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What makes anyone want to have cosmetic surgery? Such motivation lies in the combination of physical concerns, whether from aging or from genetics, and the hope of a relatively quick improvement. Even if the physical improvement is not permanent, and many cosmetic surgery results are not, the desire for physical change and self-image improvement can be very compelling.


But behind what constitutes a physical problem and what can be done with it is a world of medical marketing. Cosmetic plastic surgery today has some similarities to any other retail product in that advertising, promotions and many other sales techniques are used to both educate and recruit patients. Beautiful models and scenery, before and after photographs of good results and the allure of discounts for having the procedure by a certain time period encourages patients to consider surgery and helps shape their expectations.  


But the outcomes from any plastic surgery procedure can have little to do with any marketing associated with it. The variables of each patient’s specific anatomy, how they respond to injury and heal, and the technical maneuvers the surgeon performs all contribute to what the final result will look like.


The reality is that few plastic surgery procedures turn out perfect. In fact, it would be fair to say that almost all procedures performed have some features to them that are less than a patient expected or had something develop that they did not anticipate. In essence, there is often some discrepancy between what results occurred and what the promise of its marketing implied. This discrepancy is often very small but again no cosmetic surgery operation creates perfect results.


In the spirit of the statement ‘no plastic surgery operation creates perfect results’ is a more useful axiom that I like to discuss with every patient during a consultation. ‘Cosmetic plastic surgery is all about trading off one problem for another…you just have to be sure that you can live with the other problem(s) better than what you currently have.’ A good educated patient will be informed and understand what those potential trade-offs are. That is the crux of an informed surgical consent.


Examples abound of the assured aesthetic trade-off principle for every cosmetic surgery procedure and often they are not just one. For example, getting larger breasts with implants implies that eventually one will need to replace them as every medical device eventually fails. Liposuction reduces fat collections but will always leave some residual skin irregularities or asymmetries. Having a facelift comes with the understanding that the results will eventually be lost as aging continues. A tummy tuck buys one a long low horizontal scar to replace undesired abdominal skin and fat. Similarly, a breast lift trades off scars for a more uplifted and better shaped breast.


While many may acknowledge that some of these trade-offs exist for their chosen procedure. It is often not understood that these trade-offs may result in the need or desire for revisional or further surgery down the road. This is why the general revisional surgery rate in plastic surgery is much higher than most patients are aware…these trade-offs or imperfections are usually the culprits.    


Dr. Barry Eppley

Indianapolis, Indiana

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