A reminder to doctors and patients alike regarding the experimental nature of many new procedures. The surgeon does NOT always know more about certain techniques than the patient who is living with the outcome.  The relevant question here:  Is he willing to learn from his patients? More important:  Is he willing to treat the "teacher-patient" with the respect she deserves, or does he stash the knowledge of his error away for the benefit of future patients while attempting to convince  the "teacher-patient" that there is "nothing wrong"? 

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The Post-Meeting “Wear-You-Out” Syndrome
in Cosmetic Surgery
Rod J. Rohrich, M.D.
Dallas, Texas

Events occur every day within a practice that can literally “wear you out.” Life can seem hard at times, even when all is well. At this time in my life, with a toddler and an infant at home, it has become even more important to minimize those events that disrupt my day. We hope we can learn from each other’s mistakes to find solutions for the everyday practice of plastic surgery. However, patients with unrealistic expectations are only one part of our daily challenge. What’s frustrating and perplexing is when a technique is presented at an educational meeting (intentionally or unintentionally) that sounds appealing, yet is filled with potential problems when incorporated into our practices. We return home to try the new procedures only to discover they really do not work. The result is the “wear-you-out” syndrome: a dissatisfied patient wearing you out with an unforeseen postoperative problem from a procedure that was supposed to work well by all reports.

At our national meetings, one occasionally hears about techniques that have an incredibly
steep learning curve and probably do not work, and if they do work, the results are unexpected, sometimes surprising, and often not consistently reproducible. It is difficult to incorporate new procedures into your practice if you do not have the same experience and expertise as the individual who presented this new technique or refinement. If the presenter
fails to clearly define the learning curve or explain the number and percentage of complications, this can pave the way for big problems. For instance, the surgeon who has just learned to perform liposuction or a face lift technique cannot immediately incorporate some advanced technique into his/her practice just by watching an expert present the procedure. We should attempt to make this clear in our teaching courses.

Everybody shows his or her best results and many minimize the complication rate and learning curve at meetings, seminars, and symposia.Perhaps this is human nature, but it isnot acceptable. Even though a procedure hasbeen demonstrated time and time again, it is not proper to minimize its risks and complications.Do not tell us it works every time. In myown experience, the role and use of fat injectionsin facial cosmetic surgery is a classic example Fat injections have been touted to b the cure-all, end-all for all types of problems,
especially facial aging. My personal experience with the use of facial fat grafts and fat injections has been dismal, particularly when using fat injections for orbital rim blending of the cheek-lid interface. The results from this technique have worn me out from the perspective of patient complaints.

A word of caution: do not go home and incorporate a new procedure into your arsenal
until you are very sure it works. Here are several thoughts to help avoid the post-meeting
“wear-you-out” syndrome in your practice:

1. Do not be the first to use a new technique or technology or the last to give it up.
2. Be sure highly respected, experienced surgeons or a surgeon you know and trust is using and praising the procedure or technique before you attempt it.
3. Seek advice from the surgeon with the most experience and expertise using the same or similar techniques.
4. Call the surgeon who described the technique and put him/her under scrutiny. Does this really work? When does it not work? What are the author’s revision and complication rates?
5. Optimally, observe the new technique or rejuvenation procedure. See if the actual
procedure is the same as presented. Ask to see follow-up patients if possible.
6. After you have performed 5 to 10 procedures using the new technique or technology,
provide the author with your own feedback and follow-up on what works and does not work for you.
7. Listen to your patients and follow them closely when you change a procedure or add a new technique to your armamentarium. Ask the hard questions. Is this new technique really improving your results?
8. Beware of the technique that continues to be “modified” significantly, especially 1 year after its introduction as the latest and greatest in plastic surgery. Obviously, something is not working properly if it requires constant revision even in the hands of the “experts”!
9. Be wary of those who are never in doubt when asked about a procedure they are advocating. They may often be in error.
10. Most complications relative to a new technique or technology occur within 2 to 3 weeks after an educational meeting. This is a very important statistic to remember!

In conclusion, do you find that your patients are “wearing you out” about their result from a
procedure you are trying? If so, stop! Do not take everything you hear at a meeting as established fact. Analyze your results, compare them to old and new techniques, and formulate a plan that works best for you and your patients.

Rod J. Rohrich, M.D.
Co-editor, Plastic and Reconstructive Surgery
Department of Plastic and Reconstructive Surgery
UT Southwestern Medical Center
5323 Harry Hines Boulevard, Suite E7.210
Dallas, Texas 75390-9132
rod.rohrich@utsouthwestern.edu
1044 PLASTIC AND RECONSTRUCTIVE SURGERY, September 15, 2001