One of the interesting psychological phenomenons that is very common in plastic surgery is what often occurs after an operation. Patients initially present with a certain problem and state how happy they would be if it was better. For example, a middle-aged female is seen with extra skin and fat on the abdomen and a little waistline overhang. She undergoes a tummy tuck and initially is quite happy. But within a relatively short period of time after surgery (often no longer than a few months), the same patient begins to point out a few areas that she feels aren’t quite right or wishes they weren’t there. The very result that the patient once stated they would have been thrilled with is now no longer quite as expected.
This is an observation that I call in my Indianapolis plastic surgery practice the concept of cosmetic accomodation. Many plastic surgeons have seen it but it has not had an exact name. The most well known example of it is in breast augmentation surgery. A breast size that initially after surgery was a little too big or just right seemingly becomes smaller months later. (and the implants have not changed!) And the patient may have wished now that they went bigger from the beginning.
Results after plastic surgery can sometimes, and eventually for some, may appear anti-climatic. This is not to say that they are not happy they had the surgery, it is just that the thrill of the initial results has faded. Much like that brand new car which seems passe’ and too familiar a year later.
While this psychological observation exists for many new changes in all areas of life, there can be some troubling issues with it in plastic surgery. As the newness of the face or body changes fades, the patient may begin to find small areas to critique or be unhappy with. Some of these changes are real like the facelift that begins to relax and develop a small skin excess under the chin or at the jowls, ¦the rhinoplasty that develops a small irregularity at the tip of the nose as the last bit of swelling fades or the liposuction patient who finds some asymmetry in the waistline area months later. Some of these changes, however, are an unveiling of pre-existing issues or the failure to achieve absolute perfection from the surgery. This is where the taking of pre-operative pictures and their review after surgery is important.
While cosmetic accommodation is normal and well tolerated by the vast majority of patients, other patients may desire revisional or touch-up surgery to further improve the result or imperfections. Revisional plastic surgery always brings to the surface issues of another operative experience and its associated costs. Because of this possibility, it is important that anyone considering plastic surgery be informed beforehand of this need or desire on their part and who is responsible for this additional expense.
Dr. Barry Eppley
Indianapolis, Indiana