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How to Choose a Qualified Plastic Surgeon

If you're considering plastic surgery...

The term "plastic" comes from the Greek word "plastikos," meaning to mold or give form. Plastic surgery does just that - it gives new form to the human body. The specialty includes two kinds of procedures: reconstructive surgery, or procedures done to repair birth defects and deformities caused by accidents or disease, and cosmetic or aesthetic surgery, including facelifts, nose reshaping, fat suction and other procedures done to enhance appearance.

No matter what type of plastic surgery you're considering, the most important factor in its success is the surgeon you choose.

How can you find a well-trained, qualified, experienced plastic surgeon? This information can help you make an informed choice. It was prepared by the American Society of Plastic Surgeons (ASPS), a professional society dedicated to quality care for plastic surgery patients through education, research and the promotion of high professional standards.

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Your first step: gathering names

In choosing a plastic surgeon, your first goal is to develop a list of good candidates. Where do you find them? Some sources are better than others.

• Friends. If you know someone who's had a procedure like the one you're considering, talk to him or her about it. But don't decide on a surgeon based on one friend's experience. Every patient is unique, and so is every surgery; your results might be quite different from your friend's.
• Doctors. Your family doctor may be able to recommend a plastic surgeon. Ask your doctor how many patients he or she has referred to this surgeon and what feedback they offered later. Ask whether the doctor would send a family member to this plastic surgeon.
• Nurses. If you know an operating room nurse - or if you know someone who knows one - you can probably get a well-informed opinion on surgeons he or she has worked with.
• Hospitals. Call a respected hospital in your community and ask for the names of board-certified plastic surgeons on staff. Be sure to ask for the names of doctors who have privileges (official approval) to do the particular procedure you're considering.
• ASPS. The Plastic Surgery Information Service of the ASPS is an excellent source of names. Simply call the toll-free number, (888) 4-PLASTIC (475-2784), and leave your name, address and the procedure you're interested in. We'll send you the names of five plastic surgeons in your area who perform that procedure. Their membership in the ASPS means they're certified by the American Board of Plastic Surgery (ABPS) and members of the largest plastic surgery specialty organization in the United States . You can show this list to a doctor you trust and ask if he or she has any recommendations. You can also check the list against the one you may have received from the hospital.
• Special directories. You can find the names of board-certified plastic surgeons, listed by state and city, in two reference books available in most public libraries: The Directory of Medical Specialists, published by Marquis Who's Who, and The Compendium of Certified Medical Specialists, published by the American Board of Medical Specialties (ABMS).

• Paid advertising. You can find plenty of physicians' names in the yellow pages and other advertising sources. But keep in mind that doctors can list themselves under any specialty heading they like and can advertise any services they want to sell, regardless of their training and credentials. (Exceptions are group listings sponsored by the American Board of Medical Specialties or its member boards.) Similarly, doctors quoted in newspaper and magazine stories may or may not be qualified "experts."

Your next step: checking credentials

Once you've compiled a list of several doctors, you can start checking their credentials. While good credentials can't guarantee you a successful outcome, they can significantly increase the odds. You can obtain the following information from the directories mentioned above, hospitals and professional societies, and the surgeon's office.

• Training. More important than where your surgeon went to school is the type of training he or she received. Has the surgeon completed an accredited residency program specifically in plastic surgery? Such a program includes two or three years of intensive training in the full spectrum of reconstructive and cosmetic procedures. While your plastic surgeon may choose to concentrate on a limited number of procedures, this comprehensive background gives a solid foundation to his or her skills.

• Board certification. Everyone has heard the phrase "board-certified," but very few people know what it means or what to look for.

Patients are encouraged to consider a doctor certified by the American Board of Plastic Surgery (ABPS). By choosing a plastic surgeon who is certified by the ABPS, a patient can be assured that the doctor has graduated from an accredited medical school and completed at least five years of additional residency - usually three years of general surgery (or its equivalent) and two years of plastic surgery. To be certified by the ABPS, a doctor must also practice plastic surgery for two years and pass comprehensive written and oral exams.

