Mr. Svoboda, what is your attitude towards aesthetic operations for foreign clients?
I almost intentionally avoid foreign clients. The reason is neither the language barrier, nor the facilities we can offer, nor money.
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I don’t like to operate on them for two main reasons: Monitoring the patients after the operation is the first one. I do not lose sight of a patient until she is entirely healed, which in plastic surgery means six to eight weeks, with some operations even half a year. And I don't think there would be a foreign client willing to come for a check-up once a week for three months. And secondly, there is the question on how to handle possible complications. No one anywhere in the world can avoid possible complications.
The surgeon who says he has never encountered any complications either is lying or does not operate! It is an old surgical proverb which applies here. Though, I must say we have a minimum of complications, we cannot shut them out entirely. In the case of complications in Czech clients it is important that I am able to handle all unexpected situations quickly and that I am permanently in touch with the patient.
Just imagine a situation in which a woman leaves for her home abroad five days after the operation and the wound in her abdomen gets infected. What is she going to do? If she is our patient, there is our 24-hour phone service at her disposal. Even if the patients are from the other end of the republic, we are able to take care of them within two or three hours. Besides, we are in touch with all institutions in the republic and if, for example, a patient from Moravia had any complications, we would be able to contact our colleagues in Moravia and agree on the necessary care. Our patients can be 100% sure of subsequent care.
I'm annoyed when I hear that somebody operates on patients but never instructs them, does not care about them. I usually have no chance to invite foreign patients for check-ups, for example after an augmentation, in two months, in six months. And what happens if a patient really has a problem? We have to deal with it and the patient must come to see us.
It’s very difficult. Unfortunately, some of my colleagues do not care at all. And also, there is no solution to the situation because - as far as I know - there is no insurance company which would insure a Czech plastic surgeon against complications in foreign patients. Indeed, there is hardly any insurance company in the Czech Republic which would insure cosmetic procedures. Every plastic surgeon should have this kind of insurance; however it is really difficult to contract one. All surgeons with liability insurance almost always have a policy that does not cover cosmetic procedures. And all our procedures are in fact cosmetic ones. The insurance covering foreign clients is even more complicated.
How does it happen then that, despite all the risk, many of your colleagues operate on foreign clients?
It is lucrative and that's why it is worth the risk for many colleagues. Seriously, I have no need to take such a risk. I have been working in medicine for 38 years and I know that anything can always happen.
How many complications do you approximately have?
Fortunately we encounter them rarely, I would say that during the time we have been working here, there were about 3 to 5 more serious cases, however we handled all to the satisfaction of all concerned - the patient and us. I think the best evidence is the fact the patients come again. There is a rule that a satisfied patient brings three new ones and a dissatisfied patient takes away ten.
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How do you judge a clients' discipline regarding the post-operative care you recommend?
It is an entirely individual matter. Often you see first thing if the patient is well or poorly disciplined. And if “a warning light goes on,” the surgeon should drop the operation. Although he drops a financial profit, it is not such a loss. And we luckily have no need to operate on patients who we consider problematic. Professor Fára used to say: The biggest art of a plastic surgeon is to refuse a patient. A good plastic surgeon should be able to choose, have the courage and appreciate himself enough to say: “I’m sorry, I will not operate on you.”
Why, for example, do you refuse to operate on a patient?
There are several reasons: Either the lady has unrealistic requirements, which of course happens, or she is not suitable for the type of operation she is requesting, or she has absolutely distorted ideas about what plastic surgery can do. For example, if she brings a photo to show what she wants to look like and the surgeon knows it is just not possible. If she is reasonable, accepts the explanation and understands what we can practically do, then we can come to an agreement. However, you must have a feeling of contact. If the patient trusts you and you know you can really help her, you can operate. If you get the feeling it is not there and is not going to be there, there is no point in doing anything like this. And if you see the patient is really unable to understand that she wants unrealistic things to be done, you should refuse her right from the very beginning.
What are the reactions of patients you refuse to operate on?
