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Five dimensional framework - This term needs further explanation. Human body is a three dimensional framework of height, width and depth. However, for a cosmetic surgery patient, the surgeon must delve inside her mind (the fourth dimension), to understand her desires and wants. Such desires have to be 'properly defined and quantified', as much as possible. This is the most crucial part of a consultation. The success and failure of the surgery depends more on this than any other factor.
It is important to understand what the patient seeks and how realistic that is. At this stage, that the limitations of patient's own tissues can be related to their desires. It must be made absolutely clear that 'a surgeon can only work within the constraints of patient's body and what is there'.
A patient, who was unhappy with nose reshaping surgery done elsewhere, sought consultation with me. However, her nose seemed fine and within proportions. The complaint focused on her nostrils, which she thought, were too 'long'. She had requested her first surgeon to make her nostrils 'smaller'. The surgeon brought her nostrils inwards, to reduce the width of nostrils, which is the most commonly sought treatment for 'big nostrils'. However, in this particular case, the patient had not meant the width of nostrils but rather vertical length of nostrils. When the width was reduced, the length of nostrils became even more pronounced , resulting in a perfectly good aesthetic result, but a very unhappy patient. Lastly, the fifth dimension of Time. The Patient must understand that surgery is a controlled trauma and human body reacts to it with the standard posttraumatic response.
Following surgery, there is an initial healing process of 1-2 weeks, during which tissues are swollen and bruised. Following this, there is a period of a few months during which there is resolution of deep swelling, nerve recovery and scar tissue formation. The scar that is initially laid is immature and thick, and takes many months to settle, both inside the tissues and the skin. The skin scar is permanent. The patient should not expect to come out of the operation, looking fine and dandy and must understand that the final result won't be achieved straight away. A good surgeon takes these factors into account in planning the operation.
The post operative phase, the expected swelling, the expected scar formation and how it may affect the tissues and how likely it is that the patient will follow the instructions, are all the variables that a surgeon has to take into account in surgical planning. The surgeon has to literally visualise the final results and match this with the patient expectations. Any incongruence between the patient expectations and the likely results must be explained to the patients to bring their expectations into a realistic framework. Lastly the emotional trauma associated with the surgery must be explained in detail and patient's emotional stability to undergo the trauma must be assessed. Patients must be made aware of the risks, such as DVT/PE, wound breakdowns, infection etc. In addition, there are specific complications related to each operation.
Each individual seeking cosmetic surgery presents different situation and her needs and desires are unique to her. Therefore, a sensible surgeon always tailors the operation to that patient and a sensible patient chooses the right surgeon. |
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