Knowledge is power when dealing with cosmetic surgery

By Annemarie Cronin

What are the questions you should ask your plastic surgeon? I should know. I've had my nose done three times. Having admitted that, I might add that although I hadn't planned on encores and repeat performances, this happenstance has allowed me to join the ranks of other notables such as Michael Jackson and Mario Thomas whose nose jobs were more of a construction in prowess rather than a finite change.

I decided to call it quits after the third time. Michael kept going. Not that I like being outdone, but I rationalize this by the fact that he has more money than I do, and if anything major should go wrong, well, he’s always got his face mask to hide behind. And, oh yes, his dark glasses.

Having said all that, as I now move toward the age where a facelift is becoming more and more of a possibility, I have come to realize that I need to do better than I did the first time around. I need to be slicker now, more mature, more sophisticated. I need to know how to choose the right surgeon for my particular situation and I need to know what questions I ought to ask him or her. After all, I want to be able to shut my eyes and have them close when it's done! And I don't want my face to look like it’s held taut at the back of my head with a rubber band.

With true diligence and seriousness, I set out to make contact with some of the more respected names in this field and to ask them what questions I should ask of a plastic surgeon.

Much has changed in our approach to plastic surgery in the past 20 years. Whereas once people hardly ever admitted to face lifts, rarely walked around sporting a nose splint, and certainly would never reveal the secrets of a rounder, fuller bosom, those days are gone. No longer do we disappear from work for a short unexplained medical leave, nor do we have our noses fixed over summer vacation. These procedures have become de rigeur now with all the focus and attention to body consciousness and our eager participation in the multi-billion dollar beauty business. Madison Avenue is no longer just an address in New York. It’s now a state of mind.

In investigating how to choose a plastic surgeon and what questions to ask, I interviewed three prominent surgeons with active practices.

According to Haskell Newman, MD, a plastic and reconstructive surgeon affiliated with the University of Michigan, you should decide upon a surgeon based first on credentials and then qualifications.

"I don't necessarily mean pieces of paper. I mean performance records. Those are resources that are readily available and rarely used. Ask how many cases the doctor has done," he says. In some instances, he adds, patients will feel more comfortable talking to previous patients of the surgeon. Patients should have a plan, be diligent, and do their homework, he says. They should seek referrals from their primary caregiver or family practitioner and should solicit the recommendations of friends who have had similar procedures.

Being a professor who teaches plastic surgeons, Dr. Newman takes the empirical approach. He feels that patients need to make informed decisions based on all the information about the doctor and about the procedure. A1though many surgeons are qualified to perform some cosmetic procedures, he points out that plastic surgeons are trained to handle a wider variety of procedures. He advises that patients should call the American Society for Plastic and Reconstructive Surgeons for referrals to the surgeons in their area who are doing the procedure being sought. "This organization will give you the quality control you are looking for before you start your search," he says. Almost all of the surgeons certified by the American Board of Plastic Surgery are members of the American Society for Plastic and Reconstructive Surgery. Certified plastic surgeons have been trained in both reconstructive surgery and cosmetic surgery -- the difference being that cosmetic surgery is meant to reshape normal body structures while reconstructive surgery is performed on abnormal structures. interestingly, tumor removal is the most common plastic surgery performed, according to information provided on the ASPRS website.

Along with doctors, dentists who also possess a medical degree and have done a residency in oral and maxillofacial surgery in addition to a two-year residency are also eligible for board certification once they have passed the exam.

According to Dr. William Stefani, a Harper Woods plastic surgeon, a good starting point is to contact the American Society of Plastic and Reconstructive Surgeons, and then follow up by calling the American Society of Aesthetic Plastic Surgeons.

More and more surgeons who are qualified to do surgery, but not certified in plastic surgery are doing cosmetic procedures such as dermatologists, ear, nose, and throat surgeons, and ophthalmologists.

