Why there are no numbers on this page
Anyone reading about surgery wants to know how likely something is. It is the natural question and we are not going to answer it with an invented figure.
The reason is that reliable, comparable, published complication rates for cosmetic surgery in the United Kingdom largely do not exist. The sector is fragmented across many independent providers. Outcome reporting is not mandatory and not standardised across it. Denominators are unknown, because nobody publishes how many of each operation were performed. Complications treated in the NHS after private surgery are not systematically linked back to the provider.
Figures do exist in the international literature, and they vary enormously with the population studied, the definitions used, the operation, the setting and the surgeon. Applying a number from one context to your operation is not information. It is decoration.
What can be stated without inventing anything is which complications occur, what each one does, which are serious and which are permanent. A number without a source and a denominator tells you nothing, and a surgeon who offers one should be asked for both.
Category one: complications that can kill
These are the ones that determine where an operation should be performed and by whom.
Venous thromboembolism. A clot forming in a deep vein, which can travel to the lungs. It is the complication most associated with death after elective cosmetic surgery, and it is the one with a national framework for assessment and prevention. Covered in full at venous thromboembolism and body contouring.
Fat embolism. Fat entering the circulation and travelling to the lungs or brain. Relevant to liposuction and much more relevant to fat grafting, particularly at the gluteal site, as discussed at gluteal fat grafting.
Anaesthetic complications. Airway problems, aspiration, cardiac and respiratory events. These are the reason the facility, the anaesthetist and the recovery staffing matter, as set out at anaesthesia and the setting.
Local anaesthetic systemic toxicity. Too much local anaesthetic reaching the circulation, affecting the nervous system and the heart. Specific to techniques using large-volume infiltration.
Major haemorrhage. Uncommon in well-conducted cases and a reason facilities must be equipped to manage it.
Severe infection. Including deep tissue infection and, rarely, sepsis. Any spreading redness, fever or rapidly increasing pain is an emergency rather than something to mention at the next appointment.
Category two: complications that permanently change how you look
These rarely appear in marketing and are the ones most likely to affect how you feel about the decision for years afterwards.
Contour irregularity. Ridges, grooves, dents and waviness from uneven removal. Difficult to correct, as discussed at cannulas and access.
Over-resection. Too much removed, leaving a hollow. Harder to correct than almost anything else in this field, because the correction requires putting material back into scarred tissue.
Skin adherence. Skin healing down onto deeper tissue, producing a fixed dent that moves with the muscle.
Asymmetry. Between sides, or between a treated and untreated area.
Revealed laxity. Skin that will not retract into the reduced space, leaving a looser appearance than before.
Poor scarring. Widened, thickened, keloid, pigmented or malpositioned scars, covered at scarring after body contouring.
Skin necrosis. Death of skin from compromised blood supply, leaving a scar considerably worse than the intended one.
Fat necrosis. In grafted areas, producing firm lumps, oil cysts or calcification.
Category three: complications that change how you feel or function
Altered sensation. Numbness, hypersensitivity, tingling or nerve pain in the operated area. Some resolves and some is permanent. This is among the least discussed and most commonly experienced consequences, particularly after abdominoplasty, where numbness above the scar is usual.
Chronic pain. Uncommon but recognised, and difficult to treat.
Persistent swelling. Particularly where lymphatic drainage has been disrupted, as in arm surgery.
Seroma. Fluid collection requiring repeated drainage, sometimes over weeks. Covered at seroma and contour irregularity.
Restricted movement. From scar contracture or tightness, most relevant around joints.
Wound breakdown. An open wound requiring dressing for weeks or months, most common in long closures under tension.
Category four: the psychological complications
These belong on the list because they are real, are common, and are almost never mentioned in a consultation.
Regret. Recognised across elective aesthetic surgery, and more common where the decision was made under pressure, at speed, at a difficult time, or with expectations that surgery could not meet.
Persistent dissatisfaction with a technically good result. Where the underlying concern was not the one the operation addressed.
The low period during recovery. Common in the second and third weeks, usually resolving as swelling settles.
Displacement. Where a resolved concern is replaced by a new one, sometimes repeatedly. This pattern is a reason for careful assessment before further surgery rather than for more of it.
Professional guidance requires doctors to consider a patient's psychological needs and expectations before cosmetic surgery, and to consider whether surgery is appropriate at all. A surgeon who asks why now, and listens, is meeting that standard.
How to have this conversation properly
The question "what are the risks" produces a recitation. Better questions produce information.
- What is the worst thing that could happen to me from this operation?
- What is the most likely complication in your own practice, and what do you do about it?
- Which of these complications is permanent?
- What would a poor result look like on my body specifically?
- How often do you have to take someone back to theatre, and for what?
- Who treats me if this happens at two in the morning?
- What would make you decline to operate on me?
The GMC's consent guidance places the responsibility for this discussion on the doctor and requires that material risks be discussed in terms relevant to you. You are not being awkward by asking. You are participating in a process that is supposed to work this way.
Keeping this in proportion
A list of complications read in one sitting is frightening, and it should be read for what it is: a description of what is possible, not a prediction of what will happen. Most people who have body contouring surgery in a properly registered facility with an appropriately trained surgeon recover without a serious complication.
What the list is for is the decision. Elective surgery on a healthy body is a trade: a possible improvement in appearance against a real possibility of harm, some of which cannot be undone. Knowing what sits on the other side of that trade is what makes the decision yours.
And the option of not making the trade remains open at every point, which is the subject of deciding not to proceed.