A conversation that should happen openly
Risks and complications are part of every cosmetic surgery decision. The point of the conversation at consultation is not to put the patient off — it is to give them the information they need to make a clear decision with realistic expectations.
This article walks through the general risks that apply across cosmetic procedures, the procedure-specific risks that apply to the operations performed at this practice, and the questions that are worth asking at the consultation.
The general risks that apply to all surgery
Every surgical procedure, cosmetic or otherwise, carries a set of general risks. These apply across operations and across practitioners. They are not specific to cosmetic surgery, but they apply to it.
Bleeding
Some bleeding is normal during any surgery. Significant bleeding is uncommon in elective cosmetic surgery performed under standard conditions. Risk factors include the use of certain medications and supplements (which is why pre-operative review of medications is part of every consultation), and individual variation in clotting.
In practice: prescribed pre-operative instructions usually include guidance on which medications and supplements to pause. Following these reduces the bleeding risk.
Infection
The skin is normally an effective barrier against infection. Surgery breaks that barrier. Infection risk is reduced by:
- Sterile surgical technique
- Antibiotic prophylaxis where appropriate
- Recognised facility standards
- Patient adherence to post-operative wound care instructions
Most infections are minor, presenting as redness, warmth, or discharge at the wound site, and are managed with antibiotics. Deeper or more significant infections are uncommon but possible.
Anaesthesia complications
Modern anaesthesia is generally safe when performed by an appropriately credentialled anaesthetist in a recognised facility. Risks vary with the anaesthesia type:
- Local anaesthesia — lowest-risk; allergic reactions are uncommon
- Twilight sedation — low-risk; cardiovascular monitoring is standard
- General anaesthesia — higher-risk but well-managed in a recognised facility; risks vary with patient health, age, and medical conditions
A separate anaesthesia consultation is part of the pre-operative process for most procedures. Patients with significant medical conditions (heart disease, severe asthma, sleep apnoea, certain medications) may need additional pre-operative review.
Scarring
Every surgery leaves a scar. The placement, length, and appearance of scars depend on:
- The procedure (some procedures have shorter scars than others; brachioplasty has long scars; upper blepharoplasty has well-concealed scars)
- The incision placement (placed in natural creases where possible)
- Individual healing tendency (some people scar more visibly than others, largely determined by genetics)
- Post-operative care (scar care guidance is provided after surgery)
Scars typically fade over 12 to 18 months but do not disappear. Scarring is a permanent feature of every surgery.
Asymmetry
Subtle differences between the two sides are common after any bilateral surgery (anything involving paired structures — both breasts, both eyes, both ears). Most asymmetry settles as swelling resolves. Significant asymmetry that requires revision is uncommon but possible.
Adverse reaction to medications
Pain relief, antibiotics, and any medications used during and after surgery carry their own risk of adverse reaction. Patients with known allergies should make these clear at consultation.
Deep vein thrombosis (DVT) and pulmonary embolism
Major surgery carries some risk of blood clot formation in the legs, which can travel to the lungs. The risk is lower in elective cosmetic surgery than in major emergency surgery, but it exists. Risk factors include the type of procedure, anaesthesia duration, patient mobility, certain medications, and individual factors. Standard precautions — compression devices during surgery, early mobilisation after — reduce this risk.
Unsuccessful outcome
Sometimes the result of surgery is not what the patient or practitioner had hoped. This can be due to healing variation, complications, or factors that could not have been predicted at consultation. The realistic-expectations conversation at consultation addresses this — no outcome can be guaranteed, individual results vary, and the possibility of an unsatisfactory result is part of the decision.
Revision surgery may be considered for some unsatisfactory results, but not all are amenable to revision and revisions carry their own risks.
Procedure-specific risks at this practice
Beyond the general risks, each procedure has its own specific risks. The procedure-specific risk conversation happens at consultation, but the headline risks are:
Blepharoplasty (eyelid surgery)
- Lagophthalmos (incomplete eyelid closure) — usually mild and temporary, persistent is uncommon
- Ectropion (outward eversion of the lower lid) — more associated with lower blepharoplasty without canthal support
- Chemosis (conjunctival swelling) — usually resolves
- Dry eye — common in first weeks, persistent in patients with pre-existing dry-eye disease
- Lower-lid retraction — serious but uncommon
See the eyelid surgery practice page for the full anatomy and complication taxonomy.
