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 

Aesthetic Procedures Amongst Singaporean Men

I have had male patients from the age of 19 to 55 years old. The most common however are patients between 30 to 40 years old. They are from varied walks of life and are representative of middle-class Singapore society. They are often white collar workers and professionals. High powered executives, bankers and businessmen are not uncommon, but so are conservative civil servants, and even a smattering of students. They are often very well groomed and take much effort to upkeep themselves well.

They often come because their busy work schedules and hectic lives have started taking a toll on their faces and bodies. Wrinkles on the face, sagging cheeks are very common. Some also want to have a stronger and more defined chin or jawline. Some come because they need help losing weight, as I provide specialised weight loss programs for my patients. In fact, I have lost 12 kg in the last 2-3 months following this programme myself (without surgery). Of course the most often asked about issue is the flabby bulges on their tummies and assorted bits and bobs. The second most sought after treatment is what we affectionately call 'moobs' or 'male boobs'. Often my male patients actually do work out regularly at the gym but can't see results. In some cases, they come seeking my expertise in a very special procedure called Hi-definition liposculpture that not too many doctors in the world can perform. This is where i precisely & artistically emphasise the guy's six-pack abdominal muscles and v-shaped torso.

One or two patients were quite unusual cos they came asking for their bums to be reduced in size cos they wanted to fit into swim pants and not look like a J.Lo wannabe. Another fellow was quite a funny because wanted his penis to be bigger and asked me to transfer fat from his tummy to his penis (I turned him down flat, as that is not a good treatment, and I practice quite mainstream conservative safe surgery). They mostly come themselves and are doing this for their own satisfaction.

I find that men in general, are actually MORE upfront about their procedures done than the women. Men are open and willing to speak about what they have done and often don't try to hide it from their family members or friends. In fact they often bring their wives or partners along for subsequent visits once they have tried one treatment and had good results. I have quite a number of male couples who do lipo as a pair in fact.

I think only a handful has tried to hide their treatments from the wife of girlfriend. As we often keep close contact with our patients & give them a follow-up phone call post-procedure, we had one male patient request us not to call his home at all because he didn't tell his wife. He would quietly come when his wife didn't know. I hope his wife didn't think he was having a clandestine affair!

That fellow was a rare exception, and I like many of my male patients because they are very open. They are also decisive when deciding on a treatment, and are often more motivated than the ladies to make sure they follow medical instructions. They are appreciative of the care that goes into their treatment and aim hard to maintain their results for the long-term.

Top three most popular procedures that men in their 20s and 30s request at the clinic:

• Hi definition VASER liposculpture for six-pack abs
• Chin enhancement
• Male breast reduction

This article was contributed to Tab A Doctor by:

Dr Kevin Teh, Medical Director
Singapore Lipo, Body & Face Centre, a subsidiary of the Singapore Medical Group
10 Sinaran Drive, #08-05/06, Novena Medical Centre, Singapore 307506

Facelifts: Surgical vs. Non-Surgical

Facial rejuvenation is an all-encompassing term that includes surgical as well as non-surgical modalities. I am often asked about what modality is the better than the other. The truth is that they both have a complementary role in the plastic surgeons overall strategy in facial rejuvenation and the appropriate technique is selected based on the patient’s extent of aging changes, expectations, willingness to undergo surgery and tolerance for time of work and social engagements. 

It is also important to be clear when explaining to the patients that while these treatments do produce ‘results’, the degree of improvement attainable is off course different. Generally speaking, non-invasive procedures that have no downtime would deliver a very subtle improvement of the aging face, while surgical procedures with some downtime and require time for recovery would give a profound improvement of the aging face.

Non-surgical ‘facelift’ techniques include the use of lasers, radiofrequency and focused ultrasound. These modalities are safe and are able to provide firming and tightening of the skin. They are especially good for patients with very early aging changes and the main advantage of non-surgical facelift technique is that down time is minimal and patients are able to return to work almost immediately. The beneficial effects such as firming and tightening of the skin will gradually be felt over the coming weeks.

The next level up in terms of the results attainable is the minimally invasive surgical lift – and this is the thread lift. With this procedure, sutures with little ‘barbs’ of ‘hooks’ in them are meticulously placed under the skin and secured to the firm tissues of the temple. Lifting and redraping is achieved and these generally last up to 1 to 2 years. The procedure can be repeated at regular intervals as needed and because there are no incisions downtime and swelling are minimal.

Then, for patients who have significant laxity, excess tissues and aging changes who are seeking a significant improvement of the aging face, a properly performed facelift is the best option. Facelift as a technique have also advanced significantly over the past 10 years. Modern COMPOSITE FACELIFT performed via the FACIAL SOFT TISSUE SPACES (Figure 1) have allowed for the procedure to be safely and effectively performed. Bruising and swelling are also minimized with this technique and recovery time as a result is also significantly shortened.

Finally, the range of procedures available are off course not mutually exclusive but complement each other. A patient who has had a facelift performed and after several years would like to ‘freshen’ up, would do well with non-invasive treatments such as radiofrequency or focused ultrasound treatment.

This article was written by;

Dr Wong Chin Ho | MBBS (SPORE), MRCS (ED), MMED (SURG), FAMS (PLAST SURG)
W Aesthetic Plastic Surgery
#11-07 Mount Elizabeth Medical Center
3 Mount Elizabeth, Singapore 228510
#08 - 42, Mount Elizabeth Novena Specialist Center
38 Irrawaddy Road, Singapore 329568