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I received an inquiry from a patient of another surgeon regarding her tummy tuck.   She requested my advice for alternative solutions.   She was unhappy with the excess fat or “New Love Handle I never had before” following her procedure.   Her level of frustration and desperation was readily apparent in the tone of her email.  My edited response to preserve confidentiality of all involved is below.  She had other combined procedures (breast reduction/lift) that I will not address in this particular post.  She chose her surgeon in part based on a lower cost for the surgery.

My response to “Natasha” – fictitious name was:

Hello Natasha,

Thank you for emailing me your inquiry/concerns.  Firstly Natasha, I am so very sorry that your procedures did not result in meeting your expectations. The struggle for cosmetic or plastic surgeons is always trying to align our patients’ expectations to what we believe we can deliver.  When that does not occur neither the patient nor the surgeon is happy. 

Natasha, my cosmetic surgery practice is based on procedures that I can perform just with local anesthesia.  I believe that it is a special service that many patients desire.  Because I only perform procedures under local anesthesia (such as breast augmentation and laser liposuction) I do not perform breast lifts/mastopexy or reductions.  I am researching performing abdominoplasty/tummy tucks under local anesthesia. 

My initial advice to other surgeon’s patients is to go back to your original surgeon and discuss your concerns.  They know best what they actually performed and the nuances involved.    Usually the surgeon and patient have a common goal of the patient’s satisfaction.  However because of the tenor of your email I have addressed one of your concerns below.

 As for your new “love handle”; did your surgeon perform liposuction in this area called the flanks?  It is not unusual even in the best cases to have what aesthetically appears like more tissue on the sides of your abdomen.  I have treated a number of previous abdominoplasty/tummy tuck patients with SmartLipo laser liposuction to reduce this fatty deposit area and to restore a more curvaceous waist.  They were quite pleased with the results and their new waist line.  They understand that the contour would be improved but that the small excess skin on the outside aspects of their previous abdominoplasty/tummy tuck would not be perfect without further excision of skin.  As I frequently tell my patients; “Perfection is always the goal, never attainable.”

 SmartLipo laser liposuction is again performed under local anesthesia, where through small needle puncture sites I pass a laser fiber to melt fat and break up scar tissue.  I then perform liposuction of the liquefied fat to attain an improved contour.  Our web link is: http://laserandvein.com/smartlipo.php.

 Patty our laser liposuction liaison would be able to discuss your particular case in more depth to help determine if you are an appropriate candidate for laser liposuction of your flank “love handle” region.  Her number is (707) 542-8346 ext. 305.  Again Natasha, my biggest concern would be whether we could meet your expectations.

My above response exemplifies the difficulty in acheivig the desired aesthetic result with cosmetic surgery.  Sometimes it is because the surgeon did not perform adequately, and sometimes it is the patient’s unreasonable expectations.  Luckily most of the time if the surgeon is adept at managing expectations consistent with their experience and results and the patient has reasonable expectations both arae usually quite happy.  Thankfully!

When I meet with our patients during their consultation I show them on a large TV screen my own experience of patients before and after photos.  We try to show them a number of similar size patients with some “wow” great results and some just “ok” results.  This helps the patient understand the range of results that can be achieved.

What the patients should learn from this is to ask lots of questions, request seeing the surgeon’s own patient photos and to be reasonable in one’s expectations.  When you are paying  a decent sum of money for your procedure ask yourself if you would be happy with an “OK” result.  If you would be,  there is a great likelihood that you will be very pleased with your results!  Most good surgeons achieve really good results for their patients.  

I always believe a personal relationship between the patient and surgeon with an open line of communication benefits the patient.  Find the correct surgeon that fits your personality type.   Do not base your decision soley on cost.  If you find a good surgeon that offers a good cost value then you have scored!

In health and beauty,

Walter W. Tom, MD, FACS