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Sorting through the hype: how to choose a plastic surgeon.

The advertising and public relations world has continually brought physicians' names to the public. Ten years ago if a doctor called himself a cosmetic surgeon, the patient knew precisely what that title meant. Currently, doctors in various sub-specialties, such as dermatologists, gynecologists, opthamologists and even dentists, are performing cosmetic surgery procedures. This can utterly confuse prospective patients trying to find the most qualified surgeons. How, wonders Dr. Stanley Taub, a New York City plastic and reconstructive surgeon, "is a prospective patient to know who is a diligent, excellent, caring physician and who is a charlatan?" Taub wants to disseminate information the public can use to select a cosmetic surgeon in a country now brimming with doctors calling themselves "cosmetic surgeons."

"Public law and policy do not necessarily protect us from unreasonable and untrue claims," declares Taub. "A physician needs to be licensed in medicine which means earning a recognized medical degree--and can hang out a shingle in any specialty he chooses. The state does not control what area of medicine he practices or which type of specialist he says he is unless there are complaints and he is brought before the Office of Professional Medical Conduct. Often, however, by then it is too late."

How do we ascertain a physician's expertise and qualifications before placing ourselves under his or her care? Four basic areas must be investigated--a physician's training, certification, associations and attitude toward his or her patients.


"A physician should have and be willing to provide evidence that he or she has trained in the area of their expertise," Taub states. "For example, patients want to locate a plastic surgeon who trained in plastic surgery, which means a post-surgical residency fellowship in the sub-specialty. Each residency or fellowship program gives a certificate [indicating] the dates of service as well as the hospital or department in which the physician trained." Most physicians keep certificates and other diplomas framed in their offices. If these are unavailable, at least a curriculum vitae or brochure describing a doctor's training should be available and carefully examined by the patient. "If a physician is either unable or unwilling to disclose this information, it becomes a clear issue of 'medical consumer beware,'" Taub warns.


Each medical or surgical sub-specialty has a certifying board approved by the American Board of Medical Specialties[R] (ABMS). After training the requisite number of years, a physician must take an examination to become certified. After being certified, a surgeon often applies for a fellowship at the American College of Surgeons. These credentials can be checked in The Official ABMS Directory of Board Certified Medical Specialists, available in public and hospital libraries, which lists all physicians and their specialties as well as a number of local physician directories. "Unfortunately, the AMA and other state and local medical societies often allow physicians to self-designate a specialty, [which] can be misleading," explains Taub. A patient must be wary of self-designated specialists. "For example, The American Board of Cosmetic Surgery is not approved by [ABMS] and neither are a host of other so-called 'boards,'" says Taub, who is board certified with the American Board of Plastic Surgeons, Inc., the only plastic surgery board recognized by ABMS. Gynecologists, ENTs or general surgeons may be exquisitely trained physicians, but where did they learn to perform cosmetic surgery? Was it on-the-job training or a correspondence course? How often do they go for a refresher course? Are they affiliated with a certified hospital in case of emergency?

Moreover, Taub advises the would-be medical consumer "not to be impressed by a P.C. after the physician's name--it only means they are incorporated." People should look for a surgeon with the medical titles M.D. (i.e., Medical Doctor) and F.A.C.S. (i.e., Fellowship of the American College of Surgeons), which indicate the physician has the proper qualifications.


1. LIPOSUCTION (372,831 *)

Liposuction removes unwanted fat lumps and bulges. A vacuum and hose are attached to cannulae (i.e., thin suction tubes) which are placed into body fat through small incisions. Although healing time varies for individual patients, stitches are generally removed after the first week, bruises begin to fade after three weeks and swelling completely disappears after six months.


Augmentation mammoplasty (i.e., breast augmentation) enhances breast size and shape. An implant is inserted behind each breast after an incision is made either in the crease where the breast meets the chest, around the areola (i.e., dark skin around the nipple) or armpit. Once the incision is made, the surgeon lifts the breast tissue and skin to create a pocket. After the surgery, patients will probably feel tired and sore, but most discomfort can be alleviated with medication. Stitches are removed in approximately 10 days, but swelling may take three to five weeks to disappear.

3. EYELID SURGERY (229,092)

Blepharoplasty (i.e., eyelid surgery) removes fat, usually with excess skin and muscle, from the upper and lower eyelids. This procedure can correct drooping upper lids and puffy bags under the eyes and usually takes one to three hours to complete. The surgeon makes an incision in the crease of the upper lids and below the lashes in the lower lids. Then, the skin is separated from underlying fatty tissue and muscle, removing excess fat. After surgery, the eyes are usually lubricated and a bandage with ointment is applied. The stitches are removed two to seven days later. Typically, bruising and swelling disappear seven to 10 days later and blurry vision disappears in three to four days. Normal activities can be resumed within 10 days.

