Terribly beautiful: who can't have plastic surgery
Since the beginning of the year, three patients have died in the capital's beauty clinics due to unpredictable reactions to surgeries. One of the most common causes of death in such cases is an allergic reaction to drugs. Is it possible to predict the likelihood of developing anaphylactic shock, who should avoid liposuction, and who should refrain from a facelift? In the Izvestia article.
Safety before plastic surgery
In 2026, three women died in beauty clinics in Moscow. The last time the death was associated with the administration of an anesthetic drug. To minimize risks, preparation for plastic surgery begins with a face-to-face consultation, plastic and reconstructive surgeon at the Scandinavian Health Center Kira Kopylova-Lehman said in an interview with Izvestia.
— The surgeon must understand what exactly the person wants to change, whether there are realistic expectations, what diseases they already have, what medications the patient is taking, whether there is a history of allergic reactions, anesthesia, surgery, a tendency to form rough scars, thrombosis, bleeding. After that, they prescribe an examination," she says.
According to the specialist, before a planned operation, a general blood test, biochemistry, coagulogram (coagulation test) are usually performed, blood type and Rh factor are checked, infection tests are performed according to the requirements of the clinic, and an ECG is performed. Sometimes you may need a fluorography or chest X-ray, or a therapist's examination.
—Depending on the age and scope of the intervention, ultrasound of the veins, ultrasound of the mammary glands or mammography, consultation with a gynecologist, endocrinologist, cardiologist, anesthesiologist are added," Kopylova—Lehman lists. — Before breast surgery, the examination is usually broader, because it is important to exclude problems from the mammary glands. Before rhinoplasty, ENT and CT scans are often needed according to indications. Before blepharoplasty, you may need to see an ophthalmologist if you have dry eyes, glaucoma, or a history of eye surgery.
The interlocutor of Izvestia draws attention to the fact that it depends on the specific clinic where the patient will be tested. You can bring the results "from the outside" to some medical institution if they are fresh and made in a laboratory that the clinic trusts. In some cases, they are asked to undergo part of the examinations where the operation is planned, because uniform deadlines, standards and quality control are important for doctors.
— The main thing for the patient is not to look for the shortest way, but to understand that a preoperative examination is not necessary for show — it is required to reduce the risks of anesthesia, bleeding, infection, thrombosis and poor healing, — emphasizes the plastic surgeon.
What is anaphylactic shock and can it be avoided?
Denis Prokofiev, a cardiologist, general practitioner, and holder of the status of "Moscow Doctor", also considers it the most important rule to conduct competent and full-fledged preparation for surgery.
— If a person has arterial hypertension or coronary heart disease, then they are in the area of special attention. In such cases, a cardiologist's consultation is always prescribed to assess the cardiovascular risk. During the operation, all these indicators should be taken into account by both the operating surgeon and the anesthesiologist. If there is any risk, for example, associated with a cardiovascular disease, it is necessary to solve this problem first and only then send the patient for surgical treatment, says the specialist.
A lot depends on the clinical values of the tests that the doctor must "decipher". For example, low hemoglobin indicates anemia, but it can be of different degrees and occurs for various reasons.
— If we are talking about a decrease in hemoglobin by 10-20 units from the norm when it reaches the level of 100 units, then this is not a contraindication. If hemoglobin drops below 75 units, then this is severe anemia," comments Prokofiev.
Unfortunately, there are risks that cannot be foreseen. Anaphylactic shock is considered a life-threatening situation that develops instantly and unpredictably against the background of allergens. Any drug administered intravenously, intramuscularly or epidurally can be a provoking factor, the cardiologist notes.
— In particular, if anesthesia is administered intravenously, the drug enters the body very quickly, an allergic reaction develops within a maximum of 20 minutes and leads to impaired hemodynamics, a drop in blood pressure, and respiratory arrest. This dangerous situation often ends in death if resuscitation measures are not taken in a timely manner," the doctor clarifies.
According to him, it is simply impossible to predict or predict such a development. Scientists have tried to test for one sedative or another, but this has not led to any results.
— Even ultra-small doses of medication can trigger anaphylaxis. This is an individual reaction of each organism that cannot be tested," the specialist emphasizes, explaining that doctors usually try to choose drugs with the rarest frequency of allergic reactions.
— It is impossible to completely exclude anaphylaxis in advance, — confirms Kira Kopylova-Lehman. — Sometimes a severe allergic reaction occurs for the first time in life. Therefore, before surgery, doctors must collect an allergic history: reactions to medications, anesthesia, latex, antibiotics, antiseptics, food, insect bites. This helps you understand where the risk is higher and what is best to avoid.
The plastic surgeon emphasizes that a good clinic not only tries to predict the risk, but is also ready for it. This means a full-fledged preoperative interview, the work of an anesthesiologist, the availability of anti-shock therapy and a well-established algorithm of actions. If the patient has already had severe allergic reactions, this changes the tactics of preparation and sometimes requires additional consultation with an allergist.
— Tell the doctor honestly about your health. Operations don't go well with silence," warns the Izvestia interlocutor. — The doctor should know everything about smoking, weight loss medications, taking antidepressants, hormones, dietary supplements, allergies, thrombosis in direct relatives, anemia, pressure spikes, weight fluctuations.
Who is not allowed to remove Bicha lumps
There are general contraindications for almost any aesthetic surgery: acute infections, decompensated heart and vascular diseases, uncontrolled blood pressure, severe uncontrolled diabetes, severe blood clotting disorders, active oncological diseases, severe liver and kidney diseases, pregnancy and breastfeeding, acute mental conditions, severe eating disorders, severe exacerbation of autoimmune and Kira Kopylova-Lehman lists skin diseases in the area of surgery. An important point: active smoking dramatically impairs blood supply to tissues and increases the risk of necrosis, bad scars and complications after major operations on the face, chest, abdomen and body.
