Why a Plastic Surgeon Might Turn You Down

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Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.


May 19 2008

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The consultation appointment is the time when you can ask questions of your plastic surgeon and determine if he or she is the one you want to perform your cosmetic surgery. But this appointment is also the time when the surgeon gets a chance to check you out, too—and he or she may say no to you.

A plastic surgeon often has to explain to a patient that he or she is not a good candidate for cosmetic surgery. The reasons range from unrealistic expectations ("I want to look just like Scarlett Johansson!") to poor health or pre-existing medical conditions ("I know my blood pressure is out of control, but I want a face lift now.") to poor reasons to have the surgery ("I never had a problem with it before, but my friend said my nose is big.").

The good news is that most people have realistic expectations and an understanding of the risks and responsibilities of cosmetic surgery, said Walter Erhardt, Jr., MD, FACS, a plastic surgeon in private practice in Albany, GA. Dr. Erhardt is a past president of the American Society of Plastic Surgeons. In his experience, most people come to his office having read up on the surgical procedures they are interested in. "Men and women are better informed about plastic surgery and I think that is a good thing," he said.

If patients have unrealistic expectations, they are more likely to be about how long recovery will take rather than what the surgery will do for them, Dr. Erhardt said. Or they have an unrealistic idea of how many procedures can be safely combined into one surgery. Television shows about plastic surgery make it look like a patient can have a combined abdominoplasty, breast augmentation, face lift, and liposuction and be up and looking fabulous the next week. "People think they can have several procedures and go back to work in 5 days. Not so," he said.

Even so, Dr. Erhardt says he is more likely has to counsel patients that their health is an impediment to their cosmetic surgery than that their expectations are unrealistic. He tells his patients who are smokers that he will not perform surgeries such as a face lift, breast reduction, or abdominoplasty unless they quit smoking for at least a month before surgery and for at least 2 weeks after it, or better yet, quit completely.

"There is enough data that tells us that smokers are at between 7 and 10 times greater risk of wound healing problems," he said. Most of his smoking patients immediately understand these risks and either agree to stop smoking or decide against the surgery. Many see getting plastic surgery as a reason to quit smoking, he added.

Someone who is still losing a lot of weight after weight-loss surgery is also not a good candidate until they have reached a stable goal weight, he added. People who are still losing weight rapidly are prone to poor wound healing, he pointed out.

Being a poor candidate for cosmetic surgery also extends to the reasons why you want the surgery, Dr. Erhardt noted. Early in his practice he had a woman come in for breast augmentation and at that time he didn't ask many questions about a patient's marriage or relationships. A few months later she came in crying and devastated that her husband had left her and then revealed that she had had the surgery with the expectation that it would save her marriage. He now asks his patients more questions about their relationships and what their spouses think about the surgery.

Sometimes Dr. Erhardt has to tell a patient that they are a candidate for cosmetic surgery but that the time may not be right for it. Someone in the midst of emotional turmoil, such as during a divorce or after the death of a loved one, may be under too much stress to deal with surgery, he explained. 
Dr. Erhardt has created a list of three questions that patients should ask themselves when they are considering cosmetic surgery.

  1. Why (and for whom) am I doing this surgery? You should want the surgery for yourself, not to please other people or to meet their expectations.
  2. What kind of a result am I expecting? Do some homework about the procedure you want and cosmetic surgery in general so that you know what results are possible and what aren't.
  3. Is this a good time for me to do this surgery?  You have to allow yourself the proper amount of time to heal. You also have to be able to devote emotional energy and mental focus to healing.