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Would A Plastic Surgeon Ever Say "NO?"

by John Di Saia MD

Extreme Makeover, The Swan and similar media have increased the number of potential cosmetic surgery clients. These people are not always good candidates for surgery however. Some need to come "Down to Earth" before they can have surgery.

"Reasonable Expectations" Still Reign Supreme

The vast majority of patients want to have a pleasant encounter with cosmetic surgery. The problem is trying to figure what patients expect. Communication is important. The problem is magnified when their potential surgeon doesn't care to inquire or doesn't make time to evaluate.

Face it. Surgeons Get Paid To Operate.

In my local practice environment, I have amongst the longest cosmetic surgery consultations and I meet all my potential surgical patients personally. This has been the source of grief between prior office mates and me (I am now in solo practice). Most of my prior office mates were primarily fixated on the bottom line. Many plastic surgeons simply do not make the time to talk with their potential patients for more than a few minutes. This makes it pretty hard to figure a patient's options, motivations or expectations. I don't claim to have a 100% success rate, but the vast majority of my patients are happy. Then again if I get the impression that a patient is set up for disappointment, I will not recommend surgery.

Why would I say "NO?"

When patients seem fixated upon operations which will lead down a path of complications or problems, I tend to say "No." When patients have had too much surgery and appear distorted or strange, I say "No." What one patient finds undesirable, however another will want. I operate if it seems I can deliver what the patient will want and I will be OK with it after I am done. Every surgeon draws his or her own line here. Being one of the few that will lose money in recommending against an operation makes me pretty unusual in my locale. To many of the surgeons practicing in Southern California, this is akin to heresy. I look at this as having integrity and proving myself trustworthy. Having predominantly happy patients makes my patient referral rate very high. My practice grows by referrals. I do very little advertising compared to other surgeons.

Be Very Careful Of Looking Too Hard

When an honest surgeon says he doesn't feel that he can help you, it is not the end of the world. It does complicate things a bit however. You have to worry that if another surgeon offers you surgery, that he may be simply operating for the money. I have had patients for whom I recommended other than what they said they wanted. Some have come back after they had surgery elsewhere and looked pretty awful. Sometimes I can fix these things, but not always. In Southern California, there are so many plastic surgeons that even a poor surgical candidate will find one willing to operate if he or she keeps looking. Caveat emptor.


© John Di Saia, MD... an Orange County California Plastic Surgeon