Risk reduction in cosmetic surgery

Abstract

Cosmetic or aesthetic surgery is defined as ‘operations or other procedures that revise or change the appearance, colour, texture, structure or position of bodily features to achieve what patients perceive to be more desirable’. It differs from reconstructive surgery in that patients do not suffer from surgical pathology, but come to a surgeon desiring alteration of appearance to achieve an improvement. It has been said that cosmetic surgery patients differ from those presenting to other surgeons, in that instead of hoping that they do not need an operation, in cosmetic surgery the wish to undergo surgery is the patient's primary motivation for the consultation. There are distinctive risks in cosmetic surgery. The focus is on an individual surgeon, rather than a system of institutional care delivery. The surgeon's assessment and selection of patients is crucial to the avoidance of subsequent dissatisfaction. Mainstream surgical training concentrates on the acquisition of knowledge and technical competencies: the cosmetic surgeon's armamentarium must include in addition superlative communication skills and a degree of psychological awareness which will allow exclusion of those patients for whom it is unlikely that satisfaction can be achieved. It may circumvent disaster for the surgeon to say ‘no’. Awareness of inherent clinical risks and the ability to manage them are crucial to successful practice, as is the surgeon's commitment to support and encourage the patient throughout the entire process. There is, however, the potential for extremely high levels of satisfaction for both surgeon and patient if pitfalls are avoided, and risks are managed appropriately within a positive doctor–patient relationship.