"Candidates for aesthetic procedures are healthy individuals spending their hard-earned money to improve their appearance, and our objectives as surgeons are to achieve patient satisfaction while maintaining patient safety. Extensive face-to-face discussions are essential for reaching these goals because they are the vehicle for understanding patients' needs and making sure to the best of our ability that they are truly informed and have realistic expectations for outcomes," says Dr. McMenamin, a board-certified facial plastic surgeon and cosmetic surgeon in private practice in Sacramento, Calif., president, American Society of Cosmetic Breast Surgery (ASCBS) and editorial adviser to Cosmetic Surgery Times.
An informed consent discussion and obtaining a signature on an informed consent document are a standard part of the preoperative protocol for patients undergoing any surgical procedure. However, there is clear evidence that there may be a total disconnect between the information provided to patients before surgery and what they say they recall after the procedure. Against that background, there seems to be an important need to develop better strategies for educating patients and assessing their expectations and understanding of risks and potential outcomes."Patients often hear what they want to hear, and so from an educational point of view, I am espousing that we as physicians figure out better ways to inform our patients about risks and complications and to determine that they have engendered some sense of realistic expectations," Dr. McMenanim says.
Taking time for face time
To that end, in his own practice, Dr. McMenamin is obsessive about personally conducting comprehensive preoperative consultations and informed consent discussions.
With patients who are considering a procedure, he spends an average of 30 minutes to 45 minutes reviewing and answering questions about the details of the surgery, its expected outcomes and risks and the alternatives. Clinical photos are used as a tool to enhance understanding of the potential outcomes, and patients are also encouraged to speak with others who have had the same procedure, as personal recounts about the recovery period and results can be very insightful.
"Patients who are considering an abdominoplasty need to appreciate that they are trading some of their loose skin for a scar, and so we show those candidates a series of pictures for the range of tummy tuck procedures that can allow them to develop a realistic idea of what that scar may look like. Similarly, the appearance of the navel can vary widely after these procedures, and patients are shown pictures of those outcomes because a cosmetic result that may be judged very favorable by the surgeon may be considered completely unsatisfactory by some patients," Dr. McMenamin says.
Obtaining informed consent from patients who have decided to undergo a procedure is achieved using an extensive written form. For many cosmetic surgery procedures, the informed consent document can range between five pages and eight pages in length and contain up to 40 different items. In a face-to-face methodical discussion lasting 30 minutes or longer, Dr. McMenamin reviews and expands on each topic within the form. Patients must initial to acknowledge that each section has been discussed and then sign at the bottom.
Offering other options
In addition to reviewing the pros and cons of the procedure being considered, making patients aware of the alternatives is also an important component of the informed consent process.
For example, a patient who is seeking a flatter stomach may be better served by liposuction, while a patient who wants to be more full-figured may be satisfied with a breast augmentation procedure rather than undergoing a breast lift.
"Certainly, there is a general desire among patients to have less invasive surgery, and for some patients considering some complex cosmetic surgery procedures, a less invasive alternative may be a better choice taking into account that individual's risk tolerance level, threshold for downtime and appearance goals," Dr. McMenamin says.
For any given procedure, there is certain information that will be routinely discussed in the preoperative consultation. However, surgeons need also to recognize the importance of identifying and addressing unique features of individual patients that may influence their expectations and ability to make informed decisions.