Some people think of a plastic surgeon as an artist and themselves as the canvas. I sometimes use this analogy when I’m explaining to the patient the importance of anesthesia during an operation. If the patient is awake, with concerns and sometimes discomfort, they may move during the procedure so that the “artist” is painting on a moving canvas.

Beyond this, however, the analogy falls short for plastic surgery because the “canvas” we are working on is not a blank canvas. We are working on a canvas that already has a painting on it. In other words, the patient brings with him or her certain problems they perceive on their fully developed body. The results one can expect from a surgical procedure have a great deal to do with the starting point. For example, a man may come to us with a disfigured and distorted nose that has been broken many times in sporting events; or he may present with just a small hump on the top of his nose. A woman might come to the office desiring breast augmentation when in reality she may need a breast lift instead.

Another example would be a child with a severe genetic facial deformity or with just a small partial cleft deformity. Expectations of final results depend on where we start and what material we have to work with.

I believe it is very important that as plastic surgeons we communicate very clearly what expectations can be achieved as well as those that cannot. I have found that most patients have realistic expectations, and working together we often achieve their goals. There are a few, however, who spend their life chasing after a goal that is simply not attainable. I have seen patients who have had five or six procedures by different surgeons, all trying to get the perfect nose, only to be disappointed time after time. The importance of putting forth the effort and spending enough time with the patient to understand their concerns and to have them clearly communicate their goals cannot be overstated.

From the patient’s perspective, it is vital that they choose a board certified plastic surgeon that is experienced and has a good reputation in the community. Referrals can be obtained nationally from the American Society of Plastic Surgeons and in Austin, Texas from the Austin Plastic Surgery Institute.

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