Decisional authority' and compliance in cosmetic limb lengthening: A reverse patient-consultant role? Lies and noncompliance and their role in complications

Introduction: Cosmetic lengthening are heavy procedures, often undervalued by patients, decided for psychological improvements of their life and not for diseases or deformities. The surgical trauma can induce a subconscious freeze stress response; at that moment, the 'emotional brain' takes over the 'rational brain' for actions. Previous trauma or archaic imprints resurge and constitute references for these actions. Rational thoughts are lost. As a result, patients take the Decisional Authority over the surgeon for treatment decisions and become non-compliant to guidelines of the surgeon who is the 'knowledgeable person' in the treatment. Reaction patterns are 'Fight', 'Flight' or 'Fright'. Materials and Methods: A series of 288 cosmetic lengthening with fully weight bearing nails pointed out the patients reaction patterns, some failures of traditional psychological and psychiatric evaluations, the need for treating previous trauma (e.g. the 'Fast-Reset' technique) and having a strong physical and psychological coaching to secure a constant result. Results: Lies, sometimes difficult to detect, and deviations from guidelines generate complications, some resulting in new surgeries. Real responsibility of the patient in complications should be evaluated. Conclusions: Separating the patient and surgeon responsibilities will help to better anticipate and support deviating patients, in order to secure a faster and optimised physical and psychological results, and a quieter Patient-Doctor relation.