There's an old expression, which says, "The best way to judge a man is to meet
his dog." If the man in question happens to be a physician to whom you're entrusting
your body, then this axiom would apply to his staff, his patients, his family, and
anyone else who reflects his personality. If the people around him are unhappy or
unhealthy, if they appear to be untrustworthy, cold or rude, then this should give
you a good indication of what the doctor is like. Another consideration is whether
the doctor and his staff seem truly interested in their jobs. A doctor who loves
what he's doing can help you feel more confident about your decision.
There are many factors to consider when choosing a physician of any kind, but your
own emotional response is the most critical index of how safe you're going to feel
with this person. Because there are so many facets to consider, and because choosing
the right doctor is such an important part of the surgical process, I've broken
this chapter down into sections covering the most important elements.
- Be Procedure Specific
Each doctor's practice has a personality, and each doctor excels at something specific.
Find out which procedure(s) the doctor performs most often, and if it's the one
you're interested in, then pursue it. Before you get to the point where you actually
go to the office for a consultation, you can narrow your choices down considerably
in one easy step: ask questions that are "procedure specific."
Most physicians have a few procedures in which they are the most experienced. A
good place to start is with a doctor who specializes full-time in cosmetic surgery
(some do ordinary injury and surgical care as well).
Ask, for example, "How many liposuctions have you done?" You might want
to take it one step further and ask, "How many liposuctions have you done on
someone my age, with my coloring?" If a cosmetic surgeon has done 1,000 tummy
tucks, but you're looking for a facial laser peel and he's only done 50, then he
may not be right for you. Your best bet is to find an ultra-specialist. Some of
these procedures (noses and liposuction in particular) have learning curves up to
1,000 procedures long. Experience is almost everything.
On a personal note, recently I needed to have hernia repair surgery. I decided to
have it done through a flexible scope (endoscopic hernia repair) and I consulted
three physicians, all of whom had performed several thousand cases. I chose the
one who inspired the greatest measure of confidence. I suggest you follow this model,
and choose someone who's had extensive experience in the exact procedure you want,
and whom you feel is right for you.
- Look at the Right Kind of Before-and-After Photos
A cosmetic surgeon should always let you see before-and-after photos of his patients.
If he says he doesn't have any, for whatever reason, look elsewhere.
When you're looking at photos, don't just settle for a random handful of shots.
You need to look at dozens -- maybe even hundreds -- to get a good sense of the
doctor's work. Ask to see very specific types of photos, for example, shots of people
who've had the exact procedure you're planning to have, and who have bodies similar
to yours (skin condition, skin color, body weight, shape, and age).
- Speak with Other Patients
First, ask the doctor directly what percentage of his patients is referred to him
by other patients. The best practices get the majority of their patients by referral.
If most of the patients come in response to advertising alone, you may want to think
twice. Ask the doctor or the staff if they'll give you the phone numbers of some
other patients who've had the same procedure you're inquiring about. A percentage
of these patients should be agreeable to providing support to newcomers. If the
doctor says he cannot let you talk to his patients, this is a bad sign. There are
no better information sources on earth than people who've had the same surgery.
Another way to learn about the doctor's expertise is to "socialize" in
his waiting room. Show up 30 minutes early for your consultation, and spend some
time questioning patients in the waiting room. You'll find that most cosmetic surgery
patients are very willing to talk about what they've had done. If you see a woman
with a bandaged face, ask her
- The Scoop on Specialty Boards
Cosmetic surgery techniques change rapidly, and the technology is always new. Even
someone who was board certified as recently as five years ago may not be up to speed
on the narrow specialty field of an individual procedure. Certain specialty boards
promote themselves as being somehow superior to others, and some claim that no other
physicians but those in their group should be doing surgery at all. But this is
wrong. Dermatologists, plastic surgeons, ophthalmologists, ear-nose-throat specialists
and others have all contributed to the development of modern cosmetic surgery. Competent
physicians can be found in each group.
If I had to generalize about specialties, the following are my recommendations.
But bear in mind that modern training cuts across specialty lines, and is as recent
as yesterday.
Ear-nose-throat specialists who've had an extra year of cosmetic surgery training
might be able to do the best "nose jobs." They can do a great job with
the functional breathing apparatus as well as making you look better. Plastic surgeons
also often do a great job with noses, and generally have years of training for breast
reconstruction’s of all kinds. Most liposuction has been done in recent years
dermatologists, but now plastic surgeons have, in many cases, adopted the new "tumescent"
anesthesia, which was developed originally by Drs. Klein and Lillis (both dermatologists).
For laser work, dermatologists generally have the most experience, but many other
specialty fields are getting involved. Eyelid surgery (blepharoplasty) is performed
by dermatologists, plastic surgeons, and also by ophthalmologists specially trained
in a field called "oculo-plastics." Hair transplantation physicians come
from many specialties.
