Plastic surgeon Mr Alex Karidis discusses the PaPPS Initiative (Pre and Post Procedure Support Program) and mental health in his practice

Aesthetic Medicine: Do you think its increasingly important to offer mental health support within the aesthetics setting?

Mr Alex Karidis: I think it is essential that we offer psychological support for our patients because I truly feel that every single patient walking through the door of a cosmetic surgery clinic has some psychological issues that will be affecting their daily life or relationships.

Nobody is flippant enough to walk into a cosmetic surgery clinic and want surgery ‘just because’. There’s always something that is strongly affecting them and that’s why they are willing to go through the potential pain and risk.

So this is where something like the PaPPS Initiative really helps as my staff can offer the appropriate support both before and after the surgery. I always tell my patients that cosmetic surgery is a journey and it’s a journey that begins well before they come to us. Trying to inform themselves and navigate through the ins and outs of something they don’t inherently understand is stressful enough; they are out of their comfort zone and they also have the underlying issue that they want addressed affecting them.

From our point of view, it’s not justsimply matter of saying ‘Do you want this operation?’ We have to address any psychological issues, too.

I think it is essential that we offer psychological support for our patients

How the emotional aspect impacts the patient varies from individual to individual. Some people will show it and some won’t. The problem is that if everything goes smoothly then everyone is happy. However, sometimes things don’t go exactly according to plan and that’s where the emotional impact can be huge. We need to be there to understand and address it and offer the appropriate support.

Did you know much about the The Wright Initiative and PaPPS before signing up to the training?

AK: Norman Wright [founder of The Wright Initiative and PaPPs] is reasonably well known in our industry as he’s been preaching about the need for support for cosmetic surgery patients. If you are going to be offering a complete service to patients, you have to address this emotional aspect.

It could be an issue they have lived with for decades and, eventually, it comes to the crunch and they think I can’t live with it any longer and I want to do something about it.

The emotional aspect will have a profound impact on how the patient feels about the final outcome – how they think about their results. Because for some cosmetic surgery patients, it doesn’t matter how successful the surgery is, they will find faults. But if patients are happy and in a good frame of mind, they will be happy with the results.

AM: Have you noticed social media having an impact on patient’s motivations for surgery or their emotional outlook?

AK: I know there’s a growing trend of blaming selfies for making people feel dissatisfied with their looks, but I don’t think you can blame everything on social media. I think it is human nature to have insecurities. We all work through them at a different pace and yes, some things can exacerbate them, but they don’t create them.

AM: Is managing a patient’s expectations key to a successful outcome?

AK: Meeting patient’s expectations is the hardest part of my job, far harder than the surgical side. You can have a fantastic results and yet it might not meet the patient’s expectations.

We have to discover what patients truly want and sometimes that can be a moving goalpost. And it can change from day to day; it is not set in stone as some people might think and that’s because of the emotional aspect of what’s happening. That’s why we support the emotional side of it.

AM: Would you say your job is part psychologist as well as surgeon?

AK: I often say that cosmetic surgery is psychiatry with a knife. We are trying to address an emotional issue through the scalpel and, thankfully, by and large it’s successful. It’s not possible to totally differentiate the emotional and physical and say it’s all in the mind. If someone has a very large nose, no amount of counselling is going to make this person believe that his or her nose is small. And if it’s prominent and stands out then it can be addressed through surgery, but, at same time, you need the emotional support to take this patient through the whole journey.

AM: Why is it important to continue supporting a patient after their surgery?

AK: PaPPS is not just about preparing them for surgery, there’s also two post-procedure session sessions – it’s the complete support package and looks at all elements.

After the operation is just as important as beforehand. Healing can take many months and the patient goes through many stages – a rollercoaster of emotions. Initially, they may be thinking ‘Why did I do this?’, and then they go through a period a week later where they start to say ‘I understand why I did it and I can see the light at the end of the of tunnel’.

We need to identify the patients most in need of support and that’s why all Karidis staff get trained.

AM: Do you think plastic surgery training covers this aspect?

AK: This aspect was never addressed and there’s still a lot of deficiencies in the training. When you’re training to be a surgeon, the most important thing is learning the surgical skills and that takes many years to understand and master and you are focused solely on that aspect – your patients are usually asleep in the theatre and you aren’t engaging with them on a personal level. But when you complete training and you start seeing patients, that’s a completely different skill set to learn and you should be trained accordingly. We aren’t trained psychologists and sometimes patients need to be referred for help or support. I’m not saying every patient needs help from something like the PaPPS Initiative, but they all need support. AM

Mr Alex Karidis is one of the UK’s best known and respected cosmetic surgeons with more than 20 years’ experience in his field. Mr Karidis is renowned for his invisible scarring techniques, including his pioneering Karidis Quilting Technique that reduces post-surgical complications caused by haematomas and excessive swelling. This won The Hackett Memorial Prize at the annual scientific meeting of the British Association of Aesthetic Plastic Surgeons in 2018.