David B. Reath, MD
Knoxville, TN (865) 450-9253

My Plastic Surgery Pet Peeve: Up-Selling

up-sellingLike every other plastic surgeon, I see many patients who have already been to see another plastic surgeon – most are looking for second opinions, or another expert’s take on the solution to their concerns. I have noticed that the people who are the most unhappy with their previous consultations are those who have been given what they think is an overly-complicated solution to treat their problem. And by that I mean one which treats issues which are not a concern to them or one that treats something entirely different than what they came in to talk about. It’s like going to a furniture store to buy a chair, and being pushed by a salesman to buy two chairs, a sofa, coffee table, and two end tables. And, by the way, how about a couple of lamps? Up-selling may be good for business, but it is not so good for plastic surgery.

What I’ve learned along the way
I always start my consultations with a simple question: “What can I help you with?” And not: “Let me tell you all the things I can do for you.” I was told early on in my plastic surgery training that it is wise not to address something that is not a concern to the patient, particularly in cosmetic surgery. They may be perfectly happy with the shape of their nose, but once a plastic surgeon says something about it, they start thinking that there really is a problem with their nose when it never bothered them before. Put in somewhat more medical terms, it’s hard to make an asymptomatic patient better. The trap I try to avoid is when a patient comes in and says “Tell me what I need to have done.” I will always direct the conversation to the things that bother the patient most.

Here’s the kind of plastic surgery up-selling that really bugs me….
A typical situation is a patient who comes in for breast augmentation. She may have a little difference in nipple height which has never bothered her, even when it is pointed out. Insisting that she have a breast lift on one side to correct this, may not be what she wants. In fact, it will increase the amount of scarring which may be more noticeable than the difference in nipple height. And, if I as a plastic surgeon push this on her, she will not be happy with the consultation or her final result.

(Interestingly, we have seen an increase in patients being told they need more involved breast surgery after consultations with other plastic surgeons using imaging systems like Vectra. These systems create what I like to think of as an avatar type depiction of the body. However, since it is not a living, breathing, moving body, mild asymmetries can be made to look much greater than they do on the body in real life. This can lead to a more involved surgical plan than may be necessary or desired.)

Patients who have had this experience are really upset by it. They wonder if something is really wrong with their body. Or if there if something wrong with them because they never noticed it, or are not really concerned about it. And it really bugs me when they have been put in this situation, because the plastic surgeon has not listened to them.

Not listening to the patient bugs me a lot too.
Can you imagine seeing someone for a facelift and insisting that they have a forehead lift (brow lift) as well, when they are not at all concerned with the appearance of their forehead, eyebrows, or eyes? Or suggesting to a woman who is getting a tummy tuck that she should get breasts implants when she is not unhappy with their breasts? These are situations where it is better to focus on what the patient wants, and not what the surgeon wants for them – as long as this is a reasonable option.

When it is necessary to recommend something other than what a patient initially asks for.
I frequently see this in women seeking breast augmentation, who also have a significant amount of sagging. In these cases I will recommend a breast lift with the augmentation, because I know they cannot achieve the result they want with just a breast enlargement. And for some patients, this is not something they are willing to do, in which case I will not operate on them, and we part our ways amiably. Another situation is a patient who has loose skin in an area of the body and wants to treat with liposuction alone. In this setting it is my job to tell them they need a lifting procedure because liposuction alone in their case will only make the skin looser.

Other options may be out there.
Frequently there are different options to treating the same problem. This is where a frank discussion of what can be expected from each treatment option is very important. Dialogue between the patient and the plastic surgeon is the only way to come up with the best treatment option. But the burden is definitely on the plastic surgeon to make sure that there is a very good understanding on the patient’s part of what to expect from the different options.

The relentless pursuit of perfection and absolute symmetry can be frustrating, unrewarding, and frequently unsuccessful. There are certain anatomic features of bodies that will not allow this. And, symmetry is not something we usually see in nature. But that’s probably the topic for another blog…

Your bottom line (not your surgeon’s) is what’s important.
In any event, I have found it best to listen to the patient and address that particular patient’s concern. If you are in a situation where this is not happening, this could be a good time to seek other opinions.

All the best,

Dr. David B. Reath
David B. Reath, M.D.

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