Are there times you advise against treatment?

One patient I remember was already very slim and wanted more liposuction. They felt a certain area still had fat left, and that taking out just a little more would give them the line they wanted. But in my view, they were past the point where liposuction could make a meaningful improvement. Removing more wouldn’t have made the line more beautiful. The skin could have settled too close to the underlying structures, making the outline of bone or muscle too visible, or breaking up a line that should look smooth.

So I explained: “Liposuction doesn’t mean removing all the fat just because it’s there. To create a beautiful line, some fat has to stay.” They asked several times whether I could take out even a little, but I told them that if they were a member of my family, I wouldn’t advise removing more in their condition. In the end, we didn’t go ahead.

Another patient, who was very slim, wanted breast fat transfer. Breast fat transfer isn’t something you can decide by looking at the breasts alone. Because the fat has to be harvested from your own body, you first need to know how much fat can be harvested without putting a strain on the body, before thinking about how much you’d like added. This patient didn’t have much body fat, and I judged that even harvesting aggressively from several areas would make it hard to collect enough fat for a meaningful transfer. Pushing ahead would have meant harvesting from many areas and putting a burden on the body, with a high chance of not getting the hoped-for change in the breasts.

So I explained that the procedure could be done, but that I didn’t recommend it. What this patient wanted, after all, was a clearly visible change in their breasts. Going ahead while knowing the result wouldn’t be enough, just to give it a try, isn’t what I consider good treatment. They were very disappointed at first, but I explained the gap between the amount of fat that could be harvested and the change they could expect after the transfer, and in the end we didn’t do the fat transfer.

This is what we mean when we say, “If we wouldn’t recommend it to our own family, we won’t recommend it to you.” At a consultation, I first look not at whether I can do something, but at whether doing it will actually make that person better off. If removing more fat won’t make a difference, I stop the liposuction. If there isn’t enough fat to transfer, I don’t do the fat transfer. I think that sometimes, knowing when not to treat matters more than treating well.