Modern plastic surgical techniques competently practiced are exceptionally safe but a factor that is beyond the limits of any surgeon to control is what the patient expects and wants to get from their surgery.  It is critically important for a surgeon to establish an understanding of this at the initial consultation visit.  I have to talk with my patient enough to get a good feel for what they are looking to accomplish with a procedure that changes their appearance and if there are any underlying issues that affect body image and may adversely impact their perception of the result.  Good candidates for surgery can clearly explain what aspects of what features on their body they want to change and why.  These changes should be undertaken only for that particular patient’s needs and not the needs of any one else such as spouse, significant other, a particular social group or parent.  Additionally, it is not reasonable to expect changes in appearance to result in significant social changes such as the salvage of a troubled relationship, a promotion or raise at work or the furthering of a career in the performance arts or modeling.  The issue that concerns a patient must be easily observable by me and I must agree that it lends itself well to surgical correction.  Plastic surgery, while in general quite precise, is not like working in wood or metal where what you see when the operation is complete is exactly what you have as a final result.  The amount of changing a result goes through post-operatively can be quite extensive and varies in degree from individual to individual for any given procedure.  This “fuzziness”, or degree of imprecision, makes the precise prediction of what someone will look like after surgery impossible and I must feel that the patient can tolerate this before they are considered a good candidate for surgery.  If I get a sense that they will be unsatisfied if the final result varies in any way from their desired result, I do not recommend surgery. 

Another very important concept to get a handle on is that every patient’s result after surgery looks unique.  This is because every patient is uniquely shaped. When I see patients for breast augmentation consults, I like it when they bring photos of results that they like.  They will often make comments on results they don’t like such as “These breasts go out too much”, or “These are too low”.  What they are actually observing are the individual differences in patient appearance related to the anatomical shape of their skeleton and soft tissues and not issues related to the technique of the operation, implant size, shape, etc.  It is crucial for a patient to understand what elements of their look can be affected with the operation and what elements cannot. This can prevent misinterpreting certain natural features of a person’s look with issues directly related to the surgical technique.  My patient’s laugh when I tell them “I would really like to find a plastic surgeon that could make me look like George Clooney!” because everyone knows, at least at this level, that you cannot fundamentally change certain things about how you look.  This concept is not only true in the above rather silly example, but it extends to the whole body. 

These things being said, I find that, by far, most of the patients who see me for consultation are very realistic in their expectations of what plastic surgery can accomplish and, as importantly, what it cannot accomplish and are excellent candidates for surgery from this perspective.  If my patient realizes what their unique appearance is bringing to the operation and how it will influence the final result, then he or she is much more likely to elect to have surgery for the proper reasons and have reasonable expectations about what plastic surgery can achieve for them.  This all leads to a much higher chance of them having a satisfying outcome.

David Luethcke, MD, FACS