• Hospital privileges. Even if your surgery will be performed in the doctor's own surgical facility, he or she should have privileges to perform that procedure at an accredited hospital in your community. It means the surgeon is subject to approval by a body of his or her peers. Call the hospital to make sure.
• Experience. Although there's no magic number (of years or procedures) that defines "experience," you should feel comfortable that the surgeon you choose is well versed and up-to-date in the procedure you're considering. You can ask the surgeons on your list if they do the procedure frequently or only occasionally and when they last performed that procedure.
• Professional societies. Physicians may belong to a wide array of professional societies, but - as with board certification - some are more meaningful than others. If a physician tells you he or she belongs to a particular society, get the exact name and call the society to find out what the requirements for membership are.

Of the societies representing plastic surgeons, one of the most demanding - and by far the largest - is the American Society of Plastic Surgeons (ASPS). Its members must be certified by the ABPS and reviewed by their peers. They must also participate in continuing education and adhere to a strict code of ethics.

Finally, the consultation/interview

If you've narrowed your list down to two or three surgeons, you might want to visit them all for an initial consultation. That way you can compare their personalities, their opinions on the type of surgery you should have, their fees, and the way they answer your questions and explain the risks involved. Keep in mind, though, that you'll probably have to pay for these consultations, whether or not you choose that surgeon.

Don't be afraid to ask questions, no matter how trivial or how personal you think they'll sound. In fact, it's a good idea to write down your questions before hand so you won't forget any of them and to make a note of the surgeon's answers as well.

Here are a few general things to look for in the interview:

• The surgeon should answer all of your questions thoroughly, in language you can understand.
• He/she should ask about your motivations and expectations, discuss them with you, and solicit your reaction to his/her recommendations.
• He/she should offer alternatives, where appropriate, without pressuring you to consider unnecessary procedures.
• He/she should welcome questions about professional qualifications, experience, costs and payment policies.
• He/she should make clear not only the risks of surgery but the possible variations in outcome. If the surgeon shows you photographs of other patients, or uses computer imaging to show you possible results, it should be clear that there is no guarantee that your results will match these.
• He/she should make sure the final decision is yours.

Now it's time to make your choice

If you've obtained your surgeon's name from a good source, checked his or her credentials, are satisfied with your initial consultation, and have realistic expectations for the surgery, chances are very good that you'll be happy with the outcome of your plastic surgery.

Sources and Credentials: A Consumer Checklist

This symbol designates surgeons who are active members of the American Society of Plastic Surgeons. They are certified in the specialty of plastic surgery by the American Board of Plastic Surgery and are dedicated to the highest standards of patient welfare and surgical excellence.

© Copyright American Society of Plastic Surgeons

How many cosmetic surgery patients are having more than one procedure done at the same time?

30 percent in 1994

Psychological Aspects of Plastic Surgery

Improving your self-image with plastic surgery

Each of us has a "self-image", a perception of how we believe we look to others. People who are happy with their self-image are more likely to be self-confident, effective in work and social situations, and comfortable in their relationships. Those who are dissatisfied tend to be self-conscious, inhibited and less effective in activities.

Plastic surgery - whether cosmetic or reconstructive - encourages and promotes a strong, positive self-image. Even a small change on the outside can create an extraordinary change on the inside, allowing an individual's self-confidence to flourish.

Because the changes resulting from plastic surgery are often dramatic and permanent, it's important that you have a clear understanding of how surgery might make you feel - long before a procedure is scheduled.

This brochure will provide you with a basic understanding of the psychological issues involved with plastic surgery. It can't answer all your questions, since your individual circumstances and your self-image must be considered. Ask your surgeon if there is anything you don't understand about the possible psychological aspects and effects of your planned procedure.

Appropriate candidates for surgery

If you are considering plastic surgery, you must be honest with yourself. Exactly why do you want surgery? And, what are your goals for surgery - what do you expect plastic surgery to do for you?

There are two categories of patients who are good candidates for surgery. The first includes patients with a strong self-image who are bothered by a physical characteristic that they'd like to improve or change. After surgery, these patients feel good about the results and maintain a positive image about themselves.

