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Difficult patients pose potential for dissatisfaction after cosmetic procedures

Article-Difficult patients pose potential for dissatisfaction after cosmetic procedures

Key iconKey Points

  • During patient consultations, be sure to identify reasons for seeking cosmetic surgery
  • If 'red flags' arise, urge patient to seek a second or third consultation
  • Physician may cut ties with patient unless the patient is in the midst of an acute care situation, expert says

No cosmetic surgery practice is immune to problem patients, but careful communication with all potential patients can help surgeons make a pre-emptive choice when red flags suggest trouble is afoot.

Dr. Moy
"Sometimes surgeons have to rely on their instincts to identify these patients," says Ronald Moy, M.D., president-elect of the American Academy of Dermatology. Fortunately, he points out, surgeons' instincts in recognizing the warning signs tend to improve over time.

Some red flags that denote a problem patient during a preliminary consult include excessive criticism of other physicians, over-flattering praise of the surgeon with whom the patient is consulting, extreme obsessive-compulsive behavior, signs of unhappiness, poor listening skills, treating staff members rudely, being unfocused, and having a fixation on a minor defect, says Dr. Moy, of Moy Cosmetic Laser Surgery, Los Angeles.

Experience and good judgment are helpful in differentiating excessive behaviors from minor variations, he says.

"Difficult patients who have severe problems are not common, but many patients may demonstrate these characteristics in a mild form," Dr. Moy says. He points out that minor depression or minor obsessive behavior may be tolerated in a potential cosmetic surgery patient; it's when these characteristics are severe that problems may ensue.

Dr. Taylor
Other telltale signs of potential difficulty include when a patient is experiencing a personal or emotional traumatic event, such as divorce, or when a patient is in an emotionally abusive relationship, says Clark O. Taylor, M.D., Cosmetic Surgical Arts Center, Missoula, Mont.

"A lot of these points of information are ones that staff members may be made privy to before the consultation with the surgeon even takes place," he says. "It's critical that the surgeon be able to identify the people who are dealing with these issues, because these are the kinds of things that reinforce a low self-esteem that may be pre-existent." This vulnerable state isn't ideal for a rational response to cosmetic surgery, Dr. Taylor says. For example, some of these patients choose surgery because they think it will satisfy a disgruntled mate; some want surgery to recapture a youthful appearance after being cast aside for someone younger; and still others find themselves post-divorce competing with women 20 years younger. All of these scenarios invariably set patients up for disappointment, he says.

Dr. Taylor also says he and his staff spend a lot of time counseling patients to ensure they are making the decision to have cosmetic surgery for themselves, rather than for someone else. "We are very careful not to use terms like 'make you look younger.' Instead, we say 'make you look better.' Yes, we're going to improve certain situations, but the patient is still 50, so we let them know that we'll make them the best 50 they can be," Dr. Taylor says.

WANNABE WOES Drs. Taylor and Moy say bringing in a photo of a celebrity is one of the most common signs of potential trouble. "When someone brings in a page from a magazine and says, 'I want this nose or face or breast,' that's a red flag, because in all likelihood, you're not going to meet their expectations, because they obviously have a very specific picture in their mind's eye of what they want to look like," Dr. Taylor says. He says he tries to prevent disappointment and to help ensure realistic expectations by telling patients up front, "We can't make you look like that picture, because you come with your own unique set of anatomical factors, and we're going to deal with your unique anatomical features to make you as good as you can be.

"It's important to get rid of their ideas about Angelina Jolie lips, because that's a recipe for disappointment," he says.

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