Ptsosis - (After Facelift)-Ethical Dynamic, Thoughts On Doctor's Behavior?

A prominent doctor did my face lift . One half hour BEFORE surgery, HIS RESIDENT came in. This doctor NEVER MENTIONED him to me. After the surgery - my ears protruded and ptsosis in one eye. I know residents HAVE TO have surgical experience but know INTUITIVELY, this doctor probably allowed him to do most of this surgery, WITHOUT MY permission. I want to fix ptosis. Another surgeon said I need an ophthalmologist to fix it. Thoughts? I remain LIVID with this doctor's unethical behavior.

Doctor Answers 3

Please do not assume that this resident did anything more than assist the surgeon.

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I am sure that you did your research to find a very qualified plastic surgeon.  Any surgeon operating at a teaching institution is usually very qualified.  At many of these institutions, the surgeon will operate with a resident or fellow assisting them.  It is extremely unlikely that a resident did anything more than assist on a private aesthetics case.  I for one, do not allow residents to even put in sutures on my private cases.  I also attend at a county hospital where I volunteer my time once a month.  The situation there is completely different, there the resident does the surgery.  It is my job as the attending to make sure that the work performed by the resident or fellow is exactly to my standards that I apply to my private patients.  Don't assume that that resident surgeon did any more than retract, wipe or apply suction to assist your surgeon.  While it might be appropriate to have a fellow or senior resident do suturing at the end of a case, remember that a nurse first assistants also perform this task for surgeons.  However, with many plastic surgeons, even the fellow may not be allowed to suture on a private cosmetic case.  Before you spend energy being angry at your plastic surgeon on assumptions, you should consider asking the surgeon what this resident surgeon did during surgery.  You might be pleasantly surprised.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Multiple issues here

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There are a few issues at play here. First is the question of ethics that you present. As you state, if you are getting treatment at a teaching/University hospital, it is established that physicians in training will be involved in your treatment. The degree of involvement depends on the attending physician, the level of training of the training physician, and the complexity of the case.

It is certainly your prerogative prior to the surgery to request that only that attending physician perform the surgery. It is also the prerogative of the attending surgeon to decide to accept that request. But it should be established before the surgery. Certainly if you make the request, and he agrees, then it would be unethical for him/her to allow the resident physician do the surgery.

As an attending that works both in the University setting and also at my own private practive, I commonly have to address this issue with patients. Ultimately, the attending physician is responsible for your outcome.

Now as to the medical component of your question. I have never seen a facelift surgery cause eyelid ptosis. The incisions and dissection are in a completely different region of the face. It maybe that this is a new realization of a preexisting problem. I'm sure your surgeon took before and after photos, so evaluating these photos will be very helpful

Ear position can sometimes be affected by facelifts and photos would need to be posted to see what you mean by "ears protuded". There are different parts of the ear that can be affected, usually the tragus or pinna.

An oculoplastics surgeon is the best person to see regarding your eyelid ptosis. I have provided a link that you can find a well trained one near you.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

When the assistant performs the surgery

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First, don't be livid based on an assumption that has yet to be established. In a teaching hospital, the residents assist in procedures.  If that was a problem, then your alternative would have been an accredited surgical suite in a private practice.  Secondly, the attending is responsible for the result so, if he wasn't happy with it, he should have corrected while you were still on the operating table.  I think that, rather than jump to conclusions, you should have established a respectful dialogue with your plastic surgeon before moving on to second opinions.  Also, if you check the informed consent, I would anticipate that it includes permission for the residents or fellows to participate in the procedure. When I operate in my own facility or in a surgicenter, my patients can be assured that I am doing the entire procedure.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.