedures in cosmetic surgery inherently carry some degree of risk. The most common are potentially unsatisfactory results and possible complications. When you choose cosmetic surgery and sign the consent form, you indicate that you are prepared to accept the risks associated with it.

The only way to minimize the risks of cosmetic surgery is to objectively and correctly address one's dissatisfaction and carefully select a cosmetic surgeon with practical experience.

★What are the complications of cosmetic surgery?

The main complications after cosmetic surgery include hematoma, incision infection, and scar hyperplasia.

The main cause of hematoma formation is incomplete hemostasis by the surgeon during operation. Sometimes, during blind surgery, it is impossible to completely stop all bleeding points within the blind area, so pressure bandages are applied to the surgical site post-operatively. If the patient loosens the bandages themselves after surgery, hematomas can also occur, sometimes requiring a second surgery to remove the hematoma.

Infections occur when bacteria contaminate instruments and supplies within the surgical area, leading to bacterial growth and reproduction at the surgical site, with potentially serious consequences. In cosmetic surgery, the principles of "aseptic technique" must be firmly ingrained in the minds of every staff member. Almost all qualified cosmetic surgeons would never allow someone wearing makeup to enter the operating room while surgery is in progress.

Scarring is an inevitable result of wound healing and a new type of tissue that forms during the healing process. Unlike other surgical procedures, cosmetic surgeons and patients pay close attention to the extent of scarring, striving to avoid leaving any visible marks on the front of the face and strictly controlling any potential infections to prevent any trace from remaining.

Sometimes, the only way to determine whether someone has a tendency to form keloids is by relying on their medical history.