Patient Care in Plastic Surgery: The “Dinosaur” Who Cares

Elizabeth Keeney–With today’s mass media focused on the promotion of beauty, it is inevitable that the public has become more and more self-critical regarding their own superficial qualities, in comparison to beautiful and often photo-shopped idols. Tabloids scream at checkout lines with the latest plastic surgery ‘hit and misses’ for Hollywood’s celebrities. Heavily promoted reality TV programs focus on plastic surgery with great melodrama. One reality TV program, aired on E! in 2010 called Bridalplasty, hosted 12 women to compete for the perfect wedding, as well as their dream plastic surgery procedure; something old, something blue, and something new—including a new face perhaps.

With this intense focus on beauty and the normalization of cosmetic surgery, more people are now inclined to actually attain their dreams of beauty. In 2012 the US plastic surgery industry made over $11 billion on over 14 million minimally invasive procedures conducted– a 98% increase from 2000 (American Society of Plastic Surgeons). With this rise in the demand for these procedures, there also has been a dramatic increase in conflicts, including important questionably ethical behavior by many surgeons who focus on their own financial gain, rather than the health of their patients.

On very troubling case occurred in 2007 when Donda West, mother of the celebrated hip-hop artist, Kanye West, died of a heart attack due to post-operative complications after a breast-reduction and liposuction surgery (Glover). West had approached a few plastic surgeons with her request, but was rejected due to an undisclosed preexisting condition that could possibly lead to a heart attack. Dr. Jan Adams, a plastic surgeon previously promoted on the television program, Oprah, decided to take the risk. After West’s death, Adams received great scrutiny about his ethical practices. Not surprisingly, Adams had been involved in many previous malpractice suits, which led to the possible suspension of his California medical license (Glover).

West’s death was a highly publicized incident of a careless and imprudent cosmetic surgeon. Unfortunately imprudent cosmetic physicians are not an uncommon occurrence across the country. In Portland, the ‘medical spa doctor’, [In August 2017, this Doctor contacted our school and made a case for us to redact his name. The editors and author stand by this article but chose to redact his name. We will refer to him as “Dr. Spa Doctor.”], Dr. Spa Doctor was reprimanded in 2001 for not conforming to the Medical Practices Act, which prohibits physicians from committing fraud, negligence, and sexual misconduct (Oregon, Leg. Assem., Oregon Medical Board 1), Dr.Spa Doctor was reprimanded for exchanging free spider-vein treatment for inappropriate touching and kissing with a patient (Ho). Although Dr.Spa Doctor ’s and Dr. Adams’ misconducts differ from each other, both doctors were clearly not focused on the whole physical and emotional health of their patients. A common occurrence with aesthetic cosmetic physicians, that focus on less invasive procedures, is the emphasis of the business side of their practices. Upon visiting Dr.Spa Doctor ’s aesthetic medicine website, you are engulfed in photos of beautiful people, cheesy publicity videos, and the most curious aspect of the website: the promotional deals. Although the majority of the procedures are low risk, it is difficult to imagine choosing a doctor who will give you the cheapest deal, rather than the best result or most comfortable and safe experience. There certainly is this unattractive side to plastic surgery, where doctors focus their energy on creating a beautifully decorated practice and promoting their business on social media in order to gain clientele and therefore increase business, instead of actually caring about the wellbeing of their patients. Clearly, Dr.Spa Doctor cared more about his sexual desires than the emotional wellbeing of the patient he violated.

Although the primary image of plastic surgeons displayed in the media is too often appallingly unfavorable, there are, thankfully, also great doctors who truly care about the overall health of their patients, like Dr. Bruce Webber.

Dr. Webber’s practice, located at Providence St. Vincent’s Hospital in Southwest Portland, looks just like any other medical office. Unlike many aesthetic medicine practices that pride themselves on their calming and inviting décor, Dr. Webber’s plastic surgery practice is straightforward and clean, with thin white walls and each low-ceilinged room simply decorated. The waiting room’s perimeters are surrounded with cushioned chairs, while in the center of the room a low table is completely covered in magazines. Examination rooms hum from the bright, fluorescent lights that reflect off the white walls and tiled floors. These small rooms only contain an examination table, complete with crinkly, white paper, blue cabinets, and a few women’s magazines strewn across the matching blue counter. In these bright, cold, and seemingly sterile rooms it would be difficult to romanticize plastic surgery. No different from the rest of the practice, with large textbooks scattered on a set of shelves, papers covering his desk, and a handful of certificates hung on the wall, Dr. Webber’s office is not decorated with the objective of winning prospective patients with immaculate and expensive furniture, but rather with the facts and difficulties of the expected outcome.

