Before Surgery

 Decision process

Cosmetic surgery, by improving appearance or self-image, aims at improving quality of life. The decision to undergo any surgical procedure should not be taken without full consideration. The consequences of any cosmetic surgery – either positive or negative – will last for years following the procedure: physically, mentally and emotionally.

It is therefore essential to be in possession of all relevant information, and to have a clear and realistic understanding of the demand, the various solutions, their probable results and potential risks before making any decision.

Any prospective patient should have no hesitation whatsoever in consulting several surgeons and obtaining several expert opinions. Plenty of time should then be allocated for due reflection and consideration. A period of 15 days’ ‘consideration time’ – both for the practitioner and the patient – is necessary before any formal decision can be made to proceed.

It is our primary motivation to provide high quality surgery to patients who will benefit from the procedure, so we constantly reassess our work on two criteria: technical savoir faire and integrity, therefore Dr Le Louarn may request another practitioner opinion either on the technical opportunity to perform an operation or on the potential psychological risks or benefits. He may also prefer to postpone or simply cancel an operation just as the patient is entitled to a last minute change of mind. There is no obligation to undergo or perform the operation even though “everything is ready” and all documents are signed

Before a procedure, Dr. Le Louarn and his highly trained support staff are at patients’ disposal at all times to answer any queries or to discuss any concerns. If any points are not clear, patients should not hesitate to seek further clarification. Never hesitate to have one more preoperative consultation !

Patients should communicate to their surgeon in full frankness and detail their state of health and also their expectations (both psychological and aesthetic) regarding the proposed procedure.

For his part, the surgeon will provide patients with all information possible concerning the results of the procedure and any potential risks. There are some risks inherent to all surgical intervention (risks associated with anaesthesia, the possibility of scarring, potential for post-operative infections, disappointing results); there may also be some specific risks associated with the procedure in question. These potential risks must be fully understood and thoroughly evaluated by both surgeon and patient prior to any procedure.

Plastic and aesthetic surgery is still surgery, and necessitates thorough information, consideration, and preparation including pre-operative check-ups, strict observance of the surgeon recommendations regarding healthy living and a pre-operative anaesthetic consultation.

Is the operation for you? Relevant issues for assessment and feasibility

Before deciding to have an operation it is important to assess the opportunity to undergo the procedure taking into account in detail the following issues:

1 – What do you really expect from this operation?
2 – Is the procedure feasible?
3 – Are you ready to accept all the inconveniences?
4 – What will happen if you have a complication?
5 – Other considérations

These considerations will help not only in the decision process but also help to make yourself clear and efficient when discussing the project with the surgeon

1) What do you really expect from this operation?

What change are you expecting (both psychological and aesthetic) regarding the proposed procedure ?
Honesty and realism will be of primary importance in order to obtain a satisfactory result. For example for a woman considering a breast augmentation surgery there is basically a choice between 3 aesthetic options :

– You wish for a look “average” for your build
– You wish for a look definitely larger than average
– You wish to have the “breast implant look”

Do not let fear of what people say or of the surgeon being judgmental prevent you from explaining what « deep down » you really would like aesthetically. Of course, this doesn’t mean that in the end you and the surgeon will not opt for a compromise between aesthetic goal and other consideration such as other people judgement or daily practice of intensive sport… But this frankness will permit a good mutual understanding and thus diminish the risk of postoperative disillusion

If you realise that in fact what you want is “above all that it won’t be visible” then ask yourself what you really seek out of the operation. If it is only a question of social statue, or to do like closed friends, then maybe you should reconsider the operation, because no friends or acquaintance are going to take the risk, the inconvenience or bear the cost for you. On the other end if what you are looking for is to be unrecognizable, then you should think twice and most probably seek psychological counselling. Check if the issue really is your appearance or if you could hate yourself or punish yourself for something.

Is your demand simply “flavor of the month” or long term need ?

Cosmetic surgery is not like a dress you will be able to put in a closet when out of date. It is essential to think about your future before any decision

A too short, too little nose, too turn up nose may be quite adorable on 20 years old student but may also turn out to be more difficult to live with for a forty something head executive or public prosecutor.

2) Is the procedure feasible?

They are 3 key factors dictating feasibility:

– a surgical program technically realisable,
– a surgical program aesthetically valid
– a surgical program about which the patient feels comfortable.

