Explore Plastic Surgery - Dr. Barry Eppley

Plastic surgery is one of the marvels of modern medicine, with a wide range of options for face and body improvements. And today’s media outlets make it easier than ever before to gather information on the latest plastic surgery procedures. But how does this information apply to you and your concerns?

Every person is unique and has his or her own desires. What procedure or combination of treatments is right for you? And what can you really expect? EXPLORE PLASTIC SURGERY with Dr. Barry Eppley, Indianapolis plastic surgeon, who can provide you with a wealth of practical and up-to-date insights into the world of plastic surgery through his regular blog posts. In his writings, Dr. Eppley covers diverse topics on facial and body contouring procedures. You will be sure to find useful information that will help broaden and enrich your plastic surgery education.

The public is widely aware of the benefits of having their plastic surgeon board-certified. There is probably no other surgical specialty than plastic surgery where this is of greater importance. This is because a significant and highly visible component of plastic surgery, cosmetic procedures of the face and body, is mostly practiced outside of oversight from hospitals and medical organizations. The economics of cosmetic surgery and other factors dictate that it is done through the doctor’s office or private surgery centers. As many doctors of various training backgrounds have embarked on performing cosmetic surgery, often with limited training, patients need to know that their plastic surgeon is adequately trained.

Board certification in plastic surgery indicates that the doctor as completed a residency training program in plastic surgery and passed an examination after this training. This makes one a diplomate of the American Board of Plastic Surgery. This examination is structured to assess the knowledge and skills in plastic surgery necessary to provide competent and high quality patient care at the time the certificate was awarded. The key phrase here is ‘at the time of the certificate is awarded’. But what does that mean over the plastic surgeon’s long career? Are they still competent and up-to-date 10, 20 or 30 years after they have achieved board-certification?

When board-certification in plastic surgery began, diplomates were awarded certificates that were lifetime achievements. Once awarded, they never had to be renewed. But in 1995 that changed as plastic surgery board certificates became time-limited and were only valid for ten years. Thus every ten years a plastic surgeon has to retake an examination to continue to be board-certified. During this ten year period, the plastic surgeon must demonstrate what is known as ‘maintenance of certification’ through a process of continuing education through a variety of methods (meeting, courses etc), demonstration of professional credentials such as hospital privileges and state medical licensure, and review and evaluation of practice performance for certain procedures. In this ten year cycle, one has to show regular evidence every three years to continue to keep their board certificate valid. This is known as the Maintenance of Certification Program (MOC-PS) which assists the plastic surgeon in maintaining their knowledge and skills during the period between board examinations.

As a board-certified plastic surgeon, I was initially put off by both time-limited certificates and the Maintenance of Certification (MOC) Program. Both seemed onerous and unnecessary and a general interference with trying to run a busy practice and taking care of patients. I felt this was particularly true of the MOC process with its more frequent requirements. But having been through the process now for several years, I have come to realize that its benefits far outweigh the perceived time inconveniences that it involves.

As well described in Geoff Colvin’s book ‘Talent Is Overrated’, top performers in any endeavor in life take time to periodically review the basic educational cornerstones of their particular profession. Our memories in life are short and it is easy to forget basic principles not to mention new insights and advancements in various fields. While some may have the discipline to do basic education on a regular basis, and many plastic surgeons do, the MOC program provides a structured and documented method to do it. When combined with the online learning available at the Plastic Surgery Educational Network (PSEN) of the American Society of Plastic Surgery, the ability to pursue regular education and to stay as competent as possible is easier than ever before.

When looking for a plastic surgery specialist, board certification and the MOC-PS mark indicate that they are doing their best to stay abreast of the high educational standards that separates this specialty from many other practitioners who many perform similar procedures.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

Inadequate training and poor judgment account for a disproportionate number of complications and unsatisfactory results that occur annually from cosmetic surgery procedures. With so many different types of doctors doing cosmetic surgery, how can one make a safe and wise choice? In days gone by, the use of the terms such as ‘board-certified’ and ‘specializing in’ were enough to demonstrate to the public a doctor’s expertise, but today that is not enough. Often these physician descriptors can actually be confusing and even deceiving.

