Bleeding and bruising after plastic surgery Introduction Bruising and bleeding are frequent side effects of most surgical interventions and plastic surgery is not an exception. In the course of the surgery, incisions are performed on the skin and underlying tissues; consequently damaging blood vessels and leading to post-operative bleeding. The likelihood of such an occurrence increases in complex surgeries wherein making deeper incisions is essential. Bruising may also be present after cosmetic surgery as a result of the leakage or extravasation of blood from ruptured blood vessels into superficial tissues of the skin. During surgery, the damaged blood vessels will be sealed, but blood can accumulate in the surgical site and cause bruises that will be visible during the recovery period. When bruising occurs, the surgical area has a tendency to become discolored. Bruises after face lifting, nose jobs and body contouring surgeries are quite common. Keep in mind that some patients will experience more bleeding and bruising than others. The extent of bleeding is dependent on their lifestyle choices, overall health and taking certain medications before the surgery. Fortunately, we have plenty of treatment options available to manage bruising and bleeding after a surgical intervention. The Association Between Bleeding and Bruising The bruises are a consequence of bleeding. When the patient experiences bleeding after an intervention, the blood that is discharged from blood vessels goes through a coagulation process and takes the form of a lump with a jelly-like consistency. This remains under the skin in the area that it accumulated in. During the first weeks after surgery the contusion turns into a yellow liquid and is either absorbed by the body or transformed into a bruise. The rusty color of the bruise is determined by the presence of iron in the blood. Causes of Post-Surgical Bleeding and Bruising There are several elements that increase the likelihood of bruising and bleeding after cosmetic surgery interventions. Patients who take aspirin or other anti-inflammatory drugs have an increased risk of bleeding as the medicine acts to thin the blood and prevent coagulation. This is why plastic surgeons always suggest that patients avoid taking anti-inflammatory medication at least a week or two before the date of the operation. Remember that aside from aspirin, there are plenty other drugs that can lead to severe complications and unwanted effects after the surgery. This is why it is essential to let your surgeon know about all medication you are taking before the procedure or have been taking in the past. Your surgeon will be the one to assess what types of medication you can continue taking and which ones should be interrupted. Hypertension is the second most important cause of bleeding and bruising after an operation and it has been discovered that this is a frequent cause of bleeding in facelift surgery. If the patient is suffering from hypertension, the surgeon must know beforehand so he can take precautionary measures. Nausea is also connected with bruising and bleeding, especially after facial plastic surgery. The patient will lower the head in an attempt to vomit and this can, in turn, trigger bleeding. Plastic surgeons might prescribe drugs to control nausea after the intervention. Keep in mind that patients undergoing facial interventions are more prone to bleeding; hence they are usually advised to avoid bending from then on. Keeping the head above the level of the heart should prevent bleeding. Bleeding and bruising are most commonly encountered during the first 24 hours after the procedure. The risk decreases with time, but for the first three weeks after the surgery it is still a possibility. Avoiding air travel for the following weeks after the intervention is also beneficial as the air pressure in the cabin can also trigger bleeding. The bruises usually occur a few days after the bleeding and they are very visible on the skin before disappearing. If you are experiencing extreme bleeding after your cosmetic procedure, contact your surgeon immediately. The plastic surgeon might make use of a mild electric current to seal the damaged blood vessels. In the event of abnormal bleeding, a hematoma may develop. This condition is characterized by an accumulation of blood in a localized area surrounding an injured blood vessel. Removal and cleaning of the clotted blood from the surgical site as well as sealing the ruptured blood vessels are crucial because failure to arrest the bleeding is detrimental to the health of the patient. Signs and Symptoms of Bleeding after the Surgery In some cases, it might not be easy to diagnose post-surgical bleeding so the patient has to pay attention to the signs and symptoms he is experiencing to be able to avoid potentially life-threatening conditions. The following are a few signs and symptoms that are usually indicative of bleeding after a surgical intervention: – Blood can be seen on the wound dressing on the