Consultation

    After the examination is complete, it is important to explain the findings to the patient. While the patient holds a mirror directly in front of his or her face, I point out the abnormalities. I demonstrate ptotic brows and a wrinkled forehead, low or duplicated upper eyelid creases, excessive skin, herniated fat, skin discoloration and wrinkles, upper eyelid ptosis, orbicularis muscle hypertrophy, check bags and ptosis, nasojugal or inferior orbit rim hollowing and nasolabial folds. Then I demonstrate sites for surgical incisions and postoperative scars. I correlate the patient's complaints with what I have found and discuss what can and cannot be accomplished surgically.

    After bringing the patient into a consultation room, 1 discuss operating procedures and potential complications. I explain to the patient who has a ptotic eyebrow that unless the brow is elevated, I can only minimally eliminate the excessive upper eyelid skin folds. Additionally, I emphasize that there will be a brow scar after a direct brow lift, which can be covered with cosmetics. I explain complications of upper eyelid surgery, such as cysts, ptosis, and asymmetry, and make an effort to put these complications into perspective. I tell the patient that upper eyelid cysts are common in the incision line postoperatively but that, to date, no patient of mine has had upper eyelid ptosis.


    For surgery of the lower eyelid, I explain the possibility of ectropion postoperatively. I emphasize the potential for hair loss and sensory or motor dysfunction with forehead elevation, skin dimples with internal brow and cheek lifts, and redness and skin pigmentation with chemical peels and laser resurfacing. If the patient has a tendency for dry eyes, I discuss this problem and the possible need for artificial tears and ocular ointments after surgery.

    For cheek-midface lifts, I also emphasize possible facial asymmetry and numbness. With facelifts, I discuss asymmetry, scars, suture extrusion, and sensory and motor paresis.

    If there is a need to resect herniated orbital fat, I inform patients that I prefer them to stay for 2 to 3 hours postoperatively in the surgical facility. With this type of surgery, it is possible to produce a hemorrhage, which can migrate to the retrobulbar position and cause blindness.' The chance of this occurring, however, is rare, and I have not had a case of permanent blind-ness resulting from cosmetic surgery. If patients stay in the recovery area for several hours, they can be watched carefully for this complication; if a hemorrhage does occur, it can be detected quickly and treated.

    For any surgery whose costs are not covered by insurance, I request that all surgical fees be paid in full 2 weeks preoperatively. This eliminates payment problems later. Insurance companies will not pay for the operation if it is purely cosmetic. Also, if patients are dissatisfied, they cannot withhold or reduce the surgeon's fees. The 2-week interval is enough time for checks to clear through bank processing and discourages patients from changing the date of surgery. This prepayment does not apply to blepharop-tosis or eyelid retraction surgical procedures that are medically necessary and paid for by insurance companies.

    A second consultation and examination are performed at the surgical center immediately before the operation. This meeting allows the surgeon to view the patient and reappraise the surgical approach. It also lets the surgeon review with the patient what the operation should accomplish, the hospital's procedures, and potential complications. The patient may also use this time to ask questions, which can lessen fears of surgery and decrease any chance of misunderstanding.