Nurses’ Guide to Post-Operative Complications in Aesthetic Plastic Surgery

Nursing in plastic surgery is both rewarding and demanding. Beyond the technical aspects of wound care and dressings, practice nurses are often the first to notice subtle changes in a patient’s recovery. Your skills, attention to detail, and compassion are what protect patients from small setbacks becoming serious complications. Every observation you make, every conversation you have, and every reassurance you give makes a measurable difference in a patient’s healing journey.

This article is designed to support you in that role. By outlining common complications, early warning signs, and evidence-based management strategies, it provides a practical guide to help you feel confident in your day-to-day practice. It acknowledges the unique challenges of post-operative care while celebrating the critical role you play in surgical outcomes.

 

Purpose of this Nurses’ Guide

• This article is a simple example of a useful guide for practice nurses in an Aesthetic Plastic Surgery Practice (please create your own guide and own SOPs)

• Give nurses a clear, step-by-step approach for recognising, managing, and escalating post-op issues.

• No therapeutic guarantees. Use product names as examples only. Always follow your surgeon’s protocols and local hospital policies.

Follow Safety First Principles

• Act early, document clearly, escalate without delay.

• If the patient looks unwell, treat as unwell. Red flags override routine process.

• When in doubt, discuss with the covering surgeon or direct the patient to Emergency.

• Work within scope. Use standing orders and practice protocols. Do not prescribe unless authorised.

Rapid Patient Triage at a Glance

1. Immediate danger

• Chest pain, shortness of breath, collapse, uncontrolled bleeding, rapidly expanding swelling, fever with rigors, signs of sepsis.

• Action: Call 000 / 911 or direct to Emergency. Notify the surgeon urgently.

2. Same-day urgent review

• Marked increase in pain or swelling, spreading redness, malodour, high drain output, wound breakdown, dusky skin, anxiety with breathing issues.

• Action: Assess in rooms today. Prepare escalation. Notify the surgeon or head nurse ASAP

3. Routine review

• Mild pain, localised irritation or rash, spitting suture, minor dressing problem.

• Action: Nurse appointment, wound check, education, plan. Make good notes.

Structured Assessment in Clinic or via Phone

• Identify yourself, confirm patient, procedure, surgeon, surgery date.

• Symptoms timeline: onset, progression, severity.

• Vital signs if available: temperature, pulse, blood pressure, respiratory rate, oxygen saturation.

• Pain: location, character, score out of 10, response to analgesia.

• Wound: colour, warmth, swelling, drainage amount and colour, odour, integrity of edges, blistering, pressure points.

• Drains: type, side, last 24-hour output, colour, sudden changes.

• Breathing: cough, wheeze, chest tightness, exercise tolerance.

• Allergies, current medicines, comorbidities, smoking and vaping.

• Photos: request clear images with a ruler or coin for scale when safe and appropriate.

• Document everything in the EMR with times.

Complication overview

• Minor complications can often be managed in rooms with close follow-up.

• More severe complications need urgent review, imaging, antibiotics, procedures, or theatre.

MINOR SURGICAL COMPLICATIONS – RECOGNITION AND NURSING MANAGEMENT

Pain – mild to moderate

• Check for triggers: over-activity, inadequate analgesia, constipation, tight garment.

• Plan: reinforce regular analgesia as prescribed, rest, elevation, ice pack safety (use towel, 10–15 minutes, never on bare skin), bowel regimen, garment fit check.

• Review: phone check in 24–48 hours. Escalate if pain becomes severe, asymmetric, or associated with swelling or fever.

Skin rash and erythema

• Often from adhesive or moisture. Erythema is capillary dilation in inflamed skin.

• Plan: remove suspected dressing, cleanse with saline, apply non-adhesive or silicone interface, consider barrier film. Oral antihistamine (e.g., Telfast) only if already advised by surgeon.

• Escalate: if rapid spread, blistering, systemic symptoms, or concern for cellulitis.

Allergy to wound dressings – micropore, bandaids, tapes

• Plan: switch to hypoallergenic alternatives, silicone sheeting, tubular bandage.

• Education: patch test new products on intact skin where possible.

Drain output – high volume

• Baseline varies by procedure and surgeon protocol.

• Red flags: sharp increase, bright red blood, output not slowing over time, sudden stop with pain and swelling.

• Plan: measure and record every 8–12 hours, maintain suction if ordered, milk or strip tubing per protocol, secure to reduce traction.

• Escalate: discuss with surgeon if volumes remain high, if output becomes sanguineous, or if pain and swelling increase.

Asthma flare

• Airways narrow and swell, may produce extra mucus.

