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What you should know about plastic surgery and cosmetic surgery.

Cosmetic surgery, once considered a vain undertaking, has become common in Kenya, with numerous body enhancing procedures being performed locally. An increased number of women, and also men, are seeking aesthetic procedures to enhance beauty, rectify an abnormality, or simply to increase one's self esteem.

Dr Radovan Boca, a plastic, reconstructive, cosmetic and hand surgeon at Aga Khan University Hospital, Nairobi, clarifies some of the issues regarding this field of surgery.

Are plastic and cosmetic surgery one and the same thing?

Plastic surgery is a wide surgical specialty dedicated to reconstruction of an extensive range of defects, functional deficits and deformities due to birth disorders, trauma, burns, and disease, including cancer. Plastic surgery is intended to correct, improve and restore dysfunctional areas of the body and is reconstructive in nature.

Cosmetic surgery is an integral part of plastic surgery and only plastic surgeons are formally trained in aesthetic procedures during their specialty training.

Cosmetic surgery is focused on enhancing patients' appearance and can be performed on many areas of the body. Cosmetic procedures are elective as their main purpose is to improve the patient's aesthetic appeal, symmetry, proportion and self-esteem.

A cosmetic surgeon does not need as much training as a plastic surgeon

Unfortunately there is a common belief among patients that cosmetic surgery entails simple procedures that can be performed by anyone with a few months of training. There is nothing simple about any procedure that involves altering any part of the body irrespective of the objective.

Cosmetic surgery should only be practised by doctors with training in plastic surgery or by doctors who have undergone formal additional training related to their specialty. There are multiple medical and legal reasons for necessity of formal training in cosmetic surgery. However, the main one is patient safety.

Cosmetic procedures when performed for wrong reasons on the wrong patients and executed poorly can have disastrous consequences. A fully trained surgeon should be able to advise the correct procedure for the right patient and execute it well.

Moreover, when procedures do not go as planned, a well-trained surgeon is able to deal with complications accordingly. I cannot emphasise more that only formal training can guarantee this. Only plastic surgery as a specialty provides formal training on all cosmetic/aesthetic procedures.

In fact, nowadays, there is a trend to sub-specialise in certain anatomical areas, for example facial aesthetics, body contouring, among other specialties.

How do I know that the doctor carrying out the procedure is qualified?

Patients need to do their research on the doctor treating them and ask questions. Many patients are afraid they will offend the doctor by asking for his qualifications. I believe no fully trained surgeon will have an issue disclosing this information.

In fact, we are usually proud to admit our qualifications, and the opposite behaviour should sound alarm to the patient.

The Kenya Medical Practitioners and Dentists' Board website has a list of registered doctors and their qualifications publicly displayed. Visit reputable hospitals as they are required to hire qualified doctors and do thorough background checks.

A professional doctor will tell you the risks involved and the possible complications, and if it's not an emergency (cosmetic procedures are never an emergency), the surgeon will also give you time to think about it and explore other options.

A quack is only interested in money and does not ask the patient questions. Surgery is permanent and should be considered carefully. If the procedure is not done properly, the damage can be worse than the initial problem and might not be repairable.

Is the surgery I am requesting, or the doctor is prescribing, necessary?

Reconstructive plastic surgery is often necessary as it impacts on the function and life quality of the patient. Different plastic surgery techniques can be used to achieve the same or similar outcome, and the surgeon and the patient should together choose the most appropriate technique that best suits the patient's needs and circumstances. The patient should have the opportunity to explore advantages and disadvantages of proposed procedures during consultation, including alternative treatment options along with the option of no treatment at all.

The patient should be comfortable to raise concerns during consultation, and if in doubt about a procedure suggested by a doctor, seek a second opinion.

Patients have different motivations for seeking aesthetic procedures. A good doctor will ask the patient hard questions to understand the reason behind them wanting to undergo the procedure, and should be able to assess who is a candidate for surgery and who needs to seek help elsewhere. Sometimes the psychological causes can be dealt with by visiting a psychologist, a psychiatrist, or a counsellor.

Do your homework, the doctor does not always know best

Unfortunately, not all doctors have the patient's welfare at heart and many patients have become victims of botched procedures without much legal recourse. My advice is that patients need to be responsible for what happens to their bodies by doing research on various procedures and asking questions. There is a lot of information on the internet.

If the patient and the doctor are not on the same page, satisfaction on either side is unlikely. However, I advise patients to listen carefully. If the doctor is refusing to proceed with the requested procedure, in most cases there are good reasons behind the decision.

If you hear any of these comments, be on high alert

'It is just a simple procedure', 'There are no side effects', 'I have no complications' or 'there will be no scarring'.

There is no such thing as a simple procedure. All procedures have side-effects and any surgery can get very complicated if not handled professionally. Do your homework and be realistic about possible outcomes.

On scarring, remember that humans as a species generally heal with a scar and that African skin is particularly prone to scarring compared to Asian or Caucasian skin.

A qualified and well-trained surgeon can decrease the risk of excessive scarring by utilising certain techniques, or explain to you how they plan to make the scar less visible by tailoring their approach to your problem accordingly.
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Publication:The Star (Nairobi, Kenya)
Date:Jan 27, 2018
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