Plastic Surgery Articles

Information on aesthetic (cosmetic) plastic surgery is readily available from many sources - but not all of these sources are credible, nor is all the available information accurate. Likewise, prospective cosmetic surgery patients have many choices when it comes to selecting a surgeon. Not all physicians who perform cosmetic surgery today have equivalent training and certification. In fact, the differences are significant and can have potentially devastating consequences for
patient safety.

Selecting a qualified surgeon does not constitute a guarantee of risk-free surgery or a perfect result. Complications or less than optimal outcomes can occur even when a procedure is performed by a well-trained surgeon exercising impeccable surgical judgment. That’s because an individual patient’s response to surgery and anesthesia is not totally predictable. Nevertheless, a trained and board-certified plastic surgeon has the background and experience to potentially minimize the risks associated with surgical procedures and, importantly, to competently handle complications that might occur.

Choosing the Right Surgeon

While there are factors in aesthetic plastic surgery that you cannot control, there are measures you can take that will decidedly increase your chances for a successful and satisfying outcome. Perhaps the most important of these is choosing the right surgeon.

It is surprising that with the seemingly constant media blitz about the astounding increase in the number of people having cosmetic surgery, one disturbing fact is seldom discussed: unqualified doctors are legally allowed to perform these procedures, and they often do so in inadequate, unaccredited facilities.

These are life-threatening realities that too few people understand. The law in most states allows virtually any licensed medical doctor, including those whose training in plastic surgery may consist solely of a weekend seminar or less, to adopt the title “cosmetic surgeon” or “plastic surgeon” and to perform difficult surgical procedures without certification or peer-review of credentials. These so-called cosmetic surgeons are often unprepared to handle emergencies that may arise in the course of a surgical procedure, or complications that can occur in the post surgical period. They do not have hospital privileges to perform plastic surgery, and so they carry out their operations in unaccredited facilities that may be lacking the necessary equipment and personnel to help ensure safety.

Why have so many untrained and unqualified doctors assumed the title of “cosmetic surgeon” or “plastic surgeon” and undertaken to build practices in cosmetic surgery? The reasons are primarily economic. Changes in our health care system in recent years have drastically reduced insurance reimbursements for physicians providing a wide range of medical and surgical services. Some of these physicians are attracted to cosmetic surgery because they can set their own fees for cosmetic procedures and are paid directly by the patient.

So, even though their formal residency training, certification (if any), and experience are within another specialty, they have decided to become “self-designated” plastic or cosmetic surgeons. They may advertise themselves by these self-designated titles, and potential patients often don’t realize that the “surgeon” they have selected is not a board-certified plastic surgeon, perhaps not even a surgeon at all, and has no specialized training in the procedures advertised.

Probably nothing is more important than choosing the right surgeon. Well-meaning friends, relatives, and even other doctors who recommend a particular surgeon may actually be unaware of the details of the surgeon’s education and credentials to perform cosmetic surgery. Likewise, finding a plastic surgeon through advertisements or Internet directories alone is not the best approach.

While these resources may provide you with names of physicians in your area, some of whom may be qualified plastic surgeons, you always need to take the next step in researching the training, certification and experience of your doctor — and you should do so, as much as possible, prior to making an appointment for a consultation. Such research may be time consuming, but it is effort well spent. More than 50 percent of patients currently presenting for consultation in my practice are dissatisfied with surgery performed elsewhere. These patients almost uniformly state “that they wish that they would have done more research prior to having their first procedure.”

“Shopping” for the Right Surgeon

No one should ever “shop” for a surgeon only on the basis of the lowest price. Taking a purely economic approach to selecting a surgeon ignores the seriousness of this important decision.
While in recent years, more details about plastic surgery credentials have surfaced in the media, there still is a general lack of information as well as a great deal of inaccurate material in the popular press. Reporters will often conduct interviews with physicians, portraying them as plastic surgeons and even naming them as such, without checking to be certain of their training and certification. In addition, unqualified physicians seeking to build cosmetic practices may advertise in the media, sometimes providing consumers with misleading or erroneous information. One of the most blatant is the claim of “board certification.”

What Does Board Certification Mean?