• Plan: prompt use of reliever inhaler as per action plan, upright position, calm breathing.

• Escalate: wheeze not settling, speech limited, cyanosis, or any concern.

Abscess

• Painful, fluctuant, often with fever or malaise.

• Plan: surgeon review for incision and drainage, wound swab after opening, dressings and oral antibiotics as directed.

• Education: hygiene, analgesia, signs of spreading infection.

Wound infection

• Features: increasing pain, warmth, redness, malodour, purulent discharge, fever.

• Plan: wound swab for culture before antibiotics if feasible, cleanse, consider absorbent antimicrobial dressing (e.g., Aquacel Ag or Sorbact), commence oral antibiotics if prescribed.

• Escalate: rapidly spreading cellulitis, systemic features, or failed response within 24–48 hours.

Wound dehiscence

• Partial or full separation of edges due to healing failure.

• Plan: saline cleanse, non-adhesive moist wound environment, offload tension, review contributing factors (coughing, straining, garment pressure).

• Escalate: deep or wide dehiscence, exposed implant or fascia, heavy exudate.

Spitting sutures

• Extruding absorbable material.

• Plan: cleanse, trim exposed end flush with skin if within scope, protective dressing, observe for local irritation.

• Escalate: persistent inflammation or suspected infection.

Skin injury from hot water bottle or ice pack

• Plan: stop thermal source, cool water first aid, assess burn depth, simple non-adherent dressings.

• Escalate: blistering, full-thickness burns, large areas, or sensory deficit.

MORE SEVERE SURGICAL COMPLICATIONS – RECOGNITION AND ESCALATION

Skin necrosis

• Dark, dehydrated tissue from local ischaemia. Often at T-junctions, IMF, or edges under tension.

• Plan: urgent surgeon review, optimise perfusion and offload pressure, consider enzymatic or surgical debridement, advanced dressings, and possible hyperbaric oxygen therapy where appropriate.

Seroma

• Build-up of clear fluid causing discomfort, squelching, or contour changes.

• Plan: compression and limited activity; surgeon aspiration under aseptic technique; repeat as required; monitor for infection.

• Education: report sudden re-accumulation, redness, fever.

Hematoma

• Pooling of blood. Presents with pain, tense swelling, bruising, and possible asymmetry.

• Plan: urgent assessment. Small stable collections may be observed. Large, painful, or expanding collections need evacuation in rooms or theatre.

• Monitor haemodynamics and haemoglobin as directed.

Wound not healing

• Consider diabetes, smoking, malnutrition, steroid use, vascular issues, tension, infection.

• Plan: optimise systemic factors, select moisture-balancing dressings, consider NPWT, review off-loading and garment fit, staged debridement.

DVT – deep vein thrombosis and PE – pulmonary embolism

• DVT signs: unilateral calf pain, swelling, warmth.

• PE signs: chest pain, dyspnoea, tachycardia, syncope.

• Action: medical emergency. Send to Emergency. Notify surgeon. Anticoagulation per medical team.

NAC necrosis, nipple loss, umbilicus loss

• Rare but serious.

• Plan: immediate surgeon review, optimisation of perfusion, consider medicinal leeches for venous congestion in selected cases, meticulous wound care, counselling, and staged reconstruction planning.

LIKELY PROBLEM LOCATIONS – WHAT TO LOOK FOR

• Abdominal scar central – tension, seroma, necrosis risk at umbilicus and lower midline.

• Breast – left or right breast – watch for haematoma, infection, NAC changes.

• T-junction on breast – common site for dehiscence and necrosis.

• IMF – moisture, maceration, fungal colonisation risk.

• Umbilicus – colour change, discharge, loss of depth.

• Backlift scar central – tension points and shear.

• Arm lift or thigh lift scars – distal swelling, lymphatics, garment pressure marks.

• Face, nose, ear, eye – oedema, bruising, skin edge perfusion, ocular symptoms.

PATIENT SYMPTOMS TO WATCH FOR

• High temperature.

• Pain levels increasing or not controlled.

• Redness and swelling, especially asymmetry.

• Malodour.

• Wound breakdown.

• Nerve changes or numbness.

• Breathing issues.

• Anxiety and distress that may signal deterioration.

MAINTAIN PATIENT RECORDS

• Take Photos – every time
• Document Nursing Care- Every Time
• Detailed notes on non-compliant or slow-healing patients –
• Record Complications in the EHR log (completing Wound Management Form).

