Surgical Safety: Our Risk Assessment and Prevention Protocol
Patient safety is the criterion that defines the scope, the type and the timing of every surgery we perform — not aesthetics, not the patient’s urgency, not the aesthetics of the desired result. Before any surgical decision, we assess a structured set of clinical factors based on scientific evidence to determine what is safe for each patient individually.
This page describes the safety protocol applied to all procedures performed in our practice — from the initial evaluation to postoperative follow-up. It is not generic content: it is the methodology we actually follow, with the scientific basis that supports it.
Individualized risk assessment
Before defining the extent of any procedure, we assess a set of factors that determine how much the patient’s body can safely tolerate:
- Biological and chronological age — as a general clinical reference, patients under 45 years of age usually tolerate larger surgeries well; between 45 and 60, we opt for intermediate-sized procedures; over 60, we reduce the extent of the surgery to preserve safety. This is a guideline, not a rigid rule — the patient’s actual biological age weighs as much as or more than chronological age.
- Comorbidities — diabetes, hypertension and other systemic conditions need to be under control before any elective surgery.
- Smoking — a factor strongly associated with surgical wound complications; quitting is recommended before any elective surgery.
- Weight and body composition — we assess them by body bioimpedance for a deeper analysis than BMI alone, guiding the patient toward the best possible body composition before surgery.
- Surgical history, allergies and previous illnesses — complete the individualized anesthetic-surgical planning.
Caprini Score: assessing the risk of thrombosis
We use the Caprini Score, validated specifically to stratify the risk of venous thromboembolism (DVT/PE) in plastic surgery patients. Among patients with a score above 8, without pharmacological prophylaxis, more than 11% develop postoperative venous thromboembolism — and this risk is not limited to the first few days, as it may persist beyond the hospital stay.
Based on this score, we individually define: graduated compression stockings, intermittent pneumatic compression boots, early mobilization and, when indicated, prophylactic anticoagulation.
Anesthesia and intraoperative controls: safety from the inside out
Safety inside the operating room does not begin with the scalpel — it begins with the anesthesiologist. Most patients spend months researching their surgeon, but rarely ask who will be administering their anesthesia. The anesthesiologist is the physician who stays by your side from the beginning to the end of the procedure, actively monitoring and controlling every vital parameter throughout the surgery — and choosing this physician is as important as choosing the surgeon.
In larger body surgeries — such as HD lipo (high-definition liposuction), abdominoplasty and Mommy Makeover — we use a combination of anesthetic techniques, individually planned by Dr. Tales Laurenti, coordinator of our anesthesia team:
- Spinal anesthesia: contributes to better pain control during surgery and in the immediate postoperative period, reducing the need for opioids and their side effects
- General anesthesia: provides sleep during the procedure and allows the anesthesiologist to precisely control all anesthetic conditions throughout the entire surgery
Combining the two techniques allows lower doses of each medication to be used, with better anesthetic control and fewer side effects such as nausea and vomiting in the immediate postoperative period. The technique is always defined individually, according to the procedure, the clinical conditions and the needs of each patient.
Within this continuous monitoring, we carry out a set of active controls that go beyond the anesthesia itself:
- Body temperature control: perioperative hypothermia is associated with greater bleeding, a greater need for transfusion and even a tripling of adverse cardiac events in the postoperative period — a risk amplified in plastic surgery by the exposure of large areas of body surface. For this reason, we monitor temperature continuously and use active warming devices (thermal blankets) throughout the surgery.
- Replacement of essential vitamins and minerals: in surgeries with greater blood loss, we perform intravenous replacement of iron, B-complex vitamins and vitamin C during the surgical procedure itself — accelerating hematological recovery and promoting healing from the first hours of the postoperative period.
Anesthesia is not a detail of surgery — it is a fundamental part of your safety. Individualized planning, a specialized team and continuous monitoring are not differentiators: they are mandatory elements of any well-conducted surgery.
Watch Dr. Tales explain how anesthesia works in Dr. Marco Longo’s body surgeries:
Surgical technology and infrastructure
Intraoperative safety also depends on the facility where the surgery is performed and on the tools available to the team. In our practice, all procedures are performed with:
- Ultrasonic technology (VASER | LIPO SOUND 2) in liposuction, reducing vascular trauma and intraoperative bleeding
- Fully equipped hospital, with ICU support and a blood bank
- Dedicated anesthesiologist, with continuous monitoring
- Complete surgical team — two to three plastic surgeons in larger procedures, reducing surgical time and anesthetic exposure
- Compression stockings and intermittent pneumatic compression (IPC) boots for thrombosis prevention
- Specific medication protocols to reduce intraoperative bleeding and prevent postoperative thrombosis
Preoperative preparation
- Preoperative respiratory physical therapy, with specific evidence in abdominoplasty patients, reducing postoperative pulmonary complications
- Nutritional optimization, with assessment of macro- and micronutrients relevant to healing
- Use of compression garments in the preoperative period, conditioning the abdominal wall before surgery
Postoperative follow-up
Safety does not end in the operating room. Our follow-up model includes:
- Multidisciplinary team — physician, nursing and physical therapy working together in the immediate postoperative period
- Scheduled follow-up visits at key moments of the recovery
- Direct access to me and the team via WhatsApp, 24 hours a day, for any questions or complications
- Guided postoperative physical therapy, reducing complications such as seromas and adhesions
Frequently Asked Questions
What are the risks of plastic surgery? Like any surgery, it carries risks inherent to the surgical and anesthetic procedure — bleeding, infection, hematoma, thrombosis and healing complications. A detailed preoperative evaluation and the adoption of safety protocols reduce these risks to low levels, but do not eliminate them completely.
Is there an age limit for having plastic surgery? There is no rigid limit. We assess biological age together with chronological age, adjusting the scale of the procedure to the patient’s actual health condition.
What is the Caprini score? A scientifically validated tool to estimate the risk of deep vein thrombosis and pulmonary embolism after surgery, used to define the preventive measures for each patient.
Does the follow-up end when the patient leaves the hospital? No. It continues with follow-up visits, guided physical therapy and direct access to the team via WhatsApp for any questions or warning signs throughout the recovery.
Dr. Marco Longo — CRM 122.172 — RQE 58.398
Plastic Surgeon — PhD | USP
Specialist in High-Definition Body Contouring
This content is educational in nature and does not replace an individualized medical evaluation. Learn more about how we apply this protocol in each procedure: [Abdominoplasty], [HD Liposuction], [Mammoplasty]. For a more detailed scientific analysis with complete references, see also: [Risks of Plastic Surgery: How We Assess and Minimize Each Stage of Treatment] (blog).
