Your Favorite Technique: Time for a Change?

Abstract

“If it ain’t broke, don’t fix it.” “The enemy of ‘good’ is ‘better.’” “Don’t upset the applecart.” These are all common expressions with a common meaning: Leave it alone. Be satisfied with what you’ve got. Stick to the status quo. As aesthetic surgeons, we are often faced with the dilemma of whether to try something new in our practices. It may be a new piece of equipment, a new surgical technique, or a new safety protocol. Sometimes opting for change is a relative “no-brainer.” For example, the recommendation to use intermittent pneumatic compression devices or venous foot pumps in any plastic surgery operative case lasting over 1 hour, as well as for all our patients receiving general anesthesia,1 appears to have been widely adopted. An aesthetic surgeon is likely to assess that there is essentially no downside to incorporating these specific measures, and there are potential benefits—added protection for the patient and a reduction in the doctor’s liability risk for an untoward venous thromboembolism (VTE) event. However, recommendations for the use of chemoprophylaxis have not been as broadly embraced, particularly by surgeons operating in nonhospital ambulatory surgery centers. When it comes to chemoprophylaxis, the risk-benefit ratio can be highly patient- and procedure-dependent, and thus the subject remains controversial. This is despite recommendations, albeit measured ones, for specific uses of chemoprophylaxis from as credible a source as the Venous Thromboembolism Task Force of the American Society of Plastic Surgeons.2 The question is, upon what should we base our personal “best practices”? The recommendations of “experts”? Our own clinical experience? What is the key to making us change, or not change—not just with respect to VTE prevention but in every aspect of our surgical practices? As an American Society for Aesthetic Plastic Surgery (ASAPS) Visiting Professor, I have had the …