June 11, 2018
Dr. Anu Bajaj, M.D.
Uncategorized

Having Patience With Plastic Surgery Results

At the end of surgery, it isn’t uncommon for one of the nurses or the anesthesiologist to comment “she looks good”, “she’ll be so happy,” or “you did a great job.” The immediate impulse is self-congratulatory, or in today’s world, to take a picture and post the results on Instagram or other social media platforms — so prevalent has this practice become, that I’ve had patients ask why I don’t post pictures or videos from the surgery on this medium.

Plastic Surgery Results Evolve Over Time

Intra-operative photographs and photographs without long-term follow-up can be deceptive.

I never know how to take these congratulatory comments in surgery, and sometimes I secretly cringe. This response has nothing to do with my lack of confidence or the fact that I don’t like compliments about my work – like all of us, I love a compliment. Rather it is because I understand the unpredictability of surgery and humans, and also that surgical results take time to evolve.

The beauty of these immediate post-operative photographs is that they are taken at that perfect moment in time before the effects of the outside world can touch the patient – no bruising, no swelling, no complications. For this reason, I encourage patients to view pre- and post-operative photographs with a discerning eye. Intra-operative photographs and photographs without long-term follow-up can be deceptive and may not be indicative of the final result for a number of reasons – both good and bad.

Surgery Is Horizontal

Since the patient is lying down, the full effects of gravity are difficult to discern. Even if the surgeon sits the patient up by flexing the operating room table, it isn’t the same because gravity is not fully in play.

Healing Breasts Can Change Shape

Breasts will settle. When you do a breast reduction, breast lift, or breast augmentation, the appearance and final result will evolve with time. While the breasts may look great on the table or the day following surgery, there is no guarantee that gravity and time won’t play a role in how the result evolves. Similarly, the breasts will soften and bruising and swelling will resolve with time which means that the breasts will look more natural with time.

The following results represent the pre-operative, one week post-operative, one month post-operative, and three month post-operative results.

Fat Cells Can Be Reabsorbed

Intra-operative photographs of fat grafting or buttocks augmentation fail to account for the natural resorption of the fat that will occur to some degree in the long-term. When we graft fat, we rely on that fat to obtain a blood supply from the surrounding tissues. Not all of the fat will survive; some will dissolve which means that the volume increase you see initially will change. The following photos illustrate this concept when fat is grafted to the face for facial atrophy.

The photos represent the following time points: pre-operative, the first post-operative day following the first fat grafting procedure, three months post-operatively following the first fat grafting procedure, and three months post-operatively following the third fat grafting procedure.

Scars Fade With Time

The natural healing of a scar is that the surgical incision will become a fine red line at about 6-8 weeks after surgery, and then over the next 3-9 months, it will gradually fade to a white line.

The following photos represent the progression of the scars 3 weeks, 2 months, and a year following surgery.

There is also the possibility that complications may occur such as fluid collections (seromas), bleeding (hematoma), wound breakdowns, or infections. All of these can occur within the first few days and weeks following surgery and can impact the final result.

Seeing The Big Picture

As a patient, you should ask your surgeon questions regarding the healing process and what happens once you leave the operating room.

One could argue that we shouldn’t worry about these issues, but I believe that it is important for patients to understand what is involved with a successful procedure and that each image represents one moment in time. I encourage everyone who views and posts post-operative results to remember that while these results are good, many other variables are involved with what will happen over the ensuing months and years to determine the final outcome. As a patient, you should ask your surgeon questions regarding the healing process and what happens once you leave the operating room.

For these reasons, I hesitate to congratulate myself, and I hesitate to share my immediate intra-operative results on social media. I have learned through my years of practice that I can’t predict the future; rather, I prefer to focus on the patient in the present while in the operating room and then through the healing process.