The second category includes patients who have a physical defect or cosmetic flaw that has diminished their self-esteem over time. These patients may adjust rather slowly after surgery, as rebuilding confidence takes time. However, as they adjust, these patients' self-image is strengthened, sometimes dramatically.

It's important to remember that plastic surgery can create both physical changes and changes in self-esteem. If you are seeking surgery with the hope of influencing a change in someone other than yourself, you might end up disappointed. It's possible that friends and loved ones will respond positively to your change in appearance and self-confidence, however, understand and accept that plastic surgery will not cause dramatic changes in people other than you.

Inappropriate candidates for surgery

Not everyone is an appropriate candidate for plastic surgery, despite physical indications that are ideal for any given procedure. Experienced plastic surgeons can usually identify troubled patients during a consultation. Sometimes, plastic surgeons will decline to operate on these individuals. Other times, they may recommend psychological counseling to ensure that the patient's desire for an appearance change isn't part of an emotional problem that no amount of surgery can fix. If your plastic surgeon recommends counseling for you, feel free to ask your surgeon how he or she expects the sessions to help you.

Though there are exceptions, individuals who may be advised to seek counseling prior to any consideration of surgery include:

• Patients in crisis , such as those who are going through divorce, the death of a spouse, or the loss of a job. These patients may be seeking to achieve goals that cannot be obtained through an appearance change - goals that relate to overcoming crisis through an unrelated change in appearance is not the solution. Rather, a patient must first work through the crisis.
• Patients with unrealistic expectations , such as those who insist on having a celebrity's nose, with the hope that they may acquire a celebrity lifestyle; patients who want to be restored to their original "perfection" following a severe accident or a serious illness; or patients who wish to find the youth of many decades past.
• Impossible-to-please patients , such as individuals who consult with surgeon after surgeon, seeking the answers they want to hear. These patients hope for a cure to a problem that is not primarily, or not at all physical.
• Patients who are obsessed with a very minor defect , and may believe that once their defect is fixed, life will be perfect. Born perfectionists may be suitable candidates for surgery, as long as they are realistic enough to understand that surgical results may not precisely match their goals.
• Patients who have a mental illness , and exhibit delusional or paranoid behavior, may also be poor candidates for surgery. Surgery may be appropriate in these cases if it is determined that the patient's goals for surgery are not related to the psychosis. In these cases, a plastic surgeon may work closely with the patient's psychiatrist.

The consultation

During your initial consultation, your plastic surgeon will seek honest answers to how you feel about your appearance, how you believe others see you, and how you'd prefer to look and feel.

Honesty, with yourself and with the surgeon, is essential. It's important that you set aside any awkwardness you might feel and speak candidly about the changes you'd like to see. At the end of the consultation, you should feel confident that you and your surgeon understand each other completely.

Also, it is unwise to stress a minor functional problem if your true desire is to have an improved appearance. A patient who pretends to be seeking relief for a functional problem may confuse the surgeon about that patient's true goals for surgery.

Often these patients stress a functional problem with the hope of obtaining insurance coverage for the procedure even though a functional problem does not exist. If your goals for surgery are not clearly communicated to your surgeon, you may not be satisfied with the final result.

Plastic surgery for children

Parents may face considerable confusion and anguish in making surgical choices for their children, or when their children show a desire to change or correct a physical characteristic.

For reconstructive procedures such as cleft lip and palate repair, or infant skull surgery, the benefits of early treatment are usually quite clear. Parents typically meet with surgeons, psychologists and other specialists who provide abundant assurances that surgery is the best choice for their child.

However, in elective procedures like otoplasty (ear pinning), the choices may be more indefinite. If the child doesn't seem to notice that he or she looks "different," parents may be advised not to force the issue of surgery. However, if the child is being teased or feels he or she doesn't belong, parents should probably consider surgery for the emotional health and self-esteem of the child. It's important to follow the recommendation of a pediatrician and to consider the feelings of the child and the parents.

