Selecting a Plastic Surgeon

Today’s marketplace has seen an influx of surgeons wanting to supplement their practices with cosmetic cases. Did you know any licensed medical doctor can legally perform cosmetic surgery? The prospective patient must proceed with caution. At a minimum, selection criteria you use in evaluating a plastic surgeon should include:

• Graduation from a recognized school of medicine
• Completion of ACGME (Accreditation Council for Graduate Medical Education accredited residency)
• Licensure as a physician and surgeon in the state in which you will be having the procedure
• Board Certification in one of the four specialties that legitimately and routinely perform cosmetic procedures within their scope of practice (dermatology, head and neck surgery, ophthalmology and or/plastic surgery)
• Privileges in a nearby hospital to perform the procedures in which you are interested

In order to perform cosmetic or aesthetic procedures at the highest level, a surgeon must complete at least a decade of additional specialized training after college. Some doctors elect to participate in specialized training called fellowships, in specific areas of interest within the specialty. (See below) These surgeons customarily hope to focus their practices on specialized areas in cosmetic and aesthetic plastic surgery.

Example: You are interested in liposuction and visit a doctor who advertises "cosmetic surgery.” Other patients in the waiting room give you the impression that he/she is a general surgeon. Proceed with caution in this scenario, as this is not the defined scope of practice for a "general surgeon.”

Example: If you want a breast augmentation, you may not be a good match for a reconstructive plastic surgeon whose brilliance lies in treating patients with burns, birth defects or cancer.

Questions: Are you a plastic surgeon? Tell me about your subspecialty training. What percentage of your practice is dedicated to reconstructive vs. cosmetic? What three to five procedures represent the majority of your cases?

Strongly consider whether your plastic surgeon is certified by the American Board of Plastic Surgery. This is the only plastic surgery board recognized by the American Board of Medical Specialties. You can check to confirm that your surgeon has had this extensive and unique training in plastic surgery and successfully passed the exams by checking with the American Board of Plastic Surgery at 215-587-9322.

Keep in mind that while this is an important and prestigious credential, it will not guarantee that your particular surgeon will have the skill level to provide you with the results you want. Remember too that there are many talented surgeons certified by other specialty boards with whom you may feel a special connection. Such surgeons have excellent surgical skills and may be able to provide you with quality results. Some specialties you can expect to encounter during your search include: Dermatology, Otolaryngology (head and neck), Ophthalmology (eye and facial) and Plastic Surgery (facial, body, reconstructive). Again, it is very important that you consult with a surgeon who is not practicing beyond the scope of his or her training.

Example: You are considering an eye lift. You could get good results with a board certified plastic surgeon that routinely performs this procedure, or might be just as happy with an ophthalmic plastic surgeon whose training is concentrated exclusively on the eye and areas around the eye.

Example: You are considering a breast augmentation. A "facial plastic surgeon" advertises that he or she performs them. It is probably wise to look elsewhere for someone who has appropriate training and experience in breast augmentation. (Facial plastic surgeons should limit their practice to the face)

Question: Are you board certified in the specialty addressing the procedure in which I am interested?

A "fellowship" is an elite qualification that only a small percentage of surgeons performing cosmetic plastic surgery can claim. As noted above, a surgeon who has had an additional "fellowship" of training has completed focused and intense specialized training in a particular area of interest, usually under the guidance of a well-known and talented surgeon or group of surgeons. Fellowships typically last from 3 months to 2 years. This underscores a surgeon’s interest, commitment, and experience in performing procedures in that area of specialization.

Example: Some plastic surgeons go on to complete fellowships and/or additional specialized training in aesthetic/cosmetic surgery, microsurgery, craniofacial surgery, hand surgery, breast reconstruction surgery, etc.

Question: Are you fellowship trained in any area related to cosmetic surgery?

Society membership: Society membership is entirely voluntary. In many cases, it reflects the desire and ability of a surgeon to pay dues to that particular society. Some societies such as the American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) require that their members are board certified before being eligible for membership.

It should be noted that if you are considering aesthetic or cosmetic plastic surgery, the surgeons within the membership of the ASAPS are generally more focused on those particular procedures. Likewise, members of the "Rhinoplasty Society" are more likely to have developed a unique interest in Rhinoplasty surgery. Again, membership in these societies is voluntary and not mandatory, and do not necessarily assure you of a particular skill level or a successful outcome.

There are literally hundreds of societies that plastic surgeons can join if they choose. Each doctor has to make a decision for themselves if becoming a member offers any advantages. There are thousands of very qualified and capable surgeons such as Dr. Fisher who have made a conscious choice to not become a member or renew membership in the plethora of various societies.

