An Insider’s Guide to Choosing a Plastic Surgeon

Written by Russell B. Stokes, M.D., F.A.C.S.

Plastic surgery is currently enjoying an unprecedented growth spurt in the United States.  Television shows such as Extreme Makeover, and Nip/Tuck have elevated the number of procedures performed in the United States to an all-time high.  One of the most important considerations regarding plastic surgery is choosing your surgeon.  This can be a daunting task when you start looking into the matter.  There are loads of abbreviations that patients have to learn (ASAPS, ASPS, ABPS, and others), and confusing credentials are often thrown about by all the different types of physicians currently performing plastic surgery.

Cosmetic Surgeon does not always mean Plastic Surgeon

When trusting your appearance to a doctor, it pays to know what type of doctor you are trusting. A plastic surgeon who is certified by the American Board of Plastic Surgery (a board-certified plastic surgeon) is someone who has completed an average of 6-7 years of surgical training after medical school.  The American Board of Plastic Surgery is the only Board which is recognized by the American Council of Graduate Medical Education (the agency responsible for overseeing Boards) to certify plastic surgeons.  This training encompasses every aspect of before and after care, as well as learning the nuances of the different procedures. They learn how to take care of problems which arise during the recovery period, and how to avoid these problems. A cosmetic surgeon can be any doctor who wishes to call themselves a cosmetic surgeon. That person’s training may have been in Dermatology, Radiology, Pathology, or Obstetrics.  They may have no formal training in plastic surgery, and in fact often receive their training in seminars. Some may be very skilled, and may have taken additional training at the hands of mentors, but you have no assurance of that unless you ask. Never be afraid to ask a surgeon about their credentials.  A well trained surgeon will gladly show you his credentials as they represent a significant amount of work, and are a source of pride.  Someone who is reluctant to give you all their training information should be treated with caution.

Choosing a Board Certified Plastic Surgeon

Being a board certified plastic surgeon, and being a member of the American Society of Plastic Surgeons (ASPS) should be the bare minimum requirements you look for in a surgeon. There are several additional considerations which can give you insight into the type of practice a surgeon may have.  Plastic surgeons who perform a significant amount of cosmetic surgery (cosmetic surgery is performed to improve someone’s appearance, in contrast to reconstructive surgery, which is performed to correct defects which might arise from trauma or cancer, for instance) usually belong to the American Society of Aesthetic Plastic Surgery (ASAPS). This society is dedicated to research and education specifically targeting cosmetic surgery (sometimes referred to as aesthetic surgery), and being a member generally means the surgeon dedicates a significant amount of his continuing medical education to topics of a cosmetic nature.

Another way that a surgeon can demonstrate a strong interest in cosmetic surgery, is to obtain a Certificate of Advanced Education in Cosmetic Surgery.  This is given by the American Society of Aesthetic Plastic Surgery only to those surgeons who spend significant amounts of additional time learning about the latest techniques in cosmetic surgery.  While this does not guarantee that a surgeon will be the best choice for you, it does guarantee familiarity with current techniques and thoughts.

Asking the difficult Questions

Many patients are anxious during the consultation process, and can even be intimidated by physicians.  That is normal, but should not keep you from doing your homework. You should feel free to ask about the medical school the surgeon graduated from, where they did their plastic surgery training, and whether they are board certified.  You may also want to inquire about how many times per year they do the procedure you are considering. ASAPS keeps records of average numbers of procedures for their members, which can be found at www.surgery.org.  This will give you an idea of how this surgeon compares to the national average.  You may also want to investigate whether the surgeon has had many lawsuits against them.  This is always a touchy issue, and the surgeon may not want to offer the information readily.  You can research the surgeon through the California Medical Board at www.medbd.ca.gov.  This website will allow you to find out if a surgeon has had a malpractice settlement of greater than $30,000, or 4 lawsuits settled after January 1, 2003.

How to find a Surgeon

Where do you start when you are considering seeking a consultation for plastic surgery?  A friend who had a good experience with a surgical procedure is usually a good place to start, as is asking your primary care physician for a referral.  Nurses also tend to know who is well thought of in the community. Another source is your county medical society, the ASPS website, www.plasticsurgery.org, or the CSPS website, www.ca-soc-plasticsurgeons.org.  Billboards and flashy ads may not be the best way to choose a surgeon.

Some Practical Considerations

When you meet with a surgeon and their staff, you should be made to feel at ease.  All your questions should be answered, and you should be given pricing information which includes any additional out of pocket costs you would be responsible for (such as medications or lab tests).  You should get a full discussion of the procedure, the recovery, and the potential problems that can occur. You should never be pressured to make a decision that day, nor should you be offered a discount for signing up for surgery sooner, rather than later. These practices should be a red flag.  Also, you should ask to see before and after pictures of procedures actually done by that surgeon. Many surgeons also will have a list of patients with whom you can speak, who have had the same procedure you are considering. Lastly, trust your instincts.  If a surgeon seems to promise things which seem too good to be true, they probably are not being entirely truthful.