It's Psychological: The Plastic Surgeon Relationship w/ Dr. Jonathan Sykes

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Welcome to Park Avenue
Plastic Surgery Class,

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the podcast where we explore controversies
and breaking issues in plastic

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surgery. I'm your cohost, Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here
with Dr. Lawrence Bass,

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Park Avenue plastic surgeon,
educator and technology innovator.

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The title of today's episode
is "It's Psychological:

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The Plastic Surgeon Relationship."
Psychology is such a

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big part of plastic surgery. So much
is about how we feel about how we look.

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How does this translate
to the plastic surgeon?

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There are a couple of things I
typically think about Doreen.

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First is the patient's perception of
the result doesn't necessarily match the

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plastic surgeon's less personal,

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more technical perception.

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So a typical example is
looking at a postoperative

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result. And sometimes
the surgeon's saying,

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okay, this went okay.
Nothing good, nothing bad.

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And the patient is
thrilled with the result.

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And other times the surgeon's
saying this was difficult,

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but it just came out A+,

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patting themselves on the back
and the patient is bitterly,

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bitterly disappointed.

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So it shows that there's
this mismatch between

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whatever we might like to think
of as reality and each individual,

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both the surgeon and the
patient's perception.

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The other big thing to me is about
the doctor patient relationship.

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In plastic surgery,

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the working relationship is
particularly important because the goals

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and desires of each patient vary.

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In many other fields of medicine,

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the goal is obvious. If you have a
tumor, you want to get rid of the tumor.

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If you have appendicitis, you
want to get rid of the appendix.

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If you have a broken bone, you want
it to heal strong and pain-free.

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But in plastic surgery, that's not true.

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And that puts a big burden on
the patient to express these

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concerns clearly and on the
surgeon to make sure he or

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she understands them. So to
discuss these issues in more depth,

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I've invited my dear friend and
colleague, Dr. Jonathan Sykes,

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to come back on the podcast
for another episode.

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He's spent a great deal of time
thinking about and lecturing about these

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issues, and I'm looking forward
to hearing his perspective.

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Dr. Sykes is a facial plastic
surgeon in Beverly Hills who

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spent more than 30 years as the
director of Facial Plastic Surgery at UC

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Davis. He's the past president of the
American Academy of Facial Plastic and

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Reconstructive Surgery,

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has written hundreds of papers
given over a thousand lectures and

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trained many, many residents
and fellows. Dr. Sykes,

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thank you for joining us.

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Thank you, Dr. Bass.

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Thanks for joining us, Dr. Sykes. We're
very excited to have you on again.

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So let's run down the issues that Dr.
Bass raised at the beginning of the

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episode.

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What do you think is going on in patient's
heads when they think about their

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appearance and how does that ultimately
lead them to the plastic surgeon's

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office?

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So your question, what's
going on in their head?

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I don't know the answer of it too.

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There's a different thing
going on in everyone's head,

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and our job as the plastic surgeon is to
get an idea of what's going on in their

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head and what their
abilities are to tolerate

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what we think will make them look better.

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So the first thing is
communication, as Dr. Bass said,

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is really, really key in
this. And that communication

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starts with hearing
who they are as people,

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not just what they want to do
to their face or their body,

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but who they are as people.

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Because who they are will
have a lot to do with their

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tolerance for the postoperative period,
their outlook on what their result is,

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and everything relating to the surgery,

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whether or not they feel pain
or more pain or it will impact

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everything.

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And there are people
that are totally ideal.

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The people with positive
outlooks who are self-assured,

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who see the good most
things, who are happy,

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happy individuals who are employed,

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employed people tend to do better
than unemployed people with this.

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And none of this is a hundred percent.

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And then there's the
exact opposite of that.

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People that are unhappy with
their life, they're pessimists,

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they're not optimists.
They see the bad in things.

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Things tend to hurt them more
than they hurt other people.

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And what Dr. Bass said is, well,

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the outlook of a spine surgery,
appendicitis, they want the same thing.

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Actually these same people,

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their outlook from
appendix surgery, they get,

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some people do really well with that,
and some people don't do well at all.

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I mean, we get this variance
of people in all walks of life.

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It's worse in plastic surgery
because we're doing something that

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doesn't have any functional potential

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positive outcome. It's not functional
that your neck skin is tighter and that

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looks better than that looks.
That's not a functional thing.

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And the big question isn't,

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can Dr. Bass or I make someone's
neck look better with this?

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Is if it's 85 or 90% better,

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are they likely to see
that as a good result?

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And likely to see the positive parts
of that or dwell on the negative,

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the 10% that didn't get accomplished.

