Thursday, January 3, 2008

Suitability

There are definable risks and benefits in every surgical procedure. This risk/benefit ratio is particularly important for the cosmetic or aesthetic patient. This patient starts out "well" and will be put into a temporarily "unwell" state to ultimately help them "feel better".

Most training programs do not teach "patient selection" and not everyone is born with the "sixth sense" that will help you know who might not be a good candidate for the procedure requested.

Patients I need to watch for when doing aesthetic procedures

Inflated Expectations

  • Patient tends to be "deaf" to any attempt to educate them as to what their surgery will entail.
  • They seem to have difficulty digesting the fact that there any major procedure carries some degree of inherent risk.
  • Will use the results of computer imaging as a warranty, rather than the possibility intended. Computer imaging does not take into account healing quirks, skin thickness/elasticity, etc.

The Demanding Patient

  • The patient who brings you celebrity photographs with modifications that they want you to duplicate even though the celebrity is a completely different body type (apple vs pear).
  • The patient who brings you a picture of themselves with overlays of the changes they would like. If they can be made to understand that the human body is not clay, but tissue that heals with scars (sometimes predictable, but not always) then this can be a good start to a discussion.
  • The patient who demands no scar. Plastic surgeons are not magicians. When skin it cut, there is always a scar.

The Surgiholic

  • Patients who have had multiple (There does not seem to be a good number to put here. Is three too many or is six?) previous aesthetic surgeries.
  • The patient who had multiple surgeons for their previous surgeries. You will be compared to Dr. X.

Marital or Family Disapproval

  • Yes, the adult patient seeking aesthetic surgery does not require anyone's approval or consent, but ... Secrecy from a spouse or significant other can add stress for both the patient and the surgeon. Someone will need to know how to care for them in the postop period. It helps if they know what was done.

Capitulation

  • The other side of the coin. No patient should be pushed into surgery to please someone else. That other person may not be around in five years, whether by divorce, separation, or death. Will the patient still be glad they had the procedure?

Incompatibility

  • There are some people with whom you just don't feel comfortable. This may be for a variety of reasons. And it may be true from the patient side also. Both may be "nice" people, but may not be comfortable with each other.

Body Dysmorphic Disorder

  • In its simplest definition, it is an obsessive preoccupation with a slight, imperceptible, or actually nonexistent anatomic irregularity to the degree that it interferes with normal adjustment within society.
  • This disorder may be present in varying degrees. It is the most common aberrant personality characteristic seen by the plastic surgeon.
  • When postoperative dissatisfaction occurs (and in most cases, it will), it almost always is based on what the patient understood rather than what was actually said.

The bottom line is: Not everyone is a candidate for aesthetic surgery. Nor is it possible to eliminate every possibility of dissatisfaction or conflict that might arise. Here are some suggestions for doctor and patient

First

  • Surgeon--Be a complete physician, not just a skilled technician.
  • Patient--Be a partner in your care. Give a full and honest medical/surgical history. Don't leave out any medications. What you do when recovering often will have major impact on the final result.

Second

  • Surgeon--Avoid hyping your "unique" talent.
  • Patient-- Be honest about your reasons and expectations.

Third

  • Surgeon--Strive to maintain good communication and rapport with your patient. Listen.
  • Patient-- Do your part in maintaining that good communication and rapport. Listen. If you don't understand, say so. Have your surgeon try to explain in another way.

Fourth

  • Surgeon-- Be honest about your skills. We are all better at some procedures than others.
  • Patient -- Let your surgeon refer you to someone else, if they feel it is in your best interest. Don't "massage" his/her ego to try to get them to do it (I only want you to do it. I feel so comfortable with you. I know you are the best.)

References

Recognition of the Patient Unsuitable for Aesthetic Surgery; Aesthetic Surgery Journal, 2007 Vol 27, No 6, pp626-620; Gorney Mark MD

Streamlining Cosmetic Surgery Patient Selection-Just Say No!; Plastic & Reconstructive Surgery, 104(1):220-221, July 1999; Rohrich, Rod J. M.D.

Of Chickens and Red Flags; Plastic & Reconstructive Surgery, 112(2):684-685, August 2003; Edelstein, Jerome M.D.

Dr. Vazquez Añón's last lesson; Aesthetic Plastic Surgery, Volume 2, Number 1 / December, 1978, pp 375-382; Ulrich T. Hinderer

Body Dysmorphic Disorder and Cosmetic Surgery; Plastic & Reconstructive Surgery, 118(7):167e-180e, December 2006; Crerand, Canice E. Ph.D.; Franklin, Martin E. Ph.D.; Sarwer, David B. Ph.D.

Body Dysmorphic Disorder: Diagnosis and Approach; Plastic & Reconstructive Surgery, 119(6):1924-1930, May 2007; Jakubietz, Michael M.D.; Jakubietz, Rafael J. M.D.; Kloss, Danni F. M.D.; Gruenert, Joerg J. M.D.

Inspired by

Everything Health's -- 2008 Resolutions for Patients and Doctors

2 comments:

DermDoc said...

Outstanding post. I am certainly going to post on this in the future and will link back to this.

rlbates said...

Thanks. Looking forward to your post.