17 The Cosmetic Surgery Junkie: Doctor, What Else Do I Need?

"Doctor, what else do I need?"

This is a frequently asked question after a patient has had a satisfactory result from a procedure. The correct answer often is: more may be a mistake. Most of us have just a few areas that can be significantly improved through cosmetic surgery. Very few patients would benefit from every possible procedure. Often after a positive experience and a great result, patients become more trusting of the surgeon and also more critical of their bodies' flaws. They will frequently seek surgeries that are not always as appropriate as the first, and must be cautioned against becoming addicted to the process.

Because this is elective or voluntary surgery, the patient is responsible to a large extent for what gets done. But the doctor should refuse inappropriate requests and counsel the patient regarding potential problems. You must bear in mind two other factors when you're dealing with doctors. First, most surgeons love to do surgery of any kind. Second, although most doctors try to put the patient first, they have financial pressures. And patients are very trusting. So if the doctor leaves you with any negative feelings about your procedure, you should listen carefully. He's doing his job and he has your best interests at heart. I'll never forget what one of my mentors, Dr. Bill Cook, once said in a lecture: "Patients will trust you to do anything, so you've got to learn to say 'no.'"

One of our patients in her late thirties came in for one surgery and had an excellent result. She went to consult with someone for rhinoplasty (which we don't do) and ended up receiving cheek implants, chin implant, rhinoplasty, and a facelift all at once. (These are done routinely together and can be appropriate for some patients.) She developed scarring and a strange appearance and came back to me hoping that I could somehow take her back to the way she was before she had the surgeries. She was disappointed to find that, unfortunately, I couldn't help her. "Touch-up" procedures of most kinds are more difficult and less likely to produce a happy result. Secondary rhinoplasty, and liposuction all have a higher chance of complications and are not as predictable, even with a skilled doctor (secondary facelifts, however, may be easier, safer, and more predictable). You should go to the best physician and thus make a correction procedure unlikely. Some physicians, for example, do secondary surgeries after 25 percent of their liposuction cases! (Some even tell their liposuction patients that they will need several touch-ups to attain their goal. A reasonable liposuction touch-up rate is one in 20.) And, if you gain weight after your liposuction, don't think that it will be easy to remove it surgically. It doesn't work that way. Sometimes we can help, but not always. The areas already worked on are scarred under the skin and often don't respond as well. You must do your best to take care of yourself properly and stay fit. Try not to get into the "multiple touch-up syndrome" after any surgery. You may gradually look worse.

If you go to several doctors — a good thing sometimes — carefully evaluate each one according to our instructions and don't immediately trust the new physician because you've had a great experience with the last. Make your best judgments about what you need in light of all the information you can gather, including what the physician says. If you hear from reputable sources that you're not a candidate for a procedure, try to accept that. Don't look around for someone else to do the surgery.

When you go out to a nice restaurant, you don't eat everything on the menu. By the same token, at the doctor's office, you don't need to have every cosmetic surgery under the sun. You'll do better if you control yourself and exercise some common sense. Be careful out there.