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And all of us in plastic surgery
deal with this every day.

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So when I lecture about this,

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I say it's important for
the plastic surgeon to

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do one thing in both the pre
and the postoperative period.

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It's to listen.

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So when you listen in
the preoperative period,

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we get an idea of who the patient is
and what their tolerance is going to

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be to withstand what
we're going to do to them.

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And if we listen in the
postoperative period,

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we listen to what all of their issues are

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wrapped together. And we can't circumvent
this listening in either place.

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So in the preoperative period,

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the plastic surgeon has to be
a listener to what they want,

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but they have to be a little bit
of a different kind of person.

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They've got to be an educational person
and a little bit of a salesperson

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and a communicative person
in the postoperative period.

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If somebody comes in with a problem,
it's important to not educate.

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It's important to listen. So
listening is important in both,

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but there's a different kind of
listening before than there is after. And

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I fought through this a lot because
obviously as a guy that's done this for a

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lot of years, I've had
a bunch of issues. And

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in all of us that want good for
our patients have had issues.

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And the interesting thing about
plastic surgeons is because we tend

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to be pleasers, we try
to please our patients,

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it really affects us when we have
somebody that we don't please that they're

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unhappy with. What we did,

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we're we're trying to put
all of our education and all
of our experience and all

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of it, all that into something
that makes a good result for them.

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And that's why when we don't please, it's,

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I wouldn't say it's devastating to us,

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but it really hits us more so than
just they're unhappy. It's like,

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I didn't please them. That's problematic.

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So what I tell people to do, what
I tell plastic surgeons to do,

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young plastic surgeons, and I get calls
about this all the time, Dr. Sykes.

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You know how to deal with this.
I actually don't. I just listen.

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I actually don't know how to deal
with this. I just listen more.

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And it's not in my nature.

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If I go out with Dr. Bass and he says,

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I want the beer, I don't say, Larry,

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tell me more about why you want the
beer. Tell me. I don't say that.

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I just get him the damn beer.

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But actually with our patients that
say, I've got this pain behind my ear,

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and you can't, as a doctor, you can't
feel the pain. You can't see the pain,

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you can't even touch the pain.

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But I'm numbing behind
my ears that normal,

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our natural tendency is
to be logical with them

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and to say, well, that's sort of
normal. It's going to go away.

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That's not listening. My advice
to you is listen. Say to them,

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it sounds like that really
bugs you. Tell me more.

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I actually don't want to hear more.
Jonathan Sykes doesn't want to hear more,

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but I say to them, tell
me more. Tell me about it,

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it seems like that's impacting
your life. Is it? And they tell me,

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and the more they talk like that,

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the more they feel like I'm
listening and accepting who they are.

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And it lessens the
negative claim in the room.

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So the big thing is to listen beforehand

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because that lets you potentially see
the people that are going to be really

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difficult afterwards and
then to listen afterwards.

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So listening is a big part
of the plastic surgeon.

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And because a lot of plastic
surgeons have big egos,

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it's tough for us to listen.

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I took a course many years ago,
not very far from where you live,

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Larry in New Haven about communicating.

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And I took it with three doctors.

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I took this course because
my dean said to me, Sykes,

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you would've a communications course when
everybody in the world thought I was a

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good communicator. And this is what
they told me at the end of the course,

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at the end of the week,

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they said to the two other
doctors who were pediatricians,

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you ought to get bigger in the room.
What do you think? They told me,

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you ought to get smaller in the room.
Everybody listens to what I say.

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They say the people that were in the room
as the educators that we're teaching,

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they say, we actually
like to listen to you.

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I realized that was really screwing
me up with my patients afterwards.

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I don't need to tell
them what the logic said,

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what was going to happen
with their scars or their,

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I didn't need to be logical.
I needed to listen to them.

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And I wasn't as good at that.
I was not as good at that.

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So it makes me have a different,

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I tell plastic surgeons,

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if a patient comes to you
afterwards and they're upset,

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they're dissatisfied, and they just
could maybe be angry. And it's like,

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why would you be angry at me?
I tried my best with your face?

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And you're looking at them and they've
got a good result. Why are you angry?

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I don't say that. I sit low in
the room. I don't sit by the door.

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I don't put my hand on the doorknob
and I don't get logical with them.

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I never use logic. Logic
sucks with an unhappy patient.

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Don't use logic.

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Listen to them and they'll hear that
you're listening to them and things will

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get softer in the ring.
It may not solve it,

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but it'll make it better.
And then you say to them,

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would you mind if I told you
what I think is going to happen?

