Mrs Chien C. Kat is a consultant plastic, reconstructive and aesthetic surgeon at Spire Little Aston and Parkway Hospitals and has a wealth of experience advising people on their procedures and carrying those procedures out. She gave us a candid account of what it really takes to be a surgeon and what it's like working with people's faces, bodies and their hopes and dreams.
What is the most common concern that patients have?
Surprisingly it is usually the general anaesthetic as for many, this would be the first time they are 'going under'. I try to reassure them that if they are fit and healthy, the risk of complications from general anaesthesia is less than if they were to take a flight on a plane. I work with three regular anaesthetists and have done so for the past 12 years so they are very familiar with the type of surgeries that I carry out.
What advice would you give to women considering surgery?
Research the procedure, the surgeon and the hospital. There is a wealth of information on the internet. A good place to start is the BAAPS (British Association of Aesthetic Plastic surgeons) website. This has a summary of the common procedures and a list of the validated aesthetic plastic surgeons in UK. Speak to their GP or friends and relatives who may have had the procedure.
What is the most difficult part of your job?
Assessing a patient's expectations and making that difficult decision about whether I can meet their needs. It is crucial to be absolutely honest and transparent at this point because dealing with an unhappy patient is one of the most difficult experiences to go through. A highly regarded plastic surgeon once said 'if you say no to a patient, she may be upset with you for 20 minutes, if you say yes and she is unhappy with the result, she will be upset with you for 20 years.’
What is the most satisfying part of your job?
Happy patients whose quality of life changes for the better and this is often reflected in their domestic, social and work life.
What are the golden rules of aftercare?
All patients receive an after care instruction sheet and it is important that patients follow this religiously otherwise the result may be suboptimal or worse, they end up with complications. If things go wrong, do not panic, trust your surgeon to do the right thing because we are trained to handle complications. Whilst we will do our best to avoid complications, it can happen usually due to a combination of several factors.
How often do things go wrong? If things have gone wrong how should a good surgeon respond?
True complications like excessive bleeding, infection, wound breakdown, DVT/pulmonary embolus etc are uncommon, except in smokers and patients who are overweight. The usual 'complication' is when patients see excessive swelling, puckering etc during the early post-operative period and worry that something has gone wrong. I warn all patients that inflammation due to the trauma of surgery can take at least three months to settle. It is important to be patient and wait that three months which is when I usually review patients. At that point, it would be possible to assess the result accurately and if necessary, make adjustments.
A good surgeon will always see the patient through the complication until everything is settled. Occasionally, the issue may be complex and it is not uncommon for surgeons to seek the opinion of another colleague. It is important to reassure the patient that there will not be additional costs as this is often a major concern. Most procedures come with an inclusive package that covers the patient for six to 12 months.
Are there any common mistakes that patients make? E.g. trying to resume normal activities too soon.
Not stopping smoking or losing weight prior to surgery if advised to do so is the commonest mistake that patients make which can have dire consequences. Most patients are sensible about not overdoing things immediately post-surgery. Mothers with young children need to organise adequate help. Patients who have physical jobs need to organise adequate time off work.
What process should a patient follow if they are not happy with their results?
The most important thing is to stay calm and have faith in your surgeon. Listen to the surgeon's advice and if necessary wait the required amount of time for the inflammation to settle. A good surgeon will carry out any fine tuning at the appropriate time and this is usually covered by your inclusive package. If you remain uncertain of the advice given, most surgeons will offer to arrange a consult with another colleague for a second opinion.
How do you decide whether a candidate is suitable for surgery?
It is impossible to get this right all the time. To help me with this, I use a psychological assessment that all patients have to pass before I offer surgery. This is just another tool to sieve out patients who have unrealistic expectations or even body dysmorphic disorder. This is in addition to my personal assessment of the patient. I also rely a lot on the rest of the team - clinical nurses, secretaries etc to warn me if they feel that a patient is not suitable. Obviously, the patient has to be physically fit for surgery. I have the anaesthetist to help me with this.
Do you have to turn people away sometimes?
Absolutely, if I feel I cannot meet their expectations.
What do you wish more people knew about your job?
I cannot perform miracles. Aesthetic procedures are technically challenging and whilst I will always do my best to give you a good result, I have to do it safely as well and sometimes this means compromising on some aesthetics. I can help improve features within the constraints of what is possible. There are pros and cons to many decisions that need to be made and I can only guide patients in making the decision but ultimately all patients need to take some responsibility for their own decisions. It isn't always the surgeon's fault.
What’s the biggest misconception about being a cosmetic surgeon?
That we are only in it for the money and that we do not care about the patients once the money is collected and surgery done.
How do you manage people’s expectations for the results they might have?
Assess very carefully patient's expectations and if it means a few more consultations, I would fully encourage this at no extra cost. Be brutally honest with the patient about what is achievable and what is not. Have the strength to say no to a patient if I feel I cannot meet their expectations.
For more information about cosmetic surgery visit Spire Healthcare
The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional
