Sometimes things can go wrong, and it’s difficult to talk about them, because it’s upsetting for everyone. Today I spoke with Dr William Mooney about the importance of surgery after care and post-operative complications.
Trish: Good morning. So I’m here today with Dr William Mooney. And Dr Mooney is the owner of Face Plus Medispa. He’s an ENT based in Bondi Junction and also has a clinic in Bankstown. And today we’re gonna have a bit of a talk about pre and post-op care. So welcome, Dr Mooney.
Dr Mooney: Hey, Trish how are you?
Trish: Yeah good, thanks so much for taking the time to join us today.
Dr Mooney: Pleasure.
Trish: Awesome. Now I just wanted to talk about the importance of pre and post-op care. So, listening to the advice of medical professionals, can you just give us a bit of insight, tell us a little about pre and post-op care?
Dr Mooney: I feel very strongly and passionately about this Trish, and I think what’s changed over the years in doing a lot of procedures is realising that it’s not a procedure, it’s actually a process. And the preoperative preparation, the peri-operative care, and the post-operative care are just as important to a good outcome as the operation itself. With our preoperative work up, it really is a very personal and intimate decision our patients are making. And so we have to move through that process very slowly and carefully. And I always at least have two consultations pre-operatively.
The first consultation is really to listen to patients and find out what they don’t like, what concerns that they have, and for me to run through the different treatment options. And then the second consultation is one where I concentrate about a very thorough consent, talking about risks and complications, managing problems, peri-operatively and post-operatively. And what we’re gonna do if any of those sort of things arise. I find that that’s a lot of data to push into one consultation, so however many it takes we do that until the patient is absolutely happy. And I’ve always done that, and I’m doing it increasingly with all my patients as time goes by.
When I started practise 18 years ago, and I’ve been involved in over 18,000 operations Trish, and even though there’s the many operations, it’s something that I never lose sight of the fact that for each and every person, that one operation they’re having is so important to them.
Dr Mooney: So planning surgery is essential.
Trish: And I like what you said about the fact that a customer can come and see you as often as they need to before because I can remember booking surgery and I took four years to decide to have this surgery. That’s how long from start to finish, because I was unsure. And then the third surgeon that I’d seen, who I was going to see for the second time, he was very much like, you know, sort of a bit abrupt as if you’re wasting my time now, you’ve already spoken to me. But I just needed that final confirmation. And it’s nice to feel welcome, the third visit.
Dr Mooney: I think so. I don’t care how long it takes, you know. Going through stuff very slowly and carefully with patients is great. I’ve got a couple of, for example for rhinoplasty, some of my staff have had a rhinoplasty and I think they act as an advocate to talk about the procedure from a personal perspective. I mean, I can, you know I haven’t had a rhinoplasty. I’ve had operations but not a nose job for example, so I’ve seen it, I know what it looks like, but only a patient who’s had the operation knows what it feels like.
We’ve also got a group of past patients who are happy to talk to future patients and speak to them in detail. And so I try to marry them up and I have a guy for a guy, and a young girl for a young girl, or a middle aged lady for a middle aged lady, so they can kind of relate to that person when they talk about the surgery and what to expect.
Trish: Yep. So how many you reckon you’ve done? How many rhinos have you done?
Dr Mooney: Look, rhinoplasty is my passion. It’s what I love doing. It’s my major surgery, and I probably do 200-300 per annum, and I’ve done that for about 18 years. So I’ve done a lot of them. I do a lot of other stuff as well. I really like head and neck cancer work, I do operate on some very sick patients doing that sort of surgery. I operate on kids, on old people, on young people. I love the voice, I do a lot of laryngology and especially for professional voice users and singers. The good part about ear, nose and throat surgery, it’s got a lovely range of different operations that you can do.
Trish: Yeah, true. You’re not gonna get bored doing the same thing.
So tell me, where does the patient’s responsibility, just going back to the recovery process and the aftercare, so the patient’s …
Dr Mooney: Yeah the after care’s important. I mean no surgery is without risk or complication, as we’ve found out. And patients, I only let them proceed into surgery if they’re totally aware of all those possibilities afterwards. But they do have to assume some responsibility for their outcome as well. It can’t be, you know they have to step up to the plate and stop smoking, they have to change their lifestyle pre-operatively, avoid drugs and alcohol in the pre-operative period, we modify their diets. And afterwards they have to look after themselves as well.
Our post-op care is more complicated than our pre-operative care. You know I see patients in the hospital after their surgery always and I see them, for example rhinoplasty, one, two, three, and four weeks, at six weeks and at three months, routinely for every patient. So that’s a lot of post-op care. But we do that because it’s tricky after surgery. Patients don’t wake up, dah dah, with this fantastic new face or nose or results straight away. Afterwards they’ve had an operation, you know, they don’t feel great, they’ve got some pain, some bleeding sometimes, there’s different risks in the post-operative period, we discuss all those of course pre-operatively with patients, but they’ve gotta be part of that process as well.
Trish: Yeah sure. Just recently I had surgery, about a year ago actually, and it was back surgery and I was like, this is perfect, I’ll start dieting and just you know eat not very much, and the doctor came in and I was telling him what I was doing and he was like, no no no no nah. You need to eat protein, you need to make sure you eat your three meals a day and like he just bombarded me with this after surgery care that I had no idea about, but it helped me to heal quicker and it’s made my back really strong and I’m fully recovered, you know.
Dr Mooney: You sound like an ideal patient, Trish. That’s what we want. I like to think of me and the patient and their family as a team together, acting for a good outcome, you know acting for the best outcome. And we’ve all gotta be team players in that process.
Trish: Exactly. And it’s a big deal. Like surgery is a big deal, so it can’t be you know …
Dr Mooney: Absolutely.
Trish: Yeah, people gotta know.
Dr Mooney: It is a very big deal and it can be very anxiety-provoking for patients. But I think in anything in life, you can only make a decision if you’ve got all the information on the table in front of you, and if you’re appraised and ready for any outcome that can occur afterwards.
Trish: Mm-hmm. True. And your nose, it’s right there. Like you know everyone’s gonna see it, there’s no point hiding it, like it’s right there so you’ve gotta be really prepared and ready.
Dr Mooney: Very much so. And you know what, it doesn’t look good at the start. You know the first week under a cast patients, even though we go over it, we say in the consent form, we tell them pre-operatively, you’ll tell them immediately post-operatively, you’re not gonna like your nose this week, I still get panic phones from patients saying, I don’t like my nose this week. And so it is a bit of a mental challenge to go through, and especially because you know we live in this digital age of phones and your selfies, and patients are hypercritical of themselves as well.
You know from my youth, there’s about three grainy photos, but now every patient has walking around in the hip pocket, a 10 mega-pixel camera and routinely take hundreds of photos of themselves, or check themselves out constantly the whole time.
We also live in a very hypercritical era, I mean I think that the way that media and reporting has gone is really you know, they focus on this sort of selfie/Snapchat generation, which is not the nicest part of humanity I don’t think, and it really makes people hypercritical and insecure about themselves as well.
Trish: Oh totally.
Dr Mooney: Psychological problems pre and post-operatively are probably my biggest challenge. Body dysmorphia, I didn’t even know existed when I started, like there wasn’t even a term called body dysmorphia. And it really is, probably my biggest challenge are patients who get this condition, body dysmorphia, and they think that they see something they don’t like, when ostensibly they’ve got a great result.
Usually we can pick it beforehand and you know, patients who have had multiple procedures, patients who hate their previous surgeon, patients who’ve had five nose jobs elsewhere. Now they red flag themselves as having body dysmorphia, and I’ve got a psychologist that we use very frequently who specialises in this, and I work in concert with her very closely to deal with patients if I’m concerned about this psyche and where their heads at for surgery. And I don’t proceed on flagged patients until she signs off.
Dr Mooney: And afterwards, probably our biggest challenge afterwards is something I call emergent dysmorphia, which is patients who seem fine pre-operatively that post-operatively completely wig out and just can’t cope with their new face, or the change in appearance. And that [inaudible 00:08:51]difficult patients as well.
Trish: Yeah, cause it’s different to a boob job or a tummy, cause you can tuck that away, but this is right there.
Dr Mooney: Right in the middle of your face.
Dr Mooney: You see it all day, every day, every time you look in the rearview mirror, every time, anything reflective, even the toaster can be a challenge, because you see yourself. You know, so it’s a constant challenge I think for these patients.
Trish: Of course. And so I was gonna ask you about body dysmorphia but you’ve covered that now, so is there anyone, well before we finish on that, is there anyone in particular who’s at risk of getting that?
Dr Mooney: Body dysmorphia?
