A 45 year old lady comes for a second opinion

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A 45 year old lady comes for a second opinion following a facelift 3 months ago. She is very unhappy and describes that the previous surgeon saw her once, operated a week after consultation and did not consent her adequately and that her result is substandard. She has no documentation, will not go back to the previous surgeon, and will not consent to you contacting the surgeon.
She is seeking a revision procedure and has had two other consults with other surgeons the day before. She brings with her an advert for cosmetic surgery that states that if she has the surgery as a late replacement that she will get £1000 off the surgery. She wants to know whether you would offer this also and when you can perform the surgery as she would like to book in as soon as possible.
Following examination, you feel that a surgical revision would be relatively straightforward.
You state that she has a reasonable result. However, she disagrees stating that as she is the patient, and she has defined that her patient outcome is unsatisfactory and that your opinion is not relevant.
You document the consultation and take photographs for the medical notes. You explain the risks of surgery and that she should leave things some time to settle. She is very happy and wishes to book a surgical facelift revision for the following week.
We would like you to discuss what your concerns are for this patient and her previous management and how would you manage her moving forward?
Please discuss the pros and cons of revision surgery in terms of risks and complications in the short term and the long term.
Background discussion of topic Maximum 20marks
Criteria to consider:
? Effective summary of the issues related to consent for surgical procedures
? Demonstrates the importance of a cooling off period
? Describes the important aspects of advertising in cosmetic surgery
? Demonstrates an understanding of the varying patient related outcome measures available
Patient Assessment Maximum 25 marks
Criteria to consider:
? Describes how to assess a patient for facial rejuvenation surgery
? Describes the usual postoperative appearance and recovery following facelifting
? Demonstrates thorough knowledge to provide a full consultation including the need for psychological assessment,
? Demonstrates skills needed to identify the at risk patient
Therapeutics Maximum 25 marks
Criteria to consider:
? Demonstrates a thorough understanding of the complexity of revisionary surgery, the non surgical alternatives to surgery and autologous fat transfer as an alternative to revisionary facelifting
? Demonstrates a thorough understanding of undesirable effects of revisionary facelifting
? Describes the normal postop recovery of patients following facelifting and operative methods of improving scarring and soft tissue irregularities
Discussion and interpretation of results Maximum 25 marks
Criteria to consider:
? Summarises the discussion of assessment and treatment options
? Demonstrates an understanding of patient and clinical outcomes
? Considers the need for a psychological evaluation before proceeding to offer any treatment
? Considers the patients expectations may not be realistic and describes methods of managing this including obtaining a second opinion
Structure and style Maximum 5 marks
Marks will be awarded if there is
? An acceptable standard of grammar and spelling
? Arguments and text are sequenced logically
? Concepts are explained with clarity
? References are included where needed
? There is clear distinction between author’s opinion and published evidence/theory/opinion

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