W

hen a doctor claims that he has had no complications ever in his experience, it may be wise to reconsider.

Plastic surgical procedures are very fine and precise. Expectations of patients are often very high. The chances of things going wrong and the resulting unhappiness are more common.

Patients come for enhancements and improvements that they want to attain with satisfaction. When a procedure goes wrong, it can result in unhappiness for both patients and plastic surgeons.

The causes are often many '€” the incorrect selection of a procedure, the surgery itself, accidental trauma or infections. It can also be due to inadequate explanations to the patient regarding the importance of postoperative care and their expectations.

When such problems occur, the most important thing is to rectify them. Both the patient and plastic surgeon must exercise patience and cooperation.

First, to minimize problems, the initial consultation is very vital.

A detailed and careful consultation is important so that the plastic surgeon can explain possible problems and complications. This will allow the patients to give their final informed consent after weighing the risks. If the surgeon or patient is not comfortable, it is wise to reconsider the treatment or seek a second opinion. Patients should be patient.

Some want immediate results and may wear a plastic surgeon down with their persistence, despite accepting that, for example, post-operative swelling will take at least three to six or even more months to subside, depending on age and anatomical areas.

In these cases, a plastic surgeon must also be patient, reassuring the patients and convincing them to be patient as well and wait for the final results.

Diplomacy may not work all the time. Sometimes, it might be good for a surgeon to arrange for an unbiased colleague to re-affirm the patients.

For very anxious patients who keep coming to see the plastic surgeon over small matters like change of appearance of scars and character of the wounds, reassurance is important.

After a while, when they start to see their desired results, they will leave the surgeon alone.

With certain procedures like Botox injections and fillers, if there are complications, the damage is not permanent. Therefore, with patience, they can recover.

It can be annoying but the patients have to be reassured that the unwanted results would only last for a few months.

Similarly, excessive bruising and swelling tend to be transient and will improve with time.

When it comes to surgical procedures, there can be real complications like accidental damage to blood vessels, muscles or nerves. These can be serious and will require rectification.

Nerve injuries can be permanent like loss of muscle power leading to loss of functions or deformities. Patients must be made aware of this. They must understand that extra procedures may be required. The incidence of surgical complications would be lesser with a well-trained, experienced and careful surgeon.

Therefore, it is important for the patients to select the accredited plastic surgeons rather than untrained doctors without proper qualifications. Unfortunate incidences involving fatality or morbidity can occur, but these are rare.

Perforations of the peritoneal cavity with intestinal organ injuries during liposuction, fatal fat embolisms and anaesthetic complications can also occur. These are very damaging to the patients and their families. Accidental burn injuries to the skin leading to extensive skin necrosis or dead skin may scar or maim the patient.

These could all lead to medical-legal proceedings. It must be stressed that neither the doctor nor patient would ever want any problems during a procedure, but unfortunately these may happen at times.

In such situations, it is important for the doctor to be patient, honest and advise the patient accordingly.

Clear explanations concerning the corrective procedures must be communicated to the patients. Sometimes, it is important to seek help from other specialists.

It would also be wise for the disappointed patient to cooperate with the doctors and carefully consider the corrective process. It is natural for the outburst of anger and threats but this would not be beneficial to either party.

Complications can happen at any time with varying degrees of severity to any doctor or patient. It is natural that properly accredited plastic surgeons, with their years of arduous training and examinations, would have a lesser number of complications than those untrained non-surgeons who aspire to do plastic surgical procedures.

Accredited plastic surgeons have to maintain their standards and strive to uphold them. It is also important that patients must be comfortable with their surgeons and trust their judgements and abilities.

The writer, previously deputy head of the Department of Plastic Surgery at Singapore General Hospital, currently practices at the Mount Elizabeth Medical Center. For more information, visit dryeapplasticsurgery.sg.