The Last Word: Collaboration between surgeons and aesthetic professionals

By Dr Darren McKeown / 01 May 2014

Collaboration between surgeons and aesthetic doctors would provide patients with the best treatment solutions, argues Dr Darren McKeown

The last two decades have seen significant growth in cosmetic practice both in the UK and worldwide. This explosion in cosmetic interventions has been largely characterised by newer, less invasive surgical procedures and the emergence of a whole new field of non-surgical procedures.
As the cosmetic interventions market has grown, more and more practitioners from a wide range of backgrounds have fought for a slice of the pie, territories have been marked out and fierce competition has emerged between rival factions. There has developed a ferocious battle between surgical and non- surgical practitioners, with the former claiming their surgical results are more durable and longer lasting whilst the latter camp argues that their procedures have less down time and less risk.
There are a few surgical practitioners who will make the argument that they are qualified to offer both surgical and non-surgical solutions and therefore they alone are best placed to fully assess patients’ needs and offer the most appropriate treatment. But in my opinion this argument does not really cut it. As with all things in medicine, and indeed life in general, the more experienced you are at one particular procedure, the better your outcomes will be. A general plastic surgeon who does 10 rhinoplasty operations per year is highly unlikely to achieve the same level of results as a rhinoplasty specialist who does 10 rhinoplasty operations per week. Likewise, a plastic surgeon who does the occasional injection of Botox will not achieve the same results as a doctor who specialises in the procedure day-in, day-out carrying out thousands of procedures per year. Indeed, this sort of cavalier attitude towards non-surgical procedures fails to realise the significant benefits that can be achieved or the degree of skill required to achieve them. Whilst it may be easy for anyone to pick up a syringe and inject, doing it in such a way as to make a face look genuinely more attractive is far from easy and requires a great degree of skill, knowledge and experience.
I believe that this attitude extends both ways, and there are non-surgical practitioners attempting increasingly complex surgical procedures, which, in some cases, may be beyond their level of competence. In this situation, patients might be offered the surgical procedure the doctor can do, rather than the one that might be best for them.
But is the competition and rivalry between surgical and non-surgical practitioners justified? The cosmetic market is already a substantial size and growing every year; there is plenty of opportunity for good practitioners to grow a large and successful practice, without fear of competition from other specialists. At the heart of our practice should always be finding the right procedure, for the right patient, with delivery by the right practitioner. This is good medical practice across the board, and should equally be applied to cosmetic practice. What is required is closer collaboration between surgical and non-surgical practitioners, with the focus on the needs of each individual patient.
There are many clear overlaps between surgical and non-surgical practice. One classic example encountered every day in the non-surgical clinic is the patient with heavy upper eyelids who presents requesting treatment to improve them. The non-surgical solution is to carry out botulinum toxin treatment using a pattern of injections designed to elevate the eyebrows. Whilst this does solve the problem of the heavy upper lids, it does so at the expense of creating a whole new problem of over-elevated eyebrows that inadvertently age the face and create an unnatural appearance. The proper solution in this situation is usually to recommend an upper blepharoplasty to remove the excess skin followed by a course of botulinum toxin treatment and filler injections to improve the remaining rhytids. By combining the two, it is possible to create an optimal cosmetic result.
Whilst it is true that some patients simply do not want surgery, that is an informed decision that they need to make themselves after having a thorough consultation and explanation of the options available. It is not a decision that should be dictated based upon the availability of local skills and services. Last year I teamed up with a surgical colleague to offer joint consultations in my non-surgical practice. The objective of the collaboration was to offer our patients a more comprehensive assessment that truly put their needs at the heart of the process. Patients are assessed from both a surgical and non-surgical perspective and the options are discussed in detail until we arrive at the most appropriate treatment package for each individual. By combining the skills of surgical and non-surgical practitioners, a synergy is achieved where the result of combining skill sets achieves better results than either practitioner acting independently. The overall result is happier patients, with optimised outcomes and rapid growth in practice. In recent years, multi-disciplinary teamwork has dominated the management of most areas of medicine, although until now this has largely evaded cosmetic practice. Perhaps now is the time to re-think this position. Rather than viewing other specialists as a threat, we should look to each other as allies and work together for the benefit of everyone, not least for all our patients. 

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