Dr. Dirk Lazarus

Plastic, Reconstructive & Cosmetic Surgeon

MBChB (UCT), FCS (SA) Plast & Recon Surg

Your Consultation – What to expect

Surgery is never performed without consultation with me and usually two consultations are done.

I understand that patients are frequently nervous at consultation. I get this – see the article below – and I will endeavour to put you at ease from the start. It is your consultation. You are there to get information and you are paying for it – you are the boss. While I may not always agree with you and while I may point out issues that you may not have previously noted, I will attempt to do this in a professional and caring manner. It is not always easy to see a doctor and sometimes two individuals simply do not gel. But bear in mind that I will always have your best interests at heart. I am busy enough that I do not need to push patients into surgery. I see the consultation as your opportunity to receive information and professional advice and care.

At the first consultation we will chat about what you want. I will take a relevant medical history and then examine you. I will take clinical photographs of you for analysis on the screen. Once I have an idea of your expectations and your suitability for surgery I will discuss the options with you with some detail as to what relevant procedure(s) entail. I will review before and after photographs with you of other patients I have operated on.

I will often try to show you someone who has similar anatomy to you and try to match you to a prior patient so that you can get a realistic idea of outcome. I will show you pictures that give you an idea of the expected scarring that you can expect. Sometimes I will introduce you to a patient who has had what you want and give you time to discuss the procedure with that patient. I will give you a quote for the surgery. I do fixed price surgery, in other words, you do not pay per minute in theatre, rather you pay for the procedure in totality. There will be no surprises and no hidden expenses. You will receive a copy of the notes I make with you as we discuss the procedure.

At this consultation I will then usually pass you on to Danni, my practice nurse, who will show you around and give you further information about what to expect on the day of surgery. She will discuss how to prepare for surgery and what to expect during recovery. We are both available to answer questions about your planned procedure(s). You will be given written information about your procedure which will include information about risks and complications.

I usually like to schedule a second consultation prior to surgery. This is an opportunity for you to ask us questions (I encourage you to write them down) and to discuss risks and complications. Consent for surgery is taken at this consultation. There is no additional fee for this second consultation.

For medical tourists the two consultations will be combined into one so that surgery can follow a day or two later.

It is important to me that patients are well informed prior to surgery. Planning is vital and it is paramount that you have an understanding of what will be happening to you on the day of surgery and during the recovery.

As you can see I work very closely with Danni. I am reliant on her to pass on information and to liaise between us. I have found this to be the best way to work and in particular, the most comfortable for the patients. Nevertheless, I am always available.

How to get the most from your consultation with a plastic surgeon

Below is an article I wrote for AA magazine:

According to Wikipedia, there are only 6 supermodels in the world, and according to Answers.com, there are 20. And their photos are usually photoshopped, so expecting that kind of outcome is not a realistic expectation! Achieving the patient’s expectations is the plastic surgeon’s goal, but as the patient, your expectations need to be realistic. When the outcome of plastic surgery matches the patient’s expectations, then everyone is happy.

The goal of this article is to give you some insight into the consultation process that you will have with your plastic surgeon, to allow you to get the most of from this process and to maintain control.

At your first consultation the plastic surgeon will take a history, examine you, take photographs and then discuss the options available to you. The plastic surgeon wants to determine, firstly, if it is appropriate and safe to perform any procedure on you and, secondly, whether the procedure you envisage is advisable or whether better alternatives exist. If you are not suitable for plastic surgery then an ethical plastic surgeon will advise you of that, explain the reasons and help you move towards a more appropriate therapy.

Be aware that most doctors today are obliged to practise defensively. We want to avoid trouble in the form of complications, unhappy patients and even litigation. Defensive practice begins at the first consultation. We won’t operate on patients who are overweight or who suffer from body dysmorphia. We look out for red flags. Smoking is an issue as it impairs vascularity and is associated with a higher complication rate.

Many patients are anxious or nervous, especially at the start of the consultation. They may have been waiting for weeks to see the surgeon and now the time has finally come. No-one really wants to see a doctor. Most women don’t want to remove their clothes in front of a strange man (85% of cosmetic surgery patients are women and most plastic surgeons are men) and, even worse, display the very bits that they feel particularly vulnerable about, for him to prod and poke and photograph and later discuss. We understand that. Most of us will quickly try to put the patient at ease. I try to get the examination and photographs out of the way early on, and I choose, in my practice, to have a nurse chaperone present during the examination and photographs.

Don’t expect your first consultation with a plastic surgeon to be good for your self-esteem. For example, you may consult him or her about breast augmentation and find it mentioned that your breasts, which you thought weren’t too bad, only a little small, are asymmetrical both in size and shape, the nipples not level, and the creases at different heights. We do this not to make you feel bad but to help align your expectations. Also, frequently, patients are unaware of these issues and may want to take the opportunity to address them during surgery. Finally, post-operatively, you will become more conscious of the part operated on. You are likely to spend more time in front of the mirror examining the result. Unless these features are pointed out beforehand, you may think they are the result of your surgery whereas they were in fact there preoperatively.

