Avoiding Difficult Patients

As a cosmetic plastic surgeon,  I try and avoid the potential wrath of a disgruntled cosmetic surgery patient.  I do this by trying to predict who will not be a “good”  post-operative patient.  The key is the initial interview which is used as an effective screening process to pick out the patient with inappropriate motivation,  unrealistic expectations or those obsessed with imagined physical defects.  I then simply do not operate on these patients who  “fail” the screening.  Certain  patient  types  to  interview  carefully  before making  the  final  decision  on  whether  to  operate  or  not  include:

  • Patients whom my staff or I don’t ”gel with”for some reason. Initial “gut instincts” may be correct.
  • Perfectionists: Those seeking a flawless result, cannot accept minor asymmetries or slight imperfections after surgery.  They have the potential to be unrealistic patients.
  • Dissatisfied patients: Some of these were dissatisfied with previous cosmetic surgery by another surgeon. She or he wants me to  “fix it”.  They often put you on a lofty pedestal ready for when they fall when things don’t work out so well.
  • VIPs: Someone highly visible to the public, such as actors,  TV personalities, and politicians, have bigger stakes.

Research shows that a small percentage of cosmetic surgery patients are at risk of experiencing psychological problems, such as depression, after undergoing elective surgery.  Some of these patients sue, harass and even threaten the doctor who performed their surgery.  It ’s important then for every patient to get it straight with their surgeon as to whether they have a policy about who pays for revisions when necessary and to make sure the policy ’s provisions are clear before surgery.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

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Most plastic surgeons favour the infra-mammary incision location for most breast implants. The peri-areolar incision is made as a semicircle at the lower border of the pigmented areola. It does heal beautifully in most cases and uses the interface of the darker and lighter pigmented skin to camouflage the incision. For patients with small areolae, it may be preferable to use the infra-mammary incision, located underneath the breast. This incision also heals very well, and is especially useful for women with well defined creases under their breasts.

The axillary incision (in the armpit) is another option, but it’s better suited for saline implants than silicone gel. Because this access incision is a greater distance from the implant pocket, it’s less precise than the peri-areolar and infra-mammary approaches. Studies have confirmed that there is a higher implant revision rate using the axillary approach. Usually the axillary scars heal well, but they may still be visible when the patient wears sleeveless outfits. There is also a higher rate of breast implant infections with the peri-areolar and axillary approaches.

Patients frequently ask what effect the incision location has on maintaining nipple sensation after surgery. The answer is that the access incision usually has little effect on nipple sensation. Rather, it’s the size of the implant pocket that has the largest impact on nipple sensation. Large implants may require a pocket that stretches the nerves to the point that they do not function well, increasing the odds of impaired nipple sensation. Even so, the vast majority of my patients maintain normal nipple sensation.

Breast implants may be placed over or under the pectoralis major muscle. In the early days of breast augmentation, all implants were placed on top of the muscle. However, in recent decades, it has become more common to place implants underneath the pectoralis major muscle. The muscle covers the top half of the implant, providing additional thickness of coverage over the implant in the critical cleavage area. This makes it less likely that the implant edges or ripples will be visible when wearing a bra or swimsuit. Studies have also shown that the rate of capsular contracture is lower when the implants are placed under the muscle. Breast imaging to screen for breast cancer is more accurate when the implants are placed behind the muscle. For these reasons, I prefer to place implants underneath the muscle for most of my breast implant patients.

 

To learn more about breast augmentations, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

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Following a tummy tuck, patients should take at least 3-4 weeks to recover before returning to work. Normal exercise routines may typically be resumed approximately 6 weeks following surgery.

To learn more about abdominoplasty (tummy tuck), request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

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Breast reduction surgery is designed to make the breasts smaller and lighter to alleviate the problems of symptomatic macromastia. However, the surgeon performing the breast reduction is the most important determinant of the quality of the result. There are many different techniques for breast reduction, and each surgeon has his or her own preferences based on experience and patient needs. Often, breast reduction is combined with a breast lift.

To learn more about breast reduction, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

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There are many reasons why women seek breast augmentation. Some women feel that increasing their breast size will give them greater self-confidence. Others would like to feel more proportional between their top and bottom so they fit better into their clothing. Mothers frequently seek breast augmentation to restore what was lost with breastfeeding and ageing. Supporting loose skin and giving upper breast fullness are also common reasons for choosing breast enlargement.

Good communication with patients in breast augmentation is key. There’s a need to review their medical histories and ask patients what their goals are for breast augmentation. In some cases, it is a modest increase in size to fit better in their clothing. Other times it’s a significant increase in volume to change their look. A patient may desire an improved breast shape or, possibly, better symmetry is their goal. Still others may want to restore their pre-pregnancy figure and may choose to combine their augmentation with a breast lift or other procedures.

