Taking a history in aesthetic surgery: SAGA--the surgeon's tool for patient selection

Most patient dissatisfaction in Aesthetic surgery is based on failures of communication and patient selection criteria, and not on technical faults [Ward CM. Consenting and consulting for cosmetic surgery. Br J Plast Surg 1998;51:547-50; Gorney M. (2004) Essentials of malpractice claims prevention for the plastic surgeon. eMedicine; Jan 5, 2004]. Litigation leaves the surgeon perplexed when the operation has been performed to his or her satisfaction. Taking a history of Aesthetic Distress is critical in understanding the patient's complaint and postoperative expectation. It is often overlooked. This valuable information influences patient selection for surgery and shapes the operation to be performed. If a carefully selected patient has a surgical result that addresses their complaint and meets their expectation, the rate of dissatisfaction is reduced and litigation is avoided or more easily defended. An historical literature review of patient selection for aesthetic surgery is offered. It confirms that the need for establishing a rapport with the patient has been recognised and, indeed, stressed for many years. However, while we have found negative lists of the types of patient to avoid, and aspersions of psychiatric conditions in dissatisfied patients, we have been unable to find any structure or template for eliciting the required history, which is all important in determining patient selection. SAGA is a simple template for questioning, during consultation. It provides the surgeon with a systematic tool for recording the history of the complaint of appearance, whilst establishing rapport with the patient. It gives insight into the patient's personality and complaint, thus aiding patient selection for surgery and shaping the operation performed. Finally it provides a record for "rebuttal" in the postoperative period, should this be necessary. It has served the senior author well for twenty-five years.