The problems of aesthetic surgery

Author: Dr. Santanchè Paolo

Date: 18/12/2019

Aesthetic surgery is a therapeutic medical-surgical discipline aimed at treating the discomforts caused by the non-acceptance of a part of one's image through the surgical modification of details that the patient considers unacceptable defects. The purpose is therefore purely therapeutic.

Aesthetic surgery must therefore be applied with the same methods as any other surgery: a correct diagnosis of the problem, identification of the right indication for the procedure, the technical and aesthetic choice of the modification to be made, and the correct execution of the planned intervention according to the latest developments.

Aesthetic surgery should not be considered as a consumer good: it is a therapeutic tool and should only be used when there is reasonable certainty that it will solve the problem.

You cannot trade in aesthetic surgery simply by "selling" the surgery requested by the patient.

This sounds easy, but often the situation is as follows: the patient arrives, without having a problem, but directly requesting an intervention (which presupposes that he or she has already made a correct diagnosis and identified the appropriate intervention); it is a shame that he or she has not necessarily guessed the right therapy, and maybe the diagnosis is not correct either! This can easily happen, since aesthetics is a difficult art and not as intuitive as it may seem to non-professionals; in aesthetics, proportions count more than dimensions and sometimes it is better to increase one element rather than reduce another (for example, to increase the chin or cheekbones instead of shortening the nose, or shortening the prolabium, i.e. the white part of the lip, instead of increasing the vermilion, i.e. the red part). Tastes change in line with the times: today we often do not like a style that in the past was in fashion; if we break away from the original balance with a modification, we have to create a new balance, we cannot do half and half. For example, if we change the profile of the outside of the thighs (the notorious  saddlebags), then we will need to adjust the hips and inner side of the thighs, and often also the profile of the knees. Otherwise we end up fixing one part and not the other. Often the patient focuses their attention on one detail in particular, but loses sight of the whole, but it is the whole, and especially the harmony of the whole, that gives the result. It is useless to improve one detail if this does not benefit the improvement of the entire picture: to improve the nose if it does not improve the face, to improve the thighs if it does not improve the line of the legs.

The surgeon will therefore always have to discuss the problem by starting from the source, which is not the simple imperfection, but the discomfort that the patient feels; the surgeon will have to investigate the perception that the patient derives from their image and be able to depict what they would like to have instead. Only at this point is it possible to determine whether the intervention requested will be suitable or sufficient to meet expectations, or whether a different path must be followed.

Unfortunately, today many surgeons prefer, due to diagnostic failure, artistic blindness or for the sake of convenience, to "sell" to the patient the surgery they have requested before they change their mind, without creating any complications by proposing different solutions, perhaps more complex or more expensive, that might cause them to lose their client.

Another problem of aesthetic surgery is linked to the fact that, since no specialisation qualification is required in Italy for any medical-surgical branch (with the exception of anaesthesiology and radiotherapy), this discipline is practised by the most varied individuals, in possession of a simple degree or of less relevant specialisations. Obviously these people are not able to use the current and correct techniques, but instead provide simplified, outdated and rudimentary versions of the procedures, with the results that we often then see and hear of.

It is therefore important that patients learn the correct approach to aesthetic surgery and the correct relationship with the plastic surgeon (who is the only official guardian of this art); how to explain to the doctor their problem; how to recognise competent and prepared professionals; and how to defend themselves against "cowboy" doctors.

This is where the Internet helps if used with a certain amount of shrewdness. On, with a personal data search, you can find all the doctor's qualifications (year of graduation, state examination and specialisations). On you can check if the surgeon is a member of the society of reconstructive and aesthetic plastic surgery (that they are therefore a specialist in plastic surgery, but perhaps they deal with burns or reconstructions).  On the website you can check if the surgeon is a plastic surgery specialist who really deals with aesthetic surgery. On the websites of surgeons check first of all if it says clearly "specialist in plastic surgery". Look at the case photos to see if you have the same aesthetic tastes. Read between the lines to see if you have the same cosmetic vision for aesthetic surgery. Be wary of sites that are too commercial and too cheap: if it costs too little, they will certainly give you even less than what they make you pay, often at the expense of safety and certainly of competence. Quality has its price and don't forget that we are talking about your health and your appearance. If you can't afford the right thing, then let it go. There are no short cuts in aesthetic surgery. The wrong choice, if you are lucky, will disappoint you; if you are unlucky, it will do you harm that is sometimes difficult or even impossible to correct.

Santanchè Paolo


Dr. Santanchè Paolo

Medical Surgeon
Milano (Italy)

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