I would advise potential patients to research the following categories for any cosmetic surgeon that they are going to see. Some but not all of information can be obtained but doing a little research online.

What Are They Board-Certified In?

Are they board-certified in plastic surgery or another specialty? Many new cosmetic surgeons are board-certified but not in plastic surgery. Their board certification may be in General Surgery, Dermatology, Oral Surgery or Ob-Gyn to name a few. Some may even have an additional board-certification in cosmetic surgery. But this self-created board should not be assumed to be equivalent to those certified by the American Board of Plastic Surgery. There is a significant difference between board-certified plastic surgeons and board-certified cosmetic surgeons that makes them not equivalent at all.

In established medicine, board certification is the result of doctors being educated through long-established training programs sanctioned by the American Board of Medical Specialties. This governing board sets the standards for the education, training and testing of doctors. Of the 24 recognized specialties and boards, plastic surgery is one of them but cosmetic surgery is not. Years of residencies done in hospitals under experienced physician mentors is what is needed to qualify for plastic surgery board certification. Cosmetic surgery allows one to use their basic training in any medical specialty, with or without some private training, to quality for their boards. This is why knowing whether the doctor has hospital privileges for certain cosmetic procedures is so valuable to know. (if you can access that information)

The American Board of Plastic Surgery is the only cosmetic surgery board recognized by the American Board of Medical Specialties. The two exceptions are the American Board of Facial Plastic and Reconstructive Surgery, which is a sub-specialty of otolaryngology-head and neck surgery and the American Board of Opthalmologic Plastic Surgery, which is a subspecialty of ophthalmology. This does not mean, however, that facial plastic surgeons are trained to be doing breast augmentations or ophthalmologists are trained in facelifts or rhinoplasty surgery.

How Often Does The Doctor Do Your Procedure of Interest?

This is a hard piece of information that is not easy to ascertain. Certainly asking the doctor seems the most obvious route to learning how many they have done, but that is not the exclusive source I would use. Look at their websites and see how many before and afters of the procedure are posted. Ask for before and after photographic results and to talk to some more recent patients. (done in the past 3 to 6 months) Word of mouth still remains as a good method of recommendation. Willingness to easily and quickly divulge this information is a good sign. Hesitancy or avoidance of doing so would be of concern.

The premise of asking or having an idea of how often the surgeon performs the procedure has, at its foundation, that there is some magical number. In reality, there is no specific number for any procedure but it should suggest some degree of frequency of it being performed. This will vary based on the type of cosmetic surgery procedure and how commonly it is requested and performed on a more global basis.

Is The Surgery Being Done In a Nationally Accredited Facility?

Hospitals are obviously certified and have to meet highs standards of care and comply with stringent regulations. Surgery centers can be quite different and you want to go to one that has been accredited by either the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This accreditation and a state license to operate means the facility adheres to safe and clean operating conditions. Doctor’s office are fine for minor surgery but most are not accredited for more significant surgeries and any anesthesia that may be needed.

Who Is Doing The Surgery?

I am often surprised after a long consultation that a new patient asks me if I would be doing their surgery. Not understanding who else would be (and having had this long discussion why I would let someone else do it), I have come to learn that this may not always be standard practice. In some cosmetic practices or centers, most of the interaction may be done with other people than the surgeon themselves or they may not see the surgeon until the day of the surgery. Insist that you meet with the ‘real’ surgeon before the day of surgery.

Is The Lowest Cost A Good Choice?

