Hints, Allegations and Half-truths of cosmetic surgery

Cosmetic Surgery& Beauty magazine debunks some cosmetic surgery myths.

Dr. Somasundaram Sathappan - September 8, 11:52 AM

As the world’s obsession with reality TV and celebrity culture surge, so does the desire for cosmetic surgery increase. The problem with growing procedural awareness is that patients look for the cheapest aesthetic deals and naively seek doctors or practitioners who dupe patients into believing they’re legitimate plastic surgeons. Likewise, as Google and social media develop into everyone’s source for information, common surgical misconceptions are fostered, leading to higher chances of surgical negligence, complications and industry disrepute. 
In order for patients to access reasonable medical information, they must be able to discern which plastic surgery myths are in fact, facts. As such, we rounded up a panel of international board-certified plastic surgeons who reveal the industry’s commonest misconceptions, along with additionally explaining why patient/doctor trust is paramount in the interest of the best possible outcomes. 
Myth 1: All cosmetic surgeons are real
 plastic surgeons.
Singaporean Plastic Surgeon Dr. Matthew Yeo stresses that not all doctors practicing aesthetic surgery are legitimate plastic surgeons. He states, “There are many general practitioners, non-plastic surgeons and sometimes, even beauticians, who offer such services.” He also shares that it’s completely illegal for non-registered doctors – beauticians and spa therapists – to practice any form of surgery or minimally invasive treatments such as botulinum toxin or filler injections. In many countries including Singapore and Malaysia, non-specialists aren’t permitted to perform invasive procedures. This is why it’s important for prospective patients to check on their doctor’s qualifications to ensure practitioners are credentialed specialists who are authorised to deliver appropriate treatment. “Seeing a bona fide plastic surgeon gives patients the best chance of attaining good aesthetic outcomes while minimising medical risks,” Dr. Yeo opines. 
Malaysian Plastic and Reconstructive Surgeon, Dr. Somasundaram Sathappan (Dr. Soma) says that certified plastic surgeons come under a different category altogether. He reveals, “In Malaysia, plastic surgeons are considered specialists under the National Specialist Register which means they’ll need a post-graduate degree in plastic surgery.” He also goes on to confirm there’s no such category as ‘cosmetic surgeons’ in Malaysia. Albeit some practitioners call themselves that, Dr. Soma argues such doctors are technically cosmetic physicians or general practitioners who specialise in medical aesthetics. In Malaysia, aesthetic physicians have their own licensing programme with the Ministry of Health. This is known as the LCP or Letter of Credentialing and Privileging. In short and as shared by Dr. Soma, although there’s no such thing as cosmetic surgeons in Malaysia, all plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons. 
Australian Plastic and Reconstructive Surgeon, Dr. Dilip Gahankari believes this myth to be the industry’s commonest misconception, deliberately spread by non-qualified practitioners who dabble in cosmetic surgery. Dr. Dilip argues, “Plastic Surgeons study many more years in order to attain skills in general surgery before specialising in cosmetic surgery.” He adds, “Patients must be made aware that in order for surgeons to deal with various unpredictable events, complications, unusual clinical scenarios, clinical morbidities and medical problems, they must acquire all-round experience in general, reconstructive and cosmetic surgery.” To better put this in perspective, plastic surgeons undergo a minimum ten extra years of study after MBBS before they’re adequately trained to perform any form of cosmetic surgery. 
Dr. Soma firmly believes it’s misleading for non-plastic surgeons to call themselves cosmetic surgeons. By doing so, practitioners are giving clients a false sense of security, deceiving patients into believing they have the full repertoire of skills to manage one’s concerns of perceived deformity. Although it’s conceivable that some doctors are able to perform a procedure, non-plastic surgeons may only have capabilities of carrying out specific surgeries repeatedly. Dr. Soma outlines, “Because practitioners are unable to vary the surgery for different patients or unique needs, they won’t have the ability to manage complications either.” This, according to Dr. Soma, is where problems arise. Since practitioners aren’t able to deal with unpredictable events, patients will ultimately end up at the doorstep of a plastic surgeon who must take over the reins. Managing another practitioner’s complications, as stated by Dr. Soma, can be troublesome because most of these physicians are his friends and colleagues in the medical fraternity. “When there’s patient unhappiness, plastic surgeons have to do our level best to alleviate problems, as well as soothe frayed nerves to avoid litigation,” Dr. Soma discloses. He continues, “Regrettably, such occurrences of surgical negligence are commoner among aesthetic physicians, as plastic surgeons have the ability and know-how to better manage complications including a patient’s needs and desires. 
