Aesthetic Surgery Complications

A 56-year-old man develops rapidly progressive unilateral neck swelling, severe pain, dysphagia, hoarseness, and inspiratory stridor three hours after facelift surgery. The neck is tense, the trachea is displaced, and oxygen saturation is falling. What is the most appropriate immediate management?

A 47-year-old woman develops severe orbital pain, proptosis, rapidly decreasing visual acuity, ophthalmoplegia, and a relative afferent pupillary defect 45 minutes after lower blepharoplasty. What is the most appropriate next management step?

A 42-year-old woman presents seven years after textured breast implant augmentation with painless progressive unilateral breast enlargement. Ultrasound demonstrates a large late periprosthetic fluid collection without an obvious solid mass. What is the most appropriate next diagnostic step?

A 38-year-old woman presents two weeks after breast augmentation with fever, increasing unilateral breast pain, erythema, cloudy drainage, and partial implant exposure. Ultrasound shows a large periprosthetic collection, and the overlying skin is thin and ischemic. What is the most appropriate management?

A 35-year-old woman develops marked bilateral nipple-areola pallor, severe breast tightness, delayed capillary refill, and weak Doppler signals several hours after augmentation mastopexy with large implants. What is the most appropriate next management step?

A 44-year-old woman presents 18 hours after abdominal liposuction with severe generalized abdominal pain, tachycardia, fever, guarding, and progressive distension. The cannula sites appear normal. Computed tomography shows free intraperitoneal air and fluid. What is the most appropriate management?

A 37-year-old woman undergoing large-volume tumescent liposuction develops circumoral numbness, metallic taste, tinnitus, agitation, a generalized seizure, and widening of the QRS complex. What is the most appropriate immediate management?

A 51-year-old active smoker presents five days after abdominoplasty with increasing pain and a sharply demarcated dusky area at the central lower abdominal flap. The tissue is cool with absent capillary refill, but there is no purulence, fluctuance, or systemic toxicity. What is the most appropriate management?

A 32-year-old man presents one week after rhinoplasty with fever, severe septal pain, progressive nasal obstruction, and bilateral fluctuant septal swelling that does not shrink after topical vasoconstrictor. What is the most appropriate next management step?

A 54-year-old woman presents four months after lower blepharoplasty with persistent scleral show, tearing, ocular irritation, and incomplete eyelid closure. Examination demonstrates anterior lamellar shortage, middle-lamellar scar tethering, and lateral canthal laxity. What is the most appropriate definitive treatment?

A 49-year-old woman presents 12 days after facelift surgery with a soft fluctuant swelling over the left preauricular region. The swelling becomes larger during meals, and aspiration produces clear fluid with a high amylase concentration. There is no fever, erythema, or facial weakness. What is the most appropriate initial management?

A 34-year-old woman presents six months after breast augmentation with loss of the normal cleavage plane. The implants appear to meet across the midline, and the presternal skin is elevated from the chest wall. The implants are large and the original pockets were dissected medially. What is the most appropriate definitive management?

A 41-year-old woman presents one year after augmentation mammoplasty with progressive inferior implant displacement. The nipples now appear abnormally high on the breast mound, and the implants extend below the original inframammary folds. The skin envelope is thin, and the implants are relatively large. What is the most appropriate definitive management?

A 46-year-old woman presents three weeks after abdominoplasty with a painless fluctuant swelling of the lower abdomen. The incision is healed, and there is no erythema, fever, or tenderness. Ultrasound demonstrates a simple fluid collection between the abdominal flap and fascia. What is the most appropriate initial management?

A 38-year-old woman presents six weeks after circumferential liposuction with areas of firmness, mild waviness, and asymmetric swelling of the abdomen. Ultrasound shows no seroma, hematoma, or fat necrosis. The skin is viable, and there are no signs of infection. What is the most appropriate management?

A 29-year-old woman presents eight months after aggressive abdominal liposuction with a stable deep depression and skin tethering adjacent to the umbilicus. The deformity becomes more obvious when she bends forward, and imaging shows no fluid collection. What is the most appropriate corrective treatment?

A 43-year-old woman develops increasing facial pain and grouped vesicles around the mouth five days after full-face laser resurfacing. Several vesicles have ruptured, producing shallow erosions over the treated skin. She is afebrile and hemodynamically stable. What is the most appropriate management?

A 32-year-old man presents four months after septorhinoplasty with nasal crusting, intermittent epistaxis, and a whistling sound during inspiration. Examination shows a small anterior septal perforation with otherwise healthy surrounding mucosa. What is the most appropriate initial management?

A 55-year-old woman presents nine months after facelift surgery with an elongated, inferiorly displaced earlobe that appears pulled directly into the facelift scar. The deformity is stable, and the surrounding scars are mature. What is the most appropriate corrective treatment?

A 37-year-old woman presents ten months after reduction rhinoplasty with persistent nasal obstruction, an inverted-V shadow across the middle vault, and narrowing that worsens during inspiration. Symptoms improve with lateral support of the cheek. What is the most appropriate definitive management?