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You ask them for permission because
they're vulnerable at this point.

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Actually beforehand, they're vulnerable

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and you have all the knowledge afterwards,

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you're vulnerable and
they have the knowledge.

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But afterwards, the surgeon is
vulnerable. What I say to them,

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would you mind if I told you
what I think's going to happen?

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And then maybe propose a
potential solution down the

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road. Would that be okay? Would that
be okay? That's the way I talk to them.

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So psychology is so important in this, and

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we get before surgery,

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a little glimpse of the person's life.

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It's very small unless we try and we,

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so I always start my consultations at
the very beginning by tell me about

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yourself. Tell me what, and I listen
to how they talk about themselves.

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And they often say, well,
this bothers me. I said, no,

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don't tell me what bothers
you. Tell me about who you are.

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Tell me about yourself. I
just want to hear them talk.

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I try and get myself to not
talk and try to listen to them.

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Listening is key.

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Dr. Sykes, what is your approach
to the doctor patient relationship?

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You've already elaborated on how you
emphasize listening as part of the

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communication style,

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and how does your approach differ for
different patients or different goals?

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Well, I think that's a
really important question.

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Patients are different, just
like their faces are different,

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their minds are different.

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And they come with this bag of issues

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that you don't know about
unless you ask them.

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But getting them to talk about

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what's going on in their life lets
you know, have they had trauma?

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Has their wife or husband
been verbally abusive to

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them? Did they have issues with,

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I get people that come into me that talk
about their nose and they say things

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like,

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my dad started to criticize my
nose when I was eight years old.

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I mean, first of all, what father
does that to their 8-year-old kid?

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But secondly, I don't know
what got said in that room,

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but something about the interaction with
the father made it so they were really

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vulnerable and really sensitive to that.

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And now you're going to operate on
somebody that brings 30 years of baggage

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00:14:39,610 --> 00:14:43,120
about how their nose looked.
That's an important thing to me.

231
00:14:44,680 --> 00:14:47,770
And so you get all of that.

232
00:14:47,830 --> 00:14:52,460
You get every piece of baggage
that a person has from their

233
00:14:52,460 --> 00:14:56,750
life, and it culminates on
how their face or body looks,

234
00:14:58,190 --> 00:15:01,400
and then how they perceive
how their face or body looks.

235
00:15:01,970 --> 00:15:04,280
And we've got to understand that.

236
00:15:07,400 --> 00:15:09,950
We may not fully understand
it, but we have to accept it.

237
00:15:10,370 --> 00:15:14,540
We've got to accept it, and we've got
to let that play into how we treat them.

238
00:15:14,930 --> 00:15:18,620
Because how we treat their psyche
is as important as how we treat them

239
00:15:18,620 --> 00:15:19,880
physically, their appearance.

240
00:15:20,570 --> 00:15:25,070
And that's really the classic
quote from Tagliacozzi,

241
00:15:25,070 --> 00:15:29,810
that we're doing this more to
buoy the spirit than to heal the

242
00:15:29,810 --> 00:15:33,560
flesh. I mean, that's
at least as important,

243
00:15:33,560 --> 00:15:34,850
if not more important.

244
00:15:36,930 --> 00:15:39,230
And the damage to their spirit,

245
00:15:39,230 --> 00:15:42,050
we don't know about unless we
get an idea of it or not damage,

246
00:15:42,060 --> 00:15:44,570
but the way their security,

247
00:15:49,280 --> 00:15:52,400
an ideal patient has a
lot of inner security,

248
00:15:52,880 --> 00:15:56,600
but if they have no insecurity,
they don't arrive on our step.

249
00:15:57,980 --> 00:16:00,680
They never come to us. So they
have to have a little insecurity.

250
00:16:00,830 --> 00:16:04,730
But if they have a lot of insecurity,
then they're very difficult to treat.

251
00:16:05,060 --> 00:16:09,500
These super insecure patients are
very, and we don't know what they have.

252
00:16:09,920 --> 00:16:13,850
We don't know that until we talk
to them. Until we listen to them.

253
00:16:14,930 --> 00:16:17,120
I'm wondering, Dr. Sykes, overall,

254
00:16:17,240 --> 00:16:22,190
do you feel the benefit of plastic surgery
is mostly psychological or should it

255
00:16:22,190 --> 00:16:26,000
stay more focused on features
and achieving beauty?

256
00:16:26,540 --> 00:16:28,550
Would you say,

257
00:16:28,550 --> 00:16:31,700
how subjective and psychological
is our perception of beauty?

