Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury

Abstract

Background Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature. Objectives The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery. Methods A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery. Results Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery. Conclusions Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery. Level of Evidence: 4

Aesthetic Surgery: Impact on Quality of Life

“…In our study patients' age and BMI is normal on average similar to study done by Papadopulos, 13 but majority were married and females due to which unemployment ratio was high as compared to other studies. Studies by Chopra and Hood has shown that local complications are commonly experienced after aesthetic surgery with very low rate of severe complications rangingfrom 0.7%-1.4% similarly in this study the most of the patients show some local and treatable adverse outcomes but no severe 14,15 The outcome analysis of this study highlights the desirable effectofcosmetic procedures on QoL significantly by improving body image and increasing the satisfaction with life in general as noted by Cohen and Papadopulos. 16,17 Aesthetic procedures result in desirable impact on emotional well-beingasit is noted that there is a significant reduction of mental distress and anxiety.…”

Chronic Pain Following Cosmetic Breast Surgery: A Comprehensive Review

“…Medical management of chronic pain following breast augmentation surgery includes medications that are generally used to treat most chronic post-surgery pain syndromes. While there is no consensus on the best medication for chronic post-surgical pain, medical management may be trialed for at least 3 months before advancing to more invasive treatment strategies [27,28].…”

“…One of the most common medications for initial management of chronic pain is the nonsteroidal anti-inflammatory drug [27,28]. NSAID class.…”

“…Nonpharmacologic treatment options for chronic postsurgical pain include physical therapy, scar and myofascial massage, and psychological therapy [27,28,30,36]. While the duration of pain relief from physical therapy or scar massage may be temporary, there is some evidence that different massage techniques may provide persistent pain relief following breast surgery [36].…”

A Personal Approach to Brachioplasty

“…In addition, brachioplasty, especially performed through a medial approach, poses risk of injury to the medial antebrachial cutaneous nerve, which may result in numbness in the medial arm and ulnar forearm. Previous studies have cited low overall incidence of nerve injury after brachioplasty, ranging from 0% to 5% 16,21 . In our experience, this risk is substantially mitigated with the use of the posterior incision brachioplasty.…”