Informed Consent and Its Central Role in Plastic and Cosmetic Surgery

Abstract

Sir: Crockett et al. wrote an article,1 we should say both surgical and sociological, about the influence of plastic surgery “reality television” on cosmetic surgery patients’ expectations and decision making. The authors underline the fact that with these programs “come a host of potential concerns, ranging from the misrepresentation of surgical risks to increased unhealthy competition among surgeons to produce the best outcome,” and the level of deception can seriously preclude even the informed consent. We find all of the authors’ remarks very interesting. We would furthermore emphasize the tremendous importance of the informed consent in plastic and cosmetic surgery procedures. In Italy, the surgeon’s obligation toward patients, especially in cosmetic surgery, is of means; in fact, the surgeon is not responsible for the missed achievement of the result expected by the patient and is not obliged to ensure the result, in the absence of negligence or inexperience, as it is understood that the surgeon must realistically represent the chance to obtain the pursued result to the patient.2 It is the explanation of the subject of the procedure,3 at the moment of the consultation (it must be done also with a written report/model), that firms up both the information about the surgical procedure and the surgeon’s limit of responsibilities. The cosmetic surgery peculiarity is related mainly to the purpose of the procedure, not merely necessary to the health status but aimed at an aesthetic improvement. Although the definition of health by the World Health Organization embraces psychological satisfaction deriving from the acceptance of personal appearance, an almost unanimous chorus was raised4 affirming that informed consent should be, in the case of cosmetic procedures, more scrupulous, or at least “different.”5 Fortunately, since 1995, jurisprudence objected against this differentiation that does not find deontologic reasons to be sustained: in fact, does a patient who needs an open heart procedure have fewer rights to be carefully informed compared with the patient who asks for a breast augmentation?6 We believe that to avoid patient and surgeon misunderstandings and also medicolegal issues, a correct and complete informed consent should be delivered. This should be submitted well in advance of the operation to let the patient know correctly what he or she should expect by the procedure and what the possible risks and complications are. The above and the reasoned consideration of the informed consent to the surgical procedure are the two matters that define the surgeon’s work and the responsibility to the patient. If it is true that plastic surgery reality television plays a role in patient perceptions and decision making, only diligent information giving can avoid “unhealthy, unrealistic expectations” as, for example, in the simplest case, that a surgical procedure always leaves a scar. Andrea Armenio, M.D. Luigi Annacontini, M.D. Dimitrios Dionyssiou, M.D. Matteo D. E. Simone, M.D. Plastic and Reconstructive Surgery Department University of Bari Bari, Italy