Aaron Stone M.D.

Plastic Surgery includes two kinds of procedures:
•reconstructive surgery, 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.Choosing the right plastic surgeon for yourself is not an easy matter and should not be based solely on pricing or for emotional reasons.

Accept no substitutes, demand a Plastic Surgeon certified by the American Board of Plastic Surgery for your cosmetic and reconstructive plastic surgery needs!

1. getting names of plastic surgeons
2. checking their credentials
3. the consultation – what to ask
4. making a choice – a consumer checklist

Step 1
getting names of plastic surgeons
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.

Step 2: checking their credentials
Step 3: the consultation – what to ask
Step 4: making a choice – a consumer checklist

Friends. If you know someone who’s had a procedure like the one you’re considering,
talk to them about it. But don’t decide on a surgeon based on only one friend’s experience. Every patient is unique, and so is every surgery; your results might be quite different from your friend’s. Your surgeon should be broadly trained, in case you become one of the small percentage of patients that has a complication (see Training below).

 

<p “>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 afterward. Ask your doctor whether they 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 they have worked with in the past.

 

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 American Society of Plastic Surgeons (ASPS) http://www.plasticsurgery.org/ is an excellent source of names. Simply call the toll-free number, 1-800-635-0635, or visit their webpage http://www1.plasticsurgery.org/find_a_surgeon/ to search for plastic surgeons by name, state, or zip code. The state search opens a window to search by city and/or procedure. A list of 5 or more names then appears with links to doctor information as well as direct links to email the doctors. Membership in the ASPS means a doctor is certified by the American Board of Plastic Surgery (ABPS) and is a member of the largest plastic surgery specialty organization in the U.S. You can show this list to a doctor you trust. 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) http://www.certificationmatters.org/ The American Medical Association (AMA) also has a listing of all physicians in the U.S https://apps.ama-assn.org/doctorfinder/html/patient.jsp

State medical board. The medical board of your state is the ruling body, which allows physicians in your state to hold medical licenses. It is different from the specialties boards described above. Your state medical board can furnish you with licensing information about physicians such as training background, malpractice claims, and whether the physician’s license is in good standing. The Medical Board of California has its own website http://www.mbc.ca.gov/ Malpractice claims in and of themselves do not brand physicians as bad. Some high-risk specialties such as Neurosurgery automatically have a high number of claims filed. But a large number of claims in a short period of time are a sign of trouble.

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.”

 

Ranking or listing of the best doctors on websites or in print.
These rankings which may be titled “Guide to Top Doctors”, “Leading Doctors in Your Area”, and so on can be misleading. Some rely on patient satisfaction surveys. Others factor in board certification status, malpractice lawsuits, etc. Some blatantly mislead consumers by listing physicians based on fees paid by listed doctors. Most importantly none of these listings are based on valid data regarding physician treatment outcomes i.e. results.

 

Websites that solicit bids from prospective surgeons for patients wanting specific procedures. In these situations prospective patients choose doctors to be seen personally in consultation after reviewing the doctors’ bid and credentials online. The problems with this approach include obtaining bids for the wrong procedure since the surgeon has never examined the patient at the time of bidding, inaccurate bids due to inaccurate assessment of surgery time/anesthesia required or giving bids to prospective patients who are not capable of undergoing surgery for physical or mental health reasons. As in all other branches of surgery patients should be examined physically and an adequate medical history taken before the type of surgical procedure is decided upon. The bidding process circumvents this basic concept of medicine and therefore will compromise the safety factor in some cases.

Step 2
Checking their credentials
Once you’ve compiled a list of several doctors, you can start checking their credentials. While good credentials can’t guarantee a successful outcome, they can significantly increase the odds. You can obtain the following information from the directories mentioned above, as well as, hospitals, professional societies, and the surgeon’s office.

Step 1: getting names of plastic surgeons
Step 3: the consultation – what to ask
Step 4: making a choice – a consumer checklist

Training.More important than where your surgeon went to school is the type of training they have 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 preceded by 3 to 5 years of training in a pre-qualified field of surgery after medical school. While your plastic surgeon may choose to concentrate on a limited number of procedures, this comprehensive background gives them a solid foundation. The surgeon should have had training that covered a wide spectrum of surgery in order to be able to recognize complications or potential complications and have the medical judgement to act early so that safety is maintained and the end result is not affected. Physicians in other specialties may perform cosmetic procedures related to their area of expertise but they are not Plastic Surgeons. For example a dentist may perform cosmetic dentistry but he/she is not a Plastic Surgeon and should not be expected to perform the full gamut of plastic surgery. Likewise you would not expect an Obstetrician/Gynecologist to perform eyelid surgery or an Ophthalmologist (eye surgeon) to perform breast surgery since these areas are not covered in their post-medical school training programs. The AMA website described above https://apps.ama-assn.org/doctorfinder/html/patient.jsp lists where and what type of training a physician has undergone.

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. Few if any boards in other fields of medicine are as rigorous in examining physicians as the American Board of Plastic Surgery. Currently ABPS issues certificates that are only good for 10 years. Certificate renewal requires submission of a 6 month case list followed by a written examination based on the case list. This assures the patient their ABPS certified surgeon is up to date in the areas of surgery performed. This is the most vigorous certification renewal process of any board listed with the American Board of Medical Specialties.

