Cosmetic surgery

Last year, more than one million cosmetic procedures were performed on Americans. Once exclusively for the rich, an increasing number of middle-class Americans are getting skin-tightening and fat-removing cosmetic procedures. Although traditionally more women have sought cosmetic surgery, men are catching up; today nearly one out of every three cosmetic operations is performed on a man. Increased demand for these procedures has led to increased competition among surgeons, and many have turned to radio ads, toll-free telephone numbers, and glossy brochures to attract customers. As a result, consumers need to be savvy when selecting a plastic surgeon.

The Doctor's Qualifications

Depending upon which type of cosmetic surgical procedure you want done, different kinds of physicians may be qualified to perform the job. Two terms the cosmetic-surgery-seeking consumer will probably come across (and may be confused by) are "cosmetic" and "plastic" surgery. A cosmetic surgeon is a specialist in surgical procedures that enhance one's looks, such as breast reductions/enlargements, facelifts, hair transplants, and other proceedures. A plastic surgeon is a doctor trained in reconstructive surgery such as hand surgery, skin grafts, cleft palate repair, and other procedures to help the individual function better. Plastic surgeons are also trained in cosmetic surgery.

Many consumers prefer plastic surgeons because they have been trained in general surgery as well. Surgeons other than plastic surgeons may or may not be trained in general surgery.

Another specialist you may encounter is the otolaryngologist. This physician has had training in the stucture and physiology of the head and neck, disorders of the ears, nose, and throat, and can perform reconstructive and cosmetic surgery of the face, head, and neck.

Board-Certification.

A mind-boggling number of medical organizations (often known as a board, society, or association) has evolved that certify a physician is competent. You must be able to separate the meaningful documents from the "wall decorations." In general, it's important to distinguish between two words: boards and academies.

A board evaluates the level of a physician's knowledge in a specialty by administering an examination (typically there are written and oral components to the exam). Most boards have several requirements including the completion of a formal residency training program in a designated field. Physicians who pass the exam are considered "board certified" in the medical specialty in which they were tested. Although board certification does not ensure the competency of the physician, it is one indicator of a well-trained physician. You can confirm your physician's certification by contacting your county medical society or state medical board.

Since there are many boards that certify physicians, and different boards may have different qualifications and standards for potential candidates, you should know what each board requires of its applicants.

An academy (as well as an association or society), on the other hand, serves an educational purpose; it typically offers seminars and workshops to develop the physician's skill further in a particular field. Membership in an academy may or may not mean that a physician has been continuing his medical education; it may, for some, simply signify that dues have been paid.

How can the consumer determine whether a particular board is legitimate and qualified to test applicants? Many physicians feel that only American Board of Medical Specialties (ABMS)approved boards are legitimate. A book called the Directory of Medical Specialists, which may be found in many public libraries, lists the names of surgeons who are board-certified.

What to Look For In a Plastic Surgeon

Experience. Regardless of surgical specialty, one of the most important pieces of information you'll need to uncover is the amount of experience the surgeon has had with the specific procedure you want performed. Find someone who has performed hundreds-if not thousand f procedures of the type you want done, and comes highly recommended (from someone you trust). For example, if you are considering a collagen injection (a procedure performed to smoothen wrinkled lines or make certain areas appear more full), a surgeon who has performed hundreds of rhinoplasties (nose jobs) may not necessarily be proficient at collagen injection. Find a surgeon with a proven track record in the specific procedure that you desire.

Evidence of Continued Training. Try to establish that the surgeon has continued training since his residency. One example of the need for continuing education is liposuction. Since liposuction was not introduced in the United States until 1982, surgeons who have completed a residency program before then probably were not trained in liposuction, although they may be highly trained in other cosmetic procedures. These surgeons would need to have completed courses, workshops, or residency programs to develop skill in the liposuction proceedure.

Openness.

Your surgeon should put the operation in perspective for you. Potential side effects-such as bruising, swelling, pain, and infection-should not be glossed over. Your surgeon should explain both expected and potential side effects in a practical manner. No surgical procedure is risk-free; your surgeon should identify the potential risks and the probability of their occurrence. In addition, your surgeon should be open about referrals. Ask to speak with some of the patients on whom he has performed surgery. If the surgeon has done enough procedures, and is good at it, he won't mind.

Answers Your Specific Questions. You have every right to ask specific questions, such as, "Would you use general or local anesthesia in my case?" (Some surgeons use general anesthesia simply because it is more convenient for them, but it is often riskier for you. If your surgeon prefers to use general anesthesia, ask him why he chooses this method.)

Encourages and Is Responsive to Self-Disclosure.

This means a surgeon should try to determine why you want the procedure. Good surgeons typically inquire why you want a particular procedure; they may, for example, be trying to uncover whether you want to look better to satisfy yourself or to become the president of your company. The former is a realistic goal; the latter will probably lead to disapointment. Seek a surgeon who asks you about your motivations for and expectations from surgery.

Hospital Privileges.

You want a surgeon who has hospital operating room privileges (even if your particular procedure will be done in his office). Hospitals do not issue rights to just any physician; hospitals require physicians to meet several criteria before they are allowed to perform any surgical procedures there. This is an additional although certainly not foolproof-assurance of your physician's capability.

Last updated Jan 4/07