Author Topic: Plastic Surgery Forum - Result Good Bad? Realistic Expectations & Who 4 Revision  (Read 4839 times)

Offline DrBermant

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This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Reposted from Facebook forum asking about how to deal with evaluation of results, bad results, good results, realistic expectations and who should be doing revision surgery.

We are back to the basics of patient education about realistic expectations BEFORE the surgery. This is best accomplished with an extensive set of detailed documentation of typical results achieve by the specific surgeon available online for the patient to review extensively even before surgery. That worked best for elective surgery, but did have some application for emergency surgery for the patient to review after the repair in the ER.

Good surgery is coupled with a critical analysis of both the original problem and the result. Check this page about : Using Before and After Pictures look at the healing tab. The picture is the set up I used to review the result with the patient the day after surgery in a mirror and compare them to the before pictures on the wall. This was part of the education of what had been the original problem and where we were at that point just before I took that day's pictures and video documenting the state for the records. On the day of the dressing removal for the gynecomastia surgery I then used calipers set to the problem dimension before surgery to show where we were. Check out these pictures here for the Male Nipple Exam
This ballet of documentation and critical comparison permitted me to evolve my surgical technique over the years and educate each patient just what we achieved or the limitations of the surgery (discussed before the operation). For myself, good was never good enough, I always wanted to find a way to do something even better. But some problems I was asked to manage did not have the perfect answer. The deformity was beyond available resources. Surgery was a compromise, carefully discussing those limitations before the operation and reviewing what we achieved after.

It was rare that I needed to revise one of my own patients, Revision Plastic Surgery made a major part of my practice managing cases from around the world. The few times I heard of one of my patients going elsewhere for a "revision" the results were worse than what I finished and some asked me to again fix the mess caused by the patient's misadventure. The problem with some surgeons is that they get in over their heads with a problem they do not have experience with. For them to perform the revision surgery is an added risk as the revision surgery tends to be much more complex.

That is not the same as staged surgery or a problem that recurs like cancer or breast regrowth after new stimulus. But the new operation there is not really a revision now.

In the case of trust, it is a matter of putting online a body of the skills the surgeon has with revision surgery for that problem. In our resources we have several pages now on How to Pick your Plastic Surgeon dividing up the different requirements based on the type of surgery. For revision surgery, one should be looking for examples of that type of revision or parallel cases. If you cannot see such examples, then the risk is greater.

Hope this helps,

Michael Bermant, MD
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Michael Bermant, MD
Retired Plastic Surgeon
Surgical Sculptor, Artist, Creative Thinker, Problem Solver
Plastic Surgery
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