Frequently Asked Questions About Plastic Surgery in General

IS PLASTIC SURGERY FRIVOLOUS?

First of all, plastic surgery is not just cosmetic surgery. Plastic surgery encompasses much reconstructive surgery such as correction of defects and deformities secondary to trauma or cancer surgery, and correction of congenital birth defects such as cleft lip and cleft palate. So the question is really whether cosmetic (aesthetic) surgery is frivolous.

Cosmetic surgery was a natural outgrowth of reconstructive surgical techniques. If you could fashion a new nose in place of one destroyed by burns or cancer, why not improve the appearance of one that is simply too large or too hooked? If you could make a new breast after mastectomy, why not find a way to make small breasts larger or deflated post-pregnancy breasts full again?

Breasts that are empty and sagging after pregnancy or weight loss are not equal on the deformity scale to an absent breast due to cancer. That is certainly true. However, the emotional distress that a patient with very small breasts or sagging breasts feels or that a patient with a very crooked nose feels is not inconsequential. In these cases, cosmetic surgery can make the patient feel better about themselves and hence make a profound difference in their level of life satisfaction and happiness.
And that is not frivolous.

ARE PLASTIC SURGEONS AND COSMETIC SURGEONS THE SAME?

The short answer is “No”. The slightly longer answer is “no, absolutely not!”.

Why not? Because plastic surgeons certified by the American Board of Plastic Surgery are fully trained in all aspects of surgery. They have spent 6-8 years of training after medical school. They have learned and mastered many varied techniques and have extensive experience in solving various reconstructive, as well as, aesthetic problems. They have learned how to avoid complications and how to handle those that inevitably, but fortunately uncommonly, arise.

They have passed two rigorous national examinations. One written and one oral. They are dedicated to patient safety as well as patient satisfaction.

Cosmetic surgeons are not trained plastic surgeons. They are doctors (some are not even surgeons!) trained in other specialties (e.g. general surgery, dermatology, family practice, OB/GYN) who market themselves as cosmetic surgeons in order to fool the public as to the nature of their skills. And why? For the money. Pure and simple.

And don’t be fooled by claims of certification by cosmetic surgery boards. These are “made-up” boards whose certifications me nothing. It Is very much like “America’s Best Doctors”. You pay a fee and they send you a plaque.

IS GOING ABROAD FOR LESS EXPENSIVE COSMETIC SURGERY A GOOD IDEA?

Generally the answer is no. There are two major reasons why.

First you have little or no assurance that the practitioner is properly trained and accredited. And you have little or no assurance that the facility where surgery will be performed is accredited and, therefore, safe. There are almost weekly horror stories in the press about individuals who had been severely deformed or who have even died in “clinics” outside the United States. These clinics advertise heavily in the bigger United States cities particularly on the East Coast.

Secondly, as noted above, poor results and significant complications are not uncommon. What happens after a few days when you are back home and there is a complication? If you go to the phone book and call a plastic surgeon’s office, they will likely not see you. So you will go to an emergency room where the doctor on call will likely have little idea of what he is seeing and therefore little idea how to treat you optimally. You may or may not be seen by a plastic surgeon. You may have to be admitted to the hospital and insurance will not pay for any of this extended care.

In the United States, you will undoubtedly pay more. But you will have control over who does what and where. And most complications that do occur at the hands of a trained plastic surgeon can be managed by that surgeon outside the hospital at little or no cost to you.

So the choice is yours. The correct one seems obvious.

WHY IS PLASTIC SURGERY SO EXPENSIVE?

The Economics 101 answer to that question is “the value of any commodity or service is determined by what people are willing to pay for it”.

That is the short answer. The long answer is that providing consistently excellent care and maintaining the highest standards of patient safety both during and after surgery are very expensive propositions. Surgical supplies must be purchased and kept in stock. The anesthesia provider must be reimbursed for his/her services. Office and operating room staff must also be paid. There are the usual expenses of any small business (taxes, legal and accounting fees, mortgages or rent, building maintenance, etc.). And then there is malpractice insurance!

It is not unusual for a plastic surgeon to spend 50-60% profits on these overhead expenses. So that is the reason plastic surgery is so expensive. It costs a lot to do it right.

WHY IS BOARD CERTIFICATION IMPORTANT?

Certification by the American Board of Plastic Surgery means that the individual has been rigorously trained and is highly skilled in all aspects of plastic surgery. Reconstructive surgery as well as aesthetic surgery. Six-eight years of training past medical school are required: 3-5 years of basic training in patient care and general surgical techniques followed by 2-3 years of specialized training in all aspects of plastic surgery. All of that gets one “board-eligibility”. Certification itself only comes after two years of post-residency experience and taking and passing two rigorous national examinations. One written and one oral.

Now, you may eventually decide for reasons of personality, amount of experience, gender, and costs, to choose surgeon A over surgeon B. But board certification should be the starting point in searching for the right plastic surgeon for you.

HOW DO I CHOOSE A PLASTIC SURGEON?

This is a question I see on a lot of sites. If you live in a metropolitan area, the phone book will be full of names. How do you decide?

As I noted above, the starting point is to look for certification by the American Board of Plastic Surgery. That ensures you that your surgeon is skilled and dedicated to patient safety.
Ask around. Some of your family or friends may have had plastic surgery and they may be able to tell you about both good and bad experiences that they have had. Ask medical people. Nurses in particular know who is good and who is not.

Once you have a few names in hand, visit their websites. You can get an idea of a surgeon’s philosophy of practice from what is written on the site. You can view before and after photographs. There may even be some videos which can give you a bit of an idea of bedside manner. You will want to choose an office where you will be a good fit.

Visit more than one office. You will want to compare things like bedside manner, level of experience, how much time the surgeon spends with you, the confidence of his/her recommendations, the competence and friendliness of the staff, and, finally, costs.

Cosmetic surgery is more than a visit to the operating room. It is very much a journey from consultation through postoperative visits. And should there be complications, the journey could be longer and more difficult. You will want to be with people you like and trust throughout this journey.

Good luck