Savvy consumers know that board certification is an important indicator of a physician’s accredited training in a specific medical or surgical specialty. What they may not know, however, is that in addition to the 24 certifying boards recognized by the American Board of Medical Specialties (ABMS), there also are a host of other unrecognized, or “self-designated,” boards. Self-designated boards have been created by private individuals or organizations, and there is no affiliation with the American Board of Medical Specialties; as a consequence, certification by one of these boards may signify little and guarantee nothing.

All of this subterfuge can lead the prospective patient into some very dangerous territory. There are, however, as I will describe later in this piece, factual guideposts for finding a qualified surgeon that can point you in the right direction from the start.

In contrast to the aforementioned self-designated boards, the American Board of Plastic Surgery (ABPS) is recognized by the American Board of Medical Specialties, which serves the public interest by overseeing physician certification in the United States.

Plastic surgeons certified by the ABPS have graduated from an accredited medical school and have completed at least five years of additional surgical training including an accredited plastic surgery residency program. They must satisfy certain requirements for clinical practice prior to applying for, and ultimately completing, their written and oral Board examinations.

ABPS-certified surgeons must also adhere to the Board’s ethical and professional standards, including an absence of disciplinary actions by hospitals, licensing agencies, or financing programs. The Board also requires participation in peer review; participation in clinical self-assessment; operation of a safe, patient-centered practice that meets criteria for quality; and participation in measurement of clinical performance and patient care results, including patient satisfaction.

The ABPS is the only board recognized by the American Board of Medical Specialties to certify physicians in the specialty of plastic surgery. There are, however, other recognized boards that certify doctors in dermatology, ophthalmology and otolaryngology, and these specific specialty certifications do qualify doctors to perform some limited types of aesthetic procedures related to specific areas or structures of the face and body. Injectables such as Botox and Fillers represent an example.

Surgeons who are certified by the American Board of Plastic Surgery are the only physicians whose formal training and certification is applicable to plastic surgery procedures of the face and the entire body. Although not a guarantee of safety or results, this comprehensive training provides a significant indicator of competence.

Board certification can be confusing, and patients often may find it daunting to investigate a doctor’s hospital credentials or facility accreditation. Fortunately, there is yet another perhaps more direct way to determine whether your surgeon is a board-certified plastic surgeon operating in an accredited facility: find out if the surgeon is a member of the American Society of Plastic Surgeons (ASPS) and or the American Society for Aesthetic Plastic Surgery (ASAPS).

Education is Important when Choosing a Surgeon

As a patient, do not accept claims of expertise or be impressed by important-sounding credentials without finding out the facts. Don’t be embarrassed or afraid to ask about the surgeon’s training, board certification, hospital privileges, and experience. Verify membership in the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

There are many factors for you to consider as a potential cosmetic surgery patient. You wouldn’t get in your car without educating yourself about the rules of the road and driving safety. You buckle your seat belt. Don’t let someone operate on you without doing your homework. Learn the rules of the road as they apply to choosing the right surgeon, and the odds are that you’ll have a safe and pleasant journey.

Aesthetic plastic surgery is elective, and patients choose to undergo procedures to better their lives. In the overwhelming majority of cases in which patients select a qualified surgeon, cosmetic surgery produces the expected benefits, and patients are happy. The complications that sometimes occur are generally temporary and relatively minor. This should not lead one to be complacent, however, about the many issues involved in cosmetic surgery patient safety.

Needless to say, patient safety with any type of surgery is of paramount importance. This applies even more strongly to aesthetic surgery which is totally elective. Training leading to board certification in plastic surgery is as extensive as the training of any medical professional, with ample exposure to learning how to prevent complications, how to early recognize and treat them. Members of our specialty have always demonstrated an impressive patient safety record.

To further focus our attention to a “culture of safety” in May of 2005 I created, as incoming President of the American Society for Aesthetic Plastic Surgery, the Patient Safety Committee which since has evolved into one of the pivotal committees of the Society. The Committee reassessed safety issues, developed and implemented a large number of new patient safety initiatives, which were adopted by the members of our Society. As a result of its educational efforts, patients can feel more confident of their safety when undergoing elective cosmetic surgery.

Written by: Peter Fodor MD