People who have health conditions such as diabetes, hypertension,
lung disease, heart disease, high cholesterol, arthritis, emphysema,
are malnourished, severely depressed, obese and/or smokers are
not generally good candidates for cosmetic surgery. All surgery
has inherent risks, but if you have a health problem it makes
it more likely there may be complications. If you are overweight,
your heart has extra stresses and surgery may not be advisable.
If you smoke or drink heavily, you may not be a good candidate.
Any and all health conditions should be discussed openly with
your cosmetic surgeon so they can help you make the most informed
decision.
Smokers who do choose to have surgery must quit for at least
2 weeks prior to surgery and remain smoke-free until at least
2 weeks after surgery, for proper healing and recovery. Smokers
have a higