Last Word

By: Mr Atul Khanna
Created on 18th February 2011

Mr Atul Khanna discusses how the transformation in perceptions of normality have impacted on patient expectation

Since becoming a consultant plastic surgeon, I have noted that the public has become increasingly educated about the benefits offered by cosmetic surgery.

However, I’ve also found that perceptions of normality have transformed, which can have a worrying impact on patient expectation.

A well documented shift has been what has been termed the ‘FHM look’ with women viewing as normal what would have previously been perceived as an unnatural breast shape or size.

Perceptions of ageing have also changed. I see women who wish to look like a certain celebrity, but they are not aware that person follows a rigorous daily exercise regime, indulges in regular non-surgical treatments and might even be on their third or fourth facelift. Spending a few thousand pounds on a quick surgical fix will not achieve this.

The patient’s advocate

My worry is that all this makes patients very vulnerable. These are people who are otherwise normal and healthy, but wish to improve their appearance and an unscrupulous practitioner could play on their anxieties.

Often you have to tread a fine line between supporting a patient, as their insecurities are very real to them, and being careful not to push treatments that won’t benefit them and might ultimately be damaging.

What always guides me is that I treat a prospective patient as I would do a family member or a friend. You have to be their advocate and not a salesman.

Patient expectations

As perceptions of normality have changed so have patient’s expectations. I see patients in my clinic who have been referred with so called asymmetrical breasts and their asymmetry is so mild that it is only noticeable on close examination.

Twenty years ago that would not have been of concern to anyone, but now there is a drive for perfection driven by the media and the images of beauty that we are bombarded with everyday.

For cosmetic surgeons it is very challenging to deal with these slight imperfections. First and foremost, it is surgically demanding, to not make a slight imperfection worse. But also if these patients are not happy in the first place, then they may never be happy with the result.

The consultation process

First, the patient has to be able to articulate exactly what they perceive as wrong. If a rhinoplasty patient says I don’t like my nose, but can’t say why, or even worse, says, you should know as you’re the doctor, then this should ring warning bells.

If the patient can’t demonstrate what the problem is then there is a good chance that if you go ahead with surgery you won’t have solved their problem.

Once surgeons put knife to skin, then what they are doing is usually routine, but it is fully understanding what the patient wants prior to the operation that is actually key to success.

Empowering the patient

There has been much research done into patient recall and it has been demonstrated that anything between 40 and 80 per cent of information is forgotten immediately. This has no bearing on how intelligent you are; the patient is in a very vulnerable position and the whole process can be overwhelming.

This is why I have always provided a written summation of the consultation and I also think it is a good idea if they can bring someone with them to the appointment; an advocate rather than someone who has a vested interest in them having surgery.

The patient should never feel rushed; they should feel that they have all the time in the world to discuss their options and I always invite them to return for a second meeting if necessary.

Cosmetic surgery can bring fantastic benefits to patients but only when it is the right choice for them.