258
00:16:32,600 --> 00:16:36,410
I think it's probably
80 or 90% psychological.

259
00:16:41,480 --> 00:16:44,240
It isn't whether we have a wrinkle here.

260
00:16:44,810 --> 00:16:47,870
It's whether it bothers us and
then how much it bothers us.

261
00:16:48,170 --> 00:16:52,850
So it's the bother part that gets
us in the office and we'll accept

262
00:16:53,540 --> 00:16:57,470
if we treat it, if we get it somewhat
better versus totally better.

263
00:16:57,730 --> 00:17:02,660
And the people that are highly
insecure that have a really

264
00:17:02,750 --> 00:17:06,920
odd body image, body perception,

265
00:17:07,100 --> 00:17:10,730
face perception. Once you fix one thing,

266
00:17:11,750 --> 00:17:15,230
they have another thing. It's
like a PEZ dispenser of problems.

267
00:17:15,620 --> 00:17:18,440
You're too young during to
know what a PEZ dispenser is,

268
00:17:18,800 --> 00:17:21,770
but a PEZ dispenser is when you
pull one, another one pops up.

269
00:17:21,980 --> 00:17:26,630
These people that have
these bad body images,

270
00:17:26,630 --> 00:17:29,900
bad, I'll call it body images,
but it's about their face too.

271
00:17:31,610 --> 00:17:34,010
The next one's right around
the corner after you fix one.

272
00:17:34,760 --> 00:17:36,710
And if you don't fix it to their liking,

273
00:17:36,710 --> 00:17:40,070
then it's really bad for them. The people
that are really happy with what they

274
00:17:40,070 --> 00:17:43,370
do, they've got a definite
thing that they don't like.

275
00:17:43,970 --> 00:17:45,530
They're healthy in their dislike of it.

276
00:17:46,670 --> 00:17:50,130
They're able to have the
surgery move on with their life.

277
00:17:50,790 --> 00:17:54,270
But some people can't move on with their
life because working on their face or

278
00:17:54,270 --> 00:17:58,680
their body is a lifelong thing for
them. It's never acceptable to them.

279
00:17:59,250 --> 00:18:02,010
And those people are, they're
difficult to ever treat.

280
00:18:03,840 --> 00:18:06,810
And we think of that as,

281
00:18:06,810 --> 00:18:09,000
we're body dysmorphic or not.

282
00:18:09,270 --> 00:18:14,250
I think it's a continuum
of stuff because all of us

283
00:18:14,250 --> 00:18:17,820
have a little dysmorphia that get into
a plastic surgeon's office. I mean,

284
00:18:17,820 --> 00:18:20,400
there's somebody like
me. I don't own a comb.

285
00:18:20,430 --> 00:18:23,550
I didn't comb my hair this morning.
It's almost six o'clock here.

286
00:18:23,820 --> 00:18:26,730
I never comb my hair. I don't own a comb.

287
00:18:27,590 --> 00:18:30,870
And it's not that I'm not
clean, but I don't really look,

288
00:18:30,870 --> 00:18:32,610
if my hair's a little out of,

289
00:18:32,790 --> 00:18:37,230
some people can't leave their
home without their makeup on

290
00:18:37,350 --> 00:18:41,340
perfectly. They can't do that,
which is an odd concept to me,

291
00:18:41,820 --> 00:18:44,430
but I get it or I have to get it.

292
00:18:46,440 --> 00:18:51,120
And we have to know about the person
to be able to treat that person

293
00:18:51,450 --> 00:18:56,130
and say to them, I can't get
this a hundred percent better.

294
00:18:57,660 --> 00:19:02,220
My patient that I just had the consult
with talked to me about all these other

295
00:19:02,220 --> 00:19:06,060
noses that she liked that were really
narrow and she had really thick skin.

296
00:19:06,240 --> 00:19:09,990
We did a FaceTime consult today,
an hour before this. And I said,

297
00:19:10,680 --> 00:19:14,610
I can't get you that kind of
nose. I can make your nose better.

298
00:19:14,820 --> 00:19:19,020
I can make it thinner, but I can't
make it that thin. It's not possible.

299
00:19:19,650 --> 00:19:21,360
And I don't know if she heard that.

300
00:19:23,130 --> 00:19:27,720
That's always a concern
when sometimes you can

301
00:19:27,720 --> 00:19:32,250
tell that someone's not hearing
something and when you're saying,

302
00:19:32,610 --> 00:19:37,350
I can't do something, or this is not
something that I have expertise in,

303
00:19:37,890 --> 00:19:39,030
and they're saying, no, no,

304
00:19:39,030 --> 00:19:42,840
but I know you are going to
take care of this for me,

305
00:19:44,010 --> 00:19:48,840
that's an alarm bell that
there's not good reality testing.

