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Appropriate Expectations: Why They're Important
Dr. Green, our impressions of plastic surgery are based mostly on what we've seen on television and in the movies. We've seen enemy agents undergo facial reconstruction to look like another person. We've seen patients select the nose they want out of a book. The impression is that plastic surgery can do almost anything for anyone. But you seemed to imply that this is highly misguided. Can you explain your beliefs?
True, it's completely misguided fiction. It's good TV, not good science. We're not talking about nuts and bolts. We're talking about living tissues, and the body's ability to heal. There are many more factors to consider that vary widely from patient to patient. And you're right. I'd never let you pick a nose out of a book and promise it to you. We're not giving you a new nose; we're not giving you a new face. We are altering your face or nose in some way. We are working with what's there and modifying it within the parameters of your safety. We can change some of the characteristics you don't like; we can reduce the signs of aging; we can make you look more youthful, but it's still you. Your results shouldn't look like it's not you, and it shouldn't look weird– believe me, looking weird is far worse than looking old.
An immature physician may over-promise a certain result. The most important thing that substantial experience teaches a plastic surgeon is how to develop appropriate expectations in patients. If you don't develop an objective understanding before you operate, and afterwards you haven't met subjective expectations, there can be problems. Often you have to begin the operation and see the tissues directly before you can fully understand the situation.
If a surgeon lets the client's expectations lead the procedure, or tries to stretch beyond his ability, or strains the patient's physical capacity, he can run headlong into serious problems. Surgeons need to perform procedures in the way they are familiar with and gradually develop deeper expertise and a broader vocabulary of methods. Haphazardly attempting new ways of doing things can greatly injure patients. A surgeon needs to have the clear judgment to know what's within his current ability so that he won't harm the patient.
Here's an example. A woman came to see me who had buttock implants inserted and then immediately removed due to complications. The surgeon who had performed the procedure was attempting it for the first time and it backfired. He and the patient were both understandably upset with the result. When I was asked to take the case, I thought deeply then responded, "You know... this is a procedure that I may technically know how to do, but I haven't done before. It isn't done very much in this part of the country like it is on the west coast and Miami." I concluded that she would be best served by going to a place where buttock implants are performed regularly by experienced specialists. She may have been upset with my answer, but it was appropriate counsel and the right decision -- one with the client's interest first and foremost, not a decision based on money, surgical ambition, or a patient's insistence.
The most dangerous surgeon is one who does not have very much experience but still pushes himself on the community as an expert. There are injuries and occasionally deaths at the hands of inexperienced plastic surgeons, often due to ambitious overreaching and poor judgment. Too often I've found myself treating patients who have had inadequate and problematic results by lesser practitioners. A few times I have been so angered by what I see that I have to briefly excuse myself to regroup before returning to finish the consultation.
I am not afraid to turn patients away. Sometimes it's simply the right thing to do. Some people have had too much plastic surgery and still want more. I have to tell them straight up, "I'm sorry, you've already had too much plastic surgery and I don't think it's a good idea to do any more at this time." They may get mad, but I have to be content with that. I once met with a lady who exclaimed, "I want people to come up to me and ask who my plastic surgeon was!" I had to explain that I don't want anyone's face to proclaim they have had plastic surgery. A good result, in my opinion, looks natural. I'm a believer in moderation.
The doctor/patient relationship is about having the patient's best interests in mind; it's about healing, not hair color. It is, in many cases, a very serious procedure. With balanced, expert consultation you can identify what things are being done that are effective, and in that way you can avoid media glitz and procedures that might not be best for your health or your appearance.
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 James Green, MD | Plastic Surgery, Santa Fe | Phone (505) 988 2215
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