Is anyone disappointed with their cosmetic outcome?

[CHRIS WBS]

Today is two years since my surgery and overall I am quite pleased with the results and have no regrets. (In my first post I asked if anyone regretted their decision to have surgery.) I am also thankful that I experienced no complications whatsoever and have had a relatively easy recovery. Except for a recent issue with inflammation, I’ve had no problems associated with this surgery and no need to contact my surgeon’s office. I have to admit though that I am disappointed with my lack of cosmesis. The past few years I have seen so many awesome before and after pics posted here; and I was hoping to do the same. I had my sister take a picture of my back the day before my surgery and would have posted my results if they were worth posting. But when I look in the mirror, I still see an ugly deformed back that now has a long red scar on it. While my x-rays are impressive (there’s clearly quite a difference in the before and after), my outward appearance really hasn’t changed. I’ve read where so many of you describe getting stretched out resulting in a defined waistline and an elongated torso. I did not get that. I lost 2½” in height since I was 50 but gained only one inch after surgery. After going through this horrendous surgery, I now sort of feel like I got shortchanged. Does anyone else feel this way?

[LindaRacine]

Today is two years since my surgery and overall I am quite pleased with the results and have no regrets. (In my first post I asked if anyone regretted their decision to have surgery.) I am also thankful that I experienced no complications whatsoever and have had a relatively easy recovery. Except for a recent issue with inflammation, I’ve had no problems associated with this surgery and no need to contact my surgeon’s office. I have to admit though that I am disappointed with my lack of cosmesis. The past few years I have seen so many awesome before and after pics posted here; and I was hoping to do the same. I had my sister take a picture of my back the day before my surgery and would have posted my results if they were worth posting. But when I look in the mirror, I still see an ugly deformed back that now has a long red scar on it. While my x-rays are impressive (there’s clearly quite a difference in the before and after), my outward appearance really hasn’t changed. I’ve read where so many of you describe getting stretched out resulting in a defined waistline and an elongated torso. I did not get that. I lost 2½” in height since I was 50 but gained only one inch after surgery. After going through this horrendous surgery, I now sort of feel like I got shortchanged. Does anyone else feel this way?

Hi Chris...

I had the same sort of outcome. I gained about an inch in height, and no noticable difference in my rib hump. I can't tell you why some surgeons get great correction from the procedure while others do not. It could be the implant system that is used, or just a difference in technique.

Sorry to hear that you're not as pleased as you might have been. While I'm sure most of agree that cosmesis is really a minor part of the overall picture, it definitely can make a difference in our overall satisfaction.

Regards,
Linda

[jesscv]

I think the amount of rib hump correction depends on the degree of vertebral rotation. Even if you have mild or moderate scoliosis, you can still have significant rotation. The rotation can typically be reduced during surgery, but sometimes not a very significant amount, unfortunately.

[Davis]

out of curiousity, were both of your surgeons SRS listed? Did you discuss much about the aesthetic outcome with your DR before the surgery?

[LindaRacine]

out of curiousity, were both of your surgeons SRS listed? Did you discuss much about the aesthetic outcome with your DR before the surgery?

Mine is. We did discuss it, but it wasn't a huge issue for me.

What I've found, now that I know a lot of surgeons, and a lot of patients, is that there's a huge difference between surgeons that perform 10-20 of these surgeries a year, and those who perform a lot more. I work at UCSF, where many of the surgeons perform 50-100 scoliosis surgeries a year. On many of the post-surgical patients that we see, if it wasn't for a scar, one would not be able to tell that the patient ever had scoliosis.

With that said, I'm sure there are times when the rib hump cannot be improved without thoracoplasty because of the stiffness of the curves.

--Linda

[jesscv]

yep, my surgeon was an SRS member. he told me my "hump" would be greatly reduced, but not entirely. and that's exactly what happened...

[Back-out]

...On many of the post-surgical patients that we see, if it wasn't for a scar, one would not be able to tell that the patient ever had scoliosis.

With that said, I'm sure there are times when the rib hump cannot be improved without thoracoplasty because of the stiffness of the curves.

--Linda

Sounds great, Not for the first time I'm wishing I lived in SF where I went to school!