Otoplasty (ear surgery)
- Asymmetry between the two ears
- Suture extrusion or partial recurrence of prominence
- Skin necrosis behind the ear (rare)
- Hypertrophic scarring at the incision site (more common in patients with a tendency to keloid)
Breast reduction (reduction mammaplasty)
- Changes in nipple sensation, sometimes permanent
- Difficulty breastfeeding in the future
- Wound-healing difficulties, particularly at the T-junction in anchor patterns
- Significant scarring (permanent)
- Loss of the nipple-areola complex (uncommon but serious)
Breast lift (mastopexy)
- Similar to breast reduction
- Scar pattern depends on the degree of ptosis being corrected
- Result settles over 3 to 6 months
Breast implant removal (explantation)
- Loss of breast volume, often more than the patient anticipates
- Asymmetry between sides
- Skin laxity that may benefit from a same-time or delayed lift
- Capsule-related issues during removal
Nipple reduction
- Changes in nipple sensation
- Effect on future breastfeeding ability
- Asymmetry between sides
Inverted nipple correction
- Partial recurrence (particularly grade 3)
- Effect on future breastfeeding ability
- Asymmetry between sides
Brachioplasty (arm lift)
- Permanent, visible scarring — the defining feature of the procedure
- Scar widening or thickening
- Seroma (fluid collection)
- Temporary or permanent numbness along the inner arm
Liposuction
- Surface irregularities or waviness
- Asymmetry
- Temporary or permanent numbness
- Seroma
Each of these has a fuller explanation on the relevant practice page, and the procedure-specific risk conversation at consultation goes into detail with rough frequency framing based on Dr Konrat's clinical experience.
What "rough frequency" means
When practitioners discuss complication frequency, exact percentages are rarely available. Cosmetic surgery is not subject to the same large-scale registry-based data that some specialist surgical fields publish. Frequency framing is usually clinical:
- Common — seen regularly in practice (often in 1 in 10 to 1 in 4 patients for some categories)
- Uncommon — happens sometimes but not regularly (around 1 in 20 to 1 in 100)
- Rare — possible but not seen often (less than 1 in 100)
Frequency depends on the procedure, the patient's individual factors, the practitioner's experience, and the facility. Asking the practitioner to characterise the frequency they have seen in their own practice is reasonable, and a clear answer should be available.
What questions to ask at consultation
A clear consultation will cover the risks proactively, but specific questions worth asking:
- "What are the specific risks of this procedure?"
- "How often do you see each of these in your practice?"
- "What would constitute an unsuccessful outcome for this procedure?"
- "What would you do if [specific complication] happened to me?"
- "How is revision surgery handled if I am not satisfied with the result?"
- "Are there factors specific to me that increase my risk of any of these?"
- "What can I do before or after surgery to reduce these risks?"
- "If something serious went wrong, what is the escalation pathway?"
These are appropriate questions and the consultation should welcome them, not deflect them.
Why informed consent is more than a signed form
The AHPRA framework around cosmetic surgery — the GP referral, the two consultations, the cooling-off period — exists specifically so that consent is genuinely informed, not just signed.
Informed consent means:
- You have received the relevant information
- You have understood it
- You have had time to reflect on it
- You have had the opportunity to ask questions
- You have made the decision without pressure
- You can change your mind at any point before surgery
A signed consent form at the end of this process is the documentation of the conversation. It is not the consent itself.
When the conversation about risks is enough
If you have read this article and you can articulate the general risks, the procedure-specific risks for the operation you are considering, what realistic outcomes look like, and what you would do if a complication occurred — you have done meaningful preparation for the consultation.
The consultation builds on this with the practitioner-specific information: how often they see each complication in their own practice, how they would manage each, what to expect from their post-operative support, and what their experience is with the specific procedure you are considering.
For more on what the consultation involves, see the cosmetic surgery consultation walkthrough and the practice's general risks page.