It depends. Some women are a bit angry, some take it calmly or humorously, some feel a bit ashamed. If we, for example, tell them to loose weight. However, we always give them enough attention and recommend where and how to reduce weight, maybe even with medical assistance. We also show that we believe the women can do it. It is often a good motivation for them, they get more self-confidence and leave satisfied despite the refusal.
When you look at Czech aesthetic surgeons, what do you think about the current situation?
Many young, pushy, ambitious...some of them rather skillful with a good future but still with little experience. Medicine and surgery in particular, is very much about experience. A surgeon should know what he could happen to come across and what he should not attempt. I reject about 10% of patients. For instance, if the patient is a young woman with nice breasts and I know that the operation and scars would make them look worse. But she goes away and another plastic surgeon she finds does the operation. Then she returns in half a year crying for a repair, which is rather difficult.
What is the situation as to the number of re-operations in the Czech Republic, are they numerous?
They are starting to be. Recklessness and inexperience is to blame.
Is there any chance to treat it within a system?
No.
And if somebody comes to you with poor operation results, can you say whether it is the fault of a surgeon or, for instance, the patient neglected the post-operative care?
With difficulty. Of course we presume that every plastic surgeon tries to do his best but he doesn’t always succeed. Every surgeon may have and sometimes does have patient complications. An intelligent plastic surgeon realizes that and never blames a colleague. There should be and there is a certain loyalty among plastic surgeons, professional solidarity, we should support each other. No one ever knows when he himself will be in need of such a help – for his own or his patients’ sake.
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How far should this kind of loyalty go? For instance if you keep encountering a large number of re-operations from the same colleague.
No gossips, no disparaging remarks, rather help. If I have several poorly performed operations from one and the same surgeon, I will pick up the phone and tell him. All Czech plastic surgeons know each other and we can surely talk.
Recently however I have come across completely unknown names. If somebody puts a sign on his door that he performs plastic surgery it does not mean he is a plastic surgeon and, unfortunately, there are people like this. Moreover, they operate. If he is not a plastic surgeon and I tell him, for instance in an e-mail, I know about his activities he either never answers or turns me down.
How specialized are the doctors getting into plastic surgery?
Eye specialists operating on eyelids; ENT specialists doing rhinoplasty; some surgeons tamper with breast operations...
When a surgeon gets his certificate of specialization in plastic surgery, do you think he is prepared enough for the profession of an aesthetic surgeon?
I don't think so. Usually very little. Moreover, the specialization is in general plastic surgery and aesthetic operations are not practically taught nor tested.
What should be done about it?
I don’t know. It is a matter of the Plastic Surgery Society and Aesthetic Surgery Society to provide the education of plastic surgeons who should do aesthetic operations. So far it has not been handled at all or very poorly. It is up to a plastic surgeon to find somebody under whose guidance he will operate and get experience in such a way, but it is difficult.
What is to be done with a surgeon who has had a high percentage of complications and unsuccessful operations but does not want to take advice?
I’m afraid that so far there has not been any possibility to solve this problem in this country.
I would not say it is total care but the patients should have entirely individual care. In the beginning we all talk to them, we give them our attention, speak with them about the operation and about anything else they want to speak about. Every patient needs something else, has different ideas and different attitudes towards the procedure, different wishes. We always try to satisfy most of them. If a patient has a wish and the wish does not break any necessary rules we assist. Even with trifles – if she, for instance, wants something special for breakfast or lunch and it is in our power, we do it.
Of course before a patient is released we speak about everything which awaits her, what she should do, what she should avoid, how to behave. She gets everything she needs in hand, all contacts, she can phone any time she likes and consult with us. Our patients know that at any time there is somebody on the phone with whom they can consult with on everything. And we solve everything immediately.
On the webportal there are many women asking questions because they do not know what to do after the operation. What is the reason? Do you think that patients are afraid to ask their surgeon?
I believe that some surgeons and their assistants communicate little with their patients. It is often caused by the fact that a surgeon performs the operation and tries to get rid of the patient quickly. I have noticed this trend recently. Particularly with foreign clients.
