Cosmetic surgery: the surgeon must know how to say NO

If the reasons for having a cosmetic operation are unclear or the operation is not to relieve suffering, then the doctor can (and sometimes should) refuse to carry it out for the good of the patient.

There are risks with all operations, including cosmetic surgery, but sometimes these can be linked to the patient's motives. Cosmetic surgeon Dr Pierre Nahon tells us why surgeons should be ready to say no.

Apart from the risks associated with any operation, what are the other risks of cosmetic surgery?

Dr Pierre Nahon: When you have an operation, there are, of course, risks associated with the operation itself but there are other risks to do with the patient's motives, his or her personality and family or professional background. These factors may prevent the patient from being completely satisfied with the results. She may realize that the operation was not the answer to her problems and feel that it was unnecessary. Such a disappointment can then cause additional psychological problems.

Are patients often disappointed?

Dr Pierre Nahon: When the operation is to correct a severe defect which is causing considerable suffering or to restore balance, then patients are usually quite satisfied. However, when patients want to change, transform or improve a part of their body because they feel like treating themselves or because they want to impress and be more fashionable, then they can be disappointed.

What is the doctor's responsibility?

Dr Pierre Nahon: Patients and surgeons obviously make this decision together but the patient-doctor relationship can be ambiguous. In our society, we accept that people have the freedom to do what they like with their bodies, so we can't criticize someone for wanting to alter their appearance. If the surgeon discusses all possible risks, and the patient understands and accepts these, why not operate? Medical advances in plastic surgery mean patients will present with increasingly ridiculous requests.

Can the surgeon refuse to operate?

Dr Pierre Nahon: Of course. You have to know when to say no, to know how to refuse if you think an operation is unnecessary. Such a refusal is always in the patient's best interest at the time. If the patient persists, he or she can always have surgery later, in more favourable circumstances.

In what circumstances would you refuse to operate?

Dr Pierre Nahon: We would advise teenagers against having surgery. Their personality is not yet fully formed; they can widely exaggerate a slight defect and often they find it difficult to accept their bodies.

We won't treat children who haven't expressed any interest in treatment and who are being seen at their parents' insistence and against their own wishes.

We will not carry out procedures if they have not been requested directly by the patient but rather by his/her friends, partners or employers.

We would be very reluctant to treat depressed patients or those suffering from serious additions (smoking, alcohol, drugs, psychotropic drugs etc). We would also be reluctant to treat patients seeking to change their ethnic appearance.

We would refuse to treat patients who have financial difficulties, who want to keep their procedures secret or whose immediate friends or family are hostile to the idea. Unfortunately, such refusals can, paradoxically, be wrongly interpreted by the patient as a form of disapproval or an attack on their freedom.

What is the risk for a patient who ignores medical advice?

Dr Pierre Nahon: If the patient doesn't understand why she is having surgery, it is not rare for her to be unhappy with the end result,  and she could find herself more psychologically damaged than when she first started. She'll become even more desperate for surgery and could find herself embarking upon a series of painful operations.

A last word of advice?

Dr Pierre Nahon : In cosmetic surgery, it's not worth hiding the risks. Just because there's only a slim chance of a complication, that's no reason to hide it from patients. Some patients have made up their minds in advance of speaking to the doctor and refuse to heed any warnings but most patients do want to be fully informed and need understand what the risks are before they take their decision. A doctor informs his patients of potential risks out of respect and it's essential to establish a relationship of trust.

Thanks to Dr Pierre Nahon

Copyright © 2010 Doctissimo

Posted 30.06.2010

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