How to Choose the Best Plastic Surgeon
The word “plastic” doesn’t just refer to a man-made, petroleum-based substance that’s currently choking the world’s oceans. It also means that something is moldable or flexible, and when this term is used in relation to surgery, it conjures up images of Hollywood stars with perfectly chiseled noses, bountiful breasts and taut tummies. But there’s much more to plastic surgery than just face-lifts and breast implants; the medical specialty has its origins in reconstructing body parts after major trauma or surgery to remove disease or deformity.
The American Board of Plastic Surgery reports that “plastic surgery deals with the repair, reconstruction, or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial [head, mouth, skull and face] structures, hand, extremities, breast and trunk, external genitalia or cosmetic enhancement of these areas of the body.” Whether you’re trying to enhance your bust line for aesthetic reasons or reconstruct a breast after a mastectomy to treat breast cancer, the plastic surgeon is the doctor to help you achieve your goal.
These surgeons often work on a range of different body parts. Some focus on treating patients undergoing elective, cosmetic procedures (such as a tummy tuck, breast augmentation or liposuction), while others focus on reconstructing body parts damaged by trauma, such as rebuilding a person’s face after a bad car accident. In all of these instances, you want an experienced surgeon who has worked on lots of similar cases.
Dr. Daniel Maman, an ABPS board-certified plastic surgeon with 740 Park Plastic Surgery in Manhattan, says some patients find the search for the right plastic surgeon for their needs confusing. “The problem with plastic surgery is that you have a lot of other specialists – primary care physicians, podiatrists, gynecologists, dermatologists engaging in plastic surgical procedures” after having taken a weekend course to learn how to do a breast augmentation, for example, Maman says. These practitioners then hang out a shingle and start operating on people, and sometimes it works out. “They might get lucky the first 30 times they do it and not have a problem. But then suddenly they have a catastrophic problem down the road,” in which a complication arises during surgery that the doctor isn’t trained or equipped to deal with. This can result in scarring, disfigurement, infection or even death in the most extreme cases. Fixing the problem may take several, costly corrective surgeries.
There’s nothing inherently illegal about practicing outside your area of specialty, although Maman notes he would likely be held liable for malpractice if the procedure went wrong. “As a board-certified plastic surgeon, I can decide that I’m going to remove a brain tumor if I want. There’s no state law that prohibits you from doing that. Once you have a medical degree, you can do whatever you want. The problem is, I don’t know how to do that and the patient’s not going to do well.”
Therefore, just like you would carefully research and select a board-certified neurosurgeon to remove a brain tumor, Maman says it’s important to find a board-certified plastic surgeon to handle any and all plastic surgery procedures you’re considering. “The key is choosing a plastic surgeon who’s board-certified by the American Board of Plastic Surgery, period,” he says. The ABPS reports there are about 6,800 board-certified plastic surgeons currently practicing in the United States. The ABPS is the only specialty board for plastic surgery and cosmetic procedures that’s recognized by the American Board of Medical Specialties, the gold-standard certifying body for specialty boards.
Maman says it’s important to look at the website of surgeons you’re considering to determine their credentials. “Everybody under the sun says in their bio that they’re a board-certified surgeon. Which board certified them is the key.” You can verify whether a surgeon you’re considering is certified by the ABPS through the website.
To earn ABPS certification, doctors must complete at least six years of surgical training following medical school, with a minimum of three years of plastic surgery residency training. Once that intensive training period is complete, the surgeon must pass a comprehensive oral and written exam. The surgeon must also supply the board with documentation of cases completed since leaving training. The board “even wants to know how you’re billing, and there’s a very specific protocol you have to follow when you submit your cases,” says Dr. Gregory Wiener, a board-certified plastic surgeon in private practice in Chicago. “They want to make sure you’re billing ethically, why you made the decisions you made and how you followed up on cases and cared for patients afterwards.” It’s a lengthy and stressful process, but one that Wiener says lets patients know the doctors are capable of performing the surgeries they say they can. To remain board-certified, the doctor must take a renewal exam every 10 years.
Beyond board certification, Maman says, “a big indicator [of a surgeon’s skill] is gallery photos. The surgeon should be able to show the patient photos of similar patients who’ve undergone that procedure,” and he says it’s important that the photos the surgeon shows you are of patients who are similar to you. “Having 100 photos of a tummy tuck is great, but they have to show you a patient who looks like you. Not every patient is the same. One might be 32 years old, one might be 58 years old. One might be thin, one might be fat. The key is showing [examples of] patients who look like you and fit your age and demographic, skin color, etc.”
Maman says you should also ask the surgeon for references from previous patients. “We offer our patients the opportunity to speak with a previous patient who’s undergone that procedure. And again, I try to match them. I’m not going to have a 62-year-old woman who’s had a tummy tuck speak with a 32-year-old woman because their experiences will be totally different. So I try to match them as closely as possible,” he says.
Both Maman and Wiener warn against the current trend of plastic surgery tourism, in which patients travel to foreign countries to have cosmetic procedures for less money than it costs here in the U.S. It seems with this fad, the old adage rings true: You get what you pay for. Often, these procedures do not result in the desired aesthetic outcome, leaving patients with infections that can result in disfigurement. “I’ve seen a lot of people come back with complications that I end up treating,” Wiener says.
Worse, Maman says some patients who seek a cut-rate surgery overseas may end up spending a lot more money in the long run if complications or infection mean they need to have more, corrective surgery later on. “It’s extremely dangerous. In the U.S. we have resources like good hospitals down the street if something happens. But when you go abroad, you have no idea what their qualifications are, who their accrediting bodies are. You may also have big issues with sterility, contamination of instruments, severe infection and lack of access to quality health care at neighboring hospitals.”
Even within the U.S., Wiener says staying closer to home may be the better option. Although it’s nice to see the top surgeon in the country for whichever procedure you’re having done if you can afford that, “continuity of care is important. You don’t necessarily need to travel to faraway places to find a good surgeon. Unless you’re really out in the boonies, typically there’s going to be a board-certified plastic surgeon in your area who can do what you need to do.” This is helpful if a problem arises during the healing process or later, in which case, you “can walk into that office with a question or a problem and they’re going to be there for you. That’s important,” he says.
When first meeting with your surgeon, Wiener says it’s smart to go into the appointment “armed with questions. Ask about their certification. Ask about the facilities where the surgery is performed,” and make sure that the procedure will be performed in an accredited hospital or office space. “Ask about what happens if there’s an emergency. Ask about the recovery and the risks of the procedure. Ask about how many procedures like yours they’ve done and what your other options are. Ask to see pictures of the surgeon’s work. If the surgeon is not forthcoming in telling you all those things, you need to take a step back,” and find a different surgeon.
In addition to safety, you should also consider what you’re hoping to achieve with an elective, cosmetic procedure. Wiener says cosmetic procedures involve a level of artistry on the part of the surgeon, and that may factor into whom you choose. “If you’re a general surgeon taking out a gall bladder, there’s pretty much one way to do it. With plastic surgery there’s all kinds of nuances. If you have a belly or a breast or a face and you want to change it or make it better, you could go to three different surgeons and you may get three slightly different plans” that vary based on the surgeon’s expertise, experience and interpretation of the look you’re going for.
And herein lies a potential stumbling block for some patients. Wiener says he spends a lot of time in consultation with patients before surgery “managing expectations. It’s my job to let [patients] know what is and isn’t possible in my hands.” So by all means, bring in photos of the look you’re going for to help your doctor understand what you’re envisioning, but realize that it might not be possible for your surgeon to achieve that exactly because of physiological factors that can’t be changed, such as bone structure or age.