incision site – Confusion and anxiety – An increase in heart rate and blood pressure – Breathing problems or shortness of breath – A decrease in the frequency of urination Hematoma After Plastic Surgery Interventions Hematoma is a condition defined by the accrual of blood at the surgical site as a consequence of excessive bleeding and there are occasions where diagnosis is difficult. The hematoma tends to stretch the skin causing the patient to experience pain and in extremely rare instances, the biochemical process of hematoma formation can initiate bleeding. The condition can also constrict blood vessels and significantly reduce the blood supply to the skin which can lead to skin necrosis. The surgeon will decide the appropriate course of action depending on the size of the hematoma. For small hematomas, the body will simply reabsorb them. Conversely, additional surgery might be required to stop the bleeding and remove the accumulated blood brought about by larger hematomas. Some signs of hematoma: • Blood discharge from the surgical wound • A barely visible change in the color of the skin surrounding the incision • Inflammation in the surgical area • Skin that is stretched and painful Treatment options for bleeding after plastic surgery Intravenous blood transfusions might be recommended when the patient experiences excessive bleeding. Specific coagulation factors that are normally present in the circulation can be injected into your bloodstream to initiate the coagulation cascade and contain the bleeding. Plasma and platelets can also be transfused to help with hemostasis. Phases of Bruises Under normal conditions, the bruises vanish within one to three weeks after they occurred. However, the time needed for the bruises to recede is highly dependent on a variety of factors, such as the intensity of the trauma, the body’s ability to heal and the post-operative care. Patients can avoid bruises or contain them easily by following the surgeon’s recommendations. Here are the different stages of bruises: Phase 1: The bruise starts by having a red color Phase 2: The bruise changes color to purple, black or blue a few days after it occurred Phase 3: The bruise turns yellow or green after one or two weeks Phase 4: After two weeks, the bruise changes color to brown How to Reduce the occurrence of bruises To be able to decrease bruising after cosmetic interventions, you should follow these measures after discussing them with your surgeon: Keep the surgical area elevated. Maintaining the elevation of the surgical area can certainly reduce the likelihood of bruising. Apply ice packs. If your plastic surgeon recommends it, you can apply ice packs when the bruises occur. The cold sensation can contain the bruising by constricting the blood vessels and putting a stop to the bleeding. Avoid certain drugs. To be able to avoid bruises, you should avoid blood-thinning medication (for example, aspirin). Bear in mind that it is mandatory to let your surgeon know if you are taking any medications prior to the surgery. Apply compression. To be able to stop excessive bleeding, compression can be used. Applying pressure directly on the bleeding areas by using a bandage, garment or tape helps stop the bleeding. Even if compression is effective in arresting the bleeding, it does not diminish the likelihood of bruising after the bleeding has stopped. Apply heat. The ice packs should be used only during the first two days after the occurrence of bruising and then a heating pad should be applied on the injured area for the next couple of days. This is meant to increase blood circulation around the site and help with the elimination of damaged blood cells. Take certain supplements. There are plenty of supplements created to reduce the bruising but they should only be used at the doctor’s recommendation. Supplements such as Arnica Montana and SINECCH have proved their value in reducing the bruising. Eat Vitamin K laden foods. Vitamin K works as a blood coagulant, it makes your blood thicker, and it can easily be found in green, leafy vegetables such as kale and spinach. Conclusion Bruising and bleeding are frequent side effects of undergoing cosmetic surgery. Minor bleeding and a few bruises are inconsequential. Having said that, excessive blood loss and bruising can induce life-threatening conditions. Bleeding occurs due to the damage to the blood vessels caused by the incisions made during the operation whereas bruises form when blood cells collect under the skin surrounding the surgical wound. Through the latest advancements in medical technology, bleeding and bruising can easily be avoided and treated. In some cases, these side effects occur because of an error committed by the plastic surgeon. This is why selecting a board-certified and highly experienced cosmetic surgeon is a crucial decision for a successful operation and recovery. Make sure to contact your doctor immediately should there be any signs and symptoms of excessive bleeding or abnormal bruising after your surgery.