A 45-year-old woman presents three years after silicone breast augmentation with progressive unilateral breast firmness, pain, contour distortion, and palpable axillary lymph nodes. Magnetic resonance imaging shows extracapsular silicone extending beyond the implant shell. What is the most appropriate definitive management?

A 39-year-old woman develops marked dusky congestion of the nipple-areola complex several hours after vertical mastopexy. The nipple is warm and swollen with brisk dark bleeding on pinprick, while the breast skin remains viable and there is no expanding hematoma. What is the most appropriate initial management?

A 52-year-old woman presents four months after upper blepharoplasty with dry-eye symptoms, inability to close the eyelids completely during sleep, and superior scleral exposure. Examination shows excessive upper-eyelid skin removal and anterior lamellar shortage. What is the most appropriate definitive treatment?

A 58-year-old woman has complete inability to elevate the right corner of the mouth immediately after facelift surgery. The deficit has not improved over six weeks, and electromyography suggests loss of continuity of a facial nerve branch. What is the most appropriate management?

A 43-year-old smoker presents five days after facelift surgery with progressive dusky discoloration and blistering along the distal postauricular skin flap. There is no hematoma or infection, and the flap is not under obvious external compression. What is the most appropriate management?

A 47-year-old woman presents three months after abdominoplasty with a small area of umbilical necrosis and progressive retraction of the umbilicus into a widened scar. The abdominal flap is otherwise healthy and there is no infection. What is the most appropriate reconstructive approach?

A 35-year-old woman presents one year after reduction rhinoplasty with progressive nasal obstruction, an inverted-V deformity, and collapse of the middle vault during inspiration. Symptoms improve when the lateral nasal wall is manually supported. What is the most appropriate definitive treatment?

A 20-year-old woman presents 10 days after otoplasty with increasing ear pain, erythema, purulent drainage, and loss of normal auricular contour. The lobule is relatively spared, and the cartilage is exposed through part of the incision. What is the most appropriate management?

A 37-year-old woman presents six months after hyaluronic acid filler injection with recurrent tender erythematous cheek nodules that temporarily improve with antibiotics but repeatedly return. Ultrasound shows small fluid pockets surrounding filler deposits. What is the most appropriate management?

A 49-year-old woman presents two weeks after extensive thigh liposuction with increasing pain, firm swelling, progressive anemia, and extensive ecchymosis. Ultrasound shows a large organized hematoma without active arterial flow. What is the most appropriate management?

A 43-year-old woman presents 14 months after breast augmentation with progressive lateral displacement of the right implant when lying supine. The implant is soft and intact, the medial breast contour is flattened, and examination shows an enlarged lateral pocket without capsular contracture. What is the most appropriate definitive management?

A 37-year-old thin woman presents two years after subglandular saline breast augmentation with visible implant folds and palpable rippling along the medial and upper breast. The implants are intact, and there is no pain, infection, or capsular contracture. What is the most appropriate corrective strategy?

A 28-year-old man presents one year after surgical correction of gynecomastia with a fixed depression beneath the right nipple-areola complex. The deformity becomes more obvious when the pectoralis muscle contracts. Examination shows adherence of the nipple to the pectoral fascia and inadequate subareolar tissue. What is the most appropriate corrective treatment?

A 46-year-old woman presents nine months after abdominoplasty with a progressively narrowed umbilical opening that traps debris and causes recurrent irritation. The surrounding abdominal scar is mature, and there is no active infection. What is the most appropriate definitive treatment?

A 52-year-old woman develops dyspnea, hypoxemia, bilateral pulmonary crackles, and frothy sputum several hours after large-volume liposuction. She received a high volume of intravenous crystalloid in addition to extensive tumescent infiltration. Chest imaging shows bilateral pulmonary edema, and there are no focal signs of pulmonary embolism. What is the most appropriate management?

A 39-year-old woman presents three days after ultrasound-assisted liposuction with severe localized abdominal pain and a sharply demarcated area of blistering and black discoloration adjacent to a cannula access site. The surrounding tissue is not crepitant, and she has no fever or systemic toxicity. What is the most likely complication and appropriate management?

A 30-year-old woman presents one year after reduction rhinoplasty with excessive nostril show, retraction of both alar rims, and notching of the right nostril. Examination shows loss of alar support after aggressive cephalic trimming of the lower lateral cartilages. What is the most appropriate definitive management?

A 41-year-old woman presents three weeks after cosmetic chin augmentation with increasing pain, erythema, purulent intraoral drainage, and exposure of part of the silicone implant through the gingivolabial incision. What is the most appropriate management?

A 24-year-old woman presents eight months after otoplasty with a tender focal swelling along the posterior auricular incision. A permanent mattress suture is visible through the skin, and there is a small amount of purulent drainage. The remaining ear contour is satisfactory. What is the most appropriate management?

