Facelift Series #7: Consultation Considerations

Summer Hardy (00:01):
Welcome to Park Avenue Plastic Surgery Class, the podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host Summer Hardy, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. Today's episode in our facelift series is Consultation Considerations. What are we talking about in this episode, Dr. Bass?

Dr. Lawrence Bass (00:28):
This is the first of a few episodes in this series that provide specifics of things that patients having facelifts can do to help optimize their experience and results. On that basis, these are important episodes because they go beyond general information to specific action items to put into motion while you're in process. The consultation is the start of your journey towards actually getting a facelift. There are a succession of tasks that should be accomplished. A consultation is a process of information collection on both sides. The plastic surgeon needs to know about you medically as well as your aesthetic concerns. He or she needs to examine you. You need to know enough about the plastic surgeon's findings, how good a match their assessment is for what you perceive in your appearance, as well as what treatments will be used to solve those appearance problems. And what's involved in those treatments. We're discussing general guidelines that outline the steps that are typically associated with detailed consultations. Each individual surgeon has their own process. That's typically included in the office visits, plural, multiple visits leading up to an actual surgery. So in most cases, more than one visit occurs prior to the actual date of surgery, but for simplicity, we're talking about what happens across those visits in this episode.

Summer Hardy (02:20):
Okay, great. So can we start with how the consultation is structured?

Dr. Kylie Edinger (02:26):
Everyone has their own style, but we generally start the visit by taking a history where patients explain their concerns and answer their surgeon's questions. We then generally move on to do an exam where the surgeon will physically examine the patient and their areas of concern. Oftentimes, we take photographs during the consultation so that we can have images to study to develop our concrete surgical plan, and also so that we have a preoperative baseline to compare postoperative results to. Photographs are also a great way to show patients what you see. It's oftentimes hard to see those in yourself without directly looking at a photograph while they're talking to you. We will discuss our findings and come up with a plan to meet the patient's needs and also answer any questions. The last step of the consultation is scheduling the surgery and financial discussions that follow.

Summer Hardy (03:15):
Okay, and what exactly should the plastic surgeon ask?

Dr. Lawrence Bass (03:19):
First and foremost, this is medical care, and so the patient's medical history has to be reviewed, and most surgeons have patients fill out a medical history form that details their different medical problems, surgeries, medications they take and so forth. But all of those positive answers, medical conditions you have usually will result in a few questions by the surgeon to try to gauge, at least on a preliminary basis, how significant that medical condition is, how well controlled it is, and whether it might be a factor in proceeding with a surgical treatment. As Dr. Edinger mentioned, aesthetic concerns are central of course, to what plastic surgeons and patients are thinking about, what features you don't like, what your goal is, how you'd like to see it corrected, and how concerning a feature is, that helps factor into which things you choose to chase versus which ones you may not love but are not really worth going after. Previous aesthetic treatments and surgeries are also very important. It may impact how the surgery is done or what's going to be found at the surgery, and some surgeons will also ask about what current skincare products you're on.

Summer Hardy (04:49):
Okay, so then the next step, what should the plastic surgeon examine?

Dr. Kylie Edinger (04:55):
We always start with a global overview of the face, assessing skin quality, signs of aging facial asymmetries. We are all asymmetric and aesthetic proportions of your face. We then move on to specifics of your face broken down by area. We typically divide these into vertical thirds and horizontal fifths, and this assures that we systematically examine your face so that we don't miss any asymmetries or irregularities as we go along. We'll be looking at the degree of skin laxity, the amount of jowling, the heaviness of the neck, the loss of volume, prior scars in the area, as well as any areas of the face that could potentially benefit from another surgery to ensure that the facelift remains balanced. Lastly, we always palpate the surgical area to ensure there are no irregular masses or anatomic anomalies that would potentially impact our surgery.

Dr. Lawrence Bass (05:42):
So these findings on physical exam in combination with an analysis of the photographs by the surgeon is really important to formulate a plan. A member of the staff can look at you and get a general sense of whether you might be a good candidate for something, but to actually start formulating a detailed surgical plan, advise you about what would be involved with going ahead and correcting those features really should be done by the surgeon personally in discussion with you, and that requires them to spend not hours, but spend some time physically pulling on your skin, looking at your face, watching your face as you talk, because the dynamic aspects of what aesthetic features show is really important. And so that means you and the surgeon need to be sitting face to face in order to do that, or preliminarily sometimes nowadays that's done on a telemedicine visit, but that direct interaction and the ability to touch, feel, and pull on things is important for the surgeon to do their job properly.

