How to Choose a Plastic Surgeon

Making an Informed Decision

In today’s increasingly commercialized marketplace with widespread advertising and marketing by physicians (and even non-physicians) claiming specialization and certification, finding the right physician has become a difficult and confusing task. To make matters worse, anyone with a medical license is legally allowed to do just about anything they please in their office, including cosmetic surgery. Any type of specialization or specialty training is voluntary. Choosing a properly trained and specialty certified physician for your needs, however, is the single most important choice you will need to make. Since the physician, and not technological wizardry, will determine your eventual well being (physical and emotional), a thorough search and knowledgeable evaluation of credentials is essential.

Check for ABMS Accredited Specialty Board Certification. Be careful, there are over 100 non-accredited specialty “boards” which can make things utterly confusing. The term “board certification” by itself is meaningless, as just about anyone can obtain “certification” by some non-accredited board. As a matter of fact, anyone with a basic medical license can claim “board certification.” How is that possible? To obtain a basic medical license (after medical school) one must pass a medical licensure exam (equivalent to the bar for lawyers), given by the National Board of Medical Examiners, a legitimate board. Passing this mandatory basic medial licensing exam automatically conveys certification by the National Board of Medical Examiners. The individual can now, truthfully, claim that they are “board certified.” The real issue you need to know, however, is whether they are certified in their specialty by an accredited specialty board.

In the United States, the American Board of Medical Specialties (ABMS) is the official oversight board which has the authority to accredit the specialty boards such as the American Board of Plastic Surgery, American Board of Surgery, American Board of Internal Medicine, etc. Any board not accredited by the ABMS is a self-designated, self-proclaimed, non-accredited specialty board. ABMS, for example, does not recognize an “American Board of Cosmetic Surgery”.

What is the single most important thing to look for when searching for a plastic surgeon?

The single best criterion when selecting a plastic surgeon is membership in the American Society of Plastic Surgeons (ASPS). Choosing an American Society of Plastic Surgeons member ensures that you have selected a physician who:

• Has completed at least six years of surgical training dedicated to the practice of plastic surgery.
• The training occurs within a residency approved by the American Board of Plastic Surgery.
• Is trained and experienced in all plastic surgery procedures, including breast, body, face and reconstruction.
• Operates only in accredited medical facilities
• Adheres to a strict code of ethics.
• Fulfills continuing medical education requirements, including standards and innovations in patient safety.
• Is board certified by The American Board of Plastic Surgery or in Canada by the Royal College of Physicians and Surgeons of Canada®.

Look for the ASPS Member Surgeon seal.

What questions should I ask my doctor?

The list of questions below is a good start in terms of what you should know about your plastic surgeon.

• Are you certified by the American Board of Plastic Surgery?
• Are you a member of the American Society of Plastic Surgeons?
• Were you specially trained in the field of plastic surgery?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• Is the office-based surgical facility accredited by a nationally or state recognized accrediting agency, or is it state licensed or Medicare-certified?
• How many procedures of this type have you performed?
• Am I a good candidate for this procedure?
• What will be expected to get the best results?
• Where and how will you perform my procedure?
• If undergoing breast implants-what shape, size, surface texturing, incision site and placement site are recommended for me?
• How long of a recovery period can I expect, and what kind of help will I need during my recovery?
• What are the risks and complications associated with this procedure?
• How are complications handled?
• What are my options if I am dissatisfied with the outcome of my surgery?
• Do you have before-and-after photos I can look at for each procedure and what are reasonable results?

Advertising: separating myth from reality

In today’s cosmetic surgery environment, it can be very difficult for an individual, even a health provider, to discern an advertisement from true independent journalism. Advertisements may take the form of actual magazines such as New Beauty in which the “featured doctor” pays a large sum to be “featured.” Even legitimate magazines or airline magazines advertise directly to physicians to be listed in their “Top Docs,” “Faces of DC,” or “Best Doctors” sections. These advertising features frequently do not denote that they are paid advertisements and are deceptive to readers.

All of Dr. Baker’s media recognition has been the result of the media contacting him for his expertise on the subject. Dr. Baker has never engaged in paid advertising, so he will not appear in these magazine features. The patient should be wary of these deceptive forms of advertising.

Do the best aesthetic surgeons only perform aesthetic surgery?

Certainly, older cosmetic surgeons may limit their practice to cosmetic surgery, but almost all of the world’s best cosmetic surgeons began with reconstructive practices. In fact almost all of the groundbreaking techniques in cosmetic surgery have reconstructive origins. In reconstructive cases the patients’ problems are typically greater requiring more advanced and difficult techniques. However, as the surgeon achieves comfort and predictability with these advanced reconstructive techniques, they become powerful tools that can be adapted to the cosmetic patient. If a surgeon only performs cosmetic surgery, it is difficult, if not imprudent, to experiment with these advanced techniques in the cosmetic patient. A smaller repertoire of techniques will likely result in an improvement for most patients, but a surgeon well-versed in a multitude of advanced techniques has a much higher likelihood of safely achieving a spectacular result.

