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A Surgeon’s Guide to Considering
Plastic Surgery |
| By Joshua Korman, MD Mountain View, CA |
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Looking for the Fountain of Youth is a national pastime. Some of us look to nutrition; others work out to stay young, while still others look for magic in jars. But when those vitamins, face creams and crunches just aren't doing the trick, many of us turn to plastic surgery. Here's what you need to know before deciding if plastic surgery is right for you.
Cosmetic Plastic Surgery is all the rage these days. Baby boomers seek to defy gravity and media organizations clamor to feed our seemingly insatiable interest in rejuvenation and body enhancing procedures. From teenagers to septuagenarians, people want to know what can be done to help them look their best.
As a plastic surgeon, I can tell you that the hype in this billion-dollar-a-year industry has more gas than a politician. Not a month goes by without several magazines devoting features to the latest and greatest techniques in aesthetic surgery-articles that usually gloss over the facts. At the same time, freewheeling misinformation roams throughout the world wide web like a character out of "The Road Warrior."
Recently, two patients came in to my office the same afternoon. They were both interested in liposuction and both were somewhat confused. The first told me she heard that the latest ultrasonic techniques made it possible to have no bruising, no pain, and the ability to go back to work the next day. Where did she hear it? She "saw it on 50/50" (I think she meant 20/20). The next patient told me that he was interested in liposuction, but definitely not ultrasonic liposuction because he'd found out on the web that if you had it, you could get burned.
Being an Informed Consumer
For anyone considering plastic surgery, it is crucial to become an informed consumer. This is not a new car you are thinking about; this is your body.
The first question to ask yourself is how much does the status quo bother you. A doctor cannot tell you how much distress a sagging neck or droopy eyelids or prominent ears cause you. Plastic surgeons can operate on ears; they cannot operate on what is between the ears.
My basic philosophy is that if there is something that concerns you for more than a certain number of hours of most days, you should do something about it. Similarly, if something interferes with your activities of daily living (for example, not wearing low neck clothing because you hate the way your neck looks), you should do something about it. Doing something about it may range from buying more turtlenecks to having a facelift.
Learning all of Your Options
The next step is to find out as much as you can about your options. The idea of having surgery you don't absolutely need can be the source of much anxiety. Don't let fear of the unknown overwhelm you. You need to familiarize yourself with the possibilities. Input from friends who have had cosmetic procedures can be invaluable.
In the Bay Area, it is sometimes hard to gather information discreetly. Unlike in Southern California, where patients walk around the grocery store with their facelift bandages on, many people around here don't want to publicize the fact that they are thinking about doing something, let alone tell someone they did it. Then there are those who have had surgery and want to recommend a plastic surgeon to a friend without telling the friend that they themselves had a procedure. It's like recommending a restaurant to a friend where you claim never to have eaten.
It is generally agreed by most plastic surgeons that the mark of excellent aesthetic surgery is when people don't immediately notice that surgery has been done, but make comments such as, "Oh, did you go on vacation? You look like you lost weight," or "Did you cut your hair?" This is in contrast to second rate surgery that elicits behind the back barbs such as, "Oh, I love that new ski jump nose," or "How was that trip through the wind tunnel?"
Sorting Through the Information
As a result, many people turn to published material to learn about different doctors and procedures. Some of these books like Helen Brandford's "Welcome to Your Facelift" and Dr. Richard Jobe's "The Sophisticated Shoppers Guide to Plastic Surgery," are helpful reading to people beginning the search.
Other publications, such as the Yellow Pages, are often marketing battles between plastic surgeons that benefit Pacific Bell more than the doctor or the patient. Other forms of advertisement also disguise themselves as the "real information," such as advertorials in newspapers and magazines.
Magazine and television features other tantalizing bites of information that are often incomplete assessments of the pros and cons of cosmetic surgery procedures. As always, be sure to read between the lines and watch with a cynical eye.
The World Wide Web can be a useful source of good facts without broadcasting to the world that you are thinking about having plastic surgery. However, not all editors on the Internet do rigorous fact checking, as in the print and broadcast media. As a result, there is as much misinformation as there is good advice.
The most useful thing to be gleaned from the Internet is learning about the credentials of various plastic surgeons and what questions to ask them. Many plastic surgeons have e-mail addresses. You can find these on the Internet or you can call their offices to get their e-mail addresses. You can then ask them specific questions through e-mail, which may help you to learn more about procedures and their special areas of interest before you ever go in for a consultation.
Finding a Surgeon
After you have learned as much as you can without seeing a physician (and you're still interested in going to the next step), it is time to find a plastic surgeon. The San Francisco Bay Area has the highest number of plastic surgeons per capita in the world. As a result, there are a great many to choose from. But they vary widely in credentials, specialties, costs, experience and personalities. You may consult a plastic surgeon who has already operated on your friends, or maybe you are seeing someone you found on the web or in the yellow pages. Either way, your objective should be the same.