Summer Hardy (07:01):
Okay, so the plastic surgeon examined me. I had photos taken. Now what happens?

Dr. Kylie Edinger (07:08):
At this point, we typically sit down to have a discussion about the patient's individual goals and the exam findings to come up with a specialized treatment plan that will address both. This is where we have an honest discussion about expectations, limitations, and come up with a plan that is best suited for each patient.

Dr. Lawrence Bass (07:26):
And different surgeons do this differently. Some surgeons stay in the exam room with the patient and discuss these considerations there. And some exam rooms are set up to be able to show the photographs that were taken right in the exam room on a computer screen. But many surgeons, particularly in a detailed consultation, will sit with you in their consultation room separate from the exam room, bring up your photographs and review them with you. I like to show sort of a slideshow or presentation that diagrammatically explains where incisions are placed, what is being done to the tissues, to reposition and drape them. So I show that diagrammatically on the computer screen to patients during a consultation. Not every surgeon chooses to do that, and most surgeons will also show some before and after examples, and every surgeon can put up a pretty spectacular result. But most surgeons will try to show what are typical average results that give you a sense of what you could realistically expect in an average result that they can produce rather than in the best ever because you could be that best ever, but you're much more likely to be what produce day in and day out in what they've spent a decade of training and probably decades of refining while they've been in practice to get better and better and better.

(09:08):
But having a sense of what the surgeon's aesthetics are is the look of what they think is attractive, youthful, in line with what your aesthetics are or is their sense different? And that's very important, and this is the surgeon showing you what their view of that is and that's your chance to see if that's a good match for you.

Summer Hardy (09:34):
Okay, so now I've heard the plastic surgeon's explanation. What are good questions to ask the plastic surgeon?

Dr. Kylie Edinger (09:42):
You first and foremost want to make sure that you are comfortable with your plastic surgeon. This means feeling safe to ask all of your questions, make sure your plastic surgeon is explaining to you the limitations of surgery, what can and cannot be accomplished, what you can expect postoperatively for recovery and follow-up visits. And if there are any alternative surgeries or treatments to consider. You should also inquire about their facilities and whether they're accredited and safe and whether they're board certified.

Dr. Lawrence Bass (10:09):
Questions that patients often ask me that I think are smart questions include things like, am I a good candidate for this procedure? Are there other features you think are really prominent or need treatment at this time? Are there other procedures you think I should do at the same time? Which kind of matches up with that previous question, but it's a slightly different way of asking it. And is there something I didn't ask you that you think I should know? Because before you sign up or select a procedure, you should really understand what you're getting yourself into, what the expected recovery is, what the different limitations are going to be early on, what things will get corrected, what things are not going to be totally addressed. Those are key questions.

Summer Hardy (11:04):
Okay, we've covered a lot so far. What else should I know before going ahead with the facelift?

Dr. Lawrence Bass (11:10):
I usually focus on selecting the appropriate treatments at the initial consultation, and then I have an additional visit with the patient before the actual day of surgery to focus on other considerations.

Dr. Kylie Edinger (11:26):
Yeah, you really need to understand the risks and benefits, alternatives like Dr. Bass had said, and then incision locations and what to expect during the healing process, a typical recovery time, and then your postoperative instructions that you're going to need to follow afterwards. Some of these questions might be answered by your surgeon directly and some might be discussed with a nurse or a physician's assistant or other staff members in the office. Just make sure that you get your questions answered and are feeling prepared, well-informed before your surgery.

Summer Hardy (11:55):
That all makes sense. So beyond the consultation, does price equal quality?

Dr. Kylie Edinger (12:02):
That's a hard question to answer. As surgeons gained more experience and honed their skills over the course of many years, they tend to increase their prices to reflect the mastery that they've earned and developed over time. But it is also important to note that each surgeon has a different starting point and set of inherent surgical abilities with their own surgical potential. Different geographical areas of the country also charge differently depending on where you are for similar procedures based on the standards in the area. Price does not always equal quality. Take for example, a skincare line that maybe hit home with a celebrity as it gained popularity and it now costs three times as much as a similar product with similar efficacy. That skincare product doesn't perform better than its cohort, but it has celebrity backing and it's worked really hard to market itself and build that reputation so it charges more. In today's world of social media, celebrity influence marketing, it's hard to know the true worth of something. My best advice is to ask for before and after photographs of patients and find a surgeon whose aesthetic matches your own at a price point that feels appropriate to you.

