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How to pick the right plastic surgeon

Robin Wulffson MD's picture
Tracy Pfeiffer MD, plastic surgery, cosmetic surgery, botched surgery

Millions of Americans from teens to seniors undergo plastic surgery procedures each year in the United States. Many are pleased with the outcome; however, some are not. Dissatisfaction can be due to unrealistic expectations; however, in many cases, it is due to making a poor choice in the surgeon. I consulted Tracy M. Pfeiffer, MD, MS. She is a New York City plastic surgeon with a special interest in breast surgery. She offers the following tips to safeguard against a bad outcome.

Do your research and be well-informed: This is extremely important. Unfortunately there are unscrupulous individuals who will take advantage of patients, especially those who are paying cash for their services. The majority of plastic surgeons are highly ethical. However, patients must be alert to identify those who are not ethical.

Additionally, patients need to be aware of physicians who claim to be plastic surgeons but in fact do not have the necessary training or board certification. Over the years, several plastic surgeons have lost their license to practice medicine, so these people do exist. In addition, there are non-plastic surgeons performing plastic surgery and cosmetic treatments and these practitioners do not necessarily have the necessary training and certifications that are desired. In addition, there are bogus doctors out there. I personally took care of a young woman who was a mother of two from New Jersey. She came to my NYC office for a consultation regarding a ruptured breast implant and the story she told was frightening and a cautionary tale for all patients. She went to a “doctor” in New Jersey for buttock augmentation; the “doctor” had many certificates on the wall, etc. After the procedure, the patient went into respiratory arrest because of embolism of the product that was injected. At the hospital her parents were told she would die. She had the ruptured breast implant because of a right thoracotomy that was performed to make a diagnosis. This information was confirmed with her pulmonologist; miraculously she survived. It turns out the “doctor” was not a licensed doctor at all but was posing as one. This can serve as a warning for all patients to do extensive research before receiving a procedure.

Patients often make the assumption that if the doctor is performing the procedure “in broad daylight” that it must be okay. Nothing is further from the truth. Patients must take steps to ensure that their doctor is properly licensed and board certified in the area of their practice. Patients should talk with their states licensing board and confirm that their doctor has an active license to practice. They can also find out if there have been any malpractice judgments against the doctor. At times, there may be one or two because some doctors will settle nuisance lawsuits, but a series of awards merits further investigation or finding another doctor. The patient must take things one step further and determine if their plastic surgeon is Board Certified by the American Board of Plastic Surgery. No other certification will suffice for body surgery. Doctors may also be certified by the American Board of Otolaryngology because this ensures appropriate training, continuing medical education, etc. in plastic surgery of the head and neck. The American Board of Cosmetic Surgery is NOT equivalent to these boards on any level. Patients should also try to ascertain the specialty of the plastic surgeon. Many surgeons concentrate on certain areas such as the eyes or breasts, and these people perhaps have more comprehensive experience in these areas. Patients can ask the office staff what procedures the doctor usually performs, can look at the doctors website to see what is emphasized, look to see if the doctor regularly attends meetings in a specific specialty, has written or lectured on these areas, etc. Above all, it is imperative that patients do the necessary research before undergoing plastic surgery.

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Possible consequences of not being well-informed: See above. Your physical safety is paramount. Next you want to achieve a good aesthetic result that is in-line with your goals and expectations. A good plastic surgeon and her/his staff will be able to communicate with you regarding your goals, discuss the pros and cons of different options, and help you select the right procedures.

The most important questions you should be asking your surgeon prior to undergoing any procedure: One red flag for patients should be offices that minimize/downplay the possible adverse effects of surgery. All patients should be informed as to the risks of surgery. You must ask these questions and your questions should be answered patiently and professionally. Although the risks are small, they are present. Patients should ask if the operating facility is accredited, who performs the anesthesia, and what type of anesthesia is being used. Is it a nurse anesthetist or an anesthesiologist? Is the anesthesiologist board certified? In the case of office based surgery, what transfer agreements are in place with local hospitals? How does the doctor bill for revisions? Is the office available 24/7? Most of these issues go to safety, which is the most important factor.

