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
Indianapolis, Indiana