All About Virtual Plastic Surgery Consultations

Thanks for reading about our virtual consults. Maybe you’re interested in seeing us to discuss a cosmetic concern and can’t come to the office. You could be out of town, in another country, or maybe you’re reading this while you’re stuck at home because of the COVID-19 outbreak.

We’ve been doing virtual plastic surgery consults for a few years for the first few reasons, but it’s a big deal now with the pandemic.

Virtual consults have turned out to be more useful than I suspected. I figured that it was going to be hard to really get to the bottom of what people’s concerns were by just looking at them and talking to them over the internet. Surprisingly, we’ve been able to do probably 90% of what I would be able to do in an actual consult right here in the office.

Overall, I would say that the convenience- and in this situation the necessity- of meeting people and evaluating their concerns remotely really overshadows the limitations.

Most of what we do in medicine comes down to understanding someone’s history and their symptoms. In my type of aesthetic plastic surgery practice, it really gets down to understanding what bothers people the most, and even what about that particular area of their body part or face is most concerning to them.

For instance, someone might say they don’t like their eyes. Then I can narrow it down to their lower eyelids, and then they can show me that they don’t like the bulge and the shadow under the bulge -but don’t particularly care about the texture or crepeyness or laxity of the skin. Other patients might be able to explain that they don’t like their breasts.

I can then clarify that it’s really not the size but it’s actually the droopiness that bothers them. The limitations therefore are really different depending on what part of the body or face we’re talking about.

In the face, eyelid laxity and forehead droopiness often are combined in such a way that it’s hard to evaluate them in isolation. In general, though, I can tell someone through a video consult that we can take care of their tired appearance through just addressing their upper eyelids.

Other times I might need to defer a final answer until I see them in person to know whether I need to do any type of forehead lift or temple lift at the same time as the upper eyelids. Moving down the face, evaluating the nose aesthetics can be very simple. I can even make tracings of suggested profiles and review those drawings and their priorities with the patient.

On the other hand, technical subtleties about structural support of the nose and airway evaluation really need to be confirmed in person during a pre operative visit. Besides, most of my technical plan for the OR would rely on that in-person visit.

When looking at volume loss such as in the cheeks or temples or lips, a video consult is just about as good as assessing someone in person. On the other hand, if we’re looking at some laxity such as in the jawline, jowls, or neck, using my fingers to demonstrate some different possibilities of moving or elevating/tightening tissues or to clarify how much of the patient’s concern is hollowness versus laxity is slightly harder to do virtually.

Nonetheless, even in the face I’ve been able to put together plans for patients’ treatments that are detailed enough for my scheduler to prepare quotes for them right away.

As you’ve probably noticed during these descriptions, everything from the virtual consult needs to be confirmed during a real preoperative visit. These preoperative visits are necessary to confirm and draw scar locations, talk about the plan as I demonstrate physically such as by lifting or pinching or pushing skin or fat.

As we move down the body to the breasts, virtual consults can again be slightly easier. When it comes to the breasts, we’re usually talking either about increasing or decreasing size, or addressing droopiness through some version of a lift (or more often even a combination of these two different approaches).

Although the details about volume desires- like we would be able to workout in the office by using breast implant sizers- aren’t possible to solidify during a virtual consultation, we can usually come up with enough of a plan for my scheduler to prepare a quote right away.

The one tricky situation that I previously alluded to in the breast comes down to the common scenario where a patient is trying to decide between just a lift or a lift with an implant. This is the kind of scenario when I can give a best guess, but we need to confirm later in the office during a preoperative visit.

Elasticity of the skin is everything when it comes to deciding whether a patient is a good liposuction candidate

When it comes to body contouring there are some obvious decisions that can be made virtually. For instance, the patient and I can clearly identify whether simply liposuction of abdominal fat with tight overlying skin is appropriate, or whether some version of a tummy tuck absolutely needs to be done to address loose skin.

On the other hand, examining the rectus abdominus muscles to decide whether a muscle repair for a “rectus diastasis” during a tummy tuck is required must be performed in the office.

In contrast, the appropriateness of liposuction to the hips or love handles can be discussed and planned virtually, but again these plans need to be confirmed in an actual preoperative visit.

Actually feeling the patient’s skin is the only way to make this call because the tightness and elasticity of the skin is everything when it comes to deciding whether a patient is a good liposuction candidate.

In my experience, the accuracy of virtual consults in evaluating patients for thigh procedures is far more limiting. Operations like liposuction of the inner thighs or knees require sufficient skin elasticity and tightness, which again needs to be felt by me in person.

For laxity, possibilities such as cirumferential thigh lifts, vertical thigh lifts, or even more limited inner thigh lifts are difficult to navigate with the patient without actually being able to pull on the patient’s thigh with the patient looking in the mirror at different views as I lift and tighten skin in different orientations to simulate the forces of an actual thigh lift.

Of course, once again we can talk about different possibilities but then confirm them at a preoperative visit.

Overall, you can see that virtual consultations can be very useful but need to be confirmed in the office before proceeding with surgery. In all of my experience, most virtual consults are sufficient for putting together a preliminary surgical plan for the patient and to provide a preliminary quote.

We can also generally give the patient enough information about recovery, risks and benefits, scars, and what they can expect from the surgery so that the patient can go ahead with scheduling their surgery and scheduling their all-important preoperative visit. Particularly in times like this, all we can do is make the best of it as we get ready for life after the pandemic.

Thanks for checking out my blog. Check out our other topics and don’t forget to browse our videos including cool surgery videos on our  YouTube channel.