Dr. Webber, now a kind faced, middle aged, plastic surgeon, conducted his surgical fellowship at OHSU in oncology before he entered the field of plastics, and explains that because he was previously so dedicated to helping cancer patients battle their disease, he now still finds great satisfaction in helping post cancer patients achieve a life without the physical reminder of their previous illness (Webber). Webber believes that “in other kinds of surgery [general surgery] there is the satisfaction in if they have a ruptured appendix, you take it out. Whereas plastic surgery is very convoluted—you can do a wound or augment [breast augmentation] patient who you may see for 5 or 6 months.” Not only does Webber enjoy figuring out a long-term problem, but also enjoys helping his patients get through these drawn out processes. This sense of satisfaction is seemingly limited to plastic surgeons, as most aesthetic medicine doctors spend the majority of their time conducting many less involved procedures such as the myriad of skin, weight loss, and laser procedures and will most likely, “not remember their name, or what they did to them” (Webber).

Due to his conservative approach to plastic surgery, Webber considers himself, “a relative dinosaur” compared to many of his peers. Unlike many surgeons who show prospective patients photos of their best work on previous patients, Dr. Webber uses images of average results in textbooks during his pre-operative consultations because, “patients would say, ‘I like that one!” Although the woman [photographed] is 135 lbs and my patient is 230” (Webber). Ultimately, showing patients the best possible result can easily lead to an unhappy patient who had unrealistic expectations about the results of their surgery (Webber).

Webber also prefers to inform his patients of all of the possible outcomes of surgery imaginable, good or bad. This technique is incredibly important as, in contrast to any other kind of surgery, a plastic surgeon, “is in the odd position of making well patients ill in order to make them feel better about themselves” (Goldwyn 57). If a patient is not aware of the fact that in order to achieve an aesthetically pleasing result, they first have to become ill. Dr. Webber’s technique of informing patients of all results can significantly reduce the chances that a patient will be unhappy with the outcome, as well as the entire process. However, Webber’s conservatism does not cease with informing his patients of all possible consequences; he also will simply reject patients he deems as unfit candidates for plastic surgery, due to physical or psychological health. He no longer conducts breast reduction surgeries on women under the age of 21, and even advises patients to wait until they’re 35 or have had children and maintain a stable weight. In the past Webber operated on younger women, like most plastic surgeons, but occasionally had women complain years later because their breasts grew due to further hormonal development or weight gain, making the initial surgery futile. Although young woman will often approach him with the request of breast reduction, Webber consistently refuses the requests due to the possibility of the patient’s eventual unhappiness.

Although assessing the physical risks of plastic surgery is very important, assessing the psychological health of a patient is increasingly more important. It initially may not seem like a necessity, however, “when we alter the body, we alter the psyche,” (Cline 45), therefore any kind of surgery will affect the patient psychologically. A person’s psychological health and stability not only affects how he or she views himself or herself superficially, but can also seriously affect the recovery time, as well as how happy they are with the outcome. Dr. Richard D’Amico, president of the American Society of Plastic Surgeons, has stated that plastic surgeons need to ensure the “management of expectations” (Saether) of the procedure in patients. A common issue with many patients is the expectation that the procedure can dramatically change their lives. Many people associate what is not satisfactory in their lives, such as romantic or professional issues, with a superficial flaw, and are usually unsatisfied that their lives did not change for the better once their flaw did. A specific and very serious illness that presents unrealistic expectations is called Body Dismorphic Disorder, or BDD, “an excessive preoccupation with a physical defect that may be exaggerated or even imagined in a patient’s mind” (Diller). Surgery on somebody with BDD is inappropriate, and would most likely worsen their symptoms, and can possibly elicit an angry and blaming response toward the surgeon, for not fixing the underlying psychological problem.

Body Dismporphic Disorder is one of the more extreme mental issues that restrict cosmetic surgery, however many other and less severe, psychological issues, like depression, prohibit or cause caution for cosmetic procedures. If any procedure is conducted while the patient is emotionally unstable or has unrealistic expectations, the patient will ultimately be negatively affected by the experience. Since a doctor’s job is to help his patients be as healthy as they can be, physically and mentally, it is extremely important that the surgeon be reserved about conducting the surgery if there is the possibility that the patient can handle the procedure both physically and mentally.

Dr. Webber has also had his fair share of rejecting patients who are not eligible for plastic surgery due to their psychological health. Webber recounts the story of one man who once came to him for a nose job. After great inquiry, Webber discovered that this patient, who tried very hard to conceal his profession as a psychiatrist, did not like his nose because it looked like his father’s, whom he detested. Webber asked the man what he would suggest, professionally, if told of the absurd personal reasons for surgery. Needless to say, Webber did not give the man a nose job. However, Webber’s contemporaries are often shocked with how he often turns patients away with minor, or major, psychological issues and ask him: “If the patient is going to pay you to do it, why not?” (Webber).