4. RHINOPLASTY (1,56,973)

Rhinoplasty (i.e., a nose job) changes nose size, shape and overall appearance. The surgeon makes a small incision, known as a closed rhinoplasty. Then, the nose can be altered with minimal scarring. After surgery, patients should expect a relatively long recovery period, in which final results can be seen up to a year later. Minor swelling can persist for several months, but patients can usually return to work and daily activities a week to a month later.


Breast reduction is used to decrease the size of breasts that may be too large and cause discomfort. The most common method involves three incisions-one is made around the areola, another runs vertically from the bottom edge of the areola to the crease underneath the breast and the third follows the natural curve of the breast crease. After surgery, discomfort can be alleviated with medication. One can return to normal activities in about two weeks and aching, swelling or bruising will begin to disappear after several weeks. Scars obtained from the procedure are permanent, but, in time, become less noticeable. The new breasts' final size and shape become visible after two to 12 months.


1. BOTOX (1,658,667)

Botox is a purified protein produced by Clostridium Botulinum Bacterium. A facial plastic surgeon injects small amounts of Botox into the overactive muscles that cause fine lines and wrinkles. The effect generally lasts three to six months. Initially, patients receive two to four per year, but must patients require less Botox after several treatments.


Microdermabrasion is a simple and quick procedure for patients showing early signs of aging, sun exposure or other facial imperfections. It delivers a precise stream of sterile micro-crystals onto the skin's surface to gently exfoliate the stratum corneum without anesthesia. Although the procedure entails virtually no discomfort, downtime or recovery, patients may experience redness for about an hour after the procedure.


Collagen injections treat fine lines, wrinkles and shallow scars, including areas around the mouth, such as laugh lines and deep nasolabial creases. To check for allergic reactions, a skin patch must be done first. Afterward, the physician can determine the location and extent of the collagen injections. Patients usually experience little discomfort and results last up to six months.


Laser hair removal takes about an hour to complete both legs and can vary in time for other areas. As the laser is moved over the area, light passes through the skin and is by the melanin in hair follicles. It generally takes three to four treatments over a six- to eight-week period to achieve a reduction in the amount of hair. After the treatment, it may take a year before patients see full results.

5. CHEMICAL PEELS (495,415)

Chemical peels are used for smoothing away roughness and fine lines, improving sun-damaged skin, blotchy pigmentation, broken , capillaries and age spots. After the procedure, patients will experience redness and peeling can occur within the next three to seven days. A treatment is required every to 10 days, totaling in five to 10 treatments depending on the person, to see the peel's full benefits. After the fourth session an improvement is noticeable.


If patients are still confused, Taub suggests they "check a third area: a physician's associations and affiliations. If a physician is on the staff at a well-respected teaching hospital in the department appropriate to [his or her] qualifications, then patients know his or her qualifications have been researched by the hospital's committees and should therefore be valid and current." Today, however, because of skyrocketing hospital costs, the trend is toward "more outpatient surgery and care," states Taub. "Because of this, physicians have moved further away from hospitals. This may be good for the patient from a cost standpoint, but a well-qualified physician--especially a surgeon--should maintain a relationship with a hospital just in case there is a problem that requires hospitalization." Taub further advises patients to remember, "When a physician is outside of an institutional setting, there is no quality control--or peer review--other than what the physician sets for himself."


Finally, how does the physician treat you? "You don't have to like your surgeon as a friend, but do you think he/she has you, the patient at heart, as his first consideration?" asks Taub. "For example, did your plastic surgeon explain all that was involved or leave it up to someone else?" It is important for the physician to spend time with a patient and explain the goals of his or her care, alternatives, risks and possible complications. Usually, there is a lot of ground to be covered; ask yourself whether you were given the opportunity to ask questions and have them answered to your satisfaction or were you rushed out of the office?

"The bottom line is patients must feel comfortable with their physicians. If they are not and there is a postoperative problem, communication may not be easy," Taub cautions. If a surgeon spends little or no time with a patient before surgery, he or she will probably spend less time afterwards. "Patients should ask themselves if this is really what they want," Taub recommends. Another important question is whether the physician is available for emergencies and questions after hours. Sometimes an assistant handles all calls or an answering machine directs you to call back in the morning or go to the local emergency room. Wouldn't you prefer to talk to your doctor about the problem?

Patients must look into many areas of a physician's training, especially certification, association and personality prior to allowing him or her to manage their health care. "If you do your homework well," Taub concludes, "you should end up with a compassionate, well-trained, competent physician with whom you feel totally at ease and in whom you have the utmost confidence."

* The number of people in the United States who had this procedure last year.

Reprinted by kind permission of KMR Communications, Inc.
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Title Annotation:Special Report
Publication:American Fitness
Geographic Code:1USA
Date:Nov 1, 2003
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