CHOOSING YOUR COSMETIC SURGEON – ASK THE RIGHT QUESTIONS
Before you schedule your surgery, you may want to ask the following questions:
- Ask if the doctor is a member of the American Society for Aesthetic Plastic Surgery. ASAPS membership ensures that the doctor is certified by the American Board of Plastic Surgery (see next bullet) and has also met other special requirements for cosmetic surgery experience and continuing education.
- Ask if the doctor is certified by the American Board of Plastic Surgery. When a doctor claims to be “board certified,” ask by which board. Only one, the American Board of Plastic Surgery (ABPS) is recognized by the American Board of Medical Specialties (ABMS) to certify doctors.
- If the doctor operates in an ambulatory or office-based facility, ask if the facility is accredited. Facilities that are accredited have met strict requirements for all aspects of operation, and such accreditation denotes a high standard of care. As of July 2002, ASAPS members performing plastic surgery in which anesthesia (other than local anesthesia and/or minimal tranquilization) is used must operate in a facility that meets at least one of the following criteria: accredited by a national or state-recognized accrediting organization; state-licensed; or Medicare-certified.
During your consultation, the following questions can be discussed with the surgeon:
- What experience does the doctor have in performing this procedure? Ask what training has been completed, especially in new techniques, as well as how often he or she performs the procedure. How many they he or she has done while in practice (estimate that is).
- What are the possible risks? There are risks with any surgical procedure. Find out what they are, how often they occur, and how they will be handled if they do occur. If the doctor does not openly discuss the risks or says that there are no risks, seek another opinion.
- What is the expected recovery for the procedure? Important points to discuss are postoperative restrictions on activity and typical time periods for resuming work and social activities.
- What is the doctor’s policy on surgical revisions? A small percentage of cases may require surgical revisions to achieve the desired result. Find out about any costs for which you may be responsible.
- How much will the surgery cost? Cosmetic surgery is not covered by insurance, & payment is required in advance. Costs include the surgeon’s fees, fees for the surgical facility, & anesthesia. Other possible costs are the blood work, medications and surgical garments. While it is tempting to “bargain shop”, or compromise, the training & experience of your surgeon are the most important factors in the success of your surgery. Do not compromise based on cost.
MESOTHERAPY NOT PROVEN AS A SAFE ALTERNATIVE TO LIPOSUCTION PLASTIC SURGEONS CAUTION AGAINST UNKNOWN DANGERS
The allure of shedding unwanted pockets of fat with a series of simple injections, known as mesotherapy, sounds too good to be true – and it just might be. According to an ASPS Device & Technique Assessment (DATA) Committee report, patients should be wary of mesotherapy until the safety and effectiveness of the procedure are confirmed. “The promise of a non-surgical, permanent method for fat removal and body contouring is obviously very appealing, but mesotherapy is not proven to be the miracle cure to a thinner you. The problem with mesotherapy is the whole technique is shrouded in mystery. Liposuction remains the only proven method to safely and permanently remove fat.”
Touted as a non-surgical alternative to liposuction, mesotherapy involves injecting medications and plant extracts into layers of fat and connective tissue under the skin. The injected ingredients may include agents that are used to open blood vessels, non-steroidal anti-inflammatory medications, enzymes, nutrients, antibiotics and hormones. Mesotherapy may be used in conjunction with dietary modification, hormone replacement therapy, exercise and nutritional supplements. No drug is approved by the U.S. Food and Drug Administration for use in mesotherapy.
Although the practice of mesotherapy has been around for decades in Europe, it has only recently been introduced in the United States. There are no published scientific studies demonstrating if the effects are permanent, why or if certain ingredients work, or how safe mesotherapy is for patients. In addition, there is no standardization in mesotherapy. The types of drugs used vary from physician to physician as does the quantity and frequency of injections.
Mesotherapy may cost $1,000 to $1,500 per treatment with three to six treatments required. This can prove costly for patients who may not receive the desired results.
Plastic surgeons are constantly researching better methods to help patients achieve their desired look; however, patients’ health and safety is always foremost on our minds. There is no information on what happens to fatty acids once they leave the targeted area or how the various ingredients affect the body’s organs and other tissues. There is simply too much we do not know about mesotherapy to say it is unquestionably safe for patients.
Currently, liposuction is the only method that has been proven to safely and effectively remove fat. According to ASPS statistics, liposuction was the most popular cosmetic surgical procedure in 2004, with more than 325,000 procedures performed.
Without data to support claims that mesotherapy works, the procedure appears to be a mystic type of therapy. We need to know a lot more about this procedure before plastic surgeons can endorse mesotherapy and recommend it to patients.
CHOOSING BREAST IMPLANT SIZE: A MATTER OF AESTHETICS
Surgical breast enlargement enables a woman to choose the breast size that she feels will enhance her body image and self-confidence. However, some women find that, following breast augmentation, their ideas about the ideal breast size have changed, and this can lead them to request additional surgery. Additional surgery means additional risks, so plastic surgeons are always looking for ways to help women make better choices about breast size at the time of their initial breast augmentation surgery.
A recent survey of 1350 breast augmentation patients showed that, while satisfaction with surgery was extremely high, nevertheless 34 percent of those who underwent re-operation did so simply to change the size of their implants. In most cases, women who change implant size switch to larger implants. However, implants that are too large can leave a patient looking “proportionally disfigured.” If a patient demands a size unsuited to her body type, it is hard for a plastic surgeon to guarantee the results.
While there are different opinions on selecting the appropriate implant size, most plastic surgeons agree that the base diameter of the breast should be the key measurement determining the selection. “After measuring the breast’s base diameter, I have my patient’s actually try on a filled implant in a sports bra to allow her to get a feel for the size that will be most suitable,” Dr. Vistnes explains. “This helps the patient to see, how an implant that is too large simply won’t fit with her body type.”
Even though implant size usually is best determined by measurement of the breasts, patients who are actively involved in the decision about implant size may be more likely to be satisfied with the results of surgery. When choosing implant size, patients should be aware that large implants, compared with smaller sizes, have a greater potential for certain types of complications, both in the short-term and long-term. Patients who select a more moderate size implant will give them a well-proportioned and more natural-appearing body contour. How can breast augmentation patient’s best explore their options for implant size before undergoing surgery?
- Be frank and open in discussing size so that there is clear communication, from the beginning, between you and your plastic surgeon.
- Select several photographs from magazines illustrating ideal proportions, and show these to your plastic surgeon as a way to begin the communication process. The examples should be of individuals with a similar body type to yours.
- Don’t define your desired breast size only in terms of bra-cup size. Cup size can vary significantly among bra styles and manufacturers.
- Plastic surgeons sometimes have implants in the office that are used for patients to “try on” different sizes by stuffing them inside their bra. Dr. Vistnes always uses this option at your pre-operative exam.
- Maintain realistic objectives and don’t assume that bigger is always better. Implants that are too large not only will upset the aesthetic balance of your figure, they also may be more prone to sagging and ultimately give you a “matronly” look. The best approach is to select implants that will look like a natural part of your body.
Dr. Dean Vistnes, MD is a Stanford trained, board certified Plastic Surgeon who practices in Palo Alto. He is also the founder of SkinSpirit, a medically supervised skincare clinic and spa located in downtown Palo Alto.