The reconstructive challenges that Dr. Baker faces have given him experience and confidence in techniques that are difficult to develop when treating only cosmetic patients. The numerous complex reconstructive patients Dr. Baker sees have provided him the expertise to safely employ these complex techniques in his cosmetic patients.

Surgery Center or Hospital-Where should I have my surgery?

Many procedures in plastic surgery can be performed at either an outpatient surgery center or a hospital. Each has advantages and disadvantages. A surgery center likely offers a more serene private environment. You will need to be in excellent health to qualify for surgery at a surgery center and longer surgeries may not qualify for outpatient surgery. Because the backup facilities of a hospital are not available at a free standing surgery center, the patient may want to know the following information:

• Who is doing the anesthesia – a board certified anesthesiologist or a nurse anesthetist? If a nurse anesthetist, is there a board certified anesthesiologist in the facility offering supervision? Dr. Baker will only perform surgery under general anesthesia if a boarded anesthesiologist is either performing or directly supervising the anesthesia.
• Is there an X-ray machine on site to rectify a missing needle or sponge count?
• What is the plan if the surgical recovery requires a prolonged time or there is a complication?

All of these are important facts that should help guide each patient’s decision.

In a hospital, the disadvantage is that it is a busier preoperative environment since many more patients are getting ready for surgery. This is not as soothing to some patients. The advantage of the hospital is that if there is any unanticipated event, there will be immediate help with all the resources of a hospital. Dr. Baker will help each patient make the best decision for themself with safety in mind.

What are the other specialties sometimes confused with Board Certified Plastic Surgeons?

• Facial plastic surgeon – This is an Ear Nose and Throat doctor who has completed an additional year of facial plastic surgery. This is not to be confused with a board certified plastic surgeon, who has been trained under the rigor of the American Board of Plastic Surgery for six years.
• Oculoplastic surgeon – This is an ophthalmologist who did two additional years in periorbital surgery which is surgery of the eye and orbital region. These surgeons are ophthalmologists and not board certified plastic surgeons.
• Board certified cosmetic surgeon – This does not mean the surgeon is a board certified plastic surgeon. Almost all plastic surgeons will state “Board Certified Plastic Surgeon” if they are a true plastic surgeon, and these plastic surgeons may state that they specialize or practice cosmetic surgery. These plastic surgeons are not to be confused with “Board certified cosmetic surgeons” which includes OB/GYNs, dermatologists, ophthalmologists, oral surgeons, ENTs, and others who practice cosmetic surgery, but this board is not recognized by the American Board of Medical Specialties.
• Dermatologic surgeon – This is a dermatologist who performs surgical procedures. However, dermatology is not considered a surgical specialty. In fact, dermatologists are not even eligible for the fellowship status in the American College of Surgeons, the society that represents all surgical specialties in the United States.

Any advice for finding the right plastic surgeon for your needs?

One tip Dr. Baker recommends to obtain a recommendation for a good plastic surgeon in your area is to call the plastic surgery department of any reputable medical center (far enough away from your location to avoid bias). Ask them who would be good in your city for your needs. They almost always have a list a surgeons to whom they refer friends, family, and relocating patients.

Ask Around – Check with friends, physicians, or nurses who may have had a similar procedure. A quality reputation still takes years of hard work and dedication to develop and must be earned through skill and performance, unlike advertising which is available to anyone for a price (airline magazines, New Beauty Magazine, Faces of DC and featured doctor profiles in Washingtonian, even profiles in magazines such as Cosmopolitan).

Check for Surgical Training – Did the person graduate from an accredited medical school and receive a Doctor of Medicine (M.D.) degree? If you are considering a surgical procedure, such as liposuction or other cosmetic surgery procedure, is the physician in question actually a trained surgeon? Did he or she graduate from an accredited surgical residency program? What type of residency? Plastic surgery, otolaryngology or other? How much training did they have? Any postgraduate fellowships or specialty training? What is their experience with the particular procedure that you are interested in?

• Check for Professional Society Memberships. Just like board certification some societies are more meaningful than others. Get the exact name of the society, call them and find out what the membership requirements are. The following societies require certification by the American Board of Plastic surgery—American Society of Plastic Surgeons, American Society for Aesthetic Plastic Surgery, and the American College of Surgeons.

Online Reviews – Online reviews are a good place to start to get a sense of patient satisfaction. Keep in mind that there are services that generate favorable ratings and eliminate or reduce negative ratings. Patients with negative feelings tend to go online more than happy patients, and because of HIPAA regulations, the physician can rarely state their side of the story.

• Your Consultation with Dr. Baker