Even though a surgeon is not educated as a plastic surgeon and is not board certified in plastic surgery, he or she can be called a cosmetic surgeon. Because they both have licensing that permits them to perform surgery; this "leads to a blurring of the line between a 'plastic & reconstructive' surgeon and a 'cosmetic' surgeon," says Stefani, who completed a residency in general surgery at St. John Hospital in Detroit as well as a plastic surgery residency at Providence Hospital in Southfield. The plastic and reconstructive surgeon has more specialized training. This is a point with which Dr. Newman concurs. If you rely on the ads in media, he says to "use the ads as a reference point. But, you need to go beyond that," and verify the physician’s credentials.

An informational booklet put out by ASPRS notes that the standards for certification differ from those for licensure and that the board does not purport to interfere with or limit the profession activities of any physician, or to interfere with legitimate activities of practitioners.

[MISSING TEXT] metic or reconstructive surgeon might be appropriate. While a chemical peel might easily be done by someone trained as a dermatologist a breast augmentation perhaps shouldn't be.

Stefani advises women seeking breast augmentation to ask questions so they can make an informed decision about the procedure. "I tell them about breast implants, how I do the operation, I discuss the anesthesia and what their recovery will be like," she says.

Dr. Newman says patients will sometimes come to see him with a photo of a nose saying, "I like this nose" to which he readily answers, "I like it too, but it may not be for you." The ethical surgeon will work with the patient toward a mutually satisfactory goal. For Dr. Newman, the patient’s psychological motivation is as important as her physical motivation.

While many patients feel reassured by computer imaging, which displays a photo of the patient with an idea of what the results of her new face might look like, Newman says it shouldn't be the deciding factor in which surgeon to choose.

"Just because someone is good manipulating a computer doesn't mean he’s good with a knife," he says.

Dr. Michael Freedland, MD, a plastic & reconstructive surgeon with offices in Troy, says he believes patients need to ask more "global" questions. Instead of coming into the office with a certain procedure in mind, the patient should be looking for suggestions and recommendations from the surgeon. The approach should be one of "I know my face is aging. What are your suggestions?" Then the question should be "What are the choices and options available to me to achieve this look?," Freedland says.

Dr. Freedland relies heavily on his knowledge of three-dimensional structure when discussing cosmetic facial surgery. "You have to have the nose fit the face," he says. "The objective Is not to have people look at you and know you've had it done."

For breast enhancement, he reiterates that you need to ask the doctor for suggestions. The patient needs to be concerned about looking proportionate and natural and correcting any asymmetry; If needed. "Patients need to be aware that all noses are different, all breasts are different," he says. "Each individual will need a unique approach."

Don't be lured by gimmicks and procedures that are self limiting, says Dr. Freedland. He stresses that patients need to be aware not only of all the options available to them, but also to be aware of the limitations imposed by the number and kind of procedures a surgeon without a specialty in plastic surgery is qualified to do.

"Another good question to ask is where the surgeon is on staff," Freedland says. "You have to be a bona fide plastic surgeon to be on staff because the hospital has regulations not only about who is on staff, but also what procedures they are permitted to do. Patients need to make sure that any procedure they are considering can also be done by their surgeon at an accredited hospital where he or she has staff privileges." If the doctor cannot offer to do the same procedure at a bona Me hospital, he says that should wave a red flag.

Dr. Freedland says he likes being able to offer his patients the extra security of being hi a "leading hospital with all the incredible support staff.

As with any surgical procedure, the patient needs to be concerned not only with the surgeon's skills, but with the environment in which the procedure will take place. The smoother the surgical procedure runs, the less chance of complications. You want to be in an environment where if you need something it’s there; if you need someone to do something, he’s there, and you can give 100 percent to the patient."

Okay, I'm convinced. I'm ready: I know what questions I have to ask and where I have to start looking.

Only thing is, what if the doctor asks me what I am planning on doing with my nose?

The American Society a/Plastic and Reconstructive Surgeons can be reached at 800-635-0635 for a list of ASPRS member surgeons. They also have a website with numerous articles on all types of plastic surgery at www.plasticsurgery.org.