Dr. Lawrence Bass (13:11):
I think that's all great advice and is very well explained. So like most things, you get what you pay for it, but to an extent and at the extremes of price on both the low end and the high end, it starts to get a little more doubtful whether the value proposition is totally there, but there are wide differences in experience of surgeons. There are wide differences in what delivery of a given service costs in different locations as Dr. Edinger pointed out. And unfortunately, the marketing effect creating a sense of value or exclusivity often is associated with higher prices separate from any reality about what's going on there. And the example Dr. Edinger gave is very characteristic of what's happening in the beauty industry currently.

Summer Hardy (14:15):
Okay, and lastly, should people get more than one consultation?

Dr. Lawrence Bass (14:20):
It's often a good idea, more than one opinion and more than one style or approach will potentially tell you very clearly a right fit and a not so good fit. Too many opinions, however, can sometimes create confusion and you should expect that almost every surgeon is going to have a somewhat different approach. And it doesn't mean that one is right and one is wrong. It's almost impossible as a layperson to sort the technical details. But what each surgeon is presenting to you is what works best in their hands. And again, most surgeons have this refinement that they continuously perform to get better and better at what they do. We never stop trying to get to perfect, even though we never quite get there. We're always trying to get closer. And so they're telling you what works well in their individual hands, which may be different from what works well in another surgeon's hands. And it doesn't mean that one is better than the other, but you shouldn't be surprised that it's somewhat different. Overall, I never discourage people from seeking another opinion, and I think Dr. Edinger said very correctly that this is about before and after that looks like the right style for you and the right feel in your working relationship with the surgeon more than trying to decide that this technique or that technique is the right, "best" technique because it's virtually impossible for laypeople to figure those things. And there isn't a single right or best answer.

Summer Hardy (16:16):
And Dr. Bass, can you share your takeaways?

Dr. Lawrence Bass (16:20):
So the focus of the consultation is on having a plan for all the aesthetic features that you or your surgeon have identified. So you want to make sure you're hearing a plan that's going to chase everything that you called out. And if you're not hearing that, then something's missing either in the explanation or in the plan. Most surgeons will explain for starters what they think is an ideal treatment, but if that treatment is not something you can do based on fears, based on recovery time, based on cost, in some cases there will be alternatives and these should at least be mentioned. That might be a compromise, but still give you some meaningful improvement. Surgeons also should and usually do tell you about options that are just a waste of time. If you're saying, I want that filler facelift and you have a bag of skin hanging under your chin halfway down to your Adam's apple, there's nothing that filler is going to do to correct that, and they should appropriately tell you, don't waste your time trying to do that.

(17:35):
As I just mentioned, the focus should be on your rapport with the surgeon. Do you have a good dynamic between you? Is this someone you can work with who can get you through this procedure and makes you feel heard before and afters give you a good indication of not is it the perfect result? Because anyone can pick through a large catalog and find their best result, but it's more about the style. Does the person look natural? Do they have the look that you're going for? And hearing a wonderful promise is always very emotionally satisfying, but I believe that realism is much more important to realistically understand what you can get and you are more likely to have your hopes and expectations fulfilled on that basis than having unrealistic expectations or getting over promised. As I mentioned, it's very hard to master the technical details of different procedures. Surgeons spend literally decades mastering these technical details, and so it's more important to focus on that rapport, a good understanding and feeling comfortable with the surgeon's way of doing things and with the responsiveness of the surgeon's office staff.

Summer Hardy (19:02):
Thank you Dr. Edinger and Dr. Bass for clueing us into the necessary components and fine points of a great facelift consultation. Thank you for listening to the Park Avenue Plastic Surgery Class podcast. Follow us on Apple Podcasts, write a review and share the show with your friends. Be sure to join us next time to avoid missing all the great content that is coming your way. If you want to contact us with comments or questions, we'd love to hear from you, send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.