Medicine and surgery are about reaching a diagnosis so that the correct treatment can be formulated. It will always involve a patient history; a clinical examination and this may lead to further special investigations. All this should establish a diagnosis and a suitable management plan. All healthcare delivery must follow this traditional pathway, which has been tested since the time of Hippocrates, the father of all Western medicine.
I believe that cosmetic surgery should be based on the same principles as any other form of healthcare delivery. A consultation is a two-way communication between the doctor and patient, where a bond is established. An unwritten doctor-patient contract of trust must be ascertained based on the doctor’s humanity, knowledge and experience and the patient’s honesty and sincerity about the clinical problem. Unless all these elements are present, the consultation will fail and the wrong conclusion may be reached. There are differences between elective and emergency surgery. In emergency surgery and for surgery of children, the history sometimes cannot be obtained directly. Cosmetic surgery is always elective and a critical element is to understand directly from the patient the true aims and needs. The true aim of the doctor should be to determine what treatment (if any) would be in the patient’s best interests.
So what should you expect during a cosmetic surgery consultation? Firstly, you should not see a clinician who does not have the correct experience, skill and qualifications. The internet is a sea of both information and disinformation. However, at the very least the cosmetic surgeon should be a real surgeon with a thorough background in basic surgical training as well as cosmetic surgery. It is quite valid to directly ask about the qualifications of your surgeon and what they mean and it is fine to inquire about their experience.
Before the consultation, you will often be given medical and psychological questionnaires as well as confirming basic relevant personal details. The consultation facilities should, of course, be good with decent lighting. During the consultation, the surgeon will take a thorough history, not only of your health and condition but also about your true cosmetic aims. The surgeon should be asking about how fit both medically and psychologically you are for cosmetic surgery. Honesty and clarity are critical.
There will be a clinical examination. Your body mass index (weight and height) should be measured. So much information can be gained from a good clinical examination. There should be a chaperone for the examination. The doctor may ask permission to take photographs, which is a very important part of cosmetic surgery, not only for the record of “before and after” but the photographs can be used during the consultation to clarify areas of clinical concern. The surgeon may recommend a special investigation such as a scan to help make a decision about the course of management. However often, for a cosmetic procedure, a definitive decision can be made during the consultation regarding the appropriate treatment. Sometimes the decision will be difficult to make and require more than one consultation. For example, the decision to carry out a rhinoplasty (nose job) is complex. To appreciate the change of shape needed (which is often subtle) may need several consultations before both surgeon and patient understand each other.
Cosmetic surgery is never an emergency. The decision to go ahead should be totally under your control but this choice must be made with knowledge and trust. The trust element is something, in the end, a deep feeling and an emotion of the heart and gut. At all times the surgeon should adhere to good practice. If there is something not right or you do not understand, then run away until you meet a surgeon where everything is right. Take time to decide.