This business of "curve stiffness" - is there a rough and ready way (through attempted stretches etc) to tell how stiff one's curves are? I SEEM (to me) to be pretty flexible, scoliosis notwithstanding.

Examples: my curve is 30 deg thoracic (apex more to the left) and 60 deg. lumbar (apex to the right). Still standing or lying, I can bend well side to side - left lateral a bit harder as one would expect - and also twist into most if not all yoga positions (no, I can no longer easily put my knees behind my neck anymore, though).

It's the (ugh) kyphotic lumbar hump that just stays put more or less. I.e., when I lie on the floor I feel it touching a lot more on the lower left, and if I try to do crunches twisting my waist in that position, I tip over on the right because of it.

To repeat my main question (bolding for clarity) , is there anything else I can do to get even a vague idea abt my stiffness and possible correction? Naturally, I plan to ask surgeons on future consults (this among much else, I missed asking the first go round ). No one has said a word to me about my degree of rotation, but I gather this is behind the kyphosis - so much so, that the third surgeon said he only needed to start the fusion at T10 (instead of T4) and that the rest could be corrected by "unwinding" me - correcting the rotation. I THINK that would correct the rib hump, though I am kind of confused about whether he's right (that starting this low would suffice) or if the other two are right, that they would need to start at T4.

[CHRIS WBS]

My surgeon is an SRS member who does perform at least 100 surgeries a year according to what he told me. I do not have a rib hump. My curve was mostly lumbar. But I did not get stretched out through the mid-section and I still have asymmetric folds and creases where I had hoped my waistline would have been more defined.

[Back-out]

And Chris,

Not to hijack your well-thought out thread...I feel for you being disappointed about the less-than-desired cosmetic correction obtained. I know you try hard to be realistic and upbeat, and I am sure you hesitated to express sadness about this aspect of your surgery, considering you obtained satisfactory results otherwise (that is, not counting for the time being, your still-mysterious inflammatory episode).

I'm sure many share similar disappointment and will now feel freer to express themselves. It does seem too bad that you didn't get a dramatic change here, after going through so much! I wonder what questions to ask prospective surgeons to at least know whether a given surgeon feels he will be able to achieve a good cosmetic (as well as functional) result. Also whether some are just plain better/more experienced with certain kinds of curves.

I'm wondering how to investigate this at interviews. I tend to be polite and this is not really an area for "good manners". I guess the questions have to be pretty direct and unambiguous, in asking about their experience with one's own kind of curves and condition: what the surgeon expects/hopes to be able to accomplish and what will be more of a "wait and see" situation. For that matter, what they're pretty sure will NOT be able to be achieved!

Whatever, although I am sorry for your letdown feeling (especially hard on this Board with so many stunning results), I'll bet others don't notice it much, if at all. Guess we've all been over this many times - how little other people really notice the fine points of our physique within a certain range of "normal". I used to do art restoration and the goal was to alter damage so the viewer's eye wasn't drawn to the correction. If they knew where to look, it was almost always visible.

[Doodles]

Chris--I understand your feelings completely. I did get about 1 and a half inches and am more stretched out and less squished. I was most worried about my torso/rotation tip to the left for the first several months after surgery. Now that is still there but the rib hump just haunts me. It is better than before surgery but has gotten worse since after surgery. The rib hump is what really bothers me; I have the mirror out about twice a day checking to see if it's worse. I try not to for a few days and then it just looks more shocking. Dr. Lenke had done about 700 adult patients before me with the posterior only and I know he did what he could with me. I don't know my rib hump number before or my rotation number. Somehow that was never mentioned and I didn't know there was a number for it. I just know it was bad. The rib hump is now a 12. Maybe it just seems bad through my eyes. I've toyed with hypnosis or something to make me stop obsessing about it. My husband swears it's fine since he knows there's nothing to be done. When I showed two of my daughters in the last few months they said--well, it isn't horrible. Plus, my scar looks no different than it did at about 3 months. OK, I'll stop whining now. But it felt kind of good to get that out. Sorry, still in the long run I know I had to do it and would do it again with these results. I just wish I didn't still have to think about it all the time! Janet

[Confusedmom]

Hi Chris,

I went to see Dr. Gupta a few weeks ago for a third opinion. I got the impression that he prioritizes patient comfort and reduced risks over cosmesis. He told me that he would do a 6-hour, posterior-only fusion on me from T8-L5 even though it would result in a lesser correction because it would be "good enough." He said: "Your back will look like it did in college again, and that would be good enough, right?" Basically, my 68* curve would go down to about 30-35*. While that would obviously be an improvement, I did have some hips/waistline assymetry even back then.