Then there are the nuances of specific operations, the surgeon continues. Facelift is not done or postponed due to severe cardiovascular risks, poor tissue healing, and active smoking. Unrealistic expectations also play a role, when the patient is guided by some vague ideas about beauty, which can later lead to disappointment, even if surgeons try their best.
— Blepharoplasty should be carefully discussed in severe dry eye syndrome, glaucoma, thyroid diseases involving the eyes, and recent ophthalmic surgeries, the doctor warns. — Rhinoplasty requires a particularly balanced decision if there are pronounced nasal breathing disorders, chronic sinus inflammation, and a tendency to bad scarring. And of course, if the patient's request is not related to a real defect, but to an obsessive fixation on the shape of the nose.
Otoplasty (correction of ear defects) is usually technically safer, but in these cases doctors do not risk performing surgery against the background of an active infection of the skin and ear, with blood clotting disorders and clearly immature motivation. Conscientious surgeons care about what exactly patients want to "redo."
"Cheiloplasty, lipofilling, and removal of Bichat lumps require particularly careful selection, because these operations are often performed by patients with a request for a fashionable effect, rather than out of real necessity," Kopylova-Lehman continues. — It is not necessary to do such interventions if the tissues are already thinned, there is an asymmetry that the operation will not solve, pronounced dryness of the mucous membranes, a tendency to scarring, unstable weight.
The surgeon emphasizes that liposuction is not suitable as a treatment for obesity and should not be perceived as an alternative to weight loss. It is contraindicated in severe obesity with high anesthetic risks, coagulation disorders, severe diseases of the heart, liver, kidneys, with pronounced edema and poor skin condition, which will not be able to shrink after fat removal.
— Breast plastic surgery requires special care for formations in the mammary gland, unexplained discharge from the nipples, active inflammation, severe hormonal disorders, as well as with very unstable body weight. Operations on the buttocks, arms, and waist are among the more traumatic interventions and require a particularly careful assessment of thrombosis risk, skin condition, subcutaneous tissue, and general health," the specialist continues.
In addition, the interlocutor of Izvestia strictly advises against aesthetic surgery in two cases. The first is when the body is not objectively ready, and the risk is too high. The second is if the request is dictated not by a real defect, but by a distorted perception of oneself, external pressure, or an impulsive desire to urgently change the body at any cost.
Do I need a psychiatric certificate?
Kira Kopylova-Lehman emphasizes that patients should not skimp on safety. The clinic's license, the surgeon's experience, the anesthesiological team, a clear examination plan, and postoperative follow-up conditions are important. By the way, there is no formally rigid upper age limit for plastic surgery. It is not the number in the passport that is important, but the state of health, the amount of surgery and the anesthetic risk.
"There are patients over the age of 60 who calmly tolerate individual interventions, and there are young people who should postpone surgery due to chronic diseases, smoking, anemia, obesity, or unstable emotional state," the surgeon comments.
The lower age limit depends on the purpose of the intervention. Most aesthetic surgeries are performed only after adulthood.
— There are exceptions, for example, in otoplasty, when it comes to pronounced hearing loss and psychological discomfort. Then the intervention can be discussed earlier," the expert explains. — But everything related to the body, chest, and contour of the face is usually done after the active tissue growth is completed and with the patient's mature motivation.
In some cases, according to the surgeon, a psychiatric certificate may be required, and this is a normal practice.
— If the doctor sees signs of dysmorphophobia (painful fixation on an imaginary defect in appearance), severe anxiety, unstable emotional state, depression, sharp contradictions in the request, dependence on operations, eating disorders, then it is unsafe to go further without an assessment by a psychiatrist or a psychotherapist, — explains the interlocutor of Izvestia.
This is especially important in situations where a person has already undergone several interventions, but is still unhappy with himself. Sometimes people view surgery as a way to save a relationship, life, career, or dramatically change their self-esteem. Therefore, the doctor must make sure that the problem does not lie in the plane of mental health.
"A good surgeon regularly discourages patients from surgery,— Kopylova-Lehman admits. — This is one of the important parts of the profession. The doctor does not sell the intervention, but must soberly assess whether the operation makes sense, whether there will be a real benefit and whether the harm will be greater than the result.
Surgeons discourage patients, in particular, when their expectations are unrealistic, the risk to health is high, the problem is minimal and almost invisible, or it becomes clear that the cause of a person's dissatisfaction with himself is clearly deeper than just an external defect.
— It happens that women do not come with indications for surgery, but with internal anxiety, which they try to solve through appearance, — the specialist continues. — Sometimes it is the influence of social media, comparing oneself with processed images; in other cases, it is the pressure of a partner. Sometimes the age crisis affects. And here the honesty of a doctor is very important.
If the problem is far-fetched, then the operation will not give the psychological effect that the person is waiting for. The intervention will only reinforce the painful fixation on oneself. In this case, the correct decision is not to operate, the plastic surgeon emphasizes.
— I advise women not to make a decision too quickly. If the idea of surgery appeared abruptly, against the background of stress, divorce, comments from others or browsing social networks, it is better to give yourself a break, says Kopylova-Lehman.
The expert notes that a good operation should not be an attempt to save a life in a figurative sense. Intervention can improve appearance and well-being, but it should not become the sole pillar of self-esteem.
"If the thought sounds inside, 'I'll do this and then I'll finally become normal, beautiful, and loved,' then most likely you don't need a surgeon first," she summarizes.
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