Dr Mooney: Yeah look, I spoke to my psychologist and she was lovely and helpful about that. I actually presented at the Rhinoplasty National Congress in Perth a couple of weeks ago. I presented about, how do you find patients with body dysmorphia? There’s a few things, I mean obviously patients, the big ones are patients who have had multiple procedures, patients who aren’t happy with their previous procedures, patients who are very angry, aggressive about their surgeon, patients who’ve taken surgeons to court, you know, multiple times. Obviously these are high risk patients for problems. Other things that are a little bit more obtuse are patients with anxiety or depression, patients who’ve had eating disorders or problems in their youth. A lot of these are things you wouldn’t necessarily pick straight away as being problematic, but apparently there’s a very strong correlation, especially between anxiety and body dysmorphia post-operatively.
So I ask that now routinely. You know, when we take a full history and examination, I ask about a patient’s past, their past psyche, where their heads at, how they feel about previous surgeries, what they do, who they’re with. You know it’s not just their nose that we’re operating on. You really have to paint a complete picture of a patient to see them fully. And it helps you decide the shape of their nose as well. You know, the different sorts of people need different sorts of noses, and their personality and what they do is just as important as the shape of their face or their ethnicity.
Trish: Yeah that’s so true. And just back to the post-op care, so a surgeon and their responsibility in the post-op process, tell us a little bit about that.
Dr Mooney: Look we are responsible for patients and regardless of what happens to a patient in the post-op care, you know I think the surgeon is driving the bus and so it’s his patient. You do get complications and problems sometimes not to do with you. Sometimes it’s the anaesthetic, it’s an anaesthetic problem, sometimes it’s a post-op care problem. But I think the surgeon is responsible to perform the operation to the best of his abilities, to prepare the patient to the best of his abilities, and to consent the patient for all possible outcomes afterwards. And be prepared for them as well.
Dr Mooney: Really the responsibility of the guy doing the operation.
Trish: That’s true. And just lastly, recently you have had some negative media attention around the passing of two patients recently. Can you tell us about that?
Dr Mooney: I can and it’s a terrible tragic and heartbreaking thing to have lost two patients, and you know as a surgeon, every single patient you carry with you forever. And it is a heartbreaking thing. I extend nothing, and my team extend nothing but our deepest sympathies, and most heartfelt sympathies to the patients and friends of those patients.
But I firmly believe that both were a result of mismanagement post-operatively. One was a high blood pressure anaesthetic condition, the other one was care from another team and another hospital. And what’s happened is a terrible defamatory and untrue trial by media. You know the media has run these terribly defamatory articles, blaming me solely for the passing of these patients. And you know, I accept responsibility when it’s mine. But I firmly believe in both these case, their passing was due to post-operative complications, out of my hands really. But the truth can only be determined at coronial enquiry, and so a trial by media that’s going on now is a terrible misjustice.
Trish: So that’s all being addressed with, it’s all a coronial enquiry now anyway, so that’s when the truth will come out.
Dr Mooney: I’m confident that the truth will be shown, that the terrible passing of these two patients was due to post-operative complications.
Trish: Yep, yep. Oh thank you. Thanks so much for telling us about that cause it’s, you know, a difficult thing to talk about cause it’s upsetting for everyone.
Dr Mooney: And a most upsetting time for those patients and their families, me and my family, for all of our team, it’s heartbreaking, and for it to be mismanaged so terribly in it’s reportage is just the worst part of all. That’s the worst thing that could possibly have happened.
Trish: Yeah that’s speculation in the media, that’s for sure.
Well look thank you so much for your time today, Dr Mooney. Much appreciated.
Dr Mooney: I’m jealous of you living up in Byron Bay, it looks like a beautiful part of the world.
Trish: Yeah, I’m pretty lucky.
Dr Mooney: And I’m happy to speak at any time.
Trish: Awesome. Thank you so much.
Dr Mooney: Bless you.
Trish: Have a good day.
*This transcript is taken from an interview with Dr. William Mooney and Trish Hammond, founder of Plastic Surgery Hub. We have very gratefully reposted her work to inform and educate our customers. You can find more of Trish's wonderful articles at: www.plasticsurgeryhub.com.au
Trish is a plastic surgery blogger. She is passionate about wellbeing, health and beauty, and doesn't mind a little bit of 'help' from the amazing cosmetic and beauty procedures that are available today. Trish spends her days talking to women and men who are looking for suggestions and advice on procedures that are available to them. Cutting through the sales pitch and hype, a down-to-earth response on general information is what you will get.