Contoura Facial Plastic Surgery - Episode 6 — The Confident Choice Podcast - Determining Candidacy Dr. Roberto Garcia

Transcript

You’re listening to the Confident Choice Podcast with me, Dr. Roberto Garcia, a double board-certified facial plastic and reconstructive surgeon. Honest conversations and expert advice about the decisions that make you feel your best.

Welcome, everybody, to Episode 6 of The Confident Choice. I’m your host, Dr. Roberto Garcia, from sunny Ponte Vedra. The weather has finally begun to change, and hopefully we’re done with those cold days. For those of you still up in upstate New York listening to our podcast, I’m sorry—it’s probably going to be cold for a little bit longer. The groundhog told us that. We always believe what the groundhog says at some point in February.

Today, there are a couple of things we’re going to talk about. One question that patients often have before they ever consider surgery is: Are they a good candidate? Will they go to a consultation and have a surgeon say they are a good or bad candidate?

What surgeons are generally looking for is whether a patient is suitable for surgery. What I mean by that is this: from the surgeon’s perspective, it comes down to whether the patient is going to have a good result. Let me backstep—are they going to have a result they are seeking, can I as the surgeon deliver that result, and will the patient be happy with that result?

That’s how I define today’s episode—what the surgeon is looking at and what the patient is looking at. We define a good surgical candidate on multiple tiers.

We’ve talked about the consultation process in past episodes—what we’re looking for during and throughout the consultation—not only delivering professional advice based on photo documentation but also seeing things in person. I can speak to that particularly on the heels of COVID, where we did so many consultations virtually. It was, in my opinion, a handicap when trying to give a proper assessment through a computer screen.

So much of what we do depends on a three-dimensional impression of the face. I can’t just look at a two-dimensional image and render a three-dimensional solution. It’s very challenging. What I found happening was that when I finally met patients I had consulted with virtually, things were different. I saw things I hadn’t seen in photos. The shadowing was different. The three-dimensionality of the aging process was different.

I found myself in a difficult position. I had told a patient they needed one or two things, and now, in reality, they needed something different or additional procedures. That’s one component of determining whether a patient is a good candidate.

Another important factor is realistic expectations. We’ve touched on what defines a realistic expectation—it’s whether the surgeon can visualize and predict an outcome based on the patient’s concerns. If the patient has a concern the physician does not see, the physician cannot correct it. If the physician sees something the patient doesn’t see, our philosophy at Contoura is that we’re not going to push something that doesn’t bother the patient.

Oftentimes, patients will ask, “What do you think? Give me a total overview.” I usually respond, “Let’s first talk about what bothers you.” We address those concerns and rank them. My mentor used to use the “totem pole” concept—ranking things in order of importance.

When we see patients, we prioritize what will make the biggest impact. Often, addressing the primary concern brings balance back to the face, and the smaller concerns become less relevant. We talked about facial harmony and balance in a previous episode. Correcting a major issue can have a “butterfly effect” on minor issues.

Matching what the patient sees with what we see is a challenge. It’s an art form developed over years of experience. Early in my career, I would tell patients 20 things they needed, and you’d see them looking at you like a deer in headlights. They’d think, “I’m a lost cause,” and leave.

As a specialty, we’ve become better at allowing the patient to drive the consultation. That’s how it should be. However, there’s another extreme—patients who try to dictate everything. Some surgeons give in to that, but I don’t think it’s right. We shouldn’t sacrifice professional judgment for a patient whose knowledge may come from social media or the internet.

The responsibility is on us as surgeons to provide realistic, appropriate recommendations that address the patient’s concerns while also delivering a natural, long-term result. The goal is communication—meeting in the middle so everyone is comfortable with the plan.

Sometimes, even after the consultation, I may review a patient’s photos later and notice something we didn’t discuss. I’ll bring them back in and say, “I’m not being pushy, but I did see something else that could make a difference.”

I believe there are two types of surgeons in our industry: those who are financially driven and those who are morally driven. The way I was raised and trained is that if you don’t have a moral compass—if you’re not thinking of that patient as your mother, sister, or father—you’ve lost the proper direction of the relationship.

Patients come to us asking for help and trusting what we say. That carries a tremendous responsibility.

From the patient’s perspective, timing is another concern. Many say, “I never thought I’d be doing this, especially this soon.” But aging is unique. Two people of the same age—even sisters—can look very different. Genetics plays a role, but lifestyle and individual biology matter greatly.

My advice is: don’t get hung up on age. Focus on what’s bothering you and the impact it has on your daily life. If removing that negativity improves your well-being—whether you’re in your 40s, 50s, 60s, or beyond—then it may be the right time.

I remember a patient from about eight years ago—a 29-year-old woman who had already undergone two facial procedures. She had significant scarring and was devastated. Normally, you wouldn’t operate on someone that young, but we felt compelled to correct the damage. I performed a lift, and she had an amazing outcome.

The mistake happened with the original surgeon, who likely prioritized financial gain over proper judgment. That created emotional and physical scars. We ended up treating both. That transformation—turning something negative into something positive—is what motivates me every day.

We want patients to be doing this for the right reasons—for themselves. Not for their job, spouse, friends, or social media. We want them to feel emotionally empowered.

Another key factor in the consultation is trust. Patients today come in already knowing a lot about the surgeon—reviews, results, credentials. They’re trying to determine: can they afford the surgery, will the surgeon take care of them afterward, and can they trust what they’re being told?

Trust comes down to two questions: will the surgeon care for me, and is the recommendation truly in my best interest?

If trust is established and the patient can afford it, they usually move forward. But sometimes patients reject a recommendation because it doesn’t match their preconceived idea. They go elsewhere to find a surgeon who will do what they want instead of what’s right.

I’ve seen the consequences of that—patients returning for revisions after undergoing unnecessary or poorly executed procedures elsewhere. My role is never to judge but to help. We move forward from where they are.

Financial decisions also play a role. Some patients seek cheaper options, even going out of the country, and end up with poor results. I had a patient who went to Cuba for a facelift for $750. The scarring was severe and painful. It took two additional surgeries to correct.

Trying to save money initially can result in significantly higher costs—financially and emotionally—over time. My advice is simple: if you’re not financially ready, wait. Don’t compromise your long-term outcome for a short-term savings.

I’ll close with this thought: the words “not yet” are okay to hear. If a surgeon tells you you’re not ready, believe them. That surgeon is being honest, and that’s who you want in your corner.

Finally, I want to share something personal. As many of you know, I often talk about my dad. He passed away last year in June. He was always giving advice and encouraging others to be better.

One lesson he taught me was about ranking your friends. It sounds strange, but he explained that there are different levels of friendships. Some friends you can ask small favors of; others you can trust with much more serious matters.

As a young person, I thought every friend was a “10”—someone I could rely on for anything. Over time, I learned that’s not the case. People fit different roles in your life, and that’s okay.

Relationships evolve. Some people grow closer; others drift apart. What matters is having a core group you can truly rely on. Surround yourself with people who inspire you and make you better.

It’s a challenging lesson, but an important one.

We’re going to close here. This has been a great podcast. I’m going to go enjoy the sun today.

Good decisions always come from good information.

Thank you, ladies and gentlemen. I hope you have a blessed week, and we’ll see you next time.