I recently purchased a number of educational audiotapes which came with an unbeatable guarantee. In essence, if I'm not satisfied with the audiotapes I can return them as late as one year after purchase for a full refund of their cost. What a deal! Particularly considering that a dishonest person could listen to those audiotapes several times - and even record them - before returning them.

We, as a society, have come to expect guarantees with just about any product/service we purchase. As a plastic surgeon, I would love to offer guarantees to my patients. Imagine. Surgery without risk. Without fear of complication. A perfect result every time. As I said, I would love to offer guarantees to my patients, but I cannot.

Plastic surgery, like any medical/surgical specialty, is as much an art as it is a science (and one aspect of plastic surgery, specifically cosmetic surgery, is more of an art than it is a science). Furthermore, since no two people (other than identical twins) are alike in terms of their heritage and genetic make-up, age, state of health, lifestyle, etc., all of which affect an individual's response, in terms of healing, to an injury (which, after all, is what a surgical procedure is), the results of a surgical procedure, even a surgical procedure undertaken in an identical way from patient to patient, will vary and, in fact, can vary tremendously. Too often people assume that a complication following a surgical procedure, by definition, must be the fault of the surgeon undertaking that surgical procedure. Too often people assume that they play no role, or at least a very small role, in the outcome of a surgical procedure undertaken upon them.

They fail to realize that, as we age, our ability to withstand the trauma of a surgical procedure lessens. Furthermore, our lifestyle affects our ability to recover from the trauma of a surgical procedure. Excessive use of alcohol, nicotine and other drugs (even prescription drugs) or certain diseases, such as diabetes mellitus ("sugar diabetes") and hypertension, all compromise our ability to recover fully and satisfactorily from a surgical procedure.

More important to our recovery from a surgical procedure is not how closely we follow our surgeon's postoperative instructions and how well we behave following
surgery but how well we behaved in all the years of our life prior to surgery. And don't forget that even our heritage and genetic make-up, which of course none of us can control, affect the way we respond to a surgical procedure. For example, dark skinned, particularly brown and black skinned, individuals are more prone to unsatisfactory scar formation, such as hypertrophic scars or keloids, than are light skinned individuals.

I know from my experiences as a plastic surgeon that the expectations of patients who utilize my services are much higher than are the expectations of those same patients of the services of other surgeons, such as general surgeons, orthopedic surgeons, etc. The average individual assumes that plastic surgeons possess the ability to insure a satisfactory surgical result and an invisible scar, to boot. I only wish such were the case. Furthermore, the expectations of the average cosmetic surgical patient are even higher. Not only does he/she expect that his/her surgery will proceed without a hitch, but also that he/she will be left with precisely what he/she sought in terms of change in his/her appearance. My last article for this publication dealt with Rhinoplasty, or nose reshaping, and talked about the often unpredictable behavior of nasal skin, cartilage and bone in response to surgical manipulation and the consequent need for "touch-up" surgery in as many as 1 in 10 Rhinoplasty patients. While other parts of the body tend to behave more predictably than does the nose in response to surgical change, nonetheless a cosmetic surgical procedure undertaken as artistically and precisely as it could be undertaken will not necessarily produce the desired cosmetic result, owing to variances in the behavior of skin and other tissues, differences in wound healing among individuals (as discussed previously), etc. Therefore, all I can guarantee any patient of mine is my best effort to "set the stage" for a satisfactory surgical experience and result. In no way can I guarantee a result nor can I assure any patient that he/she will not experience a complication which may translate to further expense on the part of that patient and/or his/her health insurer, in terms of both time and money, and, conceivably, a permanently undesirable alteration in his/her appearance.

In short, surgery of any kind is not without risk. Any individual faced with a surgical procedure, particularly an elective (non-emergency) surgical procedure, should proceed only after weighing the pros and cons of that surgical procedure and only if he/she possesses the mental and emotional maturity to contend with a complication should a complication arise. Like Life in general, there are no guarantees.

For more information about this and other cosmetic and non-cosmetic procedures, please call The Pittsburgh Institute of Plastic Surgery at 1-800-321-7477 or The Plastic Surgery Information Service at 1-800-635-0635.


Dr. Richard T. Vagley, a Board Certified Plastic Surgeon, is Medical Director of The Pittsburgh Institute of Plastic Surgery and a Contributing Editor of Outpatient Surgery Magazine.

The Pittsburgh Institute of Plastic Surgery | 5989 Penn Circle South | Pittsburgh, Pennsylvania 15206-3828 | Tel: 412.345.7477
| Fax: 412.345.7478