Less is Not More

Less is not More. In Fact, Less is Usually Less.

We live in an age where everyone wants the best, the fastest, the tallest and the most expensive.

We want it now and we do not want to wait and we want it at the cheapest price. Of course this is natural. It is human nature to want to get the best deal. However, it is important to realise that often compromises will have to be made. This is very true in cosmetic surgery.

Everybody wants the least invasive procedure.

Of course they want the one stitch facelift or the scarless breast reduction or the mini tummy tuck. Less scarring, less downtime, less cost. This is fine, but it is important to realise that as with anything, there is a compromise.
A lot of plastic surgery involves removing skin in order to tighten the tissues and to combat the effects of gravity and weight fluctuations, whether it be in the face, the breasts or the tummy. If we are going to remove skin, then inevitably there will be scarring. Much of the art of plastic surgery revolves around placing the scars so that they are difficult to see and handling the tissues carefully so that when the skin has healed the scarring is just a faint line and blends in with the normal skin.

There is a big difference

between the scar you get from a cosmetic blepharoplasty compared to that when having an emergency appendicectomy, partly because as plastic surgeons we are fortunate to operate on the face a lot and the face tends to scar very well but also because the priorities of surgery are different. The whole aim of a blepharoplasty is to improve the appearance, so taking care over the scar is crucial, whereas an emergency appendicectomy can be a lifesaving procedure and quite rightly the quality of the scar will not be of paramount importance to the surgeon.
Despite our efforts to leave the best quality scars hidden in natural skin creases and shadows, it is important to realise that all scars are permanent and if you look hard enough you will be able to see them. For this reason, if it is possible to perform a procedure with less scarring then we will be all for it.
However, the problem with all of the minimal scar procedures is that if you leave less scarring then you can remove less skin and if you remove less skin, then you cannot tighten the tissues as much and if you do not tighten the tissues as much then you cannot give as dramatic a result as you might want to.
I saw a quote the other day:

Our service is cheap, fast and good quality but you can only have two of the three

By all means you can have a short scar facelift or a mini tummy tuck, but you would have to accept that the result would not be as dramatic as if you had a full facelift or a full tummy tuck. Now for many people this might be an appropriate compromise and they would be quite happy to have a slightly less dramatic result, particularly if the skin laxity preoperatively is not significant; in favour of the reduced complications and scarring. However, this is a conversation that you have to have and you cannot expect to get as impressive a result as you might have done if the surgeon is limited to the amount of scarring that he can leave.
Unfortunately advertising and marketing plays a major role in cosmetic surgery and there will always be those who will seek to use headline benefits like minimal scarring and minimal downtime to attract and seduce customers. However, I would caution you to be careful, to look behind the advertising and make sure that you see before and after photographs and even talk to previous patients to ensure that the headlines deliver on the expectations.

Managing expectations is crucial to our ultimate goal which is to deliver a happy patient.

We all know that these techniques exist.

You will often find that many surgeons do not perform these limited procedures as often as you might think given their stated and highlighted benefits. This is because if they do not deliver a happy patient, it does not matter how short the scar is, the operation will not be deemed a success.
You have to question why you are seeking surgery in the first place because the least scarring and the least downtime comes with no surgery at all, which of course is always an option. However, if you have significant skin laxity or a cosmetic problem, you need to find the best and most effective way to treat that and be guided by your surgeon rather than focus on headlines that promise scarless surgery or a lunchtime facelift.

Many plastic surgeons are against the concept of advertising in cosmetic surgery

and I can understand why but I do think that there are benefits in advertising when it is used to educate and inform the public about what is available. The problem comes when advertising is used to target vulnerable people, is insincere or inaccurate with its claims.
There will always be those who want to chase the sale and worry less about delivering the best service possible. I cannot help but think these people will have very shaky and short term businesses. Any individual surgeon in private practice is in it for the long haul and will put great emphasis on building a good reputation. There is no place for unscrupulous advertising.
It comes back to what I will always advise which is do your research and by all means look at and read advertising material but at the end of the day, ask your surgeon questions, look at the results and talk to previous patients to ensure that you are choosing the right procedure for you, not just the one with the shortest scar.