Ten More Tips for Plastic Surgeons Performing Cosmetic Surgery.

Most plastic surgery is elective, enabling preparation by the surgeon and patient. Plastic surgeons should consider these 10 principles before embarking on cosmetic surgery. 1. Medical condition. The patient’s medical condition needs optimization. Any comorbidity needs assessment and treatment. Chia et al.1 showed that optimizing glucose control decreases complications in liposuction. Hematoma risk after face lift can be reduced by optimizing blood pressure preoperatively.2 2. Body mass index. The best cosmetic results occur at the ideal body mass index for that patient. If this criterion is not met, cosmetic outcome will be impaired. In addition, complications are reduced when the body mass index is ideal. 3. Longevity of results. The aesthetic results of cosmetic surgery generally deteriorate with time. After resection of excess tissue, stretched tissue (eg, remaining skin after abdominoplasty) will lose tone with aging, and the taut postoperative result (aided by postoperative edema) will regress. Gravity does not respect cosmetic surgery. 4. Drugs. It is imperative that the surgeon be conversant with all reported side effects and complications or adverse events, including the less common ones. A stepwise approach to reduce postoperative nausea and vomiting, for example, is important, as a lot of surgery is office based. 5. The thinking surgeon. This is considered an oxymoron by nonsurgical colleagues. However, plastic surgery is fundamentally different, as it is a technique-based specialty. The surgeon should focus not only on the technical aspects (how to do it) but also on the mechanical aspects (why it works). For example, with pexy augmentation, the surgeon must keep in mind that the pexy aspect reduces the skin envelope, but the augmentation will stretch the skin envelope. Blood supply to the affected tissue must always be considered as well. 6. Critical evaluation of results. Often, patients are happy with the result, and it is easy to gloss over the outcome. What aspects of the result could be improved? Sometimes small technical maneuvers can improve outcome. This is how innovation occurs. 7. Notes and photographs. Making comprehensive notes is a “pain,” but also a source of medicolegal protection. In addition, perusal of previous notes and photographs can help when presented with a difficult case. 8. Body dysmorphic syndrome. Body dysmorphic syndrome is widespread. If a surgeon is unsure of the patient’s surgical motives, further consultations should be scheduled. One’s reputation comes from those you do not operate on rather than from those you do. Do not underestimate informed consent. 9. An experienced teacher. If I required a (complex) operation, I would want a surgeon aged 45 years or older. Find a senior colleague to work with. There are many unpublished tricks that senior surgeons perform to improve results. 10. Sex. Surgeons may be reluctant to discuss sex.3 Among other reasons, patients undergo cosmetic surgery to increase their attractiveness and sex appeal. The surgeon cannot expect the patient to know when to resume sexual activity after surgery. Orgasm can raise the pulse to 170 beats per minute and raise blood pressure,4 increasing the risk of bleeding. Goldwyn5 reported on five healthy normotensive patients who developed hematomas 9 days, on average, after rhytidectomy because of sudden physical exertion. DISCLOSURE The author has no financial interest and no funding to declare in relation to the content of this article.