Board Certification: Certification by the American Board of Plastic Surgery is the culmination of the extensive, rigorous, and unique training experience in plastic surgery. This training reflects a commitment, not only to the profession itself, but more importantly, to the consumers who seek the surgeon’s advise and expertise. As a practical reality, arduous and meticulous training and examinations unfortunately do not guarantee technical skill, measure artistic and creative endowment, or provide the assurance of exacting judgment in the operation room. There are many surgeons who excel in test taking rigors, but lack the patience and meticulous skills demanded and required to plan and carry our extensive operative procedures.

"FACS" after a doctor’s name and "MD" (John Doe MD, FACS) denote that that doctor is a "Fellow of the American College of Surgeons". Only board certified surgeons are eligible for membership.

Many deserving doctors spend a great deal of their time writing and publishing scientific journal articles and serving on professional committees. Undoubtedly, this benefits all plastic surgeons and ultimately, all patients. However such service is no yardstick of their ability to perform exacting surgery. It is worth noting that at consultations to evaluate professional skill, patients do not typically request information regarding managerial administration, journalistic reporting, or committee membership. Patients are seeking someone with whom they can communicate clearly, develop a trusting relationship and provide the best possible surgical result.

Most physicians who choose to become members in various plastic surgical societies are not elected to steering committees and may not be proficient or the least bit interested in journalistic publication. Many are excellent technical surgeons with superb judgment, and they represent appropriate choices to perform demanding surgical procedures sought by consumers.

Media Exposure: The fact that a surgeon has been featured in the media, sought after to provide opinions in popular magazines or has authored articles for these magazines, is no indication he/she can operate with great skill and offer meticulous results. Employing talented public relations personnel does not necessarily equate with the deployment of an artistic scalpel.

The attainment of professorial status and rank at a major medical university does not provide assurances that such individuals will be able to achieve the operative goals that patients desire. Some who hold the academic rank of "professor" or "chairman" of a department have reached such positions because of political skills, desire to be in academic medicine, administrate and teach students, ability to publish journal articles, and aptitude at raising money for their departments. While these contributions are in inestimable value, and deserve the respect of the entire profession, they do not necessarily translate to gifted operation room skills and judgment.

Example: You have "surfed the web" and learned there are some surgeons in your area that seem to have strong affiliations with the university and have written papers on the latest techniques regarding your procedure. Doctor X has his own talk show, Doctor Y is on TV. Others just operate.

Question: Now, it is your turn to answer a question: While impressive, what makes academic status, media celebrity, far reaching marketing campaigns, and journalistic endeavors necessary indications of one’s ability to perform exacting surgery? Many qualified surgeons advertise. Recognize these ads for the paid marketing campaigns that they are. Shouldn’t you be cautious if you are promised outstanding results, ease of recovery or lowest price on a billboard? During your consultations, you should be evaluating surgical skills and results regardless of any other extracurricular activities that the surgeon chooses to advertise.

Consulting with surgeons that have been recommended to you by satisfied patients is a great way to start. However, keep in mind your desired result may differ from your referral source. Your individual anatomy will influence the results. In addition, are you considering the exact same procedure?

Example: Don’t be too quick to draw a conclusion if your friend had a fabulous facelift, but you want liposuction. These are two very different procedures. Even if you are interested in a facelift, you must still be diligent in discussing your particular options with her surgeon because of the individual nature of each cosmetic surgery.

Excellent sources of referral are other medical personnel: doctors, nurses, anesthesia specialists, surgeons, etc. A doctor’s reputation is his life. Most important: Was this plastic surgeon recommended to you as a surgeon who other plastic surgeons would let operate on their own family members? That is the best referral.

The surgeon’s "before and after" gallery is full of clues if you know how to properly evaluate the photos. The "after" should look better, but not too different or exaggerated. Study the artistry and style—every surgeon is unique. Be certain both photos have the same lighting, angle, and profile. Hair, makeup and overall expression should be similar if you are studying the face. Beware of Internet photography as it can be easily altered.

Questions: Can I see before and after pictures? Are these your work or generic photos? Can I meet or talk to a patient who has had the same procedure? Ask to see good results, excellent results and challenging cases.

Ask your surgeon who he or she will be using to administer your anesthesia. Not all plastic surgeons utilize board-certified anesthesiologists during surgery. Some use non-certified anesthesiologists or nurse anesthetists. There is a marked difference between the two.