Board certification in and of itself has nothing to do with being up to date or continuing medical education. Only the boards listed with the American Board of Medical Specialties http://www.certifieddoctor.org should be considered as legitimate boards. There are no boards of specific procedures (such as liposuction or hairgrafting, etc.). Some boards award certificates of added qualification to those physicians who have additional fellowship training in subspecialty areas such as Hand Surgery.

By using the word “board” on a certificate that is not recognized by the American Board of Medical Specialties the consumer is confused as to what board certified means. You cannot have a board in one procedure and nor have a board without a residency program. Why don’t we give out board certificates in liposuction, appendectomies, etc.? The reason is obvious. To make up for this the ABMS has allowed actual boards to give out certificates of added qualifications. One or more boards oversee these certificates. For example the certificate of added qualifications in hand surgery are overseen by the boards of Plastic, General and Orthopedic Surgery. For a group of people to get together and form their own board is more monopolistic and anti-consumer than the process I described which favors consumer safety over the benefit of any individual or group. Any doctor advertising themself as a member of a nonexistent board or as a member of an existent board in which they are not will probably be sanctioned by their state medical board. Be wary of those doctors who advertise themselves as board certified when they are not, or as having board certification that is not recognized by the American Board of Medical Specialties.

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. Having hospital privileges means the surgeon is subject to approval by a body of his or her peers. Call the hospital to make sure. This is a very important point because many physicians have operating rooms in their own offices or other small out of hospital areas. In these environments safety can be markedly compromised because in a hospital doctors are usually not allowed to perform procedures they are not qualified for. Also, in the presence of other physicians peer review prevents the unscrupulous minority of doctors from taking advantage of patients or performing bizarre procedures. Your surgeon should have hospital privileges in the region where the surgery is performed, so that in the rare case of a complication requiring hospital treatment they will be able to provide the care you need.

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. You can even ask to speak with other patients who have had the procedure performed by the surgeon.

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 of the society and call to find out what the membership requirements are. The American Society of Plastic Surgeons (ASPS) is one of the most demanding-and by far the largest society representing plastic surgeons. Membership requires continuing medical education, adherence to high and strict ethical standards and certification by the American Board of Plastic Surgery.

Step 3
The consultation/interview
If you’ve narrowed your list down to two or three surgeons, you might want to visit them 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 at least some of these consultations, whether or not you choose that particular surgeon.

 

Step 1: getting names of plastic surgeons
Step 2: checking their credentials
Step 4: making a choice – a consumer checklist

 

Don’t be afraid to ask questions, no matter how trivial or how personal you think they’ll sound. It’s a good idea to write down your questions before hand,and to make a note of the surgeon’s answers as well.

1. The surgeon should answer all of your questions thoroughly, in language you can understand.
2. They should ask about your motivations and expectations, discuss them with you, as well as solicit your reaction to their recommendations.
   
3. The surgeon should offer alternatives, where appropriate, without pressuring you to consider unnecessary procedures. Be wary of surgeons who try to group too many procedures together at one time or sign you up for overly lengthy procedures.
4. Your plastic surgeon should welcome questions about their professional qualifications, experience, costs, and payment policies.
5. He/she should make clear not only the risks of surgery but 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.
6. The plastic surgeon should clearly go over the postoperative instructions in order for you to achieve the best results. Aftercare is as important as your surgery and the plastic surgeon who performs it. If an overnight stay at a care facility is required it should be taken care of, as safety should be your first priority. 
7. If the plastic surgeon suggests billing your health insurance for a non-covered cosmetic procedure you should know that you would be commiting insurance fraud – which is a felony. You want your surgeon to be honest with you – if the plastic surgeon would mislead an insurance company they will just as easily lie to you.
8. Your surgeon should make sure the final decision is yours.

Step 4
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. Results and safety should be your top priorities. Don’t confuse price with value. You want the best job for each dollar spent not the cheapest. Educate yourself by visiting different surgeons and then make a decision based on multiple factors, including but not solely based on cost.

 

Step 1: getting names of plastic surgeons
Step 2: checking their credentials
Step 3: the consultation – what to ask

 

Sources and Credentials: A Consumer Checklist

Good
Recommendation from a friend who had similar procedure
Recommendation from family doctor or operating room nurse
Listed by ASPS
Has privileges to do your procedure at accredited hospital
Board-certified by American Board of Plastic Surgery
Completed residency in a specialty related to your procedure:
plastic surgery (for all procedures) otolaryngology (head and neck); ophthalmology (eyes); dermatology (skin); orthopedic (hand, limb  reconstruction)
Will perform the procedure in a surgical facility accredited by a national or state recognized organization

Incomplete
Yellow pages listing
Other advertising
Media mention
General physician referral services
Listing as a top or leading doctor on a website or in print
Recommendation by “just  anyone”

Warning
Doesn’t have hospital privileges for your procedure
Certified in unrelated specialty
Completed residency in unrelated specialty
Unwilling to answer your questions
Impatient or arrogant manner
Unprofessional office or personal appearance
Pressures you to add unnecessary procedures

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