Cosmetic plastic surgery is everywhere these days. TV, movies, every magazine and most of our friends have had cosmetic surgery or know someone who has. However, as a cosmetic plastic surgeon, I find that I sometimes assume that all my patients are well versed in what plastic surgery is and know what to expect. Many, it turns out, have no clue and are often surprised by the techniques and results.

Today I saw a patient who had a fat injection in his face five days ago. This is a procedure in which fat is aspirated (sucked) out from the belly skin by liposuction and then injected into the face. The idea is to make a thin or aging face fuller and more youthful. Usually, about 10 cc of fat is injected into each side of the face in 2- 3 ml areas. There is an initial period of swelling and bruising for the first five days followed by a longer period when the swelling decreases and the fat grafts die away if they have been unable to get a blood supply to survive off of. The fat that remains then survives for a few to many years!

My patient came in and looked distraught. He could not believe he was still swollen (five days after surgery) or that there were bruises. He also told me that he was totally discombobulated by the surgery, since he had not been expecting what had happened. It turns out that when discussing the surgery  technique, I had said that “a small tube will be inserted under the skin and the fat will be removed.” I had not mentioned that this would be done multiple times and that the tube would go back and forth to suck out the fat. He had no concept of liposuction and frankly did not need one; it was my job to explain the procedure, but apparently I did not do a good job of it!

Our expectations of plastic surgery cosmetic procedures are too often based on what we see as before and afters in magazines and TV shows with miraculous changes occurring seemingly in seconds. The weeks and months necessary for cosmetic procedures to heal is not that exciting to show on TV. Patients forget that it takes time to heal and that surgery is not like getting your hair done.

The cosmetic surgeon has a duty to explain the surgery as best as possible and, it turns out, not to make any assumptions about what patients may or may not know. On the other hand, the patient has a responsibility to find out what specific surgical procedures entail and to ask questions. These days with the advances in technological aids in surgery and the immediate gratification that our culture demands, the thought of a few days recovery due to bruises and swelling may be too much for some. Still, no one wants surprises in surgery.