306
00:19:48,840 --> 00:19:53,610
The person at the extreme
of body dysmorphia clearly

307
00:19:53,620 --> 00:19:58,440
is not a good candidate to have plastic
surgery because they're not going to end

308
00:19:58,440 --> 00:19:59,880
up happy. And

309
00:20:02,080 --> 00:20:04,590
I don't worry about how
many cases I book in a year.

310
00:20:05,310 --> 00:20:09,150
I want happy patients.
It's what you said before.

311
00:20:09,330 --> 00:20:14,130
I'm doing this to make people happy and
if I can see it coming that they're not

312
00:20:14,130 --> 00:20:16,170
going to be, I don't want to get started.

313
00:20:17,460 --> 00:20:21,870
But so
Those patients clearly ought to

314
00:20:22,680 --> 00:20:27,120
head towards psychotherapy and
maybe they can rework their

315
00:20:27,630 --> 00:20:31,470
perception of life.
But for other patients,

316
00:20:31,650 --> 00:20:32,700
I used to joke,

317
00:20:33,000 --> 00:20:37,890
I can do more for someone's self-esteem
with three hours of plastic surgery than

318
00:20:37,900 --> 00:20:42,510
three years of psychotherapy. And
not to denigrate the psychotherapist.

319
00:20:42,520 --> 00:20:47,380
And I was joking, not totally serious,
but there's an element of that.

320
00:20:49,180 --> 00:20:52,900
Some features are disruptive,

321
00:20:53,170 --> 00:20:57,520
discordant, it's as you
said, real perception

322
00:20:59,710 --> 00:21:04,540
in the proper perspective of how much

323
00:21:04,600 --> 00:21:09,220
that's disrupting someone's life and how
much it will be better if they fix it.

324
00:21:10,270 --> 00:21:13,120
If it's ruining your life that
you have this tiny wrinkle,

325
00:21:13,120 --> 00:21:16,720
you probably don't have the right
perspective, and if you fix it,

326
00:21:16,720 --> 00:21:20,500
your life is going to be better, but
it's not going to be that much better.

327
00:21:21,880 --> 00:21:26,650
So it's matching up all of those
things when you talk to people

328
00:21:27,190 --> 00:21:31,870
and the need to listen
is key to that because

329
00:21:32,200 --> 00:21:37,120
it's the only way you can
have a prayer of perceiving

330
00:21:37,120 --> 00:21:38,080
what's going on.

331
00:21:39,370 --> 00:21:41,500
So true. Yeah, really true. Well put.

332
00:21:42,760 --> 00:21:45,940
Lastly, as we wrap up this
discussion, Dr. Sykes,

333
00:21:45,940 --> 00:21:48,100
what takeaways would you
leave our listeners with?

334
00:21:49,510 --> 00:21:54,190
Well, the plastic surgeons
and the surgeon has to

335
00:21:54,820 --> 00:21:59,770
really analyze the person's
psychological strength as to

336
00:21:59,770 --> 00:22:03,490
why they want surgery and whether
or not they can with go through it,

337
00:22:04,210 --> 00:22:07,810
whether or not they can psychologically
go through the surgery and the

338
00:22:07,810 --> 00:22:10,900
postoperative period and so
forth. And then of course,

339
00:22:11,560 --> 00:22:15,460
their ability to deal with the result
and what for them might be a less than

340
00:22:15,460 --> 00:22:20,440
perfect result. And then
we have to have a different

341
00:22:22,900 --> 00:22:25,870
code on when we deal with them afterwards,

342
00:22:26,290 --> 00:22:30,790
when we've already gotten to the cocoon
with them because we've done a surgery

343
00:22:30,800 --> 00:22:33,100
on them and they are who they are,

344
00:22:33,490 --> 00:22:37,930
and maybe we understood it beforehand
and maybe they evaded our radar

345
00:22:38,830 --> 00:22:42,520
and now they're unhappy with the results.

346
00:22:42,520 --> 00:22:44,770
How we deal with them when that happens.

347
00:22:45,310 --> 00:22:49,690
And that's its own set of
stuff. Both of them involve

348
00:22:51,350 --> 00:22:54,310
careful listening and

349
00:22:56,110 --> 00:23:00,040
the doctor talking less and
listening to what they hear,

350
00:23:00,760 --> 00:23:05,350
a real listen to what they
hear to decide who's a good

351
00:23:05,360 --> 00:23:09,550
candidate and who's not a good candidate
at all. I can't operate on them.

