The Dry Eye Zone

Rebecca's Blog

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Blepharoplasty: An abstract, and perspectives on social media and patient expectations

This abstract is the kind of language that makes me weep and gnash my teeth. Well, at least gnash my teeth:
Upper Eyelid Blepharoplasty: Evaluation, Treatment, and Complication Minimization
Upper eyelid blepharoplasty is one of the most common procedures performed worldwide for both functional and cosmetic indications. There is a high rate of patient satisfaction; however, in this era of social media, patient expectations are higher than ever. Today's digitally savvy patients expect perfect outcomes with no complications and rapid recovery. To achieve optimal results, a careful preoperative evaluation and sound surgical technique is essential for minimizing complications. Here the authors review their approach to the management of the blepharoplasty patient.
Yang P, Ko AC, Kikkawa DO, Korn BS.Semin Plast Surg. 2017 Feb;31(1):51-57. doi: 10.1055/s-0037-1598628. Review.

It's not just because I field so many calls from people who have dry eye after blepharoplasty without having been warned of the possibility this might happen. (For those who aren't familiar with this, a particularly painful form of dry eye can occur after eyelid surgery due to eyelids ending up too short - much more likely to happen when done by a plastic surgeon than an oculoplastic surgeon, the latter being an eye doctor who knows skin and muscle, as opposed to the former, whose knowledge of eyes and the lacrimal system in particular will be much more limited.)

It's just, simply, what it says.

"This era of social media" obviously does not make it MORE incumbent upon a surgeon to screen carefully, use good technique and minimize complications. I presume all surgeons would want to do that whether or not their patient were likely to blab about their results to all their Facebook friends.

Of course, I do get that there is a context here. This is just an intro to what, for all I know (I'm not a subscriber so I don't have the actual study), is probably a thoroughly excellent review of technique.

Nevertheless, this kind of thinking and language... makes me gnash my teeth.

When you talk about patients having expectations of perfect outcomes - where do you think they get them from? You don't think it might have something to do with your glossy brochures, your perfunctory informed consent process and your failure to have serious conversations with them about specific complications that can ensue, including what they mean and how they are managed? 

Surgeons performing elective surgeries have a role to play in setting patient expectations, and they should own it and embrace it. They need to be especially cognizant of the uphill work undoing the effects of slick media upon patient expectations.