Recognition and Management of the Patient Unsuitable for Aesthetic Surgery

Abstract

There is little disagreement between aesthetic surgeons and mental health professionals that patients who exhibit even mild signs of a variety of psychiatric diagnoses are dubious candidates for aesthetic surgery. Unfortunately, most of those patients appear in the consultation suite in various “shades of gray” without labels on their lapels. Our young colleagues, after their arduous climb to excellence, tend to be focused more intensely on maintaining their surgical skills and knowledge than on the variable human equations that motivate their patients. Thus, they often fail to distinguish between those candidates who will be ecstaticovertheirsurgicalresultsandthosewhomay prove to be unhappy regardless of the excellence of theimprovement,adilemmathatcanleadtoserious consequences for the young surgeon. When you practice aesthetic surgery, you expose yourself to risks that no other practicing physician assumes. You are not treating sick or injured patients to make them well; you are treating well people by making them temporarily unwell to make them better. This situation becomes even more complex when one realizes that the degree of improvement achieved, and the inevitable effect that the change has on the patient’s self-image, may be only in the eye of the beholder. There are no established parameters. You might think the result is great, but will the patient? Regrettably, most plastic surgery training programs pay scant attention to the dilemma of patient selection. Not everyone is born with a “sixth sense.” It is primarily up to you to develop the skill of identifying the shades of gray that color the troublesomepatient,andtoperfecttheartofturning away that patient without giving offense. There are two fundamental principles that must be considered in the process of selecting an appropriate candidate for treatment. First, determine the patient’s motivation for wanting you to alter the appearance that aging or genetic inheritance has capriciously allotted him or her. Second, think about your own motivation for treating the patient. A decision to operate based on economicconsiderationsoraneedtostrokeyourown ego, without a realistic appraisal of what you can do for the patient, may turn out to be a serious error in judgment. The unsuitability of a prospective patient may manifest itself in subtle forms that are difficult to perceive a priori. 1 However, by following a few practical applications and common sense guidelines that are sine qua non ingredients for choosing to operate, you will avoid negative repercussions. There are certain groups of patients with easily identifiable characteristics that constitute a red flag: those with great expectations, the demanding patients, the “surgiholic,” those facing marital or familial disapproval, those who are pushed into surgery by others, those with whom you are incompatible, and those with body dysmorphic disorder.