The cost of cosmetic surgery is always of concern and no one wants to overpay for their procedure(s). But the cost of cosmetic surgeries is influenced by market factors just like any other retail business. This makes a fairly consistent price range for procedures in any given geographic region. If after getting several consultations one price is considerably lower than another, the question should be why. Where are the costs being reduced to offer such a lower price? This is what makes the whole concept of Groupon and other discount programs for cosmetic surgery so unnerving. (or they should be to patients)

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

A front page article in USA today reviewed a burgeoning problem in the world of cosmetic surgery…a growing number of complications spurned by surgeons of dubious training backgrounds. As insurance reimbursements have continued downward to abysmal levels, doctors who are trained in many other medical specialities than plastic surgery are either doing or opening their own cosmetic surgery practices.

Because federal and state laws have little to no governance over what goes on in an office setting, cosmetic operations are popping up everywhere. When combined with the ease of having a professional and slick-looking presence on the internet, it is seemingly hard for the public to separate legitimate from questionable doctors and practices. With a growing age and body conscious society, there is no shortage of potential patients who are willing to spend money on a wide variety of cosmetic procedures.

We live in world now where just about anything seemingly goes. ER doctors and internists are performing liposuction, Ob-Gyns are inserting breast implants, Dermatologists are practicing facelifts and Eye doctors are having their hand at rhinoplasties, to name just a few incongruous combinations that a decade ago were unthinkable.

The unsuspecting general public understandably asks how can this be? With no oversight in a doctor’s office or in some private surgery centers, any doctor with a medical license can do whatever they want. With the allure of cash payment upfront and no interference from insurance companies which don’t oversee cosmetic surgery, little more than a doctor’s conscience separates some cosmetic operations from prospective patients.

For those procedures that require expensive equipment to perform, the manufacturers actually exacerbate this problem. They will sell any piece of equipment, lasers and liposuction machines as the most common devices, to any doctor that has a medical license regardless of their background. With such devices that cost anywhere from $25,000 to $150,000, they apparently need to expand their potential sales market. In my city of Indianapolis, I know of ENT surgeons that perform breast augmentations in their own facilities. When asking the local sales representative why would a breast implant manufacturer sell breast implants to a doctor with no formal breast surgery training, he shrugs and says we have to because that is company policy.

When you don’t have good training and a long history of satisfied patients, one of the most appealing pitches is that of a lower cost. Offering steep discounts over many board-certified plastic surgeons, lower prices help drive many non-discerning patients through the doors. With the growing discount concept like Groupon, price will continue to be a driving motivation for new cosmetic patients. But lower prices almost always reflect that the procedure will be done in the office under local or sedation anesthesia where costs can be saved. But it may also reflect that the doctor lacks adequate training and qualifications to perform the procedure in a hospital-associated or accredited facility.

While on the surface this appears nothing more than a turf battle between board-certified plastic surgeons and cosmetic surgeons, the issues go way beyond trying to stifle competition. This is an issue of adequate training, competency, and patient safety. Being trained in a plastic surgery residency program (cosmetic surgery has no residency program and is not a recognized specialty of the American Board of Medical Specialities) assures patients that the doctor has already done his/her learning on other patients beforehand.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis, Indiana

One of the many qualifiers that patients are taught to determine when choosing a surgeon to perform their cosmetic surgery  is “board certification”. While many patients look this up on a doctor’s website or inquire directly to their surgeon or his/her office staff, most people do not really know what board-certification means and how to determine its significance. Just because a doctor offers or markets cosmetic surgery does not mean that they are properly trained or credentialed to do so.

Many people assume, erroneously so, that there is some governmental agency that provides oversight as to what type of procedures that any doctor may perform. Whether it is the American Medical Association (AMA) or a state’s licensing board,  someone surely must provide control over what a doctor may do. Surprisingly, this is simply not so. Once a doctor is licensed in a state to practice medicine, there are no controls over what one does with that license.

