“It’s a scalpel, not a magic wand”

People are funny. Sometimes, no matter how carefully I think I’ve explained the hows and whys of the operations that we can do, and the options that could work for a given situation, some patients wish for what I call “plastic surgery magic”, as opposed to plastic surgery reality.The most common example of “magic” would be doing surgery without any external scars. It might be the 30 year old who wants the breast lifting results that could only be obtained with a full anchor-style mastopexy, but doesn’t want any external scars. Or it might be the 40 year old model who want the results that only a full tummy tuck would give – but only wants the scar for a mini tummy tuck… or no scars at all.

Or it might be wishing for a magic answer for skin shrinkage: the person that really needs a full body lift – but only wants the scars that come from liposuction. Or someone who really wants the results of a facelift, but is expecting to get the same result from a bottle of injectable filler.

These people are wanting a magic wand, not a scalpel.

Despite the care and skill that we plastic surgeons put into the careful closure of our incisions, there isn’t yet any magical answer to give people scarless healing. I wish there were. Similarly, we don’t have any good way – as yet – to shrink or tighten skin without surgically cutting it. Liposuction doesn’t do it. And the various lasers that have been promoted for this purpose work only mildly, if it all. The only way to predictably tighten lax skin in 2009 is to make a well-planned incision, carefully remove the excess skin, and neatly sew it up. Even then, Mother Nature may throw a few curve balls at us, with the risks of bleeding, infection, wound separation or ugly scars.

When unrealistic thinking shows up during a consultation, I explain nicely to the patient that if I give them the operation they are asking for (rather than the operation they really need), that not only will they not get the result they are hoping for, but they will likely look worse afterwards than when they started. It’s important for the patient to understand what can realistically be achieved. Most patients do, but a few don’t.

Sometimes, these unrealistic patients will go somewhere else, and find some doctor that will perform the lesser procedure anyways. This typically doesn’t turn out well… because of the inherent limitations of the lesser technique.

Sometimes, the patients will understand the limitations of what we can do with their body, and they change their mind, and choose the correct operation – despite the scars.

Sometimes, the patients change their mind about having surgery at all, once they hear what’s involved. And that’s OK too.

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