Managing expectations in cosmetic surgery

Performing cosmetic procedures is an art, and part of the artistry actually comes down to understanding your patient well. It is not just the technical and surgical aspects of a case that are important, but the whole psychosocial wellbeing of the patient. One can do the most amazing treatment and the results may be flawless, but a patient may still feel inadequate or deem the subjective outcome unsatisfactory for a number of reasons.

The most common of these are patient psychological factors. I ask myself, "why did this patient seek a cosmetic treatment in the first place?" Was she or he insecure because other people, notably friends and family, levelled some criticism about his or her looks? If the need and motivation for a cosmetic treatment was grounded in what we call an 'external locus of control', the patient is more likely to be unsatisfied by the results. This means that the patient's need to look good is a result of wanting to please others around him or her, and his or her self-confidence is significantly determined by society at large. So to have the best result, you preferably should want to do the treatment to please YOURSELF, not someone else.

Next, I ensure that I 'under promise and over deliver'. This principle is often mentioned and is truly the best way to make patients happy.

In my experience, if I share medical knowledge with in a forthright and professional way, without embellishment or promotion, my patient is most likely to very happy post-procedure, sometime wildly happy.

I firmly believe that being frank about what they can achieve and even telling them outright that certain procedures are not suitable for them, results in a more loyal patient who will trust what you say and be happy with what you do for them. I often show them photos of average results rather than the most amazing results I have achieved.

This is important to adhere to the concept of 'under promise and over deliver'.

I take time to explore the patient's expectations. I would explain to my patients that everyone is unique, and what can be achieved in each person is hence also different. If an obese 60 year old lady comes in to my clinic and says she wants to look like a supermodel, red flags wave vigorously! If a patient has severe stretch marks post-pregnancy and expects a procedure to erase all of them, that's unrealistic. If the same patient understands that some improvement is possible but that stretch marks are relatively permanent, I would say that she is realistic. An example of realistic expectations in a liposelection patient, would be their hope that they would improve their body shape by 50% and fit better into their existing clothes.

It is a rather fine line though, and every cosmetic treatment from botox to a facelift has different results. If one treads carefully and presents options honestly, patients with unrealistic expectations will understand what they can achieve and can make an informed and hopefully, realistic choice.

In my clinical experience with about a thousand liposelection operations, the vast majority of patients are really reasonable and are excellent patients. So if you are a patient thinking of doing a cosmetic procedure, please start by looking inwards and understanding yourself better. Then find a doctor who you click with, has good credentials and extensive experience, and discuss your options in an open a frank manner. Both the doctor and the patient will benefit immeasurably by 'being on the same wavelength'.

This article was written for Tab A Doctor by:

Dr Kevin Teh, Medical Director, Singapore Lipo, Body & Face Centre, 

a subsidiary of the Singapore Medical Group