I can't emphasize strongly enough how important it is for a doctor to be up to date
on new procedures, techniques, drugs and other vital information. Things change
especially rapidly in cosmetic surgery. About half of what our office does was introduced
in the last five years! We have to keep learning.
An active physician who's a leader in his field attends at least six to eight professional
seminars or conferences per year. A list of these conferences should be available
to patients, ideally in the waiting room.
- Shop Around
Cosmetic surgeons can be found in all kinds of places. Ads in your local paper or
on radio are a place to start if you don't have a personal referral. However, a
doctor with a national chain of clinics advertised on late night TV may be too commercial
and too busy to give you the best personal care.
I suggest having consultations with at least two or three physicians, using the
guidelines in this chapter to help make your decision. Although some doctors charge
for these initial visits, this is less common as the field becomes more competitive.
- How to React to Badmouthing and Puffery
Several of the national hair transplantation chains and at least one specialty board
have taken aggressive positions about the incompetence of other physicians (badmouthing).
You may also encounter individuals claiming that they are the absolute best (puffery).
Unfortunately there seems to be more of this behavior in cosmetic surgery than other
medical fields. It is extremely unprofessional and violates medical ethics.
Physicians are trained early in medical school to respect other doctors and not
to criticize their colleagues. We are a select group who has worked very hard for
our positions. Most of us understand that criticizing other doctors destroys the
trust of patients for the entire medical delivery team. If you encounter badmouthing,
ask yourself whom it reflects on. As Shakespeare said, "The fragrance of the
rose lingers on the hand that casts it." Other kinds of smells linger too.
Puffery is not as bad (we doctors are full of ourselves, as you well know), but
it is also unprofessional. Medical knowledge is widely spread through journals and
training, and any individual or any group who claims they're the "best and
only" should be tried and convicted of total egomania.
- Insurance Billing for Cosmetic Procedures is Fraud
And both the doctor and the patient could go to jail! Be wary of a "deal"
to do cosmetic surgery along with another medical procedure for which the insurance
is billed. A few procedures, such as some breast reconstruction for overly large
breasts and functional nose and eyelid work are insurance reimbursed. Remember that
you, as well as the physician, have a relationship with the insurance company, and
you are responsible for keeping that relationship as ethical as possible.
- General Anesthetics and Facility Certification
Almost all the procedures discussed in this book can be done under the new local
anesthetic combinations, usually with the help of some relaxation medicines. I believe
that some of these procedures, such as liposuction, cannot be done as accurately
under general anesthesia. So ask if you will need a tube in your throat to help
you breathe (and ask about the extra charges for an anesthesiologist). It may not
be necessary.
Your doctor should operate in a facility that is approved by a regulatory agency.
"State approved," "Medicare approved," and "AAAHC approved"
are all acceptable. In some states, such as California, it is actually illegal to
inject mind-altering drugs in an uncertified facility. The certificate of approval
should be posted in the waiting room, so ask to see it.
- Price Does Not Relate to Quality
The highest fees do not necessarily relate to the best results. When assessing fees,
the factors to consider include the doctor's experience, the size of his practice,
and even the location of his office. Some doctors may discount their fees for procedures
in which they lack experience. They do this to attract as many new patients as possible
so they can acquire the experience they need. Be sure to ask about the number of
specific procedures your doctor has done (see item #1).
On the other hand, the high-priced doctor may have an enormous overhead, which supports
seven clinics and 150 employees at ritzy addresses all over town. With a practice
that size, you may end up with a partner or associate performing your surgery rather
than the physician you originally chose. Make sure you're getting "hands-on"
service. Ask who, exactly, will be performing the surgery. If there's one partner,
or even two, there's probably nothing wrong with having Doctor B or Doctor C do
your surgery (but beware if they assign your case to Doctor Z).
- Consider the Aesthetics of the Office
Cosmetic surgery is art, and the cosmetic surgeon's artistry is reflected in the
visual qualities of his office.
If the decor is 20 years out of style, if furniture is positioned haphazardly, if
things look disorganized, if the color scheme is irritating or there's no art on
the walls, then this may be an indication that the doctor doesn't have much aesthetic
sense. You may not want him sculpting your hips, re-designing your eyelids or deciding
where to position transplanted hair on your head.
This may also apply to the way the doctor and his staffs present themselves visually.
How do they dress? Are they well groomed? Do the staff areas and consultation rooms
look organized, well designed, and clean?
It may sound like a stretch, but it's all part of the overall feeling.
Trust your instincts! Judge a doctor and his staff the same way you'd judge any
other person. The key is to be emotionally comfortable with your choice.