How to avoid having a severely botched result that causes disfigurement: Do your homework as above. Be wary of doctors who are offering procedures/treatments at very low prices that are well below the norm. Why would a doctor do this? The only reason is to drive business through the door. These doctors do not necessarily prioritize your health and safety but care more about volume and generating cash flow. I have heard many, many stories from patients who spent a lot of money on a procedure, only to be very disappointed with the result. For example, a woman I met saved thousands of dollars to have a facial laser procedure, from which she had no discernible improvement. This was a major expense for her and the result was a huge disappointment. The procedure was performed by a non-board certified doctor who marketed heavily. Patients must ask themselves why a reputable doctor with a busy practice would discount their services? Doctors who charge low prices must make up the difference by increasing the volume. This means short consult times in the office, short operating times when the doctor sometimes needs more time to get a good result, and usually less attention paid to the patient by the staff because they are swamped. The best way to protect yourself is to realize that some things are worth the price, such as your health and safety. Be wary of doctors who agree to combine multiple procedures in one case; often this is not the safest way to proceed. Be wary if the doctor or staff says you do not need medical clearance prior to your procedure. Almost all patients should have medical clearance prior to a surgical procedure. Be wary if the staff/doctor is rushed, rude, or trivializes your concerns. These are all warning signs that this office may not prioritize patient safety. Be careful of having surgery oversees because it is cheaper. Although some patients have a fine result, others do not. I know a patient who had a severe complication after abdominoplasty and liposuction in Columbia. This resulted in her requiring care in Columbia for six month because she had no insurance and could not pay for the follow-up to be done in the United States. She lost her job as a result of this and was also disfigured. This is just another example as to why your health and safety are worth the price. I strongly advise against selecting a doctor based on price. A patient’s health is not a commodity.

Reference: Tracy M. Pfeiffer, MD, MS

See also:
Plastic surgery myths debunked
Life coach offers healthy alternatives to teen cosmetic surgery



Most of this is very good advice. It is critical to research your surgeon properly. But do know this, there is much confusion about the difference between a cosmetic surgeon and a plastic surgeon. Both specialties require over a decade of training. Very basically, a cosmetic surgeon is trained to improve or enhance the aesthetics of appearance. A plastic surgeon is specifically trained in reconstruction, trauma, and correcting deformities. A plastic surgeon may or may not have concentrated training in aesthetics. A cosmetic surgeon may be a plastic surgeon, or may have previously specialized in another surgical area. This is because there is no cosmetic surgery residency program in the United States. As stated on the American Board of Cosmetic Surgery (ABCS) website, "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." As I stated above, there is no cosmetic surgery residency program in the United States. Consequently, to competently practice cosmetic surgery, a doctor of one of the above mentioned specialties may continue on to pursue a fellowship in cosmetic surgery. The path any surgeon must follow is this: 4 years pre-medical undergraduate work, 4 years of medical school, the 4th year is clinical rotation (this happens at a teaching hospital, and the word "rotation" refers to rotating duties in various medical specialties, in other words, each medical student experiences a bit of all specialties). After that is the 1 year internship, which is specialty training. The year-long general surgical internship may be included in a residency program. Then there is a 3 to 5 year residency program to specialize. As I said above, there are currently no residency programs in the United States devoted exclusively to cosmetic surgery. This means that to become a board certified cosmetic surgeon, one must follow his or her residency with a fellowship. Many other specialties in medicine also continue with fellowships. Fellowships are offered by accredited facilities and board certified physicians in a particular field. Fellowships can last for 1 to 3 years. However, to become a board certified cosmetic surgeon by the American Board of Cosmetic Surgery, one must have at least one previous board certification and complete a fellowship training in cosmetic surgery. So although the training of a plastic surgeon may have a residency in general surgery, and another 2 or 3 years training in plastic surgery, the focus is not on cosmetic treatment. Some programs do indeed include aesthetic surgery as a main track, such as UCLA, but this is not common. There is no guarantee that a plastic surgeon has more expertise or experience with any given cosmetic procedure. Licensing and board certification alone does not tell the potential patient how many times any given surgeon has performed a procedure, nor how recently. In fact, if a plastic surgeon does not concentrate on the cosmetic aspects of surgery, he or she may actually have less experience than a cosmetic surgeon in any given procedure. Dr Rhys Branman Little Rock Cosmetic Surgery Center
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