Myth 2: All plastic surgeons are the same and have the same skillset. 
Drs. Yeo, Dilip and Soma don’t believe this statement is true. As specified by Dr. Yeo, a plastic surgeon’s skillset is dependent on the individual’s training and experience, as well as their interests. Dr. Dilip agrees and explains, “Plastic surgeons who study in good institutes will gain skills that can be further enhanced by training with experienced surgeons specialising in cosmetic surgery.” Furthermore, plastic surgery is a very broad field which not only encompasses cosmetic procedures but other sub-specialties including aesthetic medicine, surgery, burns, craniomaxillofacial surgery, reconstructive surgery and lymphatic surgery. For example, though most surgeons are trained in an all-round field of plastic surgery, certain procedures such as genital reassignment surgery may be very specialised and only performed by a limited number of surgeons in a few centres worldwide.
Even if a plastic surgeon is board-certified and on the national specialist register, he or she may perform certain procedures very well and simply be average at others. Despite it being unlikely that specialists are bad in any procedure, certain doctors may have enhanced skills in specific surgeries. Dr. Soma admits, “Should a patient come to me with very complicated problems and I feel another surgeon could do better, I would refer this patient to a colleague who excels in such surgeries.” 
Myth 3: It’s rude to ask plastic surgeons tough questions about their experiences and expertise, and unseemly to ask for before and after photos of previous patients. It is also demeaning to ask to speak to a plastic surgeon’s previous patients, or request for another doctor’s contact for a second opinion. 
Dr. Dilip asserts that the bond between a doctor and patient is based on trust. This bond can only be established by honest conversation. As such, Dr. Dilip believes it’s a patient’s right to ask any question pertinent to requested surgeries. In return, plastic surgeons must reciprocate that trust by answering all questions as honestly as possible, even if questions are uncomfortable. 
Dr. Soma concurs and advises patients to always enquire how many cases your surgeon has similarly done, and look into his or her success and complication rates and to also request to view before and after photos. For better insight, Dr. Soma even recommends speaking to a surgeon’s ex-patients so a clearer picture of what’s to be expected can be achieved. “It’s best to have a patient’s perspective because doctors may provide information that’s not particularly true to form,” Dr. Soma divulges. He also recommends, “By conversing with ex-clients, patients are provided wholesome perspectives which improve your confidence in a doctor’s skill, further ensuring smoother passages through surgery and its recovery periods.” 
Though Dr. Yeo agrees it’s sensible to ask questions and view before and after photos –for better visualisations of scars and outcomes – he does warn that speaking to past patients may be limited to privacy concerns. Yet, Dr. Yeo does point out it’s reasonable to request for another doctor’s contact when desiring second opinions. 
Myth 4: All information about plastic surgery can be found online. 
Dr. Yeo disagrees with this statement. “The internet is full of information and misinformation so the best source of material regarding procedures can only be obtained during consultations,” he emphasises. Dr. Dilip however, sustains that online research is no doubt a great resource as there are massive amounts of data on the internet. Still, he does argue that appropriate and unbiased information from non-sponsored sources aren’t always easily found. To minimise chances of misinformation, Dr. Dilip tries to recommend credible online resources whenever his patients want to conduct their own research. 
Dr. Soma declares that patients can find rather comprehensive material online as long as sites are credible. For the best information, patients can Google the American Society of Plastic Surgeons and the British Association of Plastic, Reconstructive and Aesthetic Surgeons when conducting their own research. In addition to credible websites, patients can also YouTube certain procedures which not only explain a surgery’s ins and outs but also allow viewers to watch how they’re carried out. Dr. Soma concurs with Dr. Yeo that nothing can or should replace consultations. Not necessarily because resources are wrong, but because online information is typically generic. He estimates, “Every patient is unique and has different facial and bodily shapes. As such, what one reads or views online may not be what you actually need.” He also says, “You may want a certain change but that augmentation may be done differently to what you’ve read or seen online.” 
Though Google should never replace consultations, Dr. Soma does endorse some homework beforehand in order for patients to ask the right questions.    
Myth 5: Plastic surgery makes you look like a totally different person and it’ll be obvious to everyone that you’ve gone under the knife. 
Dr. Yeo thinks this myth to be untrue. He remarks, “Some patients request for a subtle change while others request for more noticeable changes.” This, in Dr. Yeo’s opinion, should be discussed during consultations so that appropriate treatments may be performed to effect in changes that are acceptable to both the patient and surgeon. 