Anesthesiologists are fully licensed doctors who have chosen to specialize in the area of anesthesiology. The must obtain a bachelor’s degree after four years of pre-medical studies, four years of medical school resulting in an M.D. or D.O. degree, followed by a four-year anesthesiology residency program – for a total of twelve years.

Board certification is obtained when an anesthesiologist meets the American Board of Anesthesiology requirements and passes both written and oral examinations. Board certification is not a guarantee but is an indicator of competency and depth of knowledge. Anesthesiologists are doctors first, then become specialists in the area of anesthesiology.

In contrast, licensed nurse anesthetists obtain a bachelor’s degree in nursing and then complete a two to three year nurse-anesthesia training program. One-year experience as an acute care nurse is mandatory.

There are some "grand fathered" nurse anesthetists in practice today who have completed four years of total training to prepare them to administer anesthesia. While these anesthetists may have successfully administered anesthesia thousands of times, they are not doctors. At the core of anesthesia practice is an understanding of the complex mechanisms of the human body in health and disease and how various chemical agents affect bodily systems. In addition to rendering you unconscious and having you awaken comfortably, anesthesia providers must be prepared to anticipate reactions and deal with changes in the patient’s physiological condition in a matter of seconds.

Be absolutely sure your surgeon has privileges in a nearby hospital to do the procedures you are considering. In the majority of cases, your operation will take place in a surgery center – either in an off-site facility, or within the doctor’s office. However, in the event you have a complication and need to be hospitalized, this privilege is critical.

Privileges in a hospital are granted after the facility has verified the training and experience requirements for the privileges requested. It provides additional screening mechanisms for your surgeon’s credentials.

Your surgeon’s surgery center must be accredited for safety. There are three accreditation bodies:

• American Association for Ambulatory plastic Surgery Facilities (AAAAPS) 847-775-1970
• Accreditation Association for Ambulatory Health Care (AAAHC) 847-853-6063
• The Joint Commission on Accreditation of Healthcare Organization (JCAHO) 630-792-5800.

Questions: Where will the surgery take place? What accreditation does it carry? Who will administer the anesthesia? In which hospitals do you carry the privileges? How close are they?

Some people want to combine their cosmetic improvement with an exotic destination. Many of these surgeons promise lower fees and a luxury setting. Be wary of leaving the protection of U.S. standards behind.

Questions: Where were you educated? What credentials do you hold? What happens if there are complications? Who is administering the anesthesia? What do I do if I am not satisfied after returning home?

Integrity, compassion, good communication skills, perfectionism, solid judgment, and artistic eye: these are the personal characteristics that patients would like their surgeon to have. They are also quite subjective. During your consultation, be sure you take enough time to determine if there is a positive connection between you and the surgeon. Your deliberation will ultimately be a blend of both concrete answers and intuition.

Questions: (to ask yourself) Am I comfortable? Do I understand him/her? Are they taking enough time with me? Do they seem honest about risks, recovery, and my expectations? Am I getting a sense he/she is thorough and meticulous? Does he/she explain all the aspects of a particular procedure? Have I been given a clear vision of what is artistically possible and can he/she do it? Does he/she surround himself/herself with a topnotch staff?

Be a patient with patience. Don’t rush. Most cosmetic procedures are elective, not emergencies. Time spent learning about your provider and options will pay great dividends in the long term. You should meet with a number of different board certified plastic surgeons for the purpose of hearing the recommendations of surgical and non-surgical alternatives. The surgeon may ask you to consider different or additional procedures than you originally intended.

A good surgeon will tell you what can and cannot be achieved in accordance with your age, skin, body type, medical history and the limits of technology. If you are talking with a surgeon you trust, he or she should be able to explain why these procedures will enhance your overall result. Consult with the one you ultimately choose as many times as necessary to feel comfortable with your decision. Take the advice seriously if more than one surgeon feels the risks of the surgery you are requesting outweighs the benefits.

Selecting a plastic surgeon can be a difficult and confusing process. Pease consider reviewing additional information and questions offered on The Naked Truth series. Many patients have found these to be helpful during their search. In the end, it is a personal decision that each patient must make for him or herself.

The award-winning "Naked Truth About Plastic Surgery" videos are incredibly comprehensive videos (1-2 hours each) covering common plastic surgery procedures. They will help you understand each procedure in great detail as well as the risks, benefits and alternatives. The "Naked Truth" is aided by live video footage of patients just like you going through each procedure (no graphic surgery or blood), with hundreds of before and after photos, graphics, illustrations and demonstrations. You will learn how to select a doctor, what questions to ask and ways to make your consultation time more efficient, memorable and effective.