On examining the patient, one needs to consider many features including breast volume, width, height, nipple position, areola size, ribcage curvature, skin tone, droopiness, asymmetry, and crease position. Breasts are highly variable, and I help the patient understand what their best options are based on their physical characteristics. We then come to a common agreement about what our goal will be. Remember, that “breast are sisters, not twins” so more often than not there is quite some variation between the two breasts so you can’t expect a perfect match following breast augmentation.

When the patient returns for their pre-operative visit, typically 1-3 weeks before surgery, I have them look through many digital photographs of breasts to show me their desired result. If there is a discrepancy between what we have discussed and what the patient is showing me with pictures, I’ll identify the difference and sort out what they really want, often using the 3D VECTRA which can simulate what the breasts may look like after augmentation. At the end of our meeting, I’m fairly confident that I understand what the patient desires. Likewise, the patient feels comfortable with our communication and our plan.

The photographs are then brought with me to the operating room. When the patient is asleep, I create the pockets for the implants on each of the breasts, and I occasionally use implant sizers to confirm the volume and shape of the optimal breast implants for the patient. Most patients are back to work and most of their usual routine in several days or up to a week. Strenuous exercise should be avoided for several weeks.

To learn more about breast augmentations, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Why “Celebrity Imitation” with Cosmetic Surgery?

Why do people try to imitate celebrities’ actual faces and bodies? Why do people think that a celebrity’s physical appearance can be copied? Occasionally I would get a patient presenting to my office for consultation requesting Nicole Kidman’s nose or Kim Kardashian’s butt. Cosmetic surgery is not the same as Mr. and Mrs. Potato Heads, with interchangeable noses, ears, lips etc.

Plastic surgeons must work with what you have (reality) and you must understand that what you want (desire) may not be achievable.

We as plastic surgeons are trained to perform delicate operations to enhance or improve people’s physical characteristics in an effort to acquire a more desirable feature. We are also taught to operate within the safest parameters possible because cosmetic surgery is elective surgery, which means it’s a want not a need. Therefore, it is vital for us to properly screen all prospective patients to be certain that they are safe candidates for this surgery. There are basic conditions that should be considered, contraindications to surgery which include physical abnormalities, medical problems that can complicate the surgery or put the patient at unnecessary risk, psychological abnormalities, unrealistic expectations, inappropriate motivations and inherent physical characteristics that hinder the achievement of the best possible result.

For people considering “celebrity imitation”, you should reconsider why you want to look like a particular celebrity.

Why is it that you are trying to become someone else? Why are you unhappy with you?  Furthermore, what if a celebrity’s image changes? As they say, “the media darling of this week is the rehab tabloid queen the next.”

Cosmetic surgery is a big change and so it’s important not to lose yourself as you start to look like someone else. I am reminded from a quote of Oscar Wilde, ”Be yourself; everyone else is already taken.

Question: Is it worth getting cosmetic surgery to look like a celebrity?  You can leave a comment below.

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Candidates for body lifts typically have lost large amounts of weight. They should be healthy and well nourished without vitamin or mineral deficiencies. They should not smoke, as smoking increases the risk of complications.

To learn more about body lifts, request a consultation by contacting us at 13000DRTIM or emailing us at info@drtim.com.au 

Wabi-Sabi In Cosmetic Surgery – Imperfect, Impermanent, and Incomplete.

Celebrities, models, and socialites have highlighted some severe complications (including death) from undergoing cosmetic surgery in their pursuit of perfection. This is very concerning and makes me reflect on what beauty is all about. I am reminded at this point of Wabi-Sabi, the Japanese philosophy that embraces the beauty of things imperfect, impermanent, and incomplete.

It is a beauty of things modest and humble. It would be interesting to see how much of this ancient Japanese philosophy could be embraced in the world of cosmetic surgery and what a difference it could make.

Wabi-Sabi represents the exact opposite of the Western ideal of great beauty as something symmetrical, extraordinary and enduring. Wabi-Sabi is about the minor and the hidden, the tentative and the ephemeral: things so subtle and evanescent they are invisible to unrefined eyes.

Simplicity is at the core of things Wabi-Sabi. Wabi-Sabi embraces the “less is more” ideal talked about today, yet often ignored. Cosmetic surgery needs a lot of Wabi-Sabi.

Thanks for reading!

Dr.  Tim  –  Sydney  Cosmetic  Plastic  Surgeon

www.cosmeticculture.com.au
www.drtim.com.au

Breast Augmentation Part 3 of 4: The Plastic Surgeon

I am amazed at how many patients spend more time shopping for a TV or washing machine than they spend selecting a plastic surgeon. Selecting your surgeon should be the single most important thing that you can do to assure an optimal result.

