The Pre-Operative Consultation

The results of cosmetic surgery can be very gratifying to both the patient and the surgeon. Before you have any treatment, a consultation with the surgeon should take place, involving a full discussion without any obligation. All your questions should be answered satisfactorily and you should be given time to think over what has been said and what has been proposed.

In an ideal world, cosmetic surgery should consist of two parties only: you and the surgeon. After all, it is the surgeon who has the task of determining your expectations, performing the operation or procedure, looking after you post-operatively and taking full responsibility for all post-operative problems, complications or unfavourable consequences.

Without doubt, the single most important stage in any cosmetic surgical procedure is the pre-operative consultation. It is at this stage that all the necessary parameters are laid down. In addition, both you and the surgeon should form an amicable relationship based on honesty, integrity and trust. If such a relationship is not formed at this stage it is better in the long term for you to seek help elsewhere or for the surgeon to decline treatment because the likelihood of an outcome unsatisfactory to you is very much increased.

A consultation is essential because the surgeon also has to ask you about your past medical history in order to find out if there are any details that might influence an operation. When the surgeon knows more about you he is then in a better position to operate effectively and safely. The surgeon will normally communicate with your GP after the consultation, as long as you have given him permission to do so.

At the initial consultation the surgeon has a duty to decide if you have a problem that can be improved by an operation. Sometimes your feelings about what you look like are very different from what other people see. The best results in cosmetic surgery are obtained when the surgeon and the patient agree about the problem in the first instance. Then the surgeon has to ask himself whether there is an appropriate treatment that will improve it. It is obviously pointless to undertake a treatment that might not work or might even make things worse. In order to be successful, an operation has to be performed on the right person using the right technique.

Once the surgeon has decided that there is a treatment that will work, he should inform you fully about the operation and the post-operative course of events, such as when the stitches are removed and when you can expect to be 'presentable' again after the operation.

Cosmetic surgery is not invisible. But, by careful operative technique and the accurate positioning of the incisions, the scars can be almost invisible and only detectable on the closest examination. Patients on their part should realise that some skin heals better than others. This, of course, should be fully discussed in the initial consultation – as should all likely complications.

The more you know about the operation because everything has been carefully explained to you, the more likely you are to be pleased with the result. This initial consultation can take up to an hour, in order for the surgeon to tell you enough about the operation for you to be able to make a valid decision. The initial consultation is a mutual process: both you and the surgeon will be trying to assess each other. You will be trying to decide whether to allow the surgeon to treat you. Most surgeons these days hand out printed information sheets that can be studied carefully later.

There are three criteria that are important in this assessment process:

1. Does the surgeon understand the problem? Did he make the appropriate responses when you explained the problem? Understanding the patient's problem is vital, because if the surgeon never quite empathised with the patient, a successful outcome would be a fluke. You need to consider whether the treatment proposed by the surgeon is actually what you are seeking and whether it is relevant to your problem.
2. Did the surgeon prove to you that he can do something about it successfully? At consultation, most surgeons show photographs of previous patients, which should give you a good idea of what the surgeon is likely to achieve. You should ensure that the photographs are relevant to your own case If you are unconvinced by the photographs of the surgeon's previous patients, you should not go ahead.
3. Has anything put you off from wanting to be a patient of this particular surgeon? Sometimes the photographs reveal that the surgeon's and your ideas of what would be a successful result are radically different. Your judgement should not be solely determined by the reputation and qualifications of the surgeon. Not all surgeons are right for all patients and vice versa. To have a cosmetic operation performed by any particular surgeon is a very personal choice. It is important to establish a good rapport. If you are put off for any reason you should seek another surgeon.

The surgeon's job at the pre-operative interview is simpler. There is only one criterion: whether he thinks you are going to be pleased if you have the proposed treatment. If the surgeon feels that there is a significant risk of disappointment then he would be unlikely to offer it.

Of course, you may decide not to go ahead after hearing all about the operation. The consultation will still have been very valuable and saved you a lot of stress and worry — and money! There should be no pressure to come to a decision at the consultation itself. On the contrary, difficult decisions, such as deciding whether to have an operation or not, must not be rushed.

Most surgeons will offer you several consultations, anticipating that you will often only think of important questions that you wish you had asked after you have given the matter a good deal of thought. Some patients may wish to book their surgery at the initial consultation in a wave of enthusiasm, only to regret it later. Commercial clinics and greedy surgeons have certainly put pressure on patients to decide quickly and have offered inducements to do so. This is extremely unprofessional practice.

The surgeon himself should of course carry out the initial consultation, the surgery and all the post-operative care, and should be available to you at all times during the treatment process.

Some surgeons use computer imaging to illustrate or emphasise possible results or outcomes of surgery. This technique may work well and be successful for some surgeons and patients. Neither of us adopt this practice routinely, because we are only too aware that it is not always possible to accurately match the final long-term post-operative appearance of a part of the body by simply editing features on a computer screen. The human body does not always comply with the before and after pictures illustrated by computer graphics for reasons already explained. We therefore urge extreme caution to all patients who have experienced a consultation where computer imaging was used — the result shown may not necessarily match the result achieved by surgery.

It is a sensible idea to see a number of surgeons before going ahead with an operation. This makes it much easier to assess individual surgeons against each other, and to decide which surgeon would be most appropriate for you.

It cannot be stressed enough that the pre-operative consultation appointment is perhaps the most important part of the whole process of undergoing a cosmetic surgical procedure. The relationship between the patient and surgeon is of the utmost importance. To make the point again: beware of establishments that offer the services of such people, and no other adviser, so-called counsellor or any other party should interfere or be involved in the counselling stage.