By Michael Sundine, MD
Choosing a Plastic Surgeon Choosing a plastic surgeon is the most important aspect in achieving a successful outcome for your procedure. A surgeon’s training, expertise, and technique are all critical to realize a successful result. Thus it vitally important that patients look for several characteristics in choosing a plastic surgeon. 1. Make sure that your plastic surgeon is a member of the American Society of Plastic Surgeons (ASPS). (link to www.plasticsurgery.org) The American Society of Plastic Surgeons is the largest organization of plastic surgeons in the United States. There are several characteristics that make ASPS members uniquely qualified for plastic surgery procedures: a. Members of the American Society of Plastic Surgeons complete at least 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. b. ASPS members are trained and experienced in all plastic surgery procedures including facial procedures, breast, body, and reconstructive procedures. c. ASPS members are required to operate at surgical facility that is accredited by one of the following organizations: American Association for Accreditation of Ambulatory Surgical Facilities, Inc.(link to www.aaaasf.org), Accreditation Association for Ambulatory Health Care, Inc.(link to www.aaahc.org), Canadian Association for Accreditation of Ambulatory Surgery Facilities (link to www.caaasf.org), or the Joint Commission on Accreditation of Health Care Organizations (link to www.jointcommission.org). d. American Society of Plastic Surgeons members are required to adhere to a strict code of ethics. e. ASPS members must fulfill rigorous Continuing Medical Education (CME) requirements including standards and innovations in patient safety. f. All members of the American Society of Plastic Surgeons are board certified by the American Board of Plastic Surgery (link to www.abplsurg.org) or in Canada by the Royal College of Physicians and Surgeons of Canada. 2. Licensure is not enough! In the State of California doctors are all licensed as physicians and surgeons even though a doctor may have had absolutely no surgical training. The licensure requirements are essentially the minimum requirements needed to practice medicine. The minimal requirements include: completion of four years of medical school, passing of a licensing examination, and completion of one year of internship (which does not have to include any surgical component). Unfortunately as the economy has tightened many new “providers” have entered the cosmetic surgery arena. Some of these “providers” include emergency room physicians, family physicians, obstetricians and gynecologists, physicians assistants, and nurses who now proclaim expertise in cosmetic medicine and surgery without any formal residency training in this arena. 3. Make sure that your surgeon has hospital privileges to perform the procedure that has been prescribed for you. Because of significant medicolegal pressures, hospitals are very rigorous in examining the qualifications of individuals who are applying for hospital staff privileges. In order for a surgeon to have plastic surgery privileges in a hospital that surgeon must have completed plastic surgery residency training and must be board eligible in plastic surgery. A physician who did not have requisite plastic surgery training would not be allowed to perform plastic surgery operations in the hospital. Physicians who are not plastic surgeons attempt to escape the scrutiny of the hospital privileging process by performing procedures in their offices or in outpatient surgery centers where the credentialing process is less rigorous. In these settings physicians who are not plastic surgeons are able to perform procedures in which they have no formal residency training. Thus it is essential to ask whether your surgeon has hospital privileges for the procedure that has been recommended for you. It is also important for your surgeon to have hospital privileges in the rare event that a complication arises that may require hospital care. 4. Make sure that your plastic surgeon has been certified by the American Board of Plastic Surgery. The American Board of Plastic Surgery (link to www.abplsurg.org) is a certifying board that is a member of the American Board of Medical Specialties (link to www.abms.org). The American Board of Medical Specialties consists of 24 medical specialty boards and represents all medical specialties. In order for a plastic surgeon to become certified by the American Board of Plastic Surgery the applicant must have completed a minimum of 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. The applicant must also pass a comprehensive and demanding written and oral examination. In addition the candidate must present his clinical cases for critical review by his peers. The certification obtained from the American Board of Plastic Surgery is only valid for 10 years. In order to remain certified the plastic surgeon must complete a Maintenance of Certification including written testing and case review. One should be wary of physicians who have certification from non-ABMS recognized boards (eg. cosmetic surgery, liposuction, hair restoration, etc.). 5. Make sure that your plastic surgeon has completed a residency in Plastic Surgery. Even more important than where your surgeon went for their undergraduate education and medical school is the type of residency training performed. Plastic surgery is now the most difficult specialty to match into out of medical school. Plastic surgery residency training is exhaustive in both the reconstructive and cosmetic treatment of the face, breast, and body. No other specialty provides this comprehensive treatment. Plastic surgery residency training involves a minimum of 5 years of dedicated surgical training with a minimum of 2 years of training specifically in plastic surgery. In addition, plastic surgeons may choose to perform additional training in focused areas of plastic surgery such as cosmetic surgery, craniofacial surgery, hand surgery, bariatric surgery, etc. Fellowship training provides for further experience and expertise in the area of specialty training. There are many physicians who have entered the cosmetic surgery arena without any residency training in plastic surgery such as OB-GYNs, dermatologists, general surgeons, family medicine, etc. Some specialties have formal training in cosmetic procedures in their area of specialty-such as ophthalmologists who perform eyelid surgery or ENT doctors who perform some facial plastic surgery procedures. These physicians, however, have no formal training for example on breast augmentation or liposuction. 6. Does the plastic surgeon have experience with the procedure? It is important that your surgeon is experienced in the proposed procedure and performs the procedure on a regular basis. Review of the results of some commonly performed procedures should be available for review. In the discussion with the surgeon he should be able to relate in detail regarding what will be treated as well as the expected postoperative outcome and results from the surgery. In addition, he should be able to review any potential complications and should answer thoroughly any questions that you might have regarding the surgery. 7. Make sure that your procedure will be performed at an accredited facility. In an effort to reduce costs many providers may try to cut corners by using non-accredited facilities. In addition, these providers may not be able to obtain privileges at accredited facilities because they have not completed the appropriate training to perform the procedure at the facility. The appropriate emphasis must be on your safety at all times! A facility that has been accredited by one of the credentialing organizations undergoes regular inspections and reviews to make sure that the safest environment possible is provided for patients having surgery at that center.