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Great expectations

Article-Great expectations

Key iconKeypoints:

  • A recent study suggests that reality TV influences potential cosmetic surgery patient expectations and choices
  • The study was conducted over four months in the Yale Plastic Surgery Clinic
  • Results were published in Plastic and Reconstructive Surgery

Battling unrealistic expectations created by media and marketing hype over aesthetic noninvasive and minimally invasive treatments requires sometimes-brutal honesty and the courage to say no, experts tell Cosmetic Surgery Times . As long as patients trust their cosmetic surgeon, they often return, the experts add.

Dr. Narins
TALKING POINTS In discussing minimally invasive treatments, Rhoda S. Narins, M.D., director, Dermatology Surgery and Laser Center of New York, says,"It's always best not only to be honest with the patient, but also to underplay it, because then they're happy with the results," even subtle ones. "My own personality is exceedingly direct. I also employ a lot of humor, even ridicule, often directed at myself," adds Edward B. Lack, M.D., American Academy of Cosmetic Surgery president.

Dr. Biesman
"If patients are not willing to accept the possibility that they may see only a modest improvement, then I'm more than happy to let them walk out," says Brian Biesman, M.D., assistant clinical professor of ophthalmology, ENT and dermatology, Vanderbilt University Medical Center. Because patients commonly expect best-case results they see on manufacturer Web sites, he says, "It's important that we educate them regarding reasonable expectations." Likewise, he says patients who request treatments ill-suited to address their aesthetic concerns must be properly educated. In discussing patient expectations, "There's a bit of a gray zone," says Dr. Lack. Because cosmetic surgeons come from many different fields, he explains, "Different specialties have different criteria" for what's appropriate. "In one person's hands," Dr. Lack says, "a noninvasive technique might be more advantageous than in another person's hands." Ditto surgical procedures, an area in which techniques also continue to evolve to meet the more sophisticated patient expectations born of media exposure of the field. In the facelift area, for example, one recent publication details a method of concealing facelift scars in the temporal region. "The hallmark of modern facial rejuvenation surgery is limiting incisions, which means less-lengthy scars, and concealing them better than in the past," says Richard A. D'Amico, President-elect, American Society of Plastic Surgeons. "We're not introducing a new idea," says Dr. Guyuron, a study co-author. "We're putting science behind what we've been doing so it can be used in a more effective and meaningful way." The paper's uniqueness is in showing how beveling the incision in different directions will "create different results because we have identified the direction of the hair that comes out of the follicle," he says. PROFOUND SHIFT Over the past 16 years, cosmetic surgeons have gained a host of tools, including the "granddaddies" of the minimally invasive movement — Botox (botulinum toxin, Allergan) and fillers, says Joseph Niamtu, D.M.D., a Richmond, Va.-based cosmetic facial surgeon and former board member of the Cosmetic Surgery Foundation. These technologies have increased public awareness and allowed physicians to treat younger and older patients who previously weren't surgical candidates, he says. However, minimally invasive procedures can have a dark side, sources concur. "Because some practitioners can only do minimally invasive surgery," Dr. Niamtu states, "they sometimes push it as the be-all, end-all."

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