Dr. Dilip believes there are two ways to look at this myth. Many of his patients seeking visible differences in their bodies and faces sometimes request for drastic surgery when aiming to achieve bodily normalcy, thus making it a case of reconstructive surgery. Others may seek facial rejuvenation without desiring to look different. Therefore Dr. Dilip stresses the importance of consultations and understanding a patient’s expectations to ensure that desires aren’t unrealistic. 
Dr. Soma considers this statement to be both true and false depending on a patient’s culture and background. In the Asian community, patients want to appear fresher without looking artificial. Caucasian patients, on the other hand, are more open to publically revealing their makeovers. With both concerns in mind, Dr. Soma believes the best way to approach patients is to find out their desires and tailor solutions based on unique needs. 
Myth 6: Physical modifications brought upon by plastic surgery are difficult to reverse. 
This is not always factual. “Most patients do not seek reversibility but if this is a concern, it should be made known to the surgeon so that appropriate treatment may be administered,” Dr. Yeo shares. For instance, a breast augmentation patient possibly seeking reversibility should opt to undergo implant augmentations rather than fat grafting as implants are easily removed as opposed to fat transplantation which is difficult to reverse. 
Dr. Soma conversely deems this myth as fact because – depending on the surgery performed – once something is done it can’t be undone. He stresses, “If patients have undergone a tummy tuck or a breast lift, how can plastic surgeons reattach skin that’s already been cut and thrown in the bin?” Yet, and in line with what Dr. Yeo said, Dr. Soma does agree that implant augmentation patients with qualms regarding asymmetry may address such complications at later stages. 
Dr. Dilip concurs with Dr. Soma and maintains that most surgical procedures may cause irreversible changes to the body. While requests for reversibility are few and far between, there are odd instances where patients regret procedural outcomes due to a change of heart, or body dysmorphic disorder. “Every attempt should be made to avoid such outcomes but when they occur, carefully planned revisional procedures may restore some or most of the body’s anatomy. Scars are of course permanent, and with more surgery comes more scarring,” Dr. Dilip cautions. 
Myth 7: All plastic surgeons more or less charge the same fee for most surgical procedures. 
Dr. Soma, Dr. Yeo and Dr. Dilip consider this assertion to be inaccurate. As divulged by Dr. Soma and Dr. Yeo, surgical fees vary based on a plastic surgeon’s experience, the hospital where he or she practices, and his or her expertise. In instances where surgeons practice in more premium facilities, higher fees will translate into a much pricier overall bill. In addition, prices will also increase according to the doctor’s experience and expertise in that specific surgery. Even in the same patient, different surgeons may recommend different procedures when reaching the same endpoint.
Dr. Dilip further verifies that procedural price may be variable based on surgical difficulty and time spent in operation. In addition, combination procedures may be carried out at the same time, with different plastic surgeons offering differing surgical fees based on the types of combination surgeries performed. 
Myth 8: Patients are encouraged to bring images of celebrities or specific facial features they desire to consultations as plastic surgeons will be able to produce similar results. 
Dr. Yeo and Dr. Soma advise against this. “Patients who bring photographs of celebrities with certain features may not have realistic expectations of what can be achieved, as each individual has different anatomical features,” Dr. Yeo states. 
Dr. Soma, on the other hand, simply chooses to not operate on such patients altogether. He explains, “Patients – especially those who want lid or nose augmentations – come in with images and request for lids or noses to look precisely like the photos in hand. When patients demand for minute and exact measurements, it’s practically impossible for surgeons to achieve good results because expectations are way too high.” According to the seasoned surgeon, patients should always maintain reasonable expectations because the body – unlike cement or wood – has the propensity to stretch, pull and swell. For example, tissues at a length of 2.5 cm can expand to 3.5 cm due to swelling and once oedema subsides, skin can shrink back down. Surgical outcomes are inconstant, involve guess work and boil down to the surgeon’s experience, Dr. Soma reminds. “If patients bring images of desired outcomes, I will instead show them before and after photos of what I’ve done and also ensure they understand unreasonable expectations can’t be met,” he concludes. 
Conversely, Dr. Dilip has no problems with clients conveying images of what they want. Despite encouraging this act, he still tells them that results are never guaranteed or even predictable. In any case, Dr. Dilip believes that images will help him better understand expectations and should such outcomes be unrealistic, in-depth consultations would be the best time to make patients aware of this. 

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