Full Text from Dr. Berman's Book

Chapter 2


Today you have an abundance of ways to find a cosmetic surgeon. In years past, word of mouth or a reluctant referral from your doctor were the only ways to find a surgeon. I still think word of mouth among satisfied patients is the best source of referral, but in today's increasingly competitive society there are more and more physicians advertising. When I was getting started, advertising was frowned upon by most of the "old guard" physicians. It is interesting to see, today, how many of those "old guard" have decided to advertise. The truth is, that unless your prospective patients know about you, it is not going to be easy to make a living as a cosmetic surgeon. Whether you see a surgeon on a television talk show, get a referral from a friend, or follow the lead of an advertisement, there are basic considerations in selecting someone to perform your cosmetic surgery.

All practicing physicians must be licensed by the state. Once licensed, a doctor may theoretically practice cosmetic surgery or for that matter neurosurgery.That doesn't happen. State medical boards and lawyers are quick to eliminate incompetent, inexperienced, negligent practitioners from the field. Many new restrictions on advertising and accreditation are quickly gaining ground among various state legislatures, also dampening the likelihood of charlatan surgeons. (Oh how I long for the good old days when I could do a craniotomy in my garage!)

John Q. Public might have noticed that there are more choices among various surgical disciplines for cosmetic surgery. It wasn't long ago that the General Plastic Surgeons were feuding over turf with the Facial Plastic Surgeons (otolaryngology, or ENT surgeons). While all those unnecessary turf battles went on, the dermatologists advanced from chemical peels and dermabrasion, to hair transplantation, liposuction, and laser surgery. The ophthalmologists were performing cosmetic eyelid surgery, and now laser resurfacing too.The American Academy of Cosmetic Surgery was developed to further the education of all surgical disciplines expressly interested in performing cosmetic procedures. Indeed, today you will find that the public is more sophisticated in its search for a cosmetic surgeon for their specific need and no longer subscribes to the dogma that anyone specialist is especially endowed to the exclusion of others. In other words, there are excellent physicians among several surgical disciplines.

In general, however, it is usually reasonable to seek out a doctor who is "board certified". Generally, "board certification" is obtained by successfully completing a residency in a surgical specialty and then passing a rigorous examination. Most residency programs require an additional 5 - 7 years of training after medical school. (It is not unlikely that your cosmetic surgeon has been in the educational process for 13 - 15 years from graduation of high school. Talk about delayed gratification.) There are several residencies that provide training in various cosmetic surgical procedures. These include Plastic Surgery, Otolaryngology (Head and Neck Surgery or ENT Surgery), Ophthalmology, Dermatology, General Surgery, and Maxillo-Facial Surgery (dentists with special training and often M.D.'s).

While all of the aforementioned specialties offer board certification, so does the American Board of Cosmetic Surgery. This board was established to credential doctors already board certified in a surgical discipline who were primarily performing cosmetic surgery. Five years experience in cosmetic surgery practice with a minimum of 1000 cosmetic procedures, or as is now required, a one year fellowship under the guidance of an approved program, are some of the criteria necessary to sit for a two day oral and written examination.

Essentially, the public today is presented with a choice of competent physicians who can perform various cosmetic procedures. It is simply ludicrous for any one surgical discipline to claim they are the finest cosmetic surgeons. Man is not a collective. He is an individual, with individual talents and abilities. Belonging to a particular group does not endow all of its members with equal ability, nor does it endow its members with superior ability to that of members of an equally learned group.

You may consider contacting any number of local, state or federal agencies for referrals or information about cosmetic surgeons in your area. Most of these organizations have "800" numbers easily obtained through information. Many are also available through Internet addresses as well. Some organizations might include, the American Academy of Cosmetic Surgery, the American Academy of Facial Plastic Surgery, the American Society of Plastic and Reconstructive Surgery, your state medical society, your local medical society, or even the local hospitals in your neighborhood. There are other private advertising referral agencies, though these are usually sponsored by individual paid members. Advertising in the phone book or in popular magazines, or through brochures or books (even this one) are other ways of getting names of potential surgeons.