Also, he said he would use a bone bank rather than bone graft from me to reduce pain. Also he said since I have a stiff curve (Amanda--bending xrays give you some idea of this), he would not try to get an extreme correction. Overcorrecting can lead to decompensation, I gather.

I left with the feeling that he would competently do the job (of stabilizing my spine to prevent further progression) and spare me a lot of risk and pain that a more aggressive surgery might cause. By contrast, my local surgeon wants to do a 12-hour A/P job from T4-L5.

So, I guess what I'm trying to say is that maybe with Dr. Gupta you gave up some cosmetic correction to have an easier time with surgery/recovery and less risk of complications. (Less aggressive surgery=shorter surgery=less time under anesthesia=less blood loss.) So, in the end it might be preferable to trade a little cosmetic improvement for a safer outcome. I could be wrong about this, of course, but that's the feeling I got from him.

Evelyn

[jrnyc]

i wouldnt trade the NYC surgeons for any in the world! they are the best! do not think that is coming from a prejudiced native New Yorker...
worth the trip for those who live in nearby states...as much as worth the trips to CA for those who live a few states away from there!
never heard of a 30 degree curve being operated on...my 42 thoracic will be ignored...and fusion will start at T11...the surgeons would like me to continue to have the botox shots in upper back after surgery, though...
true flexibility is best tested lying down, without the (amazing) help of gravity to pull the body over when bending standing up...whole other shocking story laying down on table!

jess

[Shari]

Hi Chris W., I can still remember your posts from years ago. I think the older we are when we have the surgery, the less flexible our spine is.

This surgery is not always a cosmetic fix, even though we think that after going through such a complicated surgery, it seems to come with the territory that we automatically will get the cosmetic result, as well as the stopping of the progression, and relief of the pain.

We are all different, and you still have a special place in my heart.
Shari...XOX

[CHRIS WBS]

Excellent observation, Evelyn. I think you’re right on target. And I think Gupta’s position stems from his fellowship training under Bridwell. Before I saw Bridwell, I had consults with Dr. Hammerberg at Rush and Dr. Schafer at Northwestern. They both recommended T2 to pelvis and a big anterior. Schafer even suggested an ALIF in addition (3 surgeries). So I was quite surprised when Bridwell recommended T8 or 9 to pelvis and only posterior. Initially Gupta recommended A/P from T4 to pelvis, but as my surgery date neared he changed to posterior only. And I believe one of the reasons was because of the increased risk for infection that comes with a staged approach. My posterior was 12 hours, so mine would have had to be staged a week apart. He talked about me actually leaving the hospital after the first procedure and returning for the second. Are you comfortable with Gupta’s recommendation for you?

Janet, thanks for your input. I’m sorry you did not get the desired outcome regarding your rib hump. Sometimes I think there’s only so much they can do for those of us who are older. Your scar should begin fading. I’m fair-skinned and for the longest time my scar was bright red. It’s been two years but I am seeing more of it fading with time.

Shari, thanks for your kind words. I think you’re right. Age and severity of deformity are huge factors. Both lessen your chances for a glowing cosmetic improvement. That’s why I shudder when I read where people with already severe curves say that their doctor recommends waiting. Wait for what?

Jess, just ask Suzyjay about her wonderful experience with a top NYC surgeon. Stuff happens regardless of the surgeon or where you have surgery.
http://scoliosis.org/forum/showpost....62&postcount=6

[jrnyc]

hi Chris
oh, i know how rampant infections can be in hospitals! but i figure with the best surgeon, i up my odds for a good outcome...and everybody knows NYC has the best! (especially we native New Yorkers, who are not at all prejudiced in favor of our native city ) we are completely objective in believing that NYC is the capitol of the world!

jess