In this comprehensive write-up on precautionary measures to be taken when doing cosmetic surgery on our patients, the authors begin by emphasising that facial plastic surgery is no longer limited to celebrities and the privileged. It has extended into everyday life situations involving people who in recent years have better means to undertake this surgery. The patient selection should be done with careful emphasis on patient motivation for surgery and expectation. They should not expect to obtain dramatic results such as saving of a marriage or secure employment. These patients can have variable personalities, ranging from perfectionist and narcissistic, excessively demanding, through to passive and unfocused who remain indecisive on both the need and result of the surgery. In this scenario various psychological disorders should also be considered. Some patients simply do not like their appearance, which results in altered personality traits and in extreme cases proves a continuous obsession. A note should be made of possible eating disorders and the difference between an unhappy patient and the one who is clinically depressed should be registered and psychiatric help sought. The legal aspect of an informed consent is elaborated. One can deliver relevant information (prudent patient test) based on the patient’s values and beliefs about operations and complement this with the desired level of information. The patient’s understanding of the consenting process does remain a problem and many available solutions are difficult to implement in the NHS. Documentation of the consenting process is by no means fool proof in the present legal system. A note should be made of the author’s particular statement that ‘a well prepared lawyer will manage to circumnavigate their (surgeon’s) defence’. Medical photography helps in documentation, that should not be limited to the best results of the surgeon. With image manipulation software the patient may consider the portrayed and agreed image as a guaranteed surgical result. Revision operations should be considered very carefully and only after allowing time for the healing process to complete. The patient’s family doctor should be copied into the correspondence, but sometimes patients may desire that family doctors do not know and this has to be handled very carefully. The conclusion that can be derived from this scenario is that the patient should know what to expect and the surgeon be aware of what can be done.

Pre-operative considerations in aesthetic facial surgery.
Veer V, Jackson L, Kara N, Hawthorne M.
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Madhup K Chaurasia

United Lincolnshire Hospitals NHS Trust; University of Leicester, UK.

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