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Pain 'unplugged'

Article-Pain 'unplugged'

Key iconKeypoints:

  • Although pain is an expected part of any surgery, some patients may have unrealistic expectations perhaps influenced by TV depictions that "fast forward" through the recovery period
  • Pain that lingers beyond the timeframe patients expect may leave that patient feeling unhappy about surgical results
  • Surgeons should address the topic of pain in every consultation to avoid misunderstandings

Dr. West
Pain or discomfort is an expected, natural part of any surgery — at least from the perspective of most cosmetic surgeons. So do some patients have unrealistic expectations and perceptions of pain before undergoing cosmetic surgery — fictions gleaned from T.V. depictions that "fast forward" through the grittier aspects of the surgical experience? To survey the extent to which patients' perceptions of pain have been set by the media, Cosmetic Surgery Times asked a few surgeons to share with us their anecdotal experiences on the topic.

"Rarely is pain more than expected," says Brian West, M.D. "Usually, it is less than the patient feared." Dr. West bases this view on his experience as a board-certified plastic surgeon with Beverly Hills Plastic Surgery Physicians, California, which specializes in cosmetic and aesthetic surgery. He distinguishes between immediate pain and prolonged pain. It is the lingering pain beyond the timeframe patients expected — which can vary from person to person — that can leave a patient feeling unhappy about surgical results. In contrast, he says, patients do not consider short-term pain a sign of unsuccessful surgery. "When procedures and recovery go as described, patients are very happy, grateful and satisfied — no matter how unpleasant the pain and inconvenience," he adds. Achieving such an idyllic outcome can be made difficult by the increasingly popular reality makeover television shows, however. While the shows have given more exposure to cosmetic surgical procedures — making them more acceptable and desirable — their time-compressed format can mislead some patients.

Dr. Lack
"TV has given the perception that a pre-op consult, surgery and post-op recovery all happen in a thirty-minute time slot. Pain is, therefore, considered a complication by such media-dazzled patients," comments Dr. West. "Patients often have the misconception that bruising, swelling and scar maturation happen overnight or, at most, in the time it takes to cut to a commercial and back to 'reality.'"

Dr. Hamilton
BACK IN THE SADDLE Dr. West says some patients can be surprised after a cosmetic procedure by how significantly pain can impact their normal activity levels. "For the most part, pain is not a difficult issue with patients as newer medications and pumps are excellent," he reports. "The biggest post-operative issue I encounter is a patient's recovery of endurance or stamina. It may be months before a patient returns to a normal physical state and activity." That is not quite the case for patients of Edward B. Lack, M.D., president of the American Academy of Cosmetic Surgery and president of MetropolitanMD, a cosmetic surgery center in Chicago. He is board certified in dermatology and dermatologic cosmetic surgery. "My patients are walking vigorously the next morning [after liposuction], take no pain medications, and are back to work in three days," Dr. Lack writes in his online blog. "Time off work for recovery is a preconceived notion," he comments. He practices what he preaches; after his own bowel resection, he began walking extensively on the third day post-op. He considers pain relievers unnecessary after skin and fat surgery and prescribes walking instead. Dr. Lack encourages cosmetic surgeons to take an optimistic approach to pain management, coupled with an open mind to patient feedback. "The biggest problem is that doctors [either] believe that the patients experience pain, or they dismiss the patient's discomfort," he observes. "Either way, they anger and frustrate patients by not anticipating a pleasant outcome and by not being supportive of the patient's perceptions. The important thing is to give patients the option of experiencing little pain."

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