You should have a checklist of essential things to look for in a plastic surgeon:

1)  Certified by the Royal Australasian College of Surgeons, the only college recognised by the Australian Medical Council that can train surgeons in Australia

2)  Be a Member of the Australian Society of Plastic Surgeons (ASPS) and the Australasian Society of Aesthetic Plastic Surgery (ASAPS)

3)  Has hospital privileges to do breast augmentation at an accredited hospital or day surgery facility

4)  Subspecialises in cosmetic surgery

5)  Super specialises in breast augmentation

6)  Recommended by a knowledgeable friend or doctor

7)  Has a curriculum vitae that documents scientific presentations and publications

There are also a few less reliable points that I would like to address when choosing a plastic surgeon. Advertisements and media coverage is paid for by the plastic surgeon and does not necessarily reflect how knowledgeable, competent or experienced they are. Your local doctor may not be in the know of who is best to do breast augmentation and may not have an interest in cosmetic surgery to find out either. Some just refer to surgeons who are their friends from medical school, are in the local area and thus convenient, or who may be paid for by the surgeon to refer you. Never listen to recommendations from anyone who is an “armchair expert” or who has no in-depth knowledge of breast augmentation.

At the end of the day, look at the plastic surgeon’s results to see how good they are. Be very careful with “glamour shots” that can deceive because of lighting, patient positioning and camera angle. They may even be “photo-shopped” or airbrushed. Some plastic surgeons may have models as patients that they have operated on their face but not their breasts (which was performed by another surgeon) and use them for advertising breast augmentation.

There are a further number of “red flags” that you should take notice of. These are:

1)  Completed training in a specialty other than plastic surgery

2)  Certified in an unrelated college

3)  Not a member of ASPS and ASAPS

4)  No hospital privileges

5)  If you are given false or misleading information – claims that are too good to be true.

6)  Unwilling to provide you answers to questions regarding credentials or their curriculum vitae

7)  When the office staff are not courteous, knowledgeable, or don’t spend enough time with you, and don’t tell you what you need to know. Beware of staff who give you all fluff, but no substance, and don’t offer to send you any information. Always insist that the price is broken down into the following categories: surgeon fees, anaesthetist fees, costs of implants, operating room fees, hospital stay fees, laboratory fees, mammogram or ultrasound fees, any other fees. Ask how long the prices on the quote last for. Remember, there is no such thing as bargain surgery. Have you ever seen top-quality surgery for a bargain price? How is the bargain surgeon able to offer such a good price?

When visiting the plastic surgeon’s rooms, look around and take notice of the little things. It should be a quiet, comfortable and modern, an atmosphere that reflects the good taste of the plastic surgeon. The organisation, function, and flow of the plastic surgeon’s office is a reflection of the surgeon’s personality and habits. Think about it. If the office looks messy and unclean, doesn’t that reflect badly on the surgeon who accepts this scenario?

Most of the time, you will recognise a good plastic surgeon without the surgeon having to tell you. If they have integrity, are caring and thorough, then this will definitely contribute to what you will get in the operating room and after.

Question:  What factors do you consider important when choosing a plastic surgeon to perform a breast augmentation? You can leave a comment below.

Breast Augmentation Part 4 of 4: The Surgical Facility

Your safety is of paramount importance when undergoing breast augmentation. Always have your surgery in an accredited hospital or day surgery facility. If you are young and healthy, then a day surgery facility is fine. If you are older and have health problems, then a hospital would be a better place to have the procedure performed because of the availability and back-up of an intensive care unit and other highly specialised healthcare professionals.

Accredited means that the surgical facility has passed a set of rigorous examinations to assure that the equipment and procedures meet standards for optimal safety. The hospital or day surgery facility should be fully accredited by the Australian Council on Healthcare Standards (ACHS) or a set of ISO standards that provide the highest standards of service. Patient health, safety, and comfort should be the surgical facilities main concerns and they should continually monitor and evaluate their performance to achieve these outcomes. Another requirement of accreditation is to assure that personnel is trained, experienced, and skilled healthcare professionals and procedures and equipment are in place to deal with any emergency from a power outage to cardiac arrest.

Sometimes it’s reassuring to visit the accredited facility yourself. If you’re not comfortable with a surgical facility, don’t have the breast augmentation surgery there. What you want to see is modern and comfortable surroundings, as well as caring and warm personnel. The operating room should appear state-of-the-art, spotlessly clean, and equipped with the most up-to-date equipment. The recovery area should be immediately adjacent to the operating rooms. Some surgical facilities provide overnight accommodations with one-on-one nursing care especially for patients who need overnight care for more extensive procedures.

The following checklist should help you “tie things up” when organising your breast augmentation:

1)  Check the date of surgery and pay scheduling deposit if required

2)  Review surgeon’s financial policies and policies for refunds

3)  Sign informed consent and operative consent forms for breast augmentation

4)  Schedule laboratory tests and mammography/ultrasound if required

5)  Review medications to avoid and ones to take before surgery

6)  Review post-operative instructions the night before surgery

7)  On the day of surgery wear comfortable clothes, get someone to drive you home and be with you overnight, wear no make-up, and leave your jewellery and valuables at home

Question: What things do you consider important in the surgical facility when having a breast augmentation? You can leave a comment below