Online Plastic Surgery consultations: Convenience or Trouble?

A recent New York Times article discussed the potential merits and pitfalls of online consultations for Plastic Surgery procedures. 

This led me to think about my own practice.  I am currently listed on a number of websites that drive potential patients to my practice, from breast augmentation:

• LookingYourBest.com
• BreastImplants411.com
• BreastImplantsUSA.com

...to liposuction, tummy tucks, and other related sites where people can post questions and hear back from real Plastic Surgeons on their opinion about surgery.

I post my direct email (khorton@womensplasticsurgery.com) on these types of sites, and encourage potential patients to contact me directly with questions or comments. 

In response, I always send them a personal email reply with general information about my practice and advice to make an appointment to SEE ME in person, for a formal consultation, a full history and physical examination, and my surgical opinon about whether they are even a candidate for the procedure they believe they are seeking. 

Any initial questions about procedure cost and scheduling can be answered by my Patient Coordinator, whom contactees are also encouraged to call.

When I meet these patients in person, often the procedure they were seeking (for example, liposuction of the abdomen) may not in fact the appropriate procedure to achieve their aesthetic goals (an abdominoplasty, or tummy tuck may be indicated if they have rectus diastasis - separation of the rectus abdominis mucles in the midline from pregnancies).  Only an in-person evaluation can allow me to make this determination.

Some patients seeking Microsurgical breast reconstruction such as the DIEP/SIEA or TUG flap travel far and wide for surgery, and come from another state or even country for their surgery.  My Coordinator in these cases will often ask patients to send confidential photographs of their torso so that I can get a general idea of whether they are even a candidate for a free flap.  From here, we would consider asking them to make a trip to see me in the office for further evaluation. 

However, patients are still instructed that they will need to fly into San Francisco for a formal consultation and the standard 45-90 minute visit with me and the remainder of the office staff to fully learn about the procedure, its risks and benefits, potential complications and expected outcomes of surgery.  They would then plan their procedure and return for surgery in the future.

I feel that giving advice over the phone, over the internet, or via just looking at photographs is not only risky for the doctor or patient, but can provide a false diagnosis or sense of security. 

Medicolegally, potential Plastic Surgery patients seen to be seen and examined, in person, for proper documentation and examination, careful planning for surgery, and the best possible results.