Certain cosmetic surgery procedures may also be of significant psychological benefit for some teenagers, provided that he or she is well-adjusted both socially and emotionally. Parents need to keep in mind that feelings about self-image tend to change with maturity, and that cosmetic surgery should never be forced on a teenager, nor should a teenager force an issue that a surgeon feels is not an appropriate cause for surgery.

Timing of surgery

Plastic surgery procedures can impose stress in addition to that which we encounter on a daily basis, both on the body and mind. It's important that surgery is timed at a point when you don't feel exceptional stress, or physical or emotional burden.

To make sure you're emotionally prepared for surgery, your plastic surgeon may ask some rather personal questions about your relationships, home life, work problems and other private matters. Once again, honesty is essential. In general, surgery should not be scheduled during a time of high activity or emotional upheaval. Patients who go into surgery feeling preoccupied or pressured with other matters may face longer and more difficult recovery periods.

Adjusting to change

It may take a while before you find you have emotionally recovered from surgery and have adjusted completely to change. This is particularly true if the procedure you've had has significantly changed your body image. If you're planning a relatively straight forward cosmetic procedure like chemical peel or eyelid surgery, you'll probably adjust easily to your new look. Your reflection in the mirror will be a familiar one - a refreshed, younger-looking you.

However, if you plan to have breast surgery, nose surgery or another procedure that may involve a dramatic body change, the post-operative adjustment period may take longer. Until you learn to accept your redefined body image as your own, your reflection may seem somewhat unfamiliar.

Getting the support you need

It's essential to have someone to help you, both physical and emotionally, during your recovery period. Even the most independent patient needs some emotional support after surgery. Remember, during the first week of recovery, you'll have days when you'll feel depressed and look swollen, bruised and rather unpleasant.

Be sure to select a support person who will be just that - supportive. Graciously decline offers of help from those who may be critical of your decision to have surgery or may be overly troubled by your temporarily bruised and swollen appearance.

Also keep in mind that it's not unusual for a well-meaning friend or relative to say "I liked the way you were before," or "You didn't really need surgery," Comments such as these may cause or worsen feelings of regret or self-doubt, particularly during the early recovery period. Rely on your support person or your surgeon to help you though these difficult times - and try to focus on the reasons you decided to have surgery in the first place.

Coping with post-operative depression

After surgery, most patients experience mild feelings of unhappiness. However, for an unlucky few, post-operative depression may be more severe.

Post-surgery let downs usually set in about three days after surgery - at a point when you may be regaining some of your physical stamina, but your post-operative appearance has not yet begun to improve. In fact, some plastic surgeons call this condition the "Third-Day Blues." It may last anywhere from a few days to several weeks. This emotional let down may be caused by stress, exhaustion, metabolic changes or the frustration of waiting for results to appear. Depression may be especially stressful for patients undergoing staged procedures, who must cope with an unfinished "interval image" until the final stage of surgery is complete. Patients who are most vulnerable to depression are those who have a history of depression, or who were already somewhat depressed before surgery.

Knowing what to expect in the post-operative period may help you cope better in the days following surgery. It's helpful to remember that the depression usually lifts naturally within about a week. Brisk walks, light social activity and small outings may help you shake the blues faster.

Handling the critics

The results of your surgery are likely to elicit some comment from friends and family members - and usually, it's not all positive. If you've had purely cosmetic surgery, you may be criticized for being foolish or frivolous. If your surgery involved changing an ethnic trait, you may be accused of trying to deny your cultural heritage. And, if you changed a family trait, prepare yourself for some surprised or disapproving glances. You may even get the cold shoulder from close friends who feel threatened by your improved appearance.

Some patients find it's helpful to arm themselves with a standard reply to post-operative criticism, such as, "This is something I did for myself - and I'm very happy with my results."

Remember, if you are content with how the results of plastic surgery make you look and feel, then the procedure was indeed a success.

This symbol designates surgeons who are active members of the American Society of Plastic Surgeons. They are certified in the specialty of plastic surgery by the American Board of Plastic Surgery and are dedicated to the highest standards of patient welfare and surgical excellence.

© Copyright American Society of Plastic Surgeons