DO I EVER TURN DOWN A PATIENT?
So I’m often asked, well maybe not often, if I ever turn down patients for operation. Sure! I do it because for one reason or another, I don’t think I can get the result that my patient is looking for. For another reason I don’t agree with what the person wants, am not willing to put my name on that work. I’m a plastic surgeon. This is what I do.
For one thing most other surgery comes with a regular pre-existing condition. You got a broken leg put a pin in it; you got gallbladder trouble take it out; got headache you take a pill, comes love…, but, don’t like your nose, we gotta talk… a lot.
SO I’M TALKING TO A PATIENT
One day I come into my consultation room and there sits this pretty girl. I already know she’s there because of her nose…because Amanda told me. But I look at her face and it’s really nice. And for me, her nose works really nicely with her face, so I’m primed to hear what she’s got to say, because I don’t see the problem..well right away anyway; but this could be a very short conversation.
This is cosmetic plastic surgery, and noses are, arguably, one of the most, if not the most difficult of all cosmetic operations. So, even though I’m the best plastic surgeon on the planet, I need to be convinced on this one. She looks very fine, as is, but hey that’s me not her.
So we talk, and it turns out she does not like the “ethinicity” of her nose. It’s a little high in the bridge with a slightly rounded tip, but it works. So now I have to figure out if she actually knows what she wants. So we talk, and we look at pictures, and we talk.
The nose is a big time player on the face, and the changes that can be made are infinite. So I have to know where I’m going once the operation starts. The more precise the wishes of the patient the more difficult the job. She paints with broad strokes and we go over pictures again. So now I get it. She wants to keep the essence of her nose just enough to get the ethnicity out of her nose.
Oh, is that all!
There’s another thing that’s really important. The nose and upper lip are connected to each other, and when she smiles the tip overshadows the lip. This she does not like, and in this I agree. So ok, I am now ready to accept the challenge. What else is there in life. Don’t go there.. And then she starts adding to the manifest. She is now comfortable, and is now talking about actually straightening the bridge and narrowing the tip, and what happened to ethnicity.
SPEND THE TIME
It’s why I spend time in the consultation room. Sometimes it takes a while to get the real story. Now I am less disposed to do the operation. Not so much because I can’t do it. Of course I can. It’s because she changed her story. Sure It is probably the real story but I don’t trust it, and the worst thing I can do is do what she finally comes down to. Not that she is wrong, but I know that giving her this nice smaller nose will rob her face of its special-ness. Yes that’s my opinion, but it’s not an uncommon scenario. Everyone knows of people who have changed their nose and as a result their “look”.
LET’S TRY THIS
So I tell her I will do the operation, but like some father who sends his daughter off on trip to get rid of a bad boyfriend, I am telling her to come back in a week, and if she understands the change that will take place, I will do the operation.
She did come back.
SHE CAME BACK
I must say, this time I did push, and persuaded her to let me keep the essence of her nose but fix the tip so it doesn’t cover her upper lip; and if she doesn’t think it’s enough, we can do more, but later on after she’s lived with it for a while.
MAKE IT FAIR
Sure it’s paternalistic, sort of, but part of the reason I’m good is because I happen to have a good “eye”. So telling her this, could be seen as a little self serving. Another operation for another fee. So I tell her the deal is that any second operation will be done for “hard costs” only; and this is mostly because I think she will not come to that.
These cosmetic operations are forever, and you better be right.
Thanks for listening
Oh, she hasn’t come back for the second procedure and it’s been ten years now.