Webber neither uses conservative techniques in order to deliberately lower his business, nor to have moral superiority over his peers, but simply because that was how he was taught and how he believes he should practice plastic surgery. I am very thankful that Dr. Webber doesn’t take chances, and puts his patients before his business, for my mother is a patient of his. No, she is not one of those Barbie-like women often seen on reality television, who frequently undergo major procedures, but is undergoing reconstructive procedures with Dr. Webber.

In the past seventeen years, my mother has been diagnosed, and re-diagnosed, with breast cancer three times. Her most recent battle concluded two years ago when, after her third diagnosis and subsequent chemo treatments, she had a double mastectomy, a procedure that removes both breasts. So for the last two years, my mother, although healthy, has had to struggle with the annoyance of having her chest replaced by an empty, yet constant, reminder of the taxing and painful battles she has had to face. This fall, she began her reconstructive process with Dr. Webber. Initially I was skeptical about what this doctor, who I had never met, would do to her. Was he going to pressure her into getting gigantic breasts? Or possibly tell her she should get a little Botox while she is at it? I was worried because I had only heard of the smarmy and business driven plastic surgeons, like Dr. Jan Adams or Dr.Spa Doctor. However, I soon realized, after my mother’s praise of his conservatism, that Dr. Webber really cares for the well being of his patients. My mother has repeatedly told me how comfortable she feels with Dr. Webber and how she loves how he discusses the psychological reasons behind the emotional anxiety many breast reconstruction patients feel.

In such a superficial and business obsessed nation it is not surprising that many plastic surgeons have made decisions that were not in the best interest of the patient. It is increasingly difficult for surgeons to resist their professional goals with patients pressing them to conduct possibly inappropriate surgeries, as well as the pressure amongst surgeons to ‘sell’ more procedures. Medicine is a unique profession in that it requires doctors to resist their narrow business interests and instead focus on the true interests of their patients. With all of these pressures it is not a surprise that there are great numbers of surgeons who struggle with these ethical questions. However, it is reassuring to know that the conservative “relative dinosaurs” are not extinct and are still truly concerned with and dedicated to the entire health and happiness of their patients.

Works Cited

American Society of Plastic Surgeons. 2012 Plastic Surgery Statistics Report. ASPS,

2012. Web. http://www.plasticsurgery.org/news-and-resources/2012-plastic

surgery-statistics.html.

Cline, Carolyn J. “Psychological Aspects of Breast Reduction Surgery.” Reduction

Mammaplasty. Ed. Robert M. Goldwyn, M.D. Boston: Little Brown and

Company, 1990. 45-48. Print.

Diller, Vivian, Ph.D. “Plastic Surgery: What Are the Psychological Risks and

Consequences?” Psychology Today 23 May 2011: n. pag. Web. 24 Oct.

2013. http://www.psychologytoday.com/blog/face-it/201105/plastic-surgery

what-are-the-psychological-risks-and-consequences.

Glover, Scott. “Doctor Talks about Donda West’s Death.” Los Angeles Times [Los Angeles] 20

Nov. 2007: Los Angeles Times. Web. 4 Nov. 2013.

http://articles.latimes.com/2007/nov/20/local/me-west20.

Goldwyn, Robert M., M.D. The Patient and the Plastic Surgeon. 2nd ed. Boston: Little,

Brown and Company, 1991. Print.

Ho, Sally. “Oregon’s First Twitter Libel Lawsuit Pits Tigard Doctor against Portland

Blogger.” Oregonian [Portland] 10 Oct. 2011: OregonLive. Web. 12 Nov. 2013.

http://www.oregonlive.com/tigard/index.ssf/2011/10/oregons_first_twitter_libel_la.html.

Oregon. Leg. Assem. Oregon Medical Board. Rights, Regulations and Responsibilities: A

Handbook for Physicians Practicing Medicine in Oregon. Print.

Saether, Linda. “Not Everyone’s a Good Plastic Surgery Candidate.” CNN Health. N.p.,

30 Nov. 2007. Web. 24 Oct. 2013.

http://www.cnn.com/2007/HEALTH/11/30/hfh.no.plastic.surgery/.

Webber, Bruce, M.D. Personal Interview. 31 October 2013.

Works Referenced

Marcus, Miriam. “Ten Plastic Surgery Risks You Need to Know.” Forbes. 10 Oct. 2007:

n. pag. Web. 24 Oct. 2013. http://www.forbes.com/2007/10/09/ health-surgery

risks-forbeslife-cx_mlm_1010health.html.

Cover Photo Works Cited

Aragon, Liz. “Medical Syringe Vector.” Sweet Clip Art Free. N.p., 16 Sept. 2011. Web. 8 Dec.

2013. <http://sweetclipart.com/medical-syringe-vector-447&gt;.

“Barbie Storia Pink Lipstick.” Wallpaperose. N.p., 22 Mar. 2013. Web. 8 Dec. 2013.

<http://wallpaperose.com/barbie-storia-pink-lipstick.html&gt;.

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