Plastic Surgeon's Diary - Episode 2

Dr. Karthik Ram's podcast

Plastic Surgeon's Diary - Episode 2. The video is all about our weekly experience during consultations & surgeries... CLIENT 1: RHINOPLASTY / DEVIATED NOSE CORRECTION.

SCENARIO: The client traveled to consult us for over 1000+ Kms regarding crooked nose correction, along with his parents. Mostly, such clients prefer to meet multiple doctors during a long visit before they decide upon their surgeon. I insisted that they go for all the consultations that they had scheduled for further opinions and then decide. He consulted everyone and finally came back to me as the chosen one. TREATMENT: Spreader graft, complete septum correction and Osteotomy. OUTCOME: Extremely happy client. Good review on google was a feather to the cap. MESSAGE: Encourage second opinions. Let the client choose you based on their intuition, confidence in your skillsets and eventual comfort levels. CLIENT 2: BREAST IMPLANT REMOVAL / BREAST FAT FILL / EAR LOBE FAT FILL / PLATYSMOPLASTY / FACE FAT FILL SCENARIO: The client had flown from Europe on a spiritual journey. She had had a breast implant 15 yrs ago but was somehow uncomfortable that it was unnatural. When she reconsulted the same doctor for implant removal, the doctor turned it down stating it is his masterpiece and that he wouldn't remove it. It infact was a masterpiece. TREATMENT: She approached us for a breast implant removal and a breast fat fill. Considering her marriage plans, she wanted to look younger and opted for a Plastysmoplasty of the neck and fat fill of face. In addition, she opted for ear lobe fat transfer & corrections as well. We started at 8 in the morning and completed at 1.30. OUTCOME: She hardly had any bruises and recovered very fast (in less than 5 to 6 days). MESSAGE: Clients should be given the liberty to undo a Cosmetic procedure that they have undergone if they are not comfortable around it. Many breast implant illness patients are symptom free but they do want to get rid of it. CLIENT 3: RHINOPLASTY SCENARIO: This client was a nurse by profession. When I examined her nose, it was pretty normal. When I probed further, I found that she was bullied a lot at school regarding her nose. TREATMENT: Referred to a psychiatrist for further evaluation and guidance. OUTCOME: We are very sure that the client will benefit a lot from the psychiatrist visit. MESSAGE: Bullying affects a person's self-esteem. They end up with what is known as Body Dysmorphic Syndrome. Say no to bullying. CLIENT 4: GYNECOMASTIA SCENARIO: The client had come with his mother, who had a history of being addressed as Lord Ganesha in his younger years in view of his chubby appearance and female like chest. TREATMENT: Gynecomastia treatment. OUTCOME: Male like chest appearance restored and the client is expected to get over his psychological concerns with his new found body. MESSAGE: Some comments from closed family members / bullying cause a deep psychological impact. Please handle with care. CLIENT 5 : COMPLETE FACE CHANGE. SCENARIO: Despite language issues, a man was profusely trying to reach me regarding some corrections for his wife. He eventually landed up in person insisting that I change his wifes face completely. TREATMENT: DEFINITE NO NO. Infact the husband needs to be counselled. OUTCOME: NA MESSAGE: Some people need psychological help. Sometime it is not the client. Know the difference. CLIENT 6 : MOMMY MAKEOVER. SCENARIO: Husband and wife came together for a consultation. The husband confessed that he does not find his wife attractive anymore since she has a saggy breast and flabby tummy. TREATMENT : I refused to do the procedure until I was convinced that the inclination was coming from the wife to undergo the procedure. She expressed that she too would like to undergo the procedure to look good for herself and wear good clothes. OUTCOME: For now, we have just scheduled her Tummy Tuck procedure to enable her fit into good clothes. MESSAGE: The intent with which a client comes for a procedure matters. Physical makeover doesnt just set right relationships. The emotional factor between the 2 parties is more important. CLIENT 7: FILLER SCENARIO: This mid - 40 client came to me 2 years ago. I suggested her a little conservative option like filler. TREATMENT: I adviced her that she opt for only 2 fillers and botox in that particular sitting since I did not want her to waste her money and that she should go for it if she needed more of it. She had paid up for only 2 fillers by then. But she insisted that I do a 3rd filler as well on the table and that money is not a concern. She was supposed to come the next day and pay up. Instead, she constantly started complaining that he is unhappy with the results. We had reserved a part of the content of the syringe for her future use, if she happens to come back for a further touchup. She came after a few days to avail the balance filler in the name of a review. We showed her her before/after pics and were able to demonstrate the improvements so vividly, which she prompty agreed but kept going back to her earlier opinion. She walked down to the reception and within seconds, she disappeared without paying the money for the additional filler. OUTCOME: Monetary loss for the well wishing surgeons. MESSAGE: 1 to 100 patients will behave so. No point in going behind such clients and wasting our valuable time. Legal initiatives are just a waste of our energy. We will rather spend that time helping someone else. CLIENT 8: BODY CONTOURING PROCEDURE SCENARIO: This client is an actress. She has always been adviced to resort to diet and exercise everytime she comes to me for a body contouring procedure. She always loses weight and thanks me for guiding her right later. TREATMENT : Motivated her to work on lifestyle changes. OUTCOME : She has been my very loyal client and has referred n number of clients for all sorts of procedures. MESSAGE : Cosmetic Surgery is a lifetime practice and these clients trust us and keep coming back to us. Winning the trust and confidence of the client is more important than just trying to convert them for procedures. CLIENT 9 : GLAND EXCISION UNDER LOCAL ANESTHESIA SCENARIO: This client wanted to undergo Nipple Reduction and was shared a very reasonable quote for the same. Hence, we decided to do this procedure under local anesthesia. He was briefed clearly of the pre and post-operative instruction well ahead of the surgery including the restrictions on smoking. TREATMENT : As we examined him on the day of the surgery, we felt that he needs a gland excision too but were considerate enough to not charge him anything extra as a goodwill. As his procedure was under progress, he started bleeding on the table. We spent a lot of time arresting the bleed. Intense interrogations followed with the client. OUTCOME : The client opened up that he had smoked on the day of the surgery. Fortunately for us, the client saw how we doctors suffered to arrest the bleeding and realized the seriousness of his mistake. He quit smoking from there on. MESSAGE : Compliance and abiding by every single instruction of your doctor matters. It could be a matter of life and death. CLIENT 10: GYNECOMASTIA CORRECTION SCENARIO: The client had undergone Gynecomastia correction with us. His BP was consistently high during the course of the surgery - 190/135. But our anesthetist managed it well as always. OUTCOME: The issue with such cases is that they commonly tend to start bleeding post-surgery despite appropriate hypertension medications. He developed hematoma - swollen up and blue back during the post-op period and it was immediately explored and the bleeding was arrested within 10 mins under local anesthesia. When probed further, the client had ignored earlier warnings of high BP during his regular health checks blaming it on stress etc. The information that he was a known hypertensive was hidden from the doctors prior to surgery. MESSAGE: Clients need to be very honest about their past history to enable plan the right course of treatment and take necessary precautions. Likewise, doctors should not panic and also communicate transparently with clients. CLIENT 11: BODY CONTOURING POST MASSIVE WEIGHT LOSS SCENARIO: This client was obese but deferred the popularly advised bariatric procedure and attempted weight loss by diet and exercise and lost around 120 Kgs. He is a doctor and aspires to become a lifestyle consultant. TREATMENT: a. Removed excess skin from the chest and did a free nipple graft 6 months back. b. Extended arm lift 3 months back. OUTCOME: His upper body is transformed. We look forward to addressing the skin sags in the lower half of the body. CLIENT 12: RESPECTING YOUR CLIENT SCENARIO : I rushed back from an unexpectedly long surgery this morning to see the out-patients. An elderly gentleman was the first to walk in into my consulting chamber. “I am extremely sorry to have kept you waiting” I remember telling him. OUTCOME: Towards the end of the consultation, he reached out to his pocket and pulled out two currency notes, and profusely insisted that I have it as a Shagun. He said “I have been in the Pharma industry for over 40 Yrs. I have met doctors of all age groups. But this is the first time that a doctor ever cared to apologize for having kept me waiting. Your team has been meticulously updating me of your probable delay in surgery every few minutes. You have an amazing team.” Shagun (CASH GIFTS) as a form of blessing is observed in a lot of traditions outside India as well. It is a silent wish for the receiver to continue receiving more in his life. Thank you sir for your unconditional blessings!