Not surprisingly, I am frequently asked by patients “Do I need surgery?” While the question may seem straightforward, each discussion must take into account many individual factors. My practice is focused on cosmetic procedures, so it is fair to say that virtually everything we do is based on desire rather than need. Cosmetic surgical and non-surgical procedures are a discretionary purchase which will hopefully reward the consumer with a pleasing result.
For surgical procedures, my dominant criterion for determining whether surgery is indicated is based on whether the proposed operation will lead to a visible improvement. And, if so, is the improvement worth the recovery time, expense, and scars? Hence, each of these decisions is made individually. A meticulous planning process, with patient and surgeon involvement, to think through these factors really pays a big dividend in the cosmetic surgery world.
The availability of effective non-surgical procedures has, in some ways, made answering the “Do I need surgery?” question a little more difficult. A common scenario in my practice is for new patients to have already invested a significant amount of time and money in non-surgical modalities only to find they have fallen short of expectations. When used appropriately, non-surgical treatments can be highly beneficial, but they cannot fix every problem. In some cases, they can provide treatment options which cannot be duplicated with surgery. We use non-surgical treatments all the time including neurotoxins (Botox® and Dysport®), dermal fillers (Restylane®, Juvederm®, Voluma®, and others), peels, laser, and a host of skin care products. Unfortunately, a bucket full of fillers won’t correct sagging skin or muscle bands. In that circumstance, it is best to move directly to the correct surgical treatment.
A cost/benefit analysis should also play a role selecting the best treatment. For example, if the brow is sitting a little low, and there are wrin-kles in between the eyebrows, either neurotoxin (non-surgical) or a brow lift (surgical) might be appropriate. Although the non-surgical option may seem the most cost effective at first glance, that may not be true in the long run. Spending a few hundred dollars 3-4 times per year on neurotoxin starts to add up fairly quickly and can rapidly overtake a one-time surgical expense which will provide a longer lasting benefit.
There are other circumstances in which non-surgical treatments simply cannot achieve the goal. For example, deep folds extending down from the corner of the mouth to the chin might be treated with a filler or surgery. The folds, and accompanying jowls, frequently result from excess skin in the cheek. Although use of a dermal filler may provide some temporary improvement in appearance, it will ultimately fail to correct the problem. It is impossible to treat significant extra skin by adding volume with a filler. The real treatment is surgical removal of the excess skin. Keep in mind however; there can be a range of severity. A small fold may be best treated with a filler and large folds will only be improved surgically.
Our practice strives to provide a full spectrum of surgical and non-surgical treatments. My usual approach to patient consultation is to consider the patient’s needs and goals, evaluate the patient in detail, and then discuss the various options for treatment including non-surgical and surgical. If you are wondering “Do I need surgery?” there is no substitute for the advice of an American Board of Plastic Surgery, Inc. Certified Surgeon. They uniquely possess training and experience in the full range of surgical and non-surgical procedures to allow them to guide you along the right path.