Here's a list of phone numbers that might be helpful:

American Academy of Cosmetic Surgery
312 981-6760

American Academy of Facial Plastic and Reconstructive Surgery
703 299-9291

American Society of Plastic Surgery
847 228-9900

So, you've found a doctor somehow. You make the call and set up an appointment. If your mind's made up and your comfortable, no problem. If you have questions, strike up a conversation with the receptionist or office manager. Generally speaking, the person who books appointments for the doctor should be able to answer many of your questions about surgery. Make a list of questions ahead of time. Is the doctor board certified? More importantly, does the doctor perform the kind of procedure you are interested in? What can be done for your problem? (Often, patient's are interested in a particular operation when a different procedure might be more advantageous.)How much time does the doctor spend in consultation? Is there a consultation fee? Is it applied to the surgical fee if you sign up? What are the approximate surgical fees? Does that include supplies and anesthesia? Is insurance applicable? Where is the operation performed? Does the doctor have a fully equipped or accredited operating suite or does he/she operate out of the hospital? Finally, depending upon your specific knowledge of the procedure in question, you might want to ask specific questions that you would like clarified.

Needless to say, when you finally go for your consultation, you should have an expanded idea of what you want to find out. The more knowledge you bring to the consultation, the better you'll be able to understand and discuss what the doctor has to say. The initial consultation allows the doctor to ask about your specific concerns and gives the two of you a chance to get to know one another. The doctor will inquire about your past medical history, including any history of allergies, previous surgeries, medications your taking and various habits. Depending on the kind of operation, family history and history of pregnancies might be considered. The doctor will then examine you in a discrete and professional manner. If disrobing is necessary, gowns should be provided along with privacy to change into them. The consultation might include computer imaging at that time. There is generally a lengthy discussion about the intended procedures or possible alternatives. Some doctors may offer videotapes or other literature to further educate the patient. This is a time of education, to best understand the potential operation and get to know your surgeon.

Generally, once the patient has had an opportunity to consider the consultation and make an informed decision resulting in the scheduling of the operation, a pre-operative visit is planned. It affords the patient another opportunity to discuss uncertainties, gives the physician time to further refine the operative plan, order medications or possible lab tests, and take photographs.

Photographs are always taken prior to surgery. It is an important part of the patient record. Photographs can not, however, be used without the patient's permission. Generally, along with signing an informed consent prior to surgery, permission is either granted or denied to use your photograph for an educational or commercial publication, or a demonstration.

Typically, surgical fees are collected in advance of the surgery. This may vary from office to office. The prices for procedures may vary also from office to office and state to state. It's best to contact the doctor's office to get an idea of the prices. The surgical fee includes pre and post-operative visits. In a few situations, insurance may cover some or all of the expense of a procedure. This usually occurs when the procedure is performed to correct a functional problem or following an accident.A typical example would be possible rhinoplasty following a nasal fracture resulting in deformity of the nose and/or nasal obstruction.At the end of each chapter, I have made a notation of ball-park ideas for the surgical fees. This will vary too, depending upon the costs of anesthesia and where the operation is performed (doctor's office, surgical center or hospital). Like most businesses, doctors often accept credit cards or have different finance plans available, making cosmetic surgery a little more available to the average income person.

Typically, the patient is asked to refrain from eating after midnight preceding the operation . It is also very important to refrain from taking aspirin or any medication with aspirin as an ingredient for two to four weeks prior to surgery. Generally, the patient is brought to the operation by a friend or relative who is responsible for taking them home and keeping an eye on them during the initial hours after the operation.Activities are usually limited the first week or two and then gradually increased. The doctor will provide post-operative instructions (usually at the initial consultation) and specific appointments will be provided for follow-up care and removal of dressings. Your doctor should continue to follow your progress as long as necessary. At any rate, your doctor is only a phone call away and always available to answer any questions or concerns.

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