Board Certified
Plastic Surgeon
Since 1989

How Does the Plastic Surgery Conversation Begin and What is the Initial Consultation Like?

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The following interview features Dr. Widder’s experience and insights directly with men and women who are considering plastic surgery for the first time or are looking to explore a higher level of care and quality results. Subscribe to our blog for weekly insights and feel free to suggest topics or questions you would like answered!

Q: What are the main questions you and a patient go through together to plan a course of action for surgery? How does the conversation start?

Well, when a patient comes to my office, I ask them “How did you hear about me? Did you visit the website?” Then I ask them “What brought you to the office today?” and “What can I do to help?” After that, they usually feel comfortable speaking about whatever is on their mind and any problem they have. Initially I just listen to what they say. Next, I ask to see the condition. If it’s a face, naturally, I see it immediately and I ask them what they would like to change. I show them manually how things would change with the procedure they are asking about. After that, I take them to the computer and we look at before and after pictures.

If it is a body issue, I ask them to show me the area of concern and we discuss whatever is bothering them – whatever can be improved. I show them what can be done, be it a breast or a tummy, the buttocks, the calf, or what have you. Suppose someone comes in interested in breast reduction. If it’s a man, this would be the pecs. When men talk about the chest, they usually have gynecomastia, or fat deposits on the chest. In this case, we consider a gynecomastectomy, which means I remove fat and breast tissue. With women, it will be a breast reduction – removing from the breast tissue and contouring the breast through tightening the skin envelope, creating a kind of biological bra.

So it’s up to the patient. It depends on the different issues that come up. I am quite thorough about the different options. I give them a few options – whatever they feel is most appropriate. Sometimes one option is more expensive than another and we’ll go for the other option, as long as it’s appropriate.

Q: Say someone did come in and wanted a breast reduction. What are the options?

Breast reduction is for a very large breast. Anything over a full C or D cup is a candidate for breast reduction if it’s bothering them – if they have the symptoms like shoulder pain, neck pain, limitation in exercise, in running, or if they have any intertrigo –irritation under the breast. So if they have those symptoms, I would offer them the procedure that I do. I will tell them that there are different techniques, but I’ve done the one that works for me for 25 years. I’ll show them the before and after pictures of the technique that I use. They are free to use somebody else if they prefer a different technique.

My technique is called The Keyhole. The Keyhole Technique is where you make an incision around the nipple, then vertically down the lower part of the breast, and then a horizontal incision in the crease under the breast. The other technique where the incision is only vertical results in a lot of redundancy, or loose skin. It takes a long time for the redundancy in the crease area to dissipate. Another method uses an incision just around the aereola and in the crease, but then again, I don’t like the results because they’re missing one dimension. They end up with a round breast instead of an oval, which I think is a nice breast.

There can be a lot of extra, loose skin because you either take the skin through the method I use, The Keyhole, or you leave it at the crease. With time it stretches, but it takes months and months to occur. I don’t think my patients will accept months of loose skin under the breast. If you use my technique, the breast is pretty almost from the start. Now, you have a scar, but if you are meticulous in your repair, the scar heals very, very nicely. Occasionally you have a challenge like a keloid scar, and if that is the case, I treat it with steroids. I inject with cortisone and that reduces the amount of scar formation.

When I was in training, they taught me to do the tummy tuck. They would make a very short scar, but end up with big “dog ears” – a bulge on both sides – after the tummy tuck. The reason they’d say that was the right way to do it was that the patient hates scars. What I learned through my experience is that patients don’t really care about scars as long as the procedure gives them a nice shape – as long as you hide the scar in a place where it doesn’t bother them that much. They hate the “dog ears” or bulges more, or in the case of the breasts, the laxity that causes rippled skin that ends up in the crease area. For me, the scar is a nonissue. Now, if the surgeon is not competent enough to make a nice scar, that’s a concern. My scars are very nice. It’s not that patients love my scars, but they prefer the nice results with the scar than the other way around.

Q: I imagine people ask you about safety issues. What are the things you tell people as they are considering a procedure?

If a patient comes to me referred by another patient of mine, then the issue is moot. They trust me, they know that I’m safe and reasonable and caring. They just talk about the procedure. In that case, they are interested in two things – the cost and the date. But if I have a new patient that came to me through the Internet or other printed media, they are interested in asking about safety. First of all, I tell them I am a board certified plastic surgeon. My office is accredited by the “AAAASF,” or the American Association of Accreditation of Ambulatory Surgery Facilities, which has very strict guidelines about safety. I have a board certified anesthesiologist who’s been in practice for over 30 years. So safety is really my utmost concern, and obviously I combine that with results. On my website there is a logo that says “Quality is our Niche.” Really, “Safety and Quality” is our niche.

Now I do tell them that no surgery is 100% free of any complication. They get written material about the procedure and any possible complications that can happen. Even in the best of circumstances, you can have complications for different reasons, especially if the patient is not compliant with my instructions. So all those issues are discussed in detail and they all promise that they’ll do their best. Most of them do.

Q: How long does your initial consultation take?

I have consultations that take 10-15 minutes. They know what to expect because they saw my work. Their friends had the surgery. I have many patients who do breast augmentation. It is very common in the Asian community. They see their friends and family members, and come in and say “Ok, let’s do it. Let’s do it tomorrow. Let’s do it next week.” Other patients are more detailed. It may take me half an hour, 45 minutes, or even an hour. With some patients, it will take me one meeting, with others two, three, or even four. It depends on the people, their level of anxiety, and their level of comfort with me. Some have never met me and really want to hear from me, but with the majority of patients, it is a really quick process. 10, 15, 20 minutes, and we go ahead with scheduling.

To find out more about the Widder Cosmetic & Plastic Surgery Center stop by during office hours: 9 – 5pm, Mon – Fri, or visit our website at: www.widderplasticsurgery.com.

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