The only regulating mechanism for which doctors may perform what type of surgery is a hospital.  This is  done by the granting of ‘surgical privileges’ from a hospital committee based on what the surgeon’s training and board certification is. Therefore, plastic surgeons are given privileges in plastic surgery, Ob/Gyns are given privileges in female health and reproductive medicine, and dermatologists are given privileges for treating skin diseases for example. As a general rule, hospitals do not give cosmetic surgery privileges to do facelifts, breast augmentation, liposuction, or tummy tucks to doctors other than plastic surgeons. While such hospital privileges are a real litmus test for qualifications, there is online method to obtain this information from a hospital. You may call your local hospital (or  any hospital where your surgeon has privileges) and ask the Medical Staff Office secretary whether your surgeon has privileges to perform cosmetic procedures in that hospital.

Because there are few regulations outside of a hospital that define a doctor’s ‘scope of practice’, it is now common to have almost any doctor perform whatever they choose in their own office or surgery center. Aggressive marketing and price incentives are very alluring for patients. As a result, there are gynecologists performing breast augmentation, liposuction, and tummy tucks as well as dermatologists and dentists performing facelifts, liposuction, and rhinoplasties. As incredulous as this may seem, it goes on in every major city and many smaller suburban areas. While these surgeons may be board certified in their own specialty, this does not mean they are board-certified in plastic surgery. So the real question is not are you board-certified, but board-certified in what?

Only one board, the American Board of Plastic Surgery, is recognized by the American Board of Medical Specialists to reflect a surgeon’s training in plastic and reconstructive surgery of the entire face and body. You can easily call the American Board of Medical Specialists (ABMS, 800-776-2378) and ask if your surgeon is certified by the American Board of Plastic Surgery. There are numerous other boards that have authentic or similar sounding names but are not recognized by the ABMS. The prestigous American Society of Plastic Surgery only granyts membership if one is eventually certified by the American Board of Plastic Surgery.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Board-Certification in Plastic Surgery: Who has it and What does it mean?

When one is considering plastic surgery, whether it be cosmetic or reconstructive, one of the first questions that patients have been advised to ask is……is my surgeon board-certified? Despite knowing to ask this question, most patients have no idea what it means or what to do with the answer. The question should not be are you board-certified, but are you board certified in…specifically…..plastic surgery. And you don’t even have to ask that question to the doctor directly, you can find that out even before you make an appointment. While you can go to his/her website today and get that answer, but it may be misleading. The misleading indicators are:

- Stating that one is board-certified, but not specifically saying in what specialty. Being board-certified in Dermatology or Family Practice, for example, is obviously not the same as being boarded in Plastic Surgery. A weekend course or seminar does confer the same experience and skill set as years of actual training.

- Stating that one is board-certified in Cosmetic Surgery. This is the one that is the most misleading because it conveys equivalency. Being board-certified in cosmetic surgery is not the same as being board-certified in Plastic Surgery. Plastic Surgery is one of the 22 recognized medical specialties by the American Board of Medical Specialties (http://www.abms.org/) and has been training plastic surgeons through organized medicine and its own recognized board (American Board of Plastic Surgery) since 1937. The American Board of Cosmetic Surgery is not a recognized specialty by the American Board of Medical Specialities. Rather it is a more recent political invention created by physicians and dentists from many other specialties to provide a forum for limited training through meetings and courses in areas of cosmetic surgery. As such, there is no residency program that provides years of cosmetic surgery training in this group. Most doctors certified by the Cosmetic Surgery Board have their residencies in other disciplines such as Ob-Gyn, Dermatology, and Oral Surgery.

The American Board of Plastic Surgery is the most prestigous distinction that any plastic surgeon can achieve in the world. To be certified, one has to complete a two to three year residency training program in plastic surgery after completing prerequisite training in
another surgical discipline, most commonly general surgery. After training is completed, a combination of written and oral examinations are required to attain the status of board-certification in plastic surgery. Every ten years one must re-certify by taking a repeat examination, assuring that one has maintained an adequate knowledge base in the areas of plastic surgery that one primarily practices.