Another example is the patient who comes for her eyelids and then finds that her whole face is under scrutiny. And what is pointed out with that scrutiny is not good: lines that need Botox, a sagginess here, an aging depression there, jowliness, folds, poor skin quality and the like. She may feel more despondent than when she came in. Again, we do this not to make her feel worse but because we know that we will achieve a better result if we attend to her whole face (or body, as the case may be) rather than just part of it (its no good just painting the front porch when the whole house needs renovation). We want to achieve a harmonious, balanced result. A good plastic surgeon will draw your attention to these issues so that you are given the opportunity to consider the procedures most likely to achieve the best result. The salesman, on the other hand, will try to sell you more. Being aware of this can allow you to manage the suggestions your plastic surgeon make better. Try and understand why suggestions are made, ask probing questions and get to see a range of before and after examples that include various combinations of procedures which have been mentioned. Take the time to reflect before making any decisions – decisions about elective cosmetic surgery need to made after measured consideration and not in haste.

While we may point out additional procedures that can benefit you, we are aware that patients are busy and want minimal downtime, that they generally want subtle results, that cosmetic surgery is a luxury spend and that there is a global trend towards minimally invasive procedures. A good surgeon will focus on the areas most amenable to correction and on the procedures that are most predictable and carry less downtime and cost. We will, of course, be mindful of the reason you are consulting us and of what is specifically troubling you, but a good plastic surgeon will guide you in the right direction or give you a list of options with the pros and cons of each option.

Whilst the consultation is for you to get information, understand that the information is frequently an (informed) opinion. Different surgeons may offer different routes to the same outcome. That is fine. It is also fine for you to mention that you previously saw another surgeon who suggested plan A, and to query why your current surgeon is offering plan B. Different opinions may be useful, allowing you to weigh up the alternatives, but be aware, too, that they may burden you with more options than you want – now you have to choose between two surgeons and two operative options. You will want to choose a surgeon who shares your aesthetic sensibilities and with whom you have a good emotional connection.

Guiding you to the correct procedure choices is something that comes with training and experience. It makes sense to see a specialist who can offer you the range of procedures, rather than a doctor who tries to fit the limited range of procedures they can do to your problem. (We call that “stretching the indications” and it invariably leads to unhappy patients.) Injectables, conservative skin resurfacing and the like are good, particularly in the younger patient, but there comes a time when surgery, or a mix of surgery and more conservative treatment, is more appropriate and will give you a better outcome. It is a common misconception that plastic surgeons only do surgery. In fact plastic surgeons are the only medical specialists in South Africa trained to do cosmetic procedures whether they be Botox or filler or surgery.

Finally, the consultation is your job interview for the surgeon: you need to decide whether you want to appoint him or her to perform a procedure on you. However, although you control the purse strings, the surgeon tends to control the conversation: he or she is likely to have done thousands of such consultations (many more than you) and is the expert in the field. Don’t let the power dynamic overwhelm you. Be wary of salesmanship presenting as professional advice, but also be careful of misconstruing honest professional advice as salesmanship! Listen to what is said very carefully. It has been shown that patients retain only a small percent of the information given in consultations. Make notes or request written information from the surgeon. Ask questions, take time to reflect afterwards and write down further questions. Email your queries or ask about a second consultation (some surgeons do this routinely). Understanding the dynamics of the consultation process will allow you to retain control and get the most out of the consultation process. Good luck!

What to Ask you Surgeon

The British Association of Plastic, Reconstructive and Aesthetic Plastic Surgeons (BAPRAS), have a page on their site about what to ask your plastic surgeon. Here are their questions and my answers.

1. Who will operate on me?

Me. I do all my own surgery.

2. What are your qualifications?

See about me. MBChB 1985. FCS(SA) Plast & Recon Surg 1997. I am registered with Health Professions Council of South Africa as a specialist plastic and reconstructive surgeon.

3. What is your complication and re-operation rate? 

Fair enough, but complication rates are only a measure problems, not of excellence of result. Still everyone wants to avoid problems.

I record all surgery that I do, major or minor, on and excel spreadsheet. Full patient details and operative details are recorded. I also record all complications from minor to major. In the last 10 years I have performed all cosmetic surgery in my own facility. Less than 5 patients have required hospital admission for further recovery, one for urinary retention, probably unrelated to surgery. For open surgery my rate of return to theatre for haematoma (bleeding) is less than 1%. There have been a few other minor revisions for scar improvement, dog ears, addition of suspension sutures, and one or two wound re-suturing. These rates are well below accepted norms. I am happy to reveal my complication rate for your selected procedures at consultation.

4. What are the potential risks and complications? 

Most common and serious complications are discussed on each page with each procedure. Further there is a page on complications which I suggest you review. At consultation we will go through the potential complications and risks with you further.

5. What results can I expect and how long will they last for?

Again, this is usually discussed on each procedure page. At consultation a range of before and after photographs of good and average results will be shown. We will go through how long the procedure lasts and if and when re-operation might be necessary.

6. What aftercare do you provide?

Because all my surgery is performed in my own ambulatory facility it is all done as day case surgery. You will therefore be discharged home on the afternoon of surgery. My nurse, Danni, will call you the evening prior to your procedure and again on the evening of your procedure. You will also be given my cellphone number which you can use if you need to. I will see you within 1-3 days of surgery for your first check up and then regularly thereafter. I have an open door policy in respect to check ups any time after you have had surgery with me.

Testimonials

Hi Anneli, Just have to share this…today I walked through the foyer of our company and an oldish German lady who passed through took my arm, looked at me and said in english :’ So elegant, so chic”. Anneli, it was NOT my clothes or hair or even my eye-lift, it was the confidence I exuded because I felt good about myself for the first time in many years. Kiss Dirk for me and tell him how wonderful it made me feel.