Southern Surgical Arts: How to Choose a Cosmetic Surgeon

Choosing a doctor is obviously an important decision requiring careful consideration. The following information is intended to assist individuals with their decision regarding which doctor will perform their cosmetic surgery procedure.

You should choose a doctor based on the doctor’s education, training, experience and proven competence with respect to the specific procedure you are considering. You should become informed regarding how often the doctor performs the procedure and whether the doctor has had claims against him or her with respect to the procedure or any other cosmetic procedure. You should review before-and-after photographs of other patients who have had the same procedure performed by the doctor you are considering. If possible, you should also speak with other patients who have had the procedure performed by the doctor you are considering.
 

Cosmetic Surgery and the Doctors Who Perform It.

The number of people seeking cosmetic surgery has grown rapidly over the past several years. As part of a greater focus on appearance, people are turning to cosmetic surgery as one means of enhancing their appearance. At the same time, more and more doctors are practicing cosmetic surgery. Given the growing number of cosmetic surgery patients and the highly competitive pool of doctors performing cosmetic surgery, it is vital that you obtain accurate information regarding cosmetic surgery and the doctors who perform it. Before you undergo cosmetic surgery, it is important you become informed about the doctor’s education, training, experience, and proven competence with respect to the specific procedure you seek.
 

Understanding the difference between “cosmetic” and “plastic” surgery.

Cosmetic surgery and plastic surgery are not the same thing. Cosmetic surgery involves procedures designed to enhance appearance toward some aesthetic ideal. Cosmetic surgery is practiced by doctors from a variety of medical fields including dermatologists, facial plastic surgeons, general surgeons, gynecologists, oral and maxillofacial surgeons, ophthalmologists, otolaryngologists, plastic surgeons, as well as doctors from other fields. Unlike cosmetic surgery, plastic surgery focuses on repairing and reconstructing abnormal structures of the body caused by birth defects, developmental abnormalities, trauma, infection, tumors or disease.
 

There are currently no residency programs in the United States devoted exclusively to cosmetic surgery. Therefore, doctors seeking to learn cosmetic surgery primarily obtain cosmetic surgery training and experience after completing their residency training. Understanding this fact is necessary to understanding the difference between “cosmetic surgery” and “plastic surgery.” Residency programs in dermatology, general surgery, obstetrics and gynecology, oral and maxillofacial surgery, ophthalmology, otolaryngology, and plastic surgery do not include training on every cosmetic procedure. Therefore, to find the most qualified doctor for a specific cosmetic procedure, you must compare doctors’ overall (residency and post-residency) training, experience and proven competence with respect to that specific cosmetic procedure.
 

It is important to know that the residency training required to become board certified in plastic surgery may not include training with respect to many common cosmetic procedures. (See Morrison, M.Sc., Colin, A Survey of Cosmetic Surgery Training in Plastic Surgery Programs in the United States, Plastic and Reconstructive Surgery – Journal of the American Society of Plastic Surgeons, pp.1570-1578, 2008). Therefore, while the title “board certified plastic surgeon” tells you the doctor has received certain training and experience with respect to “plastic surgery,” it does not tell you the same thing with respect to “cosmetic surgery,” nor does it tell you that the doctor has more or less “cosmetic surgery” training than a board certified dermatologist, facial plastic surgeon, general surgeon, gynecologist, oral and maxillofacial surgeon, ophthalmologist, otolaryngologist, or other doctor. It is important that you understand that the education, training, and experience required for a doctor to become competent in cosmetic surgery is not the same as that required to become competent in plastic surgery.
 

Evaluating Your Cosmetic Surgeon.

Various national health care organizations maintain that doctors should be evaluated based on their “education, training, experience, and proven competence.” For example, the Joint Commission, the American Board of Medical Specialties, American Osteopathic Association’s Healthcare Facilities Accreditation Program, and the American Medical Association maintain that a hospital should consider a doctor’s “education, training, experience, and proven competence” when deciding whether to allow the doctor to perform procedures at a hospital or outpatient facility. The criteria these national health care organizations use to evaluate doctors are based on the individual doctor’s education, training, experience, and proven competence with respect to the specific procedures he or she will perform.
You should consider and compare doctors’ education, training, experience, and proven competence with respect to the specific cosmetic procedure you seek. At a minimum, ask your doctor the following questions:

1.    How long have you been performing the specific cosmetic procedure?
2.    Where did you receive your training with respect to the procedure? What continuing medical education (“CME”) have you completed with respect to the procedure?
3.    How much experience do you have performing the procedure? How many have you performed in total? How many have you performed over the past year?
4.    How do you define success with regard to the procedure? What is your success rate performing the procedure? How many of your patients have returned for revisions or corrections with respect to the procedure? How many of your patients have returned for revisions or corrections in general?
5.    May I review “before and after” pictures of those who have had the procedure performed by you?
6.    Where will you perform my procedure? Is the facility accredited? Cosmetic surgery is performed in various facilities such as hospitals, surgical centers and office settings. An accredited surgical facility must meet certain minimum standards to obtain and maintain its accreditation. Some certifying organizations include the Joint Commission (formerly “JCAHO”), the Accreditation Association for Ambulatory Health Care (“AAAHC”), and the American Association for Accreditation of Ambulatory Surgery Facilities (“AAAASF”).
7.    Are there any alternatives to the procedure that may exist considering my desired result?
8.    What are the risks and possible complications? Before the surgery, your doctor should explain to you the risks and possible complications, and potential side effects, including the pros and cons of the procedure.

 

Board Certification and Cosmetic Surgery.

The American Board of Cosmetic Surgery (“ABCS”) is the only certifying board that evaluates and certifies doctors exclusively in cosmetic surgery. In order to be board certified by the ABCS, a doctor must:

1.    Satisfactorily complete specialty residency training and be board certified in one of the following surgical    specialties:    Dermatology;    General    Surgery;    Obstetrics    and    Gynecology; Opthamology/Oculoplastic Surgery; Oral & Maxillofacial Surgery (with MD degree); Otolaryngology; or Plastic Surgery.
2. Complete a one or two year fellowship program concentrated solely in cosmetic surgery (the fellowship route), or alternatively, demonstrate vast experience in the field of cosmetic surgery through the performance as primary surgeon of 1,000 documented cosmetic surgical cases in the 6 year period preceding certification (the experience route).
3.    Perform at least 100 documented cosmetic procedures following the completion of a one-year cosmetic surgery fellowship program (50 documented cosmetic procedures following the completion of a two-year cosmetic surgery fellowship program) in the 12 month period preceding certification.
4.    Pass a stringent 2-day oral and written examination.
5.    Be of good moral character.
Board certification by the American Board of Cosmetic Surgery represents objective and verifiable information regarding a doctor’s education, training, experience, and proven competence in cosmetic surgery. Board certified cosmetic surgeons (Diplomates of the ABCS) must at all times strive to represent the highest of ethical and moral standards. Diplomates agree to adhere to the ABCS and AMA guidelines regarding the ethical practice of cosmetic surgery, including advertising and representations to the public, and to practice the highest standard of patient care and safety at all times.