The extraordinary complexity of plastic surgery—blending art, science and exceptional technical skill—is challenging on many levels, acknowledges Dr. Cindy Wu of Cynthia Gregg Face & Body Specialists. “But,” she says, “it might surprise people to know that among the most difficult problems we face are misconceptions and misinformation about plastic surgery. That’s due in large part because our work is visible and very personal to the patient, so our responsibilities go well beyond technical expertise. Plastic surgery is a specialty where patient and physician need to be in sync not only about what’s desirable, but about what’s possible.”

Misconceptions in a Digital Age

That goal, says Dr. Wu, “is made significantly more challenging by misconceptions about plastic surgery—due to the overwhelming amount of information, misinformation, and myth available on the Internet and Social Media.”

Many misconceptions, she says, begin with a distorted understanding of plastic surgery overall. “I find that, too often, the image portrayed in the media is of plastic surgeons being ‘out there,’ engaged in experimental and extreme procedures for celebrities. In reality, the majority of us are treating very common conditions for ordinary people—breast reduction for women with large breasts, breast augmentation for women with small breasts, or a tummy tuck for the moms who have loose skin after having children.”

Individual patients’ perceptions are also distorted by the media, she adds. “It has always been important for patients to have realistic expectations about the results of their surgery. But in today’s social media-driven world, that job is much more challenging. In fact, unrealistic expectations are now the norm; and, as a consequence, one of the most important parts of any surgery I do is the pre-surgical consultation.”

Understanding Limits, Clarifying Expectations

“That educational process—before surgery—is so very important,” says Dr. Wu. “Because the truth is—there are limits to all the procedures we do. Plastic surgery is not magic—there are simply some things that can’t be done. So, the first step, is simply to get past the myths presented by Dr. Google and to help patients know their realistic options.”

The focus of the consultation, explains Dr. Wu, is to reach a shared understanding of what’s desired as well as what’s possible. “And ‘what’s possible,’ is shaped by many factors, such as the physiology of the individual patient, their health, and the condition of their skin.

“I’ve also found that often the outcome a patient thinks she wants is not only unrealistic, but won’t look the way she imagines it will. So, one of my most important surgical tools is the 3D visualization system we use that allows patients to see their bodies ‘before’ and ‘after’ the surgical changes. This is especially valuable for breast augmentation, because patients will often come in wanting to go to a specific breast size. When that happens, I’ll simulate a few different sizes—with her body—to show her how what she envisions would actually appear. Because I’m able to do that, she can see exactly what is possible and is happy with the final results.

“That’s just one example; each patient is different and presents specific challenges and limitations. For instance, a patient’s skin condition plays a role. The loss of skin elasticity is particularly challenging, and becomes more difficult with age, limiting what we can do surgically.

“Obesity is another complicating factor,” she explains. “For example, an obese breast reduction patient has a higher risk of wound breakdown because the capillaries that go to the breast have been stretched out. Where fat is located also matters,” she adds. “For example, a tummy tuck will only remove the skin and the fat above your muscles. Visceral fat—fat around your organs—cannot be removed, and the abdomen will not likely be as flat as you might wish.”

Dr. Wu notes that it’s also important to clarify expectations about the surgical experience and the recovery process. “We do everything possible to make the recovery as comfortable as possible, and to minimize pain (see box). But body surgery is a major event and recovery takes time. For example, I tell my mommy makeover patients to plan for two weeks off work or school, to allow time to heal.

“This process of clarifying expectations is so important,” says Dr. Wu. “Body surgery is a major event and you want the patient to understand and be involved—and pleased with the outcome. The goal always is to enhance the patient’s quality of life—reflecting her very specific and personal needs. Finding the right surgical path to that goal is demanding; it’s also incredibly rewarding. I really enjoy this task—getting to know patients and their desires, and designing an outcome that truly meets their needs. And when the patient has reasonable expectations and is committed to her health, there’s nothing better.”