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Why Some Patients Cannot Have The Plastic Surgery They Want

Many patients underestimate the complexity of plastic surgery and the potential pitfalls of operating on the improper candidate.  For instance, some medical issues may have never been identified for that particular patient.  Sometimes a patient may have a particularly severe form of anemia that was not recognized before a routine lab test is administered.   This patient may have a severe iron deficiency anemia that does not respond appropriately to oral iron supplementation, even when those doses are maximized.  Iron infusions can be used if oral absorption is questioned, but even then some patients do not incorporate exogenous iron well enough to the heme molecule to elevate the hemoglobin levels to allow for a safe surgery.  This patient with lower hemoglobin levels will be more susceptible to any type of bleeding during surgery or any postoperative bleeding that occurs.  Some patients have more exotic types of anemia or abnormal hemoglobin components that prevent a safe surgery as well.

Some patients may have an anatomic abnormality that will prevent the surgery from occurring.  For instance, a large hernia encountered on exam or during surgery may have to be repaired before any type of liposuction or other excisional procedure like tummy tuck can be performed.  Some plastic surgeons will not repair hernias and will abort these cases.

History of deep venous thrombosis or pulmonary embolus is another reason why some plastic surgeons will not operate on a patient.  Some plastic surgeons will recommend against elective cosmetic procedure that involved general anesthesia.

Foreign material injections such as silicone, PMMA, hydrogel, or other biopolymers will prevent many plastic surgeons from operating on those individuals. Those individuals should definitely seek to have optimal removal of these injections before considering fat transfer or implant procedures.  In addition, these removal procedures are not trivial procedures and inevitably leave behind some foreign materials in addition to defects from the removal itself.  Placement of implants as in butt implants or fat as in BBL or Brazilian buttlift later will not be easy and will have higher complication rates and will require the most skilled of plastic surgeons to perform.