Symptoms after surgery that mean you should contact the clinic right away

Normal recovery versus warning signs

For the first few days after surgery, swelling, bruising, and a dull, aching pain are common, and they usually ease little by little over time. What should concern you is when symptoms that were improving suddenly get worse, when one side becomes unusually severe, or when a new symptom appears that was not there at first.

A review of infection prevention in facelift surgery said that complications of this surgery are rare, but once they occur, they can be a difficult experience for both the patient and the surgeon ^[6]. Rare does not mean that they never happen, so it helps to know in advance which signs mean you should get in touch.

Sudden swelling and pain: hematoma

A hematoma is a collection of blood inside the surgical site. A systematic review of 48 papers published from 1975 to 2020 said that hematoma is still the most common complication after a facelift ^[1]. Various methods have been used to prevent it, including tissue glues, medications given around the time of surgery, and controlling bleeding and placing drains during surgery, and the authors concluded that an evidence-based approach combining several methods is desirable ^[1].

A case report of a 50-year-old woman who developed hematomas on both sides as an emergency after a facelift explained that a rapidly growing hematoma may require general anesthesia, and that securing the airway may be difficult in this situation ^[2]. If one side of your face or neck swells up and becomes firm within a short time and the pain increases, or if breathing or swallowing becomes uncomfortable, you must contact the clinic without delay.

Fever, redness, and pus: signs of infection

If the surgical site becomes increasingly red and hot, the pain grows instead of easing, pus or foul-smelling discharge comes out, or you have fever and chills, an infection should be suspected. A review of infection prevention in facelift surgery examined how removing bacteria from the body before surgery (decolonization), preventive antibiotics, low body temperature around the time of surgery, body mass index, and smoking relate to surgical site infection in cosmetic surgery ^[6].

Necrotizing fasciitis is a rare infection that spreads rapidly through the tissue beneath the skin. In a systematic review of 30 years of literature, 18 of 3,782 papers on necrotizing fasciitis dealt with cases after cosmetic surgery; liposuction was the most common procedure, and the buttocks and legs were mainly affected ^[3]. Most cases began with nonspecific symptoms and signs within 3 days after surgery, at least one surgical treatment was performed in 14 cases, and 11 patients survived ^[3]. The authors stressed that because the early symptoms are not distinctive, strict monitoring is needed, and antibiotic treatment should be started immediately if the condition is suspected ^[3].

Nontuberculous mycobacterial infection is also known as a complication of cosmetic procedures, and skin infections have been reported to have increased significantly as cosmetic surgery has become more common ^[4]. This review summarized that diagnosis and treatment remain difficult, and that antibiotic treatment based on drug susceptibility testing should be combined with appropriate surgical removal ^[4]. If a red lump that does not heal or ongoing discharge appears at the surgical site, it is best to let the clinic know even if some time has passed since surgery.

Leg swelling and shortness of breath: signs of blood clots

Venous thromboembolism is a term that covers both a blood clot in a deep vein of the leg (deep vein thrombosis) and a clot that has traveled to the lungs (pulmonary embolism). A 2023 review explained that this complication occurs in every field of surgery, including plastic surgery, that it can increase complications and death, and that its occurrence can be reduced with prevention tailored to the patient's level of risk and the type of surgery ^[5].

A 2016 review of outpatient cosmetic surgery settings pointed out that risk assessment tools are underused because of concerns about bleeding and hematoma ^[7]. In contrast, the 2023 review summarized that many studies have found no increase in clinically important bleeding with antithrombotic medications, but that there is still no clear evidence supporting the use of anticoagulants in plastic surgery patients ^[5]. Another review said that until evidence-based recommendations are developed, the prudent approach is to adopt a risk assessment system and apply it consistently ^[8].

Swelling, tightness, or pain in only one leg should raise suspicion of deep vein thrombosis, and sudden shortness of breath, chest pain, or coughing up blood should raise suspicion of pulmonary embolism. Shortness of breath and chest pain in particular can signal an emergency, so you must seek emergency care right away.

Symptoms that mean you should get in touch right away

Whatever type of surgery you had, the following symptoms are signs that you should not wait but contact the clinic where you had surgery or seek emergency care. Recovery speed differs from person to person, so even if a symptom is not on this list, it is best to ask if something feels different from usual.

• One side of the surgical site swells up markedly and becomes firm within a short time, with worsening pain
• Breathing or swallowing feels uncomfortable
• Redness, warmth, pus, or fever and chills that keep getting worse
• Any area where the skin turns dark red or darkens
• Swelling and pain in one leg
• Sudden shortness of breath, chest pain, or coughing up blood

What to have ready when you call

When you describe your condition over the phone, telling the clinic when the symptoms started and how they have changed, your temperature, and the medications you take helps them assess the situation. Taking photos of the surgical site makes it easier to compare changes.

It is also important to get the number to call after discharge, and how to reach the clinic at night and on weekends, during your consultation before surgery. An accurate assessment is possible only through an in-person examination, so rather than drawing your own conclusions from information online, it is safer to consult your medical team.