352
00:23:10,030 --> 00:23:14,740
And then afterwards to make them
feel accepted and understood

353
00:23:15,040 --> 00:23:19,090
for what they don't like. And
then the ability to propose

354
00:23:20,770 --> 00:23:25,330
a solution to this so
that it's a complex thing,

355
00:23:25,330 --> 00:23:30,310
but it's clear that what
people expect from the surgery

356
00:23:30,490 --> 00:23:33,220
has a lot to do with their
satisfaction of the surgery.

357
00:23:35,530 --> 00:23:40,150
I don't think as doctors, we alter
people's expectations that much.

358
00:23:40,420 --> 00:23:43,600
We try to, but I think their
expectations are what they are,

359
00:23:44,930 --> 00:23:46,700
our ability to communicate with them.

360
00:23:47,810 --> 00:23:49,940
And we always say afterwards,

361
00:23:51,590 --> 00:23:54,530
patient had unrealistic
expectations. That's a common thing.

362
00:23:54,530 --> 00:23:57,170
If a patient just says, well,
they had unrealistic, well,

363
00:23:57,800 --> 00:24:00,110
their expectations are the
same before as they were after,

364
00:24:00,170 --> 00:24:02,180
we just didn't take the time
to figure out what they were.

365
00:24:03,080 --> 00:24:05,750
And so they really
haven't changed that much.

366
00:24:06,080 --> 00:24:09,320
And if they were unrealistic beforehand,

367
00:24:10,430 --> 00:24:11,960
we probably shouldn't
have operated on them.

368
00:24:12,020 --> 00:24:16,850
But our own ego and economics
get in the way of doctor's

369
00:24:16,860 --> 00:24:21,140
good judgment. We may make good judgment
in the operating room, but we don't.

370
00:24:21,140 --> 00:24:24,500
Let's make good judgment in the
psyche. And so our ego gets in the way.

371
00:24:24,680 --> 00:24:26,510
We think we can solve
everything with our knife,

372
00:24:27,500 --> 00:24:31,010
and then economics get in the way because
we want to do the case because it pays

373
00:24:31,010 --> 00:24:35,690
us. It's pretty simple. I'm a simpleton.

374
00:24:36,590 --> 00:24:41,330
But that's really interesting
because I think it's really

375
00:24:41,330 --> 00:24:45,140
key. One thing that you just said,

376
00:24:46,430 --> 00:24:50,480
because I take a very consumerist
approach with my patients.

377
00:24:50,480 --> 00:24:55,160
I like to be very realist and be very

378
00:24:55,160 --> 00:24:59,150
forthright about what I
expect I can do and can't do.

379
00:24:59,750 --> 00:25:04,700
But you said that patient's
expectations don't

380
00:25:04,700 --> 00:25:06,080
really change that much.

381
00:25:06,080 --> 00:25:10,100
The doctor doesn't really succeed
at changing them that much.

382
00:25:10,670 --> 00:25:15,020
And that makes a lot of sense to
me because I'll tell patients,

383
00:25:16,100 --> 00:25:20,690
we're going to do this lift, but we never
get a hundred percent of the skin out.

384
00:25:20,690 --> 00:25:23,570
We're always going to keep a
little bit of skin here and here,

385
00:25:24,290 --> 00:25:28,880
and you can look younger, but
you can never be 20 again.

386
00:25:28,910 --> 00:25:33,800
And the patients uniformly say to me, oh,
Dr. Bass, I don't need to be 20 again.

387
00:25:35,060 --> 00:25:38,900
I don't need it perfect. And then I say,

388
00:25:39,560 --> 00:25:43,070
what that means is that
feature that you don't like,

389
00:25:43,160 --> 00:25:48,020
that you're going to pay all this
money and go through this procedure to

390
00:25:48,020 --> 00:25:51,830
address is going to be better, but
it's not going to be all better.

391
00:25:51,830 --> 00:25:53,870
You're still going to see it.
It's still going to be there.

392
00:25:53,870 --> 00:25:58,460
It's not going to be zero.
And I feel like, okay,

393
00:25:58,460 --> 00:26:02,360
I'm trying to be very
fair and set a realistic

394
00:26:04,040 --> 00:26:05,930
level of expectation,

395
00:26:06,710 --> 00:26:10,730
but the fact that I may not be,

396
00:26:10,880 --> 00:26:13,550
I know I'm not getting
into their head completely.