A 35-year-old man presents five days after dense follicular-unit transplantation with severe scalp pain and a dusky, sharply demarcated area within the recipient zone. Several grafts appear nonviable, but there is no purulent drainage or systemic toxicity. What is the most appropriate management?

A 46-year-old woman develops marked cyanosis and swelling of the nipple-areola complex six hours after reduction mammaplasty. Pinprick produces brisk dark blood, the breast closure is tight, and no expanding hematoma is clinically evident. What is the most appropriate next management step?

A 38-year-old woman presents nine days after primary breast augmentation with increasing unilateral pain, erythema, fever, and a moderate periprosthetic fluid collection. The incision is intact, the implant is not exposed, and the overlying skin remains viable. What is the most appropriate management strategy?

A 35-year-old woman presents three weeks after cosmetic gluteal implant augmentation with wound dehiscence in the intergluteal incision and partial implant exposure. She has increasing pain and purulent drainage but is hemodynamically stable. What is the most appropriate management?

A 54-year-old woman develops clear watery drainage from the preauricular facelift incision whenever she eats, beginning one week after rhytidectomy. The fluid has a high amylase concentration, and there is no fever, cellulitis, or facial nerve deficit. What is the most appropriate initial management?

A 49-year-old woman presents two weeks after lower blepharoplasty with mild scleral show and early lower-lid retraction. She has ocular irritation but no corneal injury, significant skin deficiency, or fixed scar contracture. What is the most appropriate initial management?

A 31-year-old man presents one year after cosmetic rhinoplasty with progressive deviation of the nasal dorsum. Examination and imaging show that a costal cartilage dorsal graft has curved despite stable nasal bones and septum. What is the most appropriate definitive management?

A 42-year-old woman presents eight months after aggressive abdominal liposuction with a stable adherent depression and visible contour step-off. The defect becomes more pronounced with muscle contraction, and ultrasound shows scar tethering without a fluid collection. What is the most appropriate corrective treatment?

A 50-year-old woman presents three weeks after a medial thigh lift with a painless fluctuant groin swelling. Ultrasound shows a simple fluid collection adjacent to the incision, and there is no erythema, fever, or purulent drainage. What is the most appropriate initial management?

A 37-year-old woman develops increasing facial pain, fever, delayed epithelialization, and green purulent exudate five days after full-face ablative laser resurfacing. What is the most appropriate next management step?

A 58-year-old smoker presents five days after facelift surgery with a progressively dark distal postauricular skin flap. The area is cool and insensate, with absent capillary refill, but there is no hematoma, purulence, or spreading cellulitis. What is the most appropriate management?

A 47-year-old woman presents three years after silicone breast augmentation with sudden painful enlargement of one breast after minor blunt trauma. The breast is tense and ecchymotic, hemoglobin has fallen, and ultrasound shows a large complex periprosthetic collection without signs of infection. What is the most appropriate management?

A 35-year-old woman presents two weeks after breast augmentation with a painful, firm, cord-like structure extending from the lower breast toward the upper abdomen. There is no breast erythema, implant displacement, fever, or fluid collection. Duplex ultrasonography confirms thrombosis of a superficial chest-wall vein. What is the most appropriate management?

A 31-year-old woman presents one year after periareolar mastopexy with recurrent areolar enlargement, a widened circumareolar scar, and flattening of the breast mound. The scar is mature, and there is no infection or implant complication. What is the most appropriate definitive management?

A 48-year-old woman presents 18 months after reduction mammaplasty with recurrent lower-pole elongation. The nipple remains at an appropriate position, but the majority of breast tissue has descended below it, producing pseudoptosis. What is the most appropriate corrective strategy?

A 52-year-old woman presents nine months after aggressive submental liposuction and neck lift with a central neck depression, visible platysmal borders, and skin adherence to the underlying muscle. The deformity worsens when she extends her neck. What is the most appropriate definitive treatment?

A 45-year-old woman presents one year after upper blepharoplasty with a hollow superior sulcus, visible orbital rim, and an aged skeletonized appearance. Eyelid closure is complete, and there is no ptosis or active scarring. What is the most appropriate corrective treatment?

A 49-year-old woman presents one year after an endoscopic brow lift with a stable widened temporal scar and a localized patch of alopecia along the incision. There is no active inflammation or ongoing hair shedding. What is the most appropriate management?

A 33-year-old man presents one year after dorsal hump reduction with a broad, flattened nasal dorsum and palpable separation of the nasal bones. The septum is straight, and there is no infection or graft extrusion. What is the most appropriate definitive management?

A 38-year-old woman presents eight months after chin implant augmentation with lower-lip incompetence, chin ptosis, and a deep submental crease. Examination shows that the implant has migrated inferiorly and the mentalis muscle was not securely reapproximated. What is the most appropriate definitive treatment?

A 29-year-old man develops diffuse shedding of native hairs around the recipient area four weeks after hair transplantation. The scalp is healthy, there is no erythema, scarring, pustulation, or graft necrosis, and dermoscopy shows preserved follicular openings. What is the most appropriate management?