GIVE GOOD PATIENT ADVICE

Know the Practice FAQs and Standard Surgeon Advice about

• Sleeping Better
• Exercise
• Compression Garments
• Nutritional Advice
• Bras
• Massage & Oils
• Use of Silicon Gels and Tapes – Strataderm, Stratamed, Silicone Tape
• Lymphatic Massage
• Tanning (Natural and Faux)

DEALING WITH NON-COMPLIANT PATIENTS

Follow the practice guidelines, make good notes and take action on non compliant patients over

• Smokers & Vapers – Nicotine patches
• Alcohol
• Using Recreational Drugs
• Over Exercisers / Gym Junkies
• Herbal Remedies

WOUND DRESSING SELECTION – PRACTICAL GUIDE

Match dressing to wound needs

• Low exudate, intact skin or closed incision

  • Tegaderm waterproof transparent film for a breathable barrier that seals out dirt, water, and germs.

  • Micropore tape for gentle fixation and scar support once closed.

  • Strataderm silicone gel for scar management as per protocol.

• Moderate exudate

  • Osmocel hydroporous foam to balance moisture and protect peri-wound skin.

• Suspected bioburden or local infection

  • Aquacel Ag Hydrofiber with ionic silver to manage exudate and reduce bioburden.

  • Sorbact dressings that bind bacteria to reduce bioburden and support healing.

  • Zorflex wound contact layer for chronic, non-healing wounds. Manufacturer materials suggest reduction in infection signs within about 4 weeks, but results vary and claims should be interpreted cautiously.

• Cavities or tunnels

  • Wound packing with appropriate ribbon or alginate. Frequency: daily or every few days depending on exudate and surgeon instructions.

• Complex or high-risk incisions

  • NPWT devices such as PICO or 3M KCI Prevena can improve edge apposition and manage exudate under negative pressure.

Dressing notes

• Protect surrounding skin with barrier film.

• Avoid stacking too many layers that create pressure.

• Reassess at each change. Downgrade dressings as exudate reduces.

PRESCRIPTION TREATMENTS – WHAT NURSES SHOULD KNOW

• Oral antibiotics at home only – common examples include Keflex and Flucloxacillin. Keflex targets many gram positive and some gram negative organisms. Flucloxacillin targets staphylococcal infections and is often used prophylactically around surgery per protocol.

• Clexane – an anticoagulant for DVT prevention when prescribed.

• Prednisolone and hydrocortisone – corticosteroids for allergic or inflammatory conditions when indicated.

• Telfast – non-sedating antihistamine for allergy symptoms.

• Always check allergies and interactions. Confirm indication, dose, frequency, and duration. Clarify any verbal order and document.

IN-ROOM PROCEDURES – NURSING ROLE

• Remove drains per protocol when outputs are low and stable, tubing is patent, and the surgeon agrees. Provide education and sterile technique.

• Wound debridement of necrotic skin within scope and under surgeon’s direction.

• Packing and re-dressing cavities with measured length documentation.

• Scar revision is a surgical procedure. The nursing role includes preparation, assistance, and follow-up care.

• Healite LED or similar low-level light therapy may be used if available and approved, as part of a multimodal plan.

THEATRE PROCEDURES – WHEN AND WHY

• Hyperbaric oxygen therapy may support compromised flaps or radiation-affected tissue under specialist guidance.

• Medicinal leeches may be used in rare cases of venous congestion.

• Aspiration of seroma or haematoma in sterile conditions.

• Return to theatre to stop bleeding, evacuate collections, or correct problems causing high-volume drainage.

• Prepare patient, notify hospital, anaesthetist, and surgeon. Ensure fasting status, consent, and transport.

HOW TO TAKE A PATIENT BACK TO THEATRE – STEPWISE

• Hospital notifications

  • Contact theatre bookings or after-hours coordinator. Provide patient details, urgency, indication, expected procedure, and surgeon.

• Nurse actions

  • Baseline obs, IV access if directed, bloods if ordered, fasting status, remove food and fluids, pressure-relieving positioning, garment removal as needed, consent paperwork support, update family contact.

• Anaesthetist

  • Share comorbidities, allergies, airway concerns, last oral intake, and medications including anticoagulants.

• Surgeon

  • Provide concise summary: procedure, day post-op, problem, vitals, trend in drain output, photos, and your recommendation.

• Documentation

  • Time-stamped notes, who you spoke with, decisions made, and pre-op checklists completed.

PATIENT COMORBIDITIES – WHY THEY MATTER

• Diabetes – impaired immunity and microvascular changes slow healing.

• Smoker – vasoconstriction and tissue hypoxia.

• Recreational drugs – interactions and healing risk.

• Allergies – reactions to medicines and dressings.

• Arthritis – steroid use and mobility issues.