A surgical program technically realisable

There is a riddle that asks : “What is the difference between God and a Plastic Surgeon ? It is that God doesn’t believe he is a plastic surgeon”. This joke is in fact very serious because it reminds the surgeon that it is of primary importance to remain modest, and to consider the feasibility of the program. Also he will have to assess the level of risk and to refuse a too risky operation.

A surgical program aesthetically valid

For the aesthetic aspect, there might be a convergence or on the contrary a divergence of taste between the patient and the surgeon. In our experience, it is always more difficult for a surgeon to perform an operation and to “give the best of himself” if he disagrees with its aesthetic goal

A surgical program about which the patient feel self-assured

Obviously it is even worse for a patient to undergo any surgery if he is uncertain with the established aesthetic goals Before a plastic surgery you must be convinced of your choice and not persuaded, you must think and not believe.

A surgeon may feel at ease technically or aesthetically with a program while one of his colleagues is not, likewise a patient may feel at ease with a program or a surgeon while another patient is not.

For these reasons it is always preferable for a patient to consult several surgeons and thus to obtain several expert opinions beforehand

3) Are you ready to accept all the inconveniences?

Do you accept a possible painful or uncomfortable recovery period?

Are you ready to follow strictly the surgeon instructions before and after surgery?

You will of course have to take the prescribed medicine and perform the wound care scrupulously. But other recommendations may turn out to be constraining like : avoiding exposure to the sun (i.e. : after a peeling or a dermabrasion), not smoking (i.e. : before and after a face lift) or daily and definitive obligation to do exercises for the muscles stomach muscles (i.e. after an abdominoplasty or a bodylift) or the necessity to wear a contention garment (i.e. a lipopanty after a liposuction), avoiding long haul flight before anaesthesia….

Are you ready to be a “patient patient” and rest the time that will be necessary?To wait, more or less longer, to see the swelling and the bruises disappearing and the scars fading.The recovery time may vary enormously depending on the type procedure, the state of health and the specific reaction of each patient.

Have you well thought the long-term implications of the considered modification? For example, if you are considering breast implants you will have to take into account (even without any complication) the cost and implication of future follow up and necessity to change the implants for an undetermined number of times . In addition, if you are looking for very important breast augmentation, you will also have to consider possible back pain resulting from the weight of the implants.

Are you ready to deal with others to commenting on or noticing your change of appearance? Cosmetic procedures, often disagreeable and even painful, generally onerous, and more or less risky, are justified by the expected improvement of well being, due to noticeable physical changes. In many cases, it is worth thinking in advance how to deal with people’s reactions because it may proved difficult or counterproductive to conceal the results of the operation. This reflection is of course, less indispensable, for a liposuction that may be passed off as a very good diet result than for a breast augmentation which will be more difficult to pass unnoticed to friends…

The very same society encourages well being quest, self-realisation, advocates tolerance values, recommends liberated body, imposes the diktat of “natural” along with

“very youth” and “very beautiful” and “very slim” as a prerequisite standard, is the one that will condemn the operated patient frivolity and his incapacity to endure his painful complex. The right of the Other to search a solution for his psychological suffering is denied.

In actual fact, some persons are very worried about their appearance but are reluctant for various reasons (fear, health, money, partner…) to do anything about it, and they may become very anxious when they notice someone they know had the courage to do it.

Other people may have religious or sociological taboos about plastic surgery: “do not change God creation”, “it is a surgery for the rich “or “for women dominated by male desire”…

For others the concept is simply to foreign from their worries or their lifestyle.

Last but not least, some maybe simply jealous or happy to ask nasty questions or make malicious comments.

Take time to assess the problem in advance because a successful plastic surgery implies a form of rebirth and other hurtful remarks may be very counter-productive in the recovery period especially when they come from nearest and dearest.

Reactions in your close circle may be very variable, whatever the result is. Not only the friend or relative will have to deal with his resistance to appearance change of a close one but also with the induced fear to have to adapt to change of this close one. This may lead to ungracious or unsettling comments.

4) What will happen if you have a complication?

Real surgery is far from a television surgery with either the endless stream of magical technique or glamorous success, or some horror show with stinging defeats and ferocious lawsuits. The modern fairytales stories with Merlin (the surgeon) and his magic stick (the knife) that wash more clean than his colleagues, like the horror stories worthy of Halloween certainly help to increase the audience but are no help for the potential patient in his decision process. On the other hand, an in-depth thought on the potential risks is a relevant criteria. Here are some important questions:

Do you understand the risks that you are on the point of taking?

Will you keep your trust in your surgeon, if it doesn’t happen as planned?

