Making the decision to have a cosmetic procedure is a big one, and one you shouldn’t take lightly. When weighing their options, many people get too focused on one particular aspect, such as cost or reputation of the surgeon, while overlooking other important details. The following can serve as a checklist to consider before making the decision to commit to a procedure and surgeon.

Patient and scalpel

  1. First and foremost, find a surgeon you are confident will do the right thing for you.  Selecting a good doctor is a process in itself that I covered a few weeks ago on this blog.  To summarize the highlights, you need to seek out a person with quality experience, board certification and fellowship training, which ensures their colleagues have seen their work and have given the stamp of approval.  It is easy to pay for a weekend course in a procedure and set up shop doing it, but there is little to no oversight in the learning process and the surgeon’s skills are an unknown. You will also hopefully like this doctor and feel they treat you with respect. If they are marginal in their manners before you have surgery, their manners are unlikely to improve once they have been paid.
  2. Ask the surgeon to explain all your options, including those that don’t require surgery.  There is rarely only one way to do things and often the best treatment is no treatment at all.  Be wary of someone who has a cookie-cutter approach to all patients, steering them into the procedure he/she is most comfortable with or is most lucrative. My patients are always surprised when I end up telling them I wouldn’t have surgery in their case.  They seem at first shocked, then appreciative that I would direct them away from something that I’m in the business of doing. For a careful surgeon, however, it is a no-brainer.  Surgery is complex and creates myriad problems that must be overcome before a good outcome can result.  Doing a procedure when it isn’t indicated or in the patient’s best interest is just a recipe for regret for all parties concerned.
  3. Don’t choose based on cost.  Choose based on outcomes.  A surgeon who is significantly cheaper than everyone else has often lowered his/her prices to attract clients that word-of-mouth referrals aren’t generating. In tough economic times you will find lower prices, but don’t let this mesmerize you into overlooking other potential negatives of the doctor or facility.
  4. Know the risks.  Every surgery, no matter how simple or how great it turned out for your best friend, has risks of complications.  For example, I perform ptosis eyelid surgery, which is notoriously unpredictable.  Correcting ptosis, or a drooping eyelid, involves isolating delicate muscles and adjusting them to move the eyelid to an exact level, symmetric with the other side. During surgery we make careful measurements and even have the patient open and close their eyes to ensure symmetry.  However, it is not uncommon to have everything look perfect in the post-op area, then a week later after swelling and scarring have taken their toll, have the eyelid be slightly off.  A difference of only 1 millimeter is often unacceptable to patients and may need a revision.  Most good surgeons will spell this out to the patient before surgery, but almost no patient seems to remember this when it actually happens to them. When you go in knowing there can be complications and directly ask about them, you are less likely to be surprised when things don’t go exactly as planned.
  5. Understand anesthesia and its limitations.  Many cosmetic procedures are performed under sedation, not general anesthesia. This means the patient is awake, but given medicine for relaxation and pain by IV infusion.  Depending on the procedure, this anesthesia can leave the patient completely aware of what is going on during surgery. Most people will see that avoiding general anesthesia is a plus as you recover much quicker immediately post-op, can leave the surgery center after as little as 30 minutes, have no sore throat from a breathing tube, and are less likely to have nausea from anesthetic gas.  For others, the thought of being aware of surgery is too much and will result in anxiety.  Talk to your surgeon about exactly what your level of awareness will be and if you are comfortable.
  6. Inquire about the site for your operation. Will it be in a hospital, an outpatient surgical center, in the doctor’s minor procedure room, or in a reclined exam chair.  Different procedures require different support and certain more involved surgeries need to be done where help exists if something goes wrong.  If a surgeon insists on doing a procedure in their office, ask if you could have it done in a surgery center if you chose. If the answer is no, there may be an issue with the doctor not having credentials to perform surgery in an accredited surgical center. This is commonly a problem with physicians operating outside of their formal training. If a family practice physician decides to start doing liposuction by getting trained at a weekend course, they will likely not be able to convince a reputable hospital of surgery center that they are proficient enough to perform the procedure. They will have to perform the lipo in a medi-spa or outpatient office where they alone would be liable in the event of a complication. A doctor maintaining privileges at one or many hospitals is a sign that he/she has been cleared by both peers and insurance adjusters to perform quality surgery.
  7. Avoid surgeons who claim to be the only one doing a procedure. This is a tough one.  We all want the latest and greatest technique, but if only one person is doing something, it may not yet be tested for general consumption, or it may be just different to entice early adopters. You want proven surgical techniques that are accepted by the majority of surgeons because of their good outcomes. Look at the history of facelift techniques and you’ll see lots of procedures that have come and gone, trying to simplify the procedure and lessen complications, but many of them gave poor outcomes and were abandoned.  Find someone doing a tried and true technique with long-term patient follow-up results.
  8. Ask about recovery time. This varies widely from patient to patient and procedure to procedure. The majority of facial cosmetic procedures will leave you looking like you’ve been in a fight for a week or two, sometimes more. As with complications, patient rarely seem to remember the conversations we have before surgery about how bad they will swell and bruise, and they tend to be shocked the next day by their appearance. Knowing that you will look pretty rough for a few weeks, and that it will get better, will help your patience to wait out the outcome you are expecting.
  9. Ask about long-term outcomes. Gravity and aging are constantly working against our desire to look young and vigorous. A great surgical result today doesn’t tell you anything about what you’ll look like in 1, 5 or 10 years.  Ask your surgeon how long they expect the results to last, and then remember, they don’t have a crystal ball and everyone ages at different rates. As cosmetic surgery is expensive, consider having a procedure done once the improvement will be more noticeable and less likely to need repeating. This will also prevent that buyer’s remorse commonly seen when people find the surgery didn’t make the life altering change they were expecting.
  10. Manage your expectations. We all want to look like we did in our youth, but there are limits to the effectiveness of surgery. As I’ve said before, the hardest part of my job is helping people understand before surgery what they can expect after surgery. Remember the older you are, the more wrinkles present, the more advanced your problem, the more difficult it will be to restore the past look. The patients I find are most pleased after surgery are those who say things like “I don’t want to look 18 again, I just don’t want to look tired all the time.”  These are reasonable expectations from cosmetic surgery.  Patients that focus on every crease and fold as if those are the key to why they don’t look like a teenager anymore are in for a potentially disappointing and expensive experience chasing youth.

 

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