Is the Patient Always Right? Plastic Surgeons Answer

Is the old adage “the customer is always right” true in plastic surgery? The answer is both yes and no. Every patient can and should come in to speak with a plastic surgeon if they are bothered by facial aging and/or body contouring issues, but this does not mean that what the patient thinks he or she needs is actually the right procedure for achieving his or her goals. Bottom line, the hot procedure that you read about online or that worked for your friend may not work for you.

It is up to the plastic surgeon to be honest and educate you on what a specific procedure can and cannot achieve for your individual anatomy. Dr. Sean Doherty of Boston, MA and Dr. Craig Colville of Toledo, OH discuss this delicate issue, and why saying “no” to patients is so important.

No is Sometimes the Hardest Word

In this age of social media influencers and our need to look like the latest trend, patients will very often come into to a plastic surgeon’s office asking for a specific procedure. Does this mean the the plastic surgeon should perform that procedure? Is the patient always right?

Dr. Doherty believes that while the patient is certainly right in wanting to talk about something, he or she does not necessarily know what can or should be done to address the issue. “Saying ‘no’ is one of the hardest things that we have to say to a patient, but sometimes we need to,” he shares.

Dr. Colville agrees. The important thing in any consultation is to really talk to the patient and find out:

• Why did you come into the office?
• What bothers you about your face, breasts or body?
• Why do you think that you want this specific procedure?

It’s About Patient Education

It all comes down to educating the patient on what a procedure can and can’t deliver. Dr. Colville will explain that this procedure combats these problems. However, those aren’t the problems that are bothering you. Your problems would better be served by this. “Patients come into the office because they are unhappy about something and they think lip filler is the solution, but maybe it’s not,” Colville explains. “Maybe it’s Botox, or some other procedure.”

Dr. Doherty finds that the most common scenario in which he says “no” to a patient is “when they are asking for something minimal, but are looking to have a significant response.” If the patient comes in to discuss his or her face, for example, and keeps pulling on the skin of the lower face from behind the ears, and thinks that a syringe of filler is going to combat the issue, it’s a problem. “It’s up to us to educate them that they’re actually looking for a surgical result,” explains Dr. Doherty.

Non-Surgical vs. Surgical – Confusing for Patients

Knowing when it is time to move from non-surgical modalities to surgical procedures is a problem area for many patients. There are great non-surgical options these days for rejuvenating the face, but when the lower face begins to sag and you get jowling around the jawline, no amount of filler is going to correct the problem.

Filler adds volume; it does not lift loose skin. A plastic surgeon could give that patient $5,000 worth of filler, explains Dr. Colville, and it’s not going to get them where they want to be. Just because filler worked for your friend does not mean that it will work for you. “So, let’s talk about actually fixing what’s bothering you and this may mean surgery,” says Colville.

Breast Implants vs. Breast Lift – Another Confusing Issue

Another example of a confusing issue for many patients is breast implants versus a breast lift. Women will come in for a breast surgery consultation “wanting breast implants because that’s what her friend got to rejuvenate her breasts,” says Dr. Doherty. But the patient has sagging breasts due to:

• multiple children
• breastfeeding
• weight gain/loss
• age
• hormone changes

Breast implants are not going to rejuvenate this patient’s breasts. She needs a significant procedure that may include a breast lift – either with or without a breast implant and/or fat grafting to the breast. It is up to the plastic surgeon to be honest with the patient. Otherwise, she will not be happy with her results.

Important for Surgeon to Hold Ground

Honesty is the key, especially since there will always be someone out there who will give the patient what she wants even if it won’t achieve what she desires. The best thing that the surgeon can do “is hold your ground,” says Dr. Colville. “Nobody is perfect all the time and no one is correct all the time, but we try to be.”

Dr. Doherty agrees: “We are in aesthetics, but we are physicians and we need to take care of our patients.”