Will you accept the need to be re-operate early on or, on the contrary, to wait for a certain time even if it seems excruciating and inconceivable?

If most of the time, the follow-up period is simple, a complication may always occur. One must remember that even the best surgeons have failures, only by not performing surgery anymore, can a surgeon be totally sure, to avoid defeat and poor results. An excellent practitioner certainly has a lower rate of complication, but the risk is never nil.

It is also, through the manner the surgeon limits the risks, inform his patients and, assume his complications, that the value of a surgeon may be assess.

During preoperative consultations, surgeon will provide patients with all information possible concerning the results of the procedure and any potential risks. He will list:

– Risks inherent to all surgical interventions: infections, hematoma, problems of scarring (skin necrosis, cheloïd…), risks associated with anaesthesia,
– Risks that exist for all cosmetic procedures: asymmetry, disappointing result, effect insufficient or too efficient, necessity to perform a correction/retouch
– Specific risks associated with the proposed procedure

These potential risks must be fully understood and thoroughly evaluated by both surgeon and patient prior to any surgery.

– One the one hand, patient like surgeon must avoid to take excessive risks compare to the expected benefit.
– On the other hand, a fair discussion about risk prior to surgery, understanding the ins and outs of each of them, allow the patient to better assess and endure the situation in case of a severe blow
– Finaly, in the cases, were a complication unfortunately occurs, the final outcome will a lot depends of both patient and surgeon surgeon. If they manage to remain stand together, they give themselves the best chances to analyse the situation correctly and to adopt the best course of action in order to save what can be save, improve what can be improve and above all to prevent the situation from getting even worse.

5) Other considérations

Was this a difficult decision for you to make, or was it an easy decision?

Have you discussed your decision with friends and family or are you doing this alone?

Has anyone in your family had plastic surgery? If so, how did this influence your decision?

Who is your major concern when it comes to your appearance? yourself, your partner, your children, your colleagues, your pals…

Have you recently received any unsettling comments about your appearance?

Has some particular life event triggered your decision? death, divorce, separation …

Do you have a particular goal which this surgery forms part of? make a fresh start, hold a job …

Check up and anaesthetic consultation

Firstly, the surgeon checks with you your medical background to evaluate the opportunity to propose you an operation. If a procedure is decided a blood test will be prescribed. The anaesthetist will add during the anaesthesia consultation any other check-up he will consider necessary. Please note that in France, the pre operative anaesthesia consultation must be hold at least 2 days and no more than one month prior to the procedure date.


Any general anaesthesia or neuroleptic analgaesia necessitates a pre-operative consultation. It is the responsibility of the anaesthetist to decide what type of anaesthetic is required for the procedure in question, and he/she reserves the right to cancel or postpone the procedure if the patient’s state of health is in any doubt.

Even if in this field also, the progress of anaesthesia and the continuous supervision ensure the best security condition, and that security is optimal when a procedure is realized out of emergency context, on a patient in good health, there still persist, during and after operation, some inherent risks and hazards due to anaesthesia.

Fear of anaesthesia is common and is in itself a sound thing, as it demonstrates that the patient has well understood that this is surgery and not sorcery. The pre-operative anaesthetic consultation is undertaken in order to establish and eliminate any potential risks. However, if the patient has an overpowering fear of anaesthesia, then this is perhaps an indication that he/she is not ready for surgery.

Local anaesthetic

This type of anaesthetic is usually applicable for lighter surgical procedures such as beauty spot surgery or injection of filling product in the lip… The patient doesn’t need to fast. Like at the dentist, the surgeon realizes an infiltration of anaesthetic product. The anaesthetization is nearly instantaneous and the patient may leave very short time after the operation.

Patients too often imagine, that local anaesthetic is safer than neurolept anaesthetic or general anaesthetic. In fact, nothing is more wrong:

– A too considerable intervention, performed under local anaesthesia is unsafe, because the products that are used, are not made for anaesthetize large area for a long time, they are provided for short time operation on limited area. Their use must be strictly observed otherwise some shock may happen due to unreasonable quantity of product
– Even for small operating area, the surgeon may prefer a neuroleptic anaesthetic to a local one because he knows the procedure will be slightly sophisticated, the duration time a little long and he want to avoid the risk of the patient moving if he is anxious or not enough anaesthetized (for example for eyelid surgery).

What is safest, is to have an anaesthesia well adapted both to the planned procedure and the patient state of health that is realized by a competent person in a suitable place.

