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Risks vs Benefits

What happens when the outcome of a surgery isn’t what you had expected or hoped for?

I hear (or rather see) this question all the time — I can scroll through Real Self and read the questions which others have posted about what is normal, what can be expected from surgery, and if a revision is necessary.

My father – my senior partner who has been in practice for over 40 years – has always said that every plastic surgeon has bad results, mediocre results, and amazing results. Similarly, my chairman in residency also said that every plastic surgeon has complications – and if you don’t have complications, you aren’t operating enough because statistically, complications will happen. But no one wants to be that 1% or 0.3 percent.

As a physician, none of us wants complications or results that are less than perfect. And as a patient, you want every outcome to be perfect – particularly yours. And when it isn’t, it can lead to frustration, anger, and disappointment.

As doctors, we are always reminded that our primary mission is “to do no harm.” That means that when I see a patient I have to first determine if I can help him or her with reasonable or minimal risk. As plastic surgeons, much of what we do is related to quality of life as opposed to life or death – so, if the risks are too high, it may be best not proceed with surgery. Risks may be too high for a variety of reasons – these may be related to medical and lifestyle factors such as a prolonged history of smoking or tobacco use, obesity, or multiple medical problems.

However, if the risks are reasonable, I then have to determine what the problem is and if the desired result can be achieved with a reasonable risk and a reasonable outcome. This is often related to expectations. If your breasts are large and cause back pain, we can make them smaller and help with those symptoms. However, if your goal is to look like a specific celebrity or to get a new job, I may not be able to help you as much.

So when a patient has a less than satisfactory result, I do take it personally – I think and rethink about what I could have done differently. The hard part is that there isn’t always a person whom one can blame. A patient wants to blame someone for the average or less than perfect result or complication; the physician is caught in the middle – I want to defend my work and say that I worked really hard but I also want to acknowledge the patient’s discontent and work towards improving the outcome.

Regardless, when you look at yourself after surgery, the goal is that you have improvement when compared to what you saw before surgery; however, you will still have scars, and you may still have subtle asymmetries.

I encourage everyone to have realistic expectations – asymmetries may occur (rarely is anyone symmetrical from side-to-side prior to surgery)…

Where you start has a great deal to do with your end result – for example, if your skin elasticity is poor prior to surgery, you may find that you will still have some loose skin; or if your belly button wasn’t in the middle before surgery, it will likely still be that way after surgery.

However, there are times, when a revision will be necessary because neither you nor I are satisfied with the results. Under these circumstances, we have to again weigh the risks vs benefits of performing a revision as well as whether we will be able to achieve the desired result. If we both believe that this is possible, then we will proceed. Like most plastic surgeons, we do have a revision policy in which the surgeons’ fees are typically waived although you may be responsible for the operating room and anesthesia fees.

I encourage everyone to be frank and open about their goals and expectations.