397
00:26:13,970 --> 00:26:15,680
I can't just pour it in there,

398
00:26:16,220 --> 00:26:21,170
but the fact that they may
not move more than an inch or

399
00:26:21,170 --> 00:26:26,090
maybe at all in their expectations
is something I think is

400
00:26:26,480 --> 00:26:30,230
a key thing for doctors to understand

401
00:26:31,670 --> 00:26:36,620
in deciding if a patient realistically
is going to be happy when

402
00:26:36,620 --> 00:26:37,453
they're done.

403
00:26:38,060 --> 00:26:42,770
They have to understand the margin
of error that we have in what we do.

404
00:26:43,410 --> 00:26:46,500
But some of them can do that really well,
and some of them can't do that at all.

405
00:26:47,130 --> 00:26:50,640
And our job is figuring
out who those people are,

406
00:26:52,320 --> 00:26:54,600
who's going to be okay
with what we do. I mean,

407
00:26:55,080 --> 00:26:58,680
we're trying to do everything for
everyone. That's what we try and do.

408
00:26:58,710 --> 00:27:00,600
That's what, we're pleasers. We try and

409
00:27:03,000 --> 00:27:07,050
when I have a psychologically good
patient and I do a good job on them,

410
00:27:07,290 --> 00:27:09,060
there's nothing that makes
me happier in the world.

411
00:27:09,810 --> 00:27:14,520
But when I have a patient that I've done
a really good surgery on and they're

412
00:27:14,530 --> 00:27:18,300
unhappy and I can't feel or
touch what they're unhappy about,

413
00:27:19,320 --> 00:27:21,900
that's one of the most stressful
things in the world for me.

414
00:27:22,290 --> 00:27:25,560
And I've just tried to figure out
in my career how to deal with that,

415
00:27:26,730 --> 00:27:27,660
how to best deal with it.

416
00:27:28,680 --> 00:27:32,190
Finally, Dr. Bass, would you like to add
any takeaways for our listeners today?

417
00:27:32,970 --> 00:27:37,140
So Dr. Sykes talked a lot about how the

418
00:27:37,140 --> 00:27:41,280
doctor needs to think about what
patients are thinking about.

419
00:27:41,280 --> 00:27:45,780
Let me flip it a little bit
the other way and talk about

420
00:27:46,590 --> 00:27:48,450
from the patient's point of view,

421
00:27:48,450 --> 00:27:53,400
what they should expect in
the relationship and how
the relationship ideally

422
00:27:53,400 --> 00:27:54,233
should go.

423
00:27:54,480 --> 00:27:58,890
So perception of psychological
needs and psychological support

424
00:27:59,460 --> 00:28:00,600
before, during,

425
00:28:00,600 --> 00:28:05,520
and after a treatment or a surgery
are just as important in the doctor

426
00:28:05,520 --> 00:28:09,870
patient relationship as the technical
aspects of the medical care.

427
00:28:09,870 --> 00:28:13,860
And we have this incredible luxury of time

428
00:28:14,820 --> 00:28:19,770
and a much more personal encounter

429
00:28:20,250 --> 00:28:25,230
in aesthetic plastic surgery than
almost any other part of medicine has.

430
00:28:25,560 --> 00:28:28,530
That's becoming more and
more of an assembly line.

431
00:28:28,530 --> 00:28:30,630
So that's a tremendous luxury.

432
00:28:31,230 --> 00:28:34,170
That's very important for
what we're trying to do.

433
00:28:37,350 --> 00:28:38,280
Not only that,

434
00:28:38,280 --> 00:28:42,690
but the relationship is
different than a classic

435
00:28:42,690 --> 00:28:47,460
surgical practice nowadays
because there are a

436
00:28:47,460 --> 00:28:49,560
lot of recurrent treatments.

437
00:28:49,590 --> 00:28:53,190
Dr. Sykes talked about
injectables and other things,

438
00:28:53,670 --> 00:28:56,910
and these things are recurrent.

439
00:28:56,910 --> 00:29:01,890
So we now have a relationship with
people rather than just a short

440
00:29:01,900 --> 00:29:06,510
term encounter of selecting a surgery,

441
00:29:06,540 --> 00:29:11,340
helping the patient through
recovery for two or three or four

442
00:29:11,340 --> 00:29:12,173
visits.

443
00:29:14,460 --> 00:29:19,290
The patient ideally wants
to use the surgeon for

444
00:29:19,290 --> 00:29:22,470
their technical expertise
and their judgment,

445
00:29:24,360 --> 00:29:26,850
especially in that initial encounter.

