Plastic surgery complications range from minor scarring to life-threatening emergencies, and they happen more often than most people expect. Even with a qualified surgeon and proper preparation, every procedure carries risk. Understanding what “going wrong” actually looks like, why it happens, and what you can do about it helps you make better decisions before surgery and respond faster if problems arise afterward.
What “Going Wrong” Actually Looks Like
The most common complications after cosmetic procedures are wound separation (where an incision opens back up), infection, and fluid buildup under the skin called seroma. In a study of 123 cosmetic tourism patients treated at a major U.S. hospital, wound separation occurred in 39 cases, infection in 38, and seroma in 34. Over half of all patients required some form of medical intervention, and nearly one in four needed hospital admission.
Less common but more dangerous complications include hematoma (blood pooling under the skin), tissue death from disrupted blood supply, blood clots that travel to the lungs, and fat embolism, where fat enters the bloodstream and blocks vessels in the lungs. Fat embolism is the signature risk of the Brazilian Butt Lift, which has been the deadliest cosmetic procedure in recent years. South Florida alone recorded 25 fat embolism deaths from BBL surgery between 2010 and 2022, with 2021 being the worst year at six deaths. When a large fat particle reaches the lungs, it is almost always fatal.
Other outcomes that patients consider “going wrong” aren’t medical emergencies but are still devastating: asymmetry, visible scarring, an unnatural appearance, numbness that doesn’t resolve, or simply not looking the way you expected. These are more common than life-threatening complications and often harder to address.
Who Is Most at Risk
Certain factors significantly raise your odds of complications. For surgical site infections after breast procedures, the biggest risk factors are elevated BMI, current smoking, diabetes, a suppressed immune system, and having multiple procedures done at once. Older age also increases risk across most procedures.
For hematoma, the risk factors shift slightly: blood-thinning medications, older age, tobacco use, and conditions like high blood pressure or cancer. Male patients have higher hematoma rates than female patients, likely due to differences in blood vessel density in facial tissue.
Smoking deserves special emphasis. It shows up as a risk factor for nearly every category of complication because nicotine constricts blood vessels and slows healing. Most surgeons require patients to stop smoking at least several weeks before and after surgery, and some will cancel the procedure if you haven’t.
The Brazilian Butt Lift Problem
The BBL stands apart from other cosmetic procedures in terms of danger. The procedure involves taking fat from one part of the body and injecting it into the buttocks. If the fat is injected too deeply, into or below the gluteal muscle, it can enter large veins and travel to the lungs. This type of fat embolism kills in the range of 10% to 30% of cases for smaller emboli. Larger ones are almost universally fatal.
Safety organizations responded with guidelines in 2018, recommending that surgeons inject fat only into the layer just beneath the skin, use stiff cannulas larger than 4 millimeters, and maintain constant awareness of the cannula tip position. A 2019 survey found that 86% of responding surgeons had adopted the subcutaneous-only technique, and estimated mortality had dropped to roughly 1 in 20,000 procedures.
But those numbers told an incomplete story. In South Florida, the years following both the safety guidelines and a state emergency rule restricting the technique were actually the deadliest on record: 14 deaths occurred after the guidelines, and 12 after the state rule took effect. By mid-2022, Florida passed a stricter emergency rule limiting surgeons to three BBL procedures per day and requiring ultrasound guidance throughout the operation, with timestamped video kept as part of the medical record. If you’re considering a BBL, asking whether your surgeon uses ultrasound guidance and how many procedures they perform daily is a reasonable starting point.
Medical Tourism and Traveling for Surgery
Getting surgery abroad or in another state adds a layer of risk that people often underestimate. The biggest practical problem isn’t necessarily the quality of the surgery itself. A study comparing complications from international and domestic cosmetic tourism found that overall complication rates, infection rates, need for repeat surgery, and hospital admissions were statistically similar between the two groups. International patients did have significantly higher rates of fluid buildup and needed more antibiotics, both oral and intravenous.
The real danger is what happens after you fly home. If a complication develops days or weeks later, your surgeon is in another country or state. You end up in a local emergency room where doctors may not have your operative records, may not know exactly what was done, and may encounter antibiotic-resistant infections picked up at a foreign facility. Follow-up care becomes fragmented, and corrective procedures become more complicated without the original surgeon’s involvement.
How to Check Your Surgeon’s Credentials
One of the most important things you can do to reduce risk is verify that your surgeon is board certified in plastic surgery, specifically by the American Board of Plastic Surgery. This distinction matters more than most people realize. Any licensed physician can legally call themselves a “cosmetic surgeon” and perform procedures, regardless of their training background. A dermatologist, an emergency medicine doctor, or a general practitioner can all technically offer facelifts or liposuction.
A board-certified plastic surgeon, by contrast, has completed at least six years of surgical training after medical school, including a minimum of three years specifically in plastic surgery residency. They’ve passed both written and oral examinations and are required to complete continuing education every year. Members of the American Society of Plastic Surgeons must hold this board certification as a prerequisite for membership. You can verify certification directly through the ABPS website before scheduling a consultation.
Warning Signs After Surgery
Knowing what’s normal and what isn’t can be the difference between a manageable complication and a dangerous one. Some swelling, bruising, and discomfort are expected after any procedure. What’s not normal: a fever above 101°F, a sudden increase in drainage from the incision site, rapidly worsening pain or swelling in the surgical area, or skin that turns dark, cold, or hard near the incision. These can signal infection, hematoma, or tissue death, all of which get worse fast without treatment.
Signs of a blood clot or fat embolism are more systemic: sudden shortness of breath, chest pain, rapid heartbeat, or confusion. These are emergencies. They require an ER visit, not a call to your surgeon’s office.
What Happens if You Need Corrective Surgery
If your results are unsatisfactory or a complication has caused visible damage, revision surgery is often possible, but it requires patience. In most cases, a revision surgeon will want you to wait about a year before operating again. This isn’t arbitrary. Tissues need time to fully heal, scar tissue needs to mature and soften, and swelling can take many months to completely resolve. What looks like a poor result at three months may look significantly better at nine months as the body continues healing.
Revision surgery is generally more complex than the original procedure. Scar tissue is harder to work with, the anatomy has been altered, and the margin for error is smaller. Finding a surgeon who specializes in revision work, rather than simply returning to the original surgeon, is often the better approach, particularly if you suspect the first procedure was performed poorly.
Legal Options After a Bad Outcome
A disappointing result is not automatically malpractice. To succeed in a medical malpractice lawsuit, you need to establish three things: that a patient-physician relationship existed, that the surgeon breached the standard of care, and that the breach directly caused your injury. The standard of care means what a similarly trained surgeon would have done in the same situation. If your surgeon followed established techniques and protocols but you simply don’t like the result, that typically doesn’t meet the legal threshold.
Where cases become stronger is when a surgeon operated outside their training, failed to disclose known risks, ignored contraindications like active smoking or uncontrolled diabetes, performed the procedure in an unaccredited facility, or deviated from accepted surgical techniques in a way that directly caused harm. Documenting everything, including pre-operative communications, consent forms, photos, and post-operative records, strengthens any potential claim. Consultations with a medical malpractice attorney are typically free, and these cases are usually taken on contingency, meaning you pay nothing unless you win.