Introduction: Addressing the Most Common Procedures in Cosmetic Surgery: Why This Book Is Different

Rod J. Rohrich and Yash J. Avashia

Abstract

Success in cosmetic surgery involves preoperative, intraoperative, and postoperative attention. Developing a rapport and understanding with the patient is a critical part of the initial patient visit and builds a foundation for all future interactions throughout the perioperative period. Proper patient selection is the first step in optimizing results. Setting patient expectations is a critical aspect to the preoperative process and directly influences patient’s experience and satisfaction. A detailed preoperative analysis will set the surgeon up to perform the right operation. Inadequate patient assessment can lead to performing the wrong operation and result in complications and revision surgery.

Safety – surgical complications – preoperative analysis – patient selection – imaging – patient expectations

2 How to Optimize Results and Minimize Complications in Cosmetic Surgery

Key Points

Success in cosmetic surgery involves preoperative, intraoperative, and postoperative attention.
Developing a rapport and understanding with the patient is a critical part of the initial patient visit and builds a foundation for all future interactions throughout the perioperative period.
Proper patient selection is the first step in optimizing results.
Setting patient expectations is a critical aspect to the preoperative process and directly influences patient’s experience and satisfaction.
A detailed preoperative analysis will set the surgeon up to perform the right operation. Inadequate patient assessment can lead to performing the wrong operation and result in complications and revision surgery.
Safe technique is a principle in cosmetic surgery.

2.1 Initial Patient Experience

There are three groups of new patients:
- Patients who know about the surgeon’s practice.
- Patients who are referred by another patient.
- Patients who are completely unknown.
The surgeon typically has 60 seconds to develop a connection with the patient that sets the tone for the remainder of the patient visit.
It is important for the surgeon to make a serious effort to connect with the patient during this time period. Engaging the patients in talking about themselves allows the surgeon to identify a potential connection.
Following the patient visit, there is normally a 2 to 3 days window to seek a second contact with the patient by email or phone to follow-up. Lack of connecting with the patient during this period often leads to the patient not proceeding with surgery.
Patient’s experience is truly the intangible aspect that governs the patient’s response to both good and bad surgical outcomes. This is an aspect that includes not only the surgeon, but every staff member. The patient interacts with everyone and all the interactions comprise the “patient’s experience.”

2.2 Patient Selection

The major determinant of a successful cosmetic surgery is patient selection.
Most patient dissatisfaction in aesthetic surgery is based on failure of communication and adhering to patient selection criteria.
- Patient selection criteria: The following medical criteria deem patients as poor candidates and at risk for complications:
  - Smokers.
  - High body mass index (BMI) (>35).
  - Active cardiovascular disease (metabolic equivalents [METS] <4).
  - Anticoagulation and/or antiplatelet therapy.
  - Chronic inflammatory disease with steroid use.
  - Connective tissue disease (Ehlers–Danlos syndrome).
Through trial-and-error, the aesthetic surgeon improves his or her sense of identifying patients who are poor candidates for aesthetic surgery.
The practicing surgeon learns to identify certain patient characteristics or personality traits which predict a low level of postoperative satisfaction.
Sarwer et al showed that individuals who seek cosmetic improvement have a higher rate of body dysmorphic disorder (BDD) and other psychiatric conditions than the general population.
The rate of BDD may be as high as 15% in aesthetic surgery patients.
Implicit in patient selection is performing a detailed preoperative evaluation that seeks to uncover both the patient’s physical concerns and psychological perspective.
Gorney described a set of guidelines for patient selection that was based on correlating the severity of deformity with the patient’s level of concern.
- Patients with a low level of concern for a severe deformity were considered good candidates for surgery.
- Patients with a high level of concern for a minor deformity were considered poor candidates for surgery.