The plastic surgeon has two important jobs in the care of patients.
The first and more intuitively obvious of these, is to select and perform the operation well. Just as important, but perhaps less obvious, however, is what should precede this... the surgeon must help the potential patient decide if surgery is well indicated.
Is The Patient a Good Candidate?
Cosmetic surgery has no absolute indications because it is performed, by definition, upon individuals who are normal. No one is forced by disease or the risk of disability to undergo cosmetic surgery. Instead, patients come to believe that treatment could effect a change in their lives that would justify the intervention. The process used to determine this justification for surgery is generally known as "patient selection."
At the first level, the surgeon must determine the overall health of the patient. The pursuit of elective cosmetic surgery is rarely proper if the patient is not generally well and vigorous. And although significant chronic illness is a common impediment to treatment, even minor health problems may contraindicate surgery if they are of a type that would increase the risks of the specific operation in consideration.
Where the patient is medically suited to treatment, a frank discussion of patient goals must begin, and the physician should assess his ability to deliver an outcome consistent with these. Since no doctor can produce precisely what the patient envisions, consideration of the limitations of surgery becomes appropriate. If the patient's goals are consistent with these limitations, then continuing down the decision-making tree is appropriate. (A careful consideration of "before and after" photos may help to illustrate the limitations discussed.)
The side effects of treatment must next be considered. "Side effects" are those downsides that patients must accept even when all goes well, (e.g. scarring, sensation changes, etc.). If these so-called "sequelae" of surgery are acceptable to the patient, then a detailed consideration of the medical and cosmetic risks should follow.
Once all of the above has been accomplished, a dependable decision regarding the pursuit of surgery is likely to follow.
Patient Checklist: Good Things to Ask Yourself Before Having Cosmetic Surgery
- Do I feel as though I have been able to explain to the doctor what I am hoping for?
- Does the doctor seem enthusiastic about his/her ability to achieve a good outcome?
- Does it seem that what I am hoping for is realistic? Will I be happy
with a "real-world" result, together with its limitations?
- Are the treatment side effects acceptable to me and do I consider them a "small price" to pay.
- Am I willing to accept the risks of surgery, including the possible need for secondary surgery to deal with medical complications?
- Am I willing to accept that there may be cosmetic shortcomings in the outcome, and that these may or may not be modifiable with more surgery?
The surgeon's hope is that each and every patient be satisfied. Although this can not be guaranteed, use of the methods described above can help a great deal in the pursuit of this worthy goal.