Neuroleptic Anaesthetic

This is a form of anaesthesia, which doesn’t incapacitate the patient and therefore doesn’t require an overnight stay in hospital. It is still administered by an anaesthetist. As with general anaesthesia, it needs to be made on an empty stomach but is a much lighter anaesthesia involving no intubation and a much faster recovery. The anaesthetist places a perfusion and a controlled sleep is induced. The surgeon then realizes a complementary local anaesthesia.

The conscious state is recovered much quicker (as soon as the operation is completed), then the patient rests a few hours, and after a light meal, if everything is ok, he is allowed to leave the clinic. If preferable (very tired, dizziness, vomiting…) he will be kept one night under observation.

This kind of anaesthesia is used for a lot of cosmetic procedure like eyelid surgery, small liposuction, tip of the nose…

Secondary effects and risks of neuroleptic anaesthetic :

– Digestive problems, like nausea and postoperative vomiting
– Headache
– Inflammation of the vein used for perfusion
– Regurgitation of gastric liquid with risk of inhalation and pulmonary infection. This complication may be fatal. It happen especially if the fast has not be respected.
– Anaphylactic shock (major allergic reaction) may be fatal
– Heart trouble and even heart failure

General anaesthetic

General anaesthetic is a form of anaesthesia practised in cases involving hospitalisation overnight. As with neuroleptic analgaesic it must be administered to the patient on an empty stomach.

If the anaesthetist agrees, it will be possible to recover a standard alimentation a few hours after the operation. The anaesthetist and the surgeon, will tell you beforehand, an estimated duration of stay. But if your state of health requires it, your stay may need to be prolonged.

Upon your outing, a medical examination will be performed by the physician that will deliver your “leaving authorization”.

Secondary effects and risks of general anaesthetic:

– Digestive problems, like nausea and postoperative vomiting
– Headache
– Inflammation of the vein used for perfusion
– Swallowing difficulty, hoarseness, vocal cords irritation resulting from the intubation’s tube.
– Sensory or motor function resulting of nerve compression when an operation posture is maintained for a long time
– Lesion of a tooth or of a dental prosthesis during intubation
– Urination trouble that may necessitate a urinary catheter
– Pneumothorax by bursting of some emphysema bubble without prior indication
– Exceptional necessity of blood transfusion with impending risk of contraction of viral disease like hepatitis, AIDS, herpes…
– Phlebitis that can lead to pulmonary embolism, which may sometimes turn out to be fatal. This risk increases with – some pathology, – long distance flights too close prior operation, – and for operation on the pelvis area such as abdominoplasty or bodylift.
– Regurgitation of gastric liquid with risk of inhalation and pulmonary infection. This complication may be fatal. It happen especially if the fast has not be respected.
– Anaphylactic shock (major allergic reaction) may be fatal
– Heart trouble and even heart failure

Pre-operative instructions: Preparation, Health and Hygiene

Patients should not arrive for procedures either mentally of physically tired. Notify the surgeon of any change in your state of health, and don’t forget that there is no rush with any aesthetic procedure.

It is mandatory to postpone the procedure if you are hill, as well as for ladies, if you are pregnant. And of course if you do not respect the fasting hours before the operation (no food, no beverage)

For many procedures, the patient will be asked to stop smoking beforehand. Nicotine contracts the microscopic subcutaneous blood vessels which are essential to scar-free healing.

For some procedures, a stability of body weight is necessary. A weight loss of 5 kilos or more can result in excessive skin following a lift or a body surgery. A weight gain of more than 5 kilos can put excessive strain on skin and scars following lifts, abdominoplasties and mammoplasties, and can reduce the positive results of liposuction.

It will also be safer to postpone the procedure, if you unable to respect the non-smoking or stabilization of weight requested by the surgeon. Because there is no emergency to perform cosmetic procedure, they should not be started in negative conditions

Some medicines, which increase bleeding, are prohibited during the preoperative period: aspirin, anticoagulants, etc. Likewise long haul flights because they increase embolism risk.

The anaesthetist when you will meet him in preoperative consultation will stipulate treatment specific to your case. Because the respect of the fast period is compulsory, the anaesthetist will, if applicable, specify how to take your current treatments on the operative day or prescribe specific medecine for the preoperative period (for example in order to limit the nausea if you are subject to it…).

Treatments to reduce bruising can be administered either orally or locally. These treatments do not prevent bruising, but in our experience they tend to diminish their magnitude and duration

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