446
00:29:27,420 --> 00:29:30,360
And picking someone based on reputation,

447
00:29:31,800 --> 00:29:33,780
the results that they can show,

448
00:29:34,080 --> 00:29:37,410
not micromanaging the
technical details of care.

449
00:29:37,410 --> 00:29:39,870
You need the surgeon for that expertise.

450
00:29:41,050 --> 00:29:42,550
But at the same time,

451
00:29:43,330 --> 00:29:48,040
you want a surgeon who's responsive
and who's listening, as Dr. Sykes said.

452
00:29:48,640 --> 00:29:51,520
So Jon,

453
00:29:51,550 --> 00:29:54,940
I'd like to thank you for
joining us again on the podcast.

454
00:29:54,940 --> 00:29:57,310
This was a really stimulating discussion,

455
00:29:57,310 --> 00:30:02,230
and I think it points up a
lot of the challenge both to

456
00:30:02,410 --> 00:30:07,390
plastic surgeons and to plastic
surgery patients to try to get a

457
00:30:07,690 --> 00:30:12,100
positive experience to try to do the right

458
00:30:12,110 --> 00:30:12,943
thing.

459
00:30:13,510 --> 00:30:18,370
And it's a seldom discussed,

460
00:30:18,370 --> 00:30:21,580
but obviously critical
aspect of what we do.

461
00:30:22,540 --> 00:30:25,660
Just to add one more thing, there's
one thing that you said really quickly,

462
00:30:25,660 --> 00:30:26,770
just a personal anecdote,

463
00:30:28,630 --> 00:30:32,560
and you talked about the
recurrent relationship and
how we have a stronger bond

464
00:30:34,120 --> 00:30:38,110
and how we've got to take care of
the patient. So a bunch of years ago,

465
00:30:38,230 --> 00:30:40,000
30 years ago, a little more actually,

466
00:30:40,450 --> 00:30:45,370
I had back surgery and I went
back to my neurosurgeon six

467
00:30:45,370 --> 00:30:49,450
days afterwards and he said, how are you
doing? I said, I'm doing pretty well.

468
00:30:49,570 --> 00:30:53,470
He said, everything looks good. And I
said, so when do you want to see me again?

469
00:30:53,470 --> 00:30:55,530
He said, I don't want to see
you. I don't need to see you.

470
00:30:57,730 --> 00:31:00,730
If you have a problem, you'll just call
me, pass me in the hallway or whatever.

471
00:31:01,480 --> 00:31:04,870
And if I did that with my facelift
patients or my nose job patients,

472
00:31:06,250 --> 00:31:10,300
99% of them would be very annoyed
with me. Not a little annoyed,

473
00:31:10,450 --> 00:31:11,283
but very annoyed.

474
00:31:11,710 --> 00:31:16,060
Their expectation is that I talk them
through this process of doing it.

475
00:31:16,600 --> 00:31:20,140
It's as important as the surgery
itself. It's as important.

476
00:31:20,740 --> 00:31:23,680
So we develop a relationship,
as you mentioned, Larry,

477
00:31:23,680 --> 00:31:28,060
that goes beyond just the knife patient.
We're not just taking out a tumor.

478
00:31:28,330 --> 00:31:30,790
We're not just fixing a
herniated disc, whatever.

479
00:31:31,780 --> 00:31:36,640
And for surgeons, we have to
recognize this and patients know that,

480
00:31:36,650 --> 00:31:39,130
and they all want a
different aspect of this,

481
00:31:39,130 --> 00:31:41,290
but I just wanted to share
that anecdote at the end.

482
00:31:42,100 --> 00:31:44,530
That was wonderful. Thank you, Dr. Sykes.

483
00:31:44,530 --> 00:31:48,220
I'll echo Dr. Bass and say thank you for
coming on our podcast and sharing your

484
00:31:48,220 --> 00:31:50,170
thoughtful insights with
all of our listeners.

485
00:31:50,530 --> 00:31:51,880
Thank you. It's been my pleasure.

486
00:31:52,720 --> 00:31:56,410
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.

487
00:31:56,830 --> 00:31:58,330
Follow us on Apple Podcasts,

488
00:31:58,330 --> 00:32:00,430
write a review and share
the show with your friends.

489
00:32:00,850 --> 00:32:03,940
Be sure to join us next time to avoid
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490
00:32:03,940 --> 00:32:07,450
coming your way. If you want to
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491
00:32:07,480 --> 00:32:08,350
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492
00:32:08,830 --> 00:32:13,000
Send us an email at podcast@drbass.net
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493
00:32:13,930 --> 00:32:14,020
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