Antibiotics are commonly used in cosmetic plastic surgery. After all, who wants to have an infection as a complication after a cosmetic procedure? The threshold for avoiding any complication is much lower in cosmetic surgery than other surgeries, and the plastic surgeon will typically give these medications to all patients—whether they need them or not—to reduce the risk of an infection or abscess.

Abuse of antibiotics

This practice has been so abused over the past 20 years that we are on the verge of a medical disaster. It seems like every week we are hearing about “flesh-eating bacteria” resistant to medication and other types of hospital-acquired infections (yes, you actually get these from the hospital!) such as MRSA (Methicillin Resistant Staphylococcus Aurea), which are resistant to all but the last line of antibiotics we have. This means there is only one option to treat you, and when resistance develops to that… we are back to zero protection against infections from bacteria.

New drugs are being developed, but they may take time. The action plastic surgeons and patients need to take is to learn when these medications should be used in cosmetic plastic surgery and when there is no need for them.

Cosmetic procedures not needing antibiotics

There are a number of procedures in plastic surgery where antibiotics are not necessary, such as liposuction. Studies have shown that liposuction patients actually have a lower rate of infection than controls without antibiotics—so no need for them there!

  • Faceift surgery
  • Eyelid  surgery
  • Rhinoplasty (nose surgery)

All of these also have very low rates of infection due to the abundant blood supply of the face. These cosmetic patients also do not need prophylactic antibiotics unless specific reasons exist.

Use of antibiotics in plastic surgery

Antibiotics should be used whenever an implant is used in the body; a breast implant, whether a saline or silicone breast implant, chin implant or buttock implant forms a microfilm around the implant that seems to protect bacteria from natural body defenses.

When large incisions are made around fatty tissues, such as in abdominoplasty (tummy tuck), breast reduction and breast lifts, antibiotics can be used to prevent what can become a large area of infection.

We must be judicious about which cosmetic patients get antibiotics before they have developed any signs of infection. This will help us all have greater choices in antibiotic use for when we really need them for treatment.

Morad Tavallali, M.D., FACS

Cosmetic Plastic Surgeon


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