Reflections on Expectations Part III

As a plastic surgeon, it can be frustrating not to achieve the best possible outcome or result every time we operate. However, unfortunately (as some might view it) there is no uniformity to the results that can be achieved with plastic surgery procedures. There is no catalogue that a patient can choose a desired nose or breast from and no plastic surgeon can guarantee a particular result (please treat claims such as guaranteed not to bruise or totally invisible scarring with a significant degree of suspicion!)

Whilst this may seem incredibly obvious, a significant number of patients will (perfectly reasonably) bring to consultations screen shots or print-outs of results they have seen on the internet that they would like to emulate. It is infrequently possible to do this, as the result that can be achieved for any procedure is entirely dependent on the patient’s starting position, particularly with respect to their anatomy, genetic make-up and other history (smoking, pregnancies, weight loss etc.)

For example, if someone has widely spaced apart nipples, no matter what technique of breast augmentation performed, their nipples will remain widely spaced apart. If someone has a droopy breast with low-lying nipples, they are unlikely to achieve a satisfactory result from a breast augmentation without a breast lift.

If someone has thin, sun-damaged skin and is an ex-smoker to boot, they will not achieve the same quality or longevity of a facelift as someone who has better quality, less damaged skin. These are examples inescapable situations that have a direct impact on the result an individual patient can hope to achieve.

This is why a crucial part of the consultation process is termed “patient education”. This encompasses, in the first place, understanding and becoming aware of your starting position and its impact on decision making and future outcome. From there it leads on to a discussion about what is reasonably achievable in you, personally, and what factors contribute (positively and negatively) to your likely outcome. A recent example is a 45-year old mother of 3 coming to see me showing me “before and after” pictures of 24-year old patients who have not had children. After examining her and educating her about her breasts, their skin and soft tissue support quality and nipple position, she recognised the lack of reality in her expectations, and was able to re-adjust her expectations in to line with a much more achievable goal (and hence vastly improve the chances of her happiness with her result).

Even with all of this in mind, there is still a variation in results – after all, as plastic surgeons we are working with mobile soft tissues and skin, as opposed to rigid materials that will stay where we put them if we fix them securely enough. Hence being unable to judge someone’s surgical result until a few months after surgery once the swelling has subsided.

Therefore, there is a proportion of any patient’s result that is predictable and is within our control (as plastic surgeons), but there is also a proportion that is out of our control – predetermined by pre-existing factors, anatomy and genetics.

I wrote this blog not intending to be “glass half empty” and negative, but in fact to help anyone reading’s expectations to be realistic and gain an understanding of influences that may not have crossed their mind. In that way, I hope it has been useful reading!


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