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Beverly Hills Plastic Surgery Group
436 N Bedford Dr #214
Beverly Hills, CA 90210

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Ask Dr. Layke: What Are the Most Difficult Challenges You Face as a Plastic Surgeon?

By January 31, 2018 No Comments

The most difficult challenges I face as a Beverly Hills plastic surgeon have generally fallen into three categories:  handling the unrealistic patient, dealing with my own complications, or seeing the lack of defined borders within our specialty.

I cannot tell you how many hours I have laid awake at night, reviewing every injection, every procedure, every consult that I had seen earlier that day, wrestling with the decisions that I had made – hoping that each action was executed perfectly.  Despite the years of acquiring medical knowledge, the near-decade of nights filled with sleepless torture as a resident, the multitude of Board Examinations and certifications, acronyms that follow our names, accolades that are presented, and awards that are given – we are still human, a fact that the unrealistic patient will fail to acknowledge, a complication will not yield to, and those not trained within the scope of plastic surgery will use to their advantage.

I had a patient who underwent a rhinoplasty for cosmetic reasons.  Simply put, the preoperative photo of her profile reminded me of a toucan:  A large, hooked beak that stood out from her face, inordinately large for her visage.  After thoroughly examining her, creating a 3D rendering of her “new nose,” she booked surgery without hesitation.  The surgery went particularly well, every stitch was placed at the right point, my hands seemed to glide through the case with every textbook-style maneuver.  Postoperatively, the patient had no bruising, barely swelled, and the scars were imperceptible by three weeks!  I loved watching her result unfold, as she was overly excited about the amazing job I had done.  This went on for months, until one day I opened the exam room door at the one-year mark with a smile on my face, expecting to hear songs of praise, only to find a different person inside.  “I’m not happy with my nose,” she said dryly.  “I wanted it to be smaller, cuter,” and any other -er word she could muster up.  For months she had loved what she saw in the mirror… until she didn’t.  She had completely forgotten what she started out with, and demanded the impossible:  she wanted someone else’s nose.  The patient had developed unreasonable image issues, wishing her nose could be even better than it already was, despite how good everyone told her she looked.  This type of patient takes years off my life.

Another trying scenario:  the nicest, sweetest patient in the world – who saved for years to improve her body after multiple pregnancies – undergoes a common, everyday procedure… and the incision broke down.  The patient was healthy, the surgery went perfectly well, but for some reason that may never be understood, the incision opened.  Weeks of wound care, antibiotics, thickened scars, injections, and the patient still smiles every time she comes to the office and is grateful for each minute I spend with her.  This takes years off my life for an entirely different reason; I can’t bear seeing a complication on anyone – let alone someone who certainly should never deserve it.

Lastly, the single most challenging aspect of being a Double-Board Certified plastic surgeon in a competitive market is seeing many non-certified, non-credentialed, or even non-plastic surgeons performing plastic surgical procedures.  From OB/GYNs performing liposuction and breast augmentation to family physicians doing eyelid surgery to dentists giving Botox – there simply isn’t a structure set forth by the American Board of Medical Specialties allowing, or preventing, certain physicians from performing procedures outside of their own scope of practice.

With this all being said, for me, there is no single better profession or vocation, and as I struggle through a few of the aforementioned stressors here and there, I could list some 1000 stories as to why I believe this to be true.