It is easy to find out if your doctor is board-certified in plastic surgery. Simply go to the website of the American Board of Plastic Surgery (http://www.abplsurg.org/) and see if you doctor is listed as a member.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

How Good are the Plastic Surgeons of Reality TV ??

The explosion of reality TV shows on plastic surgery and the public’s thirst for them has been one of the principle driving forces behind the large increase in cosmetic surgeries that have been done in the past five years. From Extreme Makeover to Dr 90210 to even Nip Tuck (obviously not a reality TV show…rather unreal….grossly misrepresentative of the average plastic surgeon’s life), the merging of cosmetic surgery with TV has been a very fruitful marriage in terms of viewer interest and ratings.

What is not apparent, however, is the qualifications of the plastic surgeons who are on these shows. As it turns out, some of them are not even board-certified. As I point this out to my patients who frequently ask question about these shows, they are usually quite surprised. How could this be, they ask? The answer is simple……the most important criteria for being on TV is…..appearance, personality, and how one comes across to the public…in short, being comfortable in front of a camera and being pleasing to watch. ‘Acting’ is more important than medical qualifications. After all, it is a TV show first and foremost.

Why would a plastic surgeon not be board-certified in today’s world? They either aren’t qualified by training to take the examination, have taken it and failed, or simply don’t see the benefits of having board-certification. After all, once you have a TV show, your practice will grow exponentially, regardless of board-certification. The public assumption is that if you on TV, you must be the most qualified or the best in your field. Maybe…..or maybe not!

Remember…being on TV is not a criteria for medical skill assessment…..it is more an indication of camera persona and viewability…..probably not the criteria you would use first and foremost to determine who should cut on you.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com/
http://www.ologyspa.com/
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

Demand for cosmetic plastic surgery continues to increase. Last year, Americans spent over $11 billion on 11 million cosmetic procedures, a 50% increase over the number performed in 2000. While TV shows like Extreme Makeover or Dr. 90210 always show great results, cosmetic plastic surgery is not without risk. After all, surgery is surgery.

The most common dangers or ‘complications’ are numbness, seroma, and poor healing (necrosis). Temporary numbness or loss of feeling at the site of the incisions is common in facelifts and tummy tucks, although it is rarely permanent. Seroma is a collection of watery body fluids that occurs most often in tummy tucks and usually a preventative measure, such as inserting a drain during surgery, is often done. Some tissue death from surgical handling, known as necrosis, may occur when long incisions are made on the body and the skin is widely undermined. This may result in incisions coming apart as the skin struggles to heal the cut edges. Your risks increase significantly for that problem if you are a smoker. That’s because smoking affects blood supply to the tissue, furthering the injury due to the surgery. While everyone worries about infection, these are fairly rare in plastic surgery patients, since most are healthy to begin with.

The single best way to lessen the likelihood that these problems may occur is to have a competent surgeon doing your procedure in the right type of setting or location. This can be done by:

- Make sure your surgeon is board-certified in plastic surgery. This is the only
organization that certifies competency in all areas of plastic surgery. You can
check our your surgeon’s standing with the American Board of Plastic Surgery,
based in Philadelphia.
- Make certain your surgeon has the necessary experience to perform the procedures
you want. This can be done by asking for their before and after surgery examples,
given a name(s) of patients that have had the procedure in the past 30 days so you
can speak to one of them, and ask questions until you are satisfied. If you meet
resistance or delays on any of these requests, find another surgeon!
- Make certain that your surgery is going to be performed in a hospital or surgery
center that is a fully accredited facility. For hospitals, this is the JCAH (Joint
Commission on Accreditation for Health Care Organizations). For surgery centers, this is the AAASC (American Association of Ambulatory Surgery Centers).

These three simple and easily verifiable qualifications will help ensure that you have the best chance for a good plastic surgery result.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis