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What is the Right Operation for Your Problem?

As you go in to see a plastic surgeon for an elective cosmetic consultation, what operation do you want…and what type of operation do you need? You may say…’well that is why I am seeing the doctor, he is to tell me what I need’ And while there is great truth to that position, you the patient must realize that you are an obvious participant in the process and you should try and understand the why and how of what you are subjecting yourself to. I have had many patients over the years who say when I start to explain an operation to them…’I don’t want to know anything about it…..just do it! I personally don’t like that approach from a patient because much of what they experience after surgery, of which I will get many questions and concerns then, could have been anticipated by them had they tried to have some understanding before surgery about the operation.

There are three things about a cosmetic surgery that a patient should try to get a handle on during a consultation with a plastic surgeon. First and foremost….options. What are the different methods that can be used to treat my aesthetic concern(s)? The beauty of plastic surgery is that there is rarely one way to do anything. Usually, there are several methods to treat any problem…each will have a slightly different outcome with their own levels of risk and recovery. Even something as relatively simple as a breast augmentation has many subtle variations…..saline vs. silicone implant, above or below the muscle, different placements of the incisions, etc. Your plastic surgeon should go over all the options that are available, from simple to complex, and make you aware of how effective they may be for your concerns. The education of a plastic surgeon is that he/she knows all the options, what their advantages vs disadvantages are, and can do the surgery. Only you, however, can select the operation that meets your needs the best and give permission to actually undergo it. The plastic surgeon provides you with an education……you decide what you want to do with it.

Secondly….does the operation make sense to you? Amd what I specifically mean by that is….does the operation seem to match your concerns/problems. There is a basic rule that I apply to operative selection and I used to teach my residents when I was at the University. Match the solution to the problem! You don’t need a big operation to treat a small problem. This exposes the patient to a lot of risk, which if they occur, will likely be worse than the original concern. For example, if your concern is only a small bump on your nose and you are happy with the rest of it….then a three hour rhinoplasty procedure doesn’t match that problem. Conversely, a small operation for a big problem……will usually not solve the problem at all. For example, a waddle of skin in the neck with droopy jowls is not going to be significantly improved by a threadlift and some laser resurfacing. You may like the allure of the simplicity of that procedure…but you won’t be happy with the results. Small problems need small fixes……big problems need real operations. While no patient is a plastic surgeon, most patients have enough common sense to understand this concept. This operative mismatch happens to today for two reasons……the plastic surgeon may be motivated to do more surgery than necessary due to ego or economic ncentives……and the patient may be tempted to something less invasive because of the appeal of less recovery and less cost.

Lastly, does the operation fit your lifestyle? Specifically, I am referring to recovery and costs here. Don’t shortchange the amount of recovery that may be needed. Facial plastic surgery usually is an issue of social recovery (how do I look), body plastic surgery is about physical recovery. (e.g., how soon can I lift or get in and out of a car alot for my work) Don’t get caught trying to ‘squeeze’ an operation in your schedule when you really don’t have adequate time. That may adversely affect the outcome and cause complications and you may valuable work time. Make sure you have a clear understanding of recovery…before surgery! And make you sure you can afford the operation. While I could argue that your finances are not my concern, they may be after the fact. I always advise my patients with this statement….if you can’t afford the costs associated with the potential for revisional surgery, you shouldn’t undergo the original surgery. For example, if you have breast augmentation and one implant has healed differently in shape to the other one and you want it reworked, there are additional costs…these are your responsibility. What you pay for up front…is my best effort based on my experience and skill….not a guarantee of a perfect outcome.

Dr Barry Eppley

Indianapolis, Indiana

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