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Cosmetic Surgery - Is it really worth the risk?

Medical reviews have proved beyond doubt the rising popularity of Cosmetic Medical Services, especially Cosmetic Surgery. It is a fact that a physically attractive or smart person has better opportunities in life, is judged more positively and gets preferential treatment in situations such as marriage and employment. This can significantly impact the person's life as a whole.

At the same time, there are reports in media of complications after Cosmetic surgery procedures - "Patient dies after Liposuction surgery". This has led to confusionamong the layman about whether to consider Cosmetic Surgery at all. The man on the street hears of either stories of cosmetic surgery involving glamorous people, OR 'horror' stories of Cosmetic Surgery gone wrong. Neither of these is something the common man can relate to. Is there nothing in between these two extremes? Can Cosmetic Surgery or procedures not be done safely for the layman?

Cosmetic procedures can certainly be done safely, ensuring both cost effectiveness and patient satisfaction, very often giving a new lease of life to the person concerned. All that is needed is to take care of a few issues. Let us see what they are.

• Patient expectations
• Procedure related risk
• Procedure benefits - extent and duration
• Health care facility
• Surgeon involved
• Procedure Costs
• Decision making

What is a reasonable expectation?

Reasonable is one that matches with common opinion. In case of a Cosmetic problem, there exists a consensus opinion (scientific impression) about what is beautiful and what is not, which also has a scientific basis. This can be confirmed by the surgeon, who will accurately tell how different from the normal the present condition is.

When the opinion of the surgeon and the patient match each other, the expectation is considered reasonable. Sometimes, this does not match-seen usually as the patient referring to a minor problem (minor in the Surgeon's opinion) as very severe, enough to upset the person significantly and interfere in their daily life. This is called an unreasonable expectation. This is a tricky situation, with high chances that the patient is unhappy even when the cosmetic treatment is successful.

In such a situation, the surgeon will discuss frankly with the patient the amount of correction possible, most importantly whether complete correction is possible or not. This varies with each different type of problem; based on his personal experience with similar cases, the surgeon will explain the likely result by keeping the procedure risks low. A reasonable person is usually willing to accept that in certain situations, a minor problem may be very difficult to correct perfectly OR that complete correction of a major problem is difficult. If the person still refuses to understand, the surgeon should realize that chances of an unhappy patient or complications are high.

How does the risk severity change with the procedure?Usually, the less invasive (deeper) the procedure, lesser are the risk of complications. However, long lasting and better corrections can be achieved only with invasive procedures, for problems that have more than one treatment option. Thus, a balance has to be kept between the amount of correction desired and it's longevity to keep the risk reasonable.

Further, there is an inherent risk in every procedure that a surgeon usually will explain to the patient. This risk depends how well established the procedure is worldwide and how familiar the surgeon is with the procedure.

To illustrate, liposuction procedure for body reshaping is extremely safe when done to a reasonable extent. However, If extensive liposuction is planned-called Mega liposuction-the risk of complications increase - depending on the patient's general health, the surgeon's experience, the availability of intensive post op care, etc.

Similarly, when correction for a sagging face is planned, it can be done as a minimally invasive procedure called thread lift with minimal risks as an office procedure. Alternatively, a face lift procedure is a major surgery under general anaesthesia with definite risks of nerve injury, face swelling-bruising and needs a few days to recover both in hospital and at home. Also, the surgery needs a skilled and experienced person to keep risks low. However, with severe sagging problem, thread lift cannot help; face lift surgery is needed.

Further, with mild to moderate problems, risks may be kept low by choosing a minimally invasive procedure if available, such as thread lift; but keeping in mind that results will last only about half as long as a face lift surgery where results will last about 12-15yrs or more.

Does the choice of the health care facility really matter while opting for Cosmetic Surgery?

Usually those undergoing major Cosmetic Surgery are healthy or have minor medical problems that are under good control; the stay after surgery in hospital lasts about 2-3 days. A health care setup with basic safety facilities in the Surgical Suite will suffice, more so if no major anaesthesia is involved and patient will not stay overnight. Sometimes, a setup with an ICU facility is essential, as when doing a Megaliposuction procedure, OR when doing a regular procedure but for a person with definite medical problems.

Training and experience of the Physician (Surgeon) are very essential. With the presence of self proclaimed experts in Cosmetic Medical Care, how does one choose/identify the right Physician?

Basic considerations in choosing a Surgeoninclude

• Qualification
• Association/professional body memberships
• Experience of the surgeon with the procedure
• Approval by Hospital to surgeon
• Hospital approval

A trained Plastic Surgeon completes at least 6 years of surgical training with at least 3 years intensive training in Reconstructive & Plastic Surgery. In India, this earns the qualification of either a M.Ch. or a DNB in Plastic Surgeryand the membership of the Specialty Association - association Plastic Surgeons of India - www.apsi.org.in. Similar qualification in the UK is a FRCS in Plastic Surgery and in US the person will be a Board Certified Plastic Surgeon.

What makes a Plastic Surgeon competent to handle Cosmetic Medical Care?

Plastic surgeons work with patients at all stages of life, evaluating health, medical, psychological history, and body type to provide comprehensive advice according to their personal cosmetic medicine goals. They help explain the specific results a procedure can and cannot deliver and its associated risks; how to choose the right course of action depending on our age, needs, and wishes; and what we can expect to look like after the procedure.

Unlike others who may be trained in only a few cosmetic procedures, plastic surgeons are educated in the full spectrum of cosmetic surgical and non-surgical care. They hone their skills and techniques through one of the lengthiest and most comprehensive training programs in all of medicine.

Besides delivering great results for patients through comprehensive cosmetic procedures, our focus as plastic surgeons is on patient safety. We believe that patients deserve the highest quality of care and safety, which is delivered in our accredited facilities. Also, Plastic surgeons are actively involved in research to develop new techniques and improve existing procedures that will deliver scientifically proven outcomes for patients undergoing cosmetic or reconstructive procedures.

Are procedure costs related to risks or outcomes in any way?

With increasing demand for Cosmetic Surgery, patients and physicians look for cheaper services. However, cutting costs beyond a point can compromise safety. Practical ways to keep costs less include choosing a non-Metro city (such as Mangalore) OR choosing a surgeon who is less busy, provided he meets your satisfaction and gives you time.

Chances of complications are higher with physician or others who undertake procedures without the suitable training, knowledge or experience. It leads to disappointment, loss of time and money besides bringing disrepute to the specialty.

How quickly can a decision for Surgery be made?

Though a quick decision can be made about treatment for a common problem, a second consultation is usually helpful - whether with the same or another surgeon. Collecting information on the matter from websites and discussion forums will give you a better idea of what to expect with the procedure.

Popular stories of disasters after cosmetic surgery result from inappropriate/hasty decisions or poor surgical technique. Examples of inappropriate decisions include agreeing for an over-sized breast implant (high risk of wound breakdown and implant removal) OR excess liposuction (leading to skin necrosis, fat embolism or death).

A popular quote among physicians says "A Good Surgeon knows how to operate, The Better one knows When to operate, The Best one knows when not to operate"

A competent surgeon knows the shortcomings of a procedure well.

The responsibility of creating this awareness lies with the Plastic Surgery Fraternity.

To conclude, the answer to the question posed at the beginning of this write - up, is fairly clear by now. Cosmetic Surgery is worth not just the risk, but much more - it can be kept safe and cost effective, while more people avail these benefits and improve their lives... All this provided it is done by a competent person!

For more information, visit www.lineacosmeticsurgery.in OR mail to drbhatsp@gmail.com