You should find someone with first-rate credentials who performs the procedure you're interested in often. Ideally, you should see his or her work in photos and/or talk with previous patients who have already had the same procedure. The doctor should certainly be someone who you feel listens to you and understands your concerns. It may take a few consultations to find the right physician for you.
In all the "how to find a plastic surgeon" guides and suggestions, the first edict is to make sure your doctor is board certified. But that is really not the most important question. It is more important to ask the next question: what is the name of the board that has certified the physician?
You should look for certification by the American Board of Medical Specialties, which is the governing board in the United States. The only member plastic surgery board is the American Board of Plastic Surgery. Because managed care has wrought havoc with reimbursement in medicine, many physicians without proper surgical training practice "cosmetic surgery" because that is one of the few areas in medicine which is still fee-for-service and free from managed care.
Finally, if you decide to shop by phone for prices, make sure you are quoted global fees. This fee should include the surgical fee, the operating room cost, the anesthesiologist and any special charges such as laser fees.
Consulting With Your Doctor
Once you have selected a plastic surgeon, you need to be proactive in predetermining what it is you are trying to accomplish. It is important for the plastic surgeon to help you with what bothers you when you look in a mirror rather than what bothers him or her.
You will need the plastic surgeon's help to determine if liposuction of the abdomen will accomplish what you want or whether an abdominoplasty (tummy tuck) is more appropriate. Similarly, you probably will not be able to decide by yourself whether your droopy eyelid condition is caused from your eyelids or mainly from your brows.
These are questions to be answered in the consultation. Risks and possible complications should be carefully explained. Make sure you get all your questions answered.
One of the newer areas in cosmetic consultations is computer imaging. Although this technology is sometimes most useful as a physician's marketing tool, it can be helpful for patients to see what they might look like after surgery and helpful to the doctor to get an idea of what the patient expects. Current state-of-the-art software is excellent for noses and chins. It is also good for facelifts and liposuction, but not ideal for eyelids and breasts. Although the chance to see what you might look like is very appealing, remember, it is only a computer simulation. Realistic expectations are vital to surgical success.
Confronting Your Concerns
The common worries that prospective patients have concern safety, recovery time and looking bizarre. National tabloids love to highlight plastic surgical complications. In skilled hands and in an accredited surgical facility, cosmetic procedures are extremely safe.
Many patients like to have multiple procedures done at the same time. However, combining too many together can be dangerous. Recovery time depends on the procedure and what is meant by recovery. Pain, bruising, and swelling subside at different rates depending on the body and extensiveness of the procedure. Make sure you tell your doctor what medicines, vitamins and herbs you take. Vitamin E, aspirin, and Advil type medications need to be stopped several weeks before surgery because they thin your blood and can cause excessive bleeding.
Looking "pulled" or "surprised" is a concern of many prospective aesthetic surgery patients. It is important to have realistic expectations and to convey these to the physician. You need to have complete trust in your doctor as you go into the operating room. Anything less is unsatisfactory.
Considering Some New Procedures
As always, there are some new procedures in the cosmetic arena now. BOTOX (short for Botulinum Toxin) was used originally for twitching eye muscles but has become effective in treating frown lines and crow's feet. It works by deactivating the muscles that cause these unwanted aspects of aging. It is quite safe, but it only lasts a few months and it can also cause temporary eye droopiness.
The Erbium laser for facial wrinkles tends to cause less redness than the carbon dioxide laser, but does not penetrate as deeply into the skin. Lasers for removing hair have recently gained popularity as well. These work by going after the melanin in your skin and, at the same time, destroying the hair follicle adjacent to the melanin. However, it is not permanent and requires multiple treatments. Also, it can cause lightening of the skin, usually in darker-skinned people.
In the liposuction field, there are a few different machines for ultrasonic liposuction. These work by emulsifying and suctioning only the fat, thereby leaving many of the other fibers attached to the skin. It is especially useful in thick-skinned areas such as the back. Recovery time is probably equivalent to traditional liposuction. Advantages are possibly more skin contraction and contour results. Disadvantages are risks of skin burning (should not happen in experienced hands) and fluid collections. Another very helpful technique in liposuction is the use of post-operative massage. This can markedly improve the contour results.
As with any procedure, especially the newer ones, it is important to get as much information as possible before proceeding.
This is Happiness Surgery
Finally, remember that this is happiness surgery. You should be happy with the doctor, the procedure, the timing, the anticipated recovery time, the cost and the result. Try to have realistic expectations. Taking the time to be an informed consumer is the important first step.
Dr. Josh Korman is a plastic surgeon board-certified by the American Board of Plastic Surgery practicing in Northern California.
Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs. For confidential, personalized information at no cost or obligation, use the Find A Specialist tool to find a board-certified plastic surgeon near you. It’s your first step to looking and feeling better today!
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