• Thalassemia – anaemia and transfusion considerations.

• Clotting disorder – bleeding or thrombosis risks.

• MTFI gene – documented genetic factor at your clinic; clarify with the surgeon how it affects care.

• Lupus – autoimmune impacts on healing and infection risk.

INFECTIONS – MICROFLORA SWABS AND WHAT THEY MEAN

• Staphylococcus aureus – Gram positive, round-shaped, common on skin and in the upper respiratory tract. Often called Golden Staph.

• Pseudomonas – environmental organism from soil and water. Can colonise moist areas and wounds.

• Serratia marcescens – rod-shaped, Gram negative, opportunistic. Can grow in moist locations where phosphorous-containing materials or fatty substances accumulate, including soap residue in bathing areas, faeces in toilets, and soap or food residues in pet water dishes.

• Rapidly growing mycobacteria – Mycobacterium abscessus, M. chelonae, M. fortuitum are associated with cosmetic surgery infections. They can form biofilms and tend to resist disinfectants.

• Leukocytes – white blood cells indicating immune response. Types include granulocytes, monocytes, and lymphocytes.

Swab technique and interpretation

• Cleanse surface first to avoid contamination, then swab the wound base or aspirate fluid for culture.

• Mark the site and date. Request microscopy, culture, and sensitivities.

• Start empiric therapy only if clinically indicated, then refine to targeted therapy once results are back.

• Consider imaging for deep or persistent collections.

MANAGING INFECTION RISKS – WHAT THE DATA AND EXPERIENCE SUGGEST

• Overall infection risk after plastic surgery is low at roughly 1 percent.

• Higher-risk patients include those with diabetes, smokers, steroid users, or vascular disease. Longer procedures carry higher risk.

• Prevention focus: pre-op optimisation, aseptic technique, normothermia, haemostasis, gentle tissue handling, appropriate prophylaxis, and good post-op instructions.

LATE COMPLICATIONS – BEYOND 2 WEEKS

• Late-onset haematoma or seroma – often after activity increase or pressure changes.

• Delayed healing – consider tension, perfusion, occult infection, or systemic factors.

• Scar issues – hypertrophic or keloid change. Options include silicone therapy, taping, massage when appropriate, and later steroid injections or laser per surgeon.

PATIENT EDUCATION – SIMPLE PATIENT SCRIPTS YOU CAN USE

• Pain control

  • Take medicines as prescribed on time. Rest, elevate, and use ice safely. Call if pain suddenly worsens or is one-sided.

• Wound and dressing care

  • Keep the dressing clean and dry. Do not remove unless told. Watch for redness, swelling, bad smell, or fluid that changes colour.

• Breathing and mobility

  • Short walks help your lungs and circulation. Do ankle pumps every hour while awake.

• When to call us

  • Fever, chills, fast heart rate, shortness of breath, sudden swelling, new dark skin, or any worry.

• Emergency

  • If severe symptoms, call 000 or go to Emergency. Then let us know.

EMERGENCY CONTACTS

• Nurse on call – number per clinic policy.

• Surgeon cover – weekday and after-hours contact.

• If urgent – Emergency Department doctors and plastic surgery registrars.

NURSE DOCUMENTATION AND QUALITY – CHECKLISTS

Phone triage checklist

• Patient identifiers, procedure, date, surgeon.

• Symptoms with onset and trend.

• Vitals if available.

• Wound status and drain outputs.

• Allergies and medicines taken.

• Photos requested and stored securely.

• Safety net advice given and understood.

• Plan, review time, and who was notified.

Drain output log template

• Date and time – left or right – volume – colour – nurse or patient initials – comments.

Wound review note template

• Subjective: pain score, fever, function.

• Objective: vitals, wound description, exudate, odour, measurements, perfusion.

• Assessment: probable diagnosis, differential.

• Plan: dressing choice, medicines, procedures, follow-up, red flags, education given.

QUALITY AND COMPLIANCE NOTES

• Follow local regulatory policies

  • Avoid misleading statements or promises of results. Provide balanced, factual information. Use clear consent processes.

• Product names

  • Use generically where possible. If a brand is specified by the surgeon, document rationale and follow directions.

• Infection control

  • Hand hygiene, PPE, clean field setup, safe sharps, correct disposal, sterilisation tracking.

Medical References

• Most common plastic surgery complications – Healthline

  • https://www.healthline.com/health/most-common-plastic-surgery-complications

• Negative pressure wound therapy devices – WoundSource

  • https://www.woundsource.com/product-category/negative-pressure-wound-therapy/negative-pressure-wound-therapy-devices-powered

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