I was impressed by this article in The New York Times by Pauline Chen MD last week, which reported on a study by the Michigan Bariatric Surgery Collaborative that looked at ways to measure the surgical skills of practicing surgeons and correlate those measurements with patient outcomes.
I found it interesting because their findings objectively confirmed something that I, probably like many others, have long suspected. Simply put, some surgeons have excellent technique whereas others do not.
The study showed that the dexterity of a surgeon’s hands and how the surgeon plans the operation account for much of the differences in how well patients do after surgery as well as their overall results.
As I trained in plastic surgery, my observations where similar to Pauline’s. I saw some surgeons who were highly skilled in the operating theatre and made the operation look easy whereas others, even though they may have presented well with their patients, had technique that was simply not in the same class.
Hands not as precise. Tissue handling not as soft and caring. The movements not as planned or elegant. And unfortunately… final surgical results not at the same high standard. This is a daunting prospect however it is an important finding as it explains how better handling of the tissues and sound operative technique translates into quicker recovery times, less adverse events such as bruising/swelling/pain, and lower rates of complications!
The reality is that a patient’s choice of surgeon certainly does make a difference to the final result.
Because plastic surgery is one of the most intricate surgical specialties and the results are visible for the rest of your life, it is vital that you choose a plastic surgeon who has operative techniques and skill that deliver the best results possible.
As the people do not have access to information on what exactly happens behind closed doors in the operating room, patients contemplating plastic surgery often have difficulty selecting the most highly skilled surgeon- the surgeon who is best for them and their needs!
Despite this difficulty, there is in fact much information available to all patients that can help them choose the best doctor for them. What follows is a list of 5 questions you may choose to ask your surgeon in order to investigate their techniques before you make your final choice…
Surgical Technique: What exact surgical technique are you (the surgeon) proposing and are there other less invasive surgical options or non-surgical treatment options?
Be aware that there are hundreds of different techniques that go by the same name such as ‘facelift’, ‘eyelid surgery’ or ‘nose surgery’. These will all vary (often widely) on operative time, risks, recovery time, fees and results! You must choose a technique that will deliver results that meet your requirements – this is ultimately what is most important!
Track record of results: Please show me a number of (say 5) sets of before and after photos of patients similar to me who have undergone the same surgical technique in your (the surgeon) hands?
This will allow you to assess the amount of result likely from the exact surgical technique being proposed and the aesthetic style delivered by that technique and surgeon. Look at the overall amount of correction of any problems but also look at the aesthetic quality of the result – it should look like the result of natural beauty or graceful ageing rather than surgery. There is an art to plastic surgery – the aesthetic eye of the surgeon determines the aesthetic quality of the result. It is vital that surgery does not change the intrinsic and pleasing characteristics of a face that give it its individual identity.
Results expected in you: What results can be realistically expected in me personally?
This is usually best demonstrated using computer imaging, such as Vectra 3D Imaging, to simulate your likely surgical result on a digital image of yourself. A second best alternative, though more limited, is to ask your surgeon to draw the realistic planned results on a photograph of yourself.
Risks: What are the risks of the procedure being proposed?
How many times has the surgeon performed the exact same type of procedure that you are considering? What are that surgeon’s success rates – ie what % of patients return to theatre for revisional or touch-up surgery? What are the complications possible with that particular procedure and what % of patients have experienced such complications in that surgeon’s practice?
Recovery time: What is my expected recovery time? (Please tell me the usual time period and the worst case scenario if I have slower healing)
These can be assessed by the following questions and is very important information to allow you to plan time off work and social activities. These questions also indicate the usual and worst case healing time and the levels of visible bruising, or swelling for the surgeon’s technique.
- When will I be able to attend social functions and not be detectible as having had surgery?
- When will I be able to return to usual duties at work?
- When will the swelling go down such that I look my best in a photo?
Finally, it is also important to find a plastic surgeon who you trust. You must feel comfortable with them in ensure the most open and effective communication both before and after your surgery. This communication is vital for the optimal outcome of your surgery. Make sure that your surgeon has excellent training and credentials, and also that they are personable and well suited to your individual needs and expectations.
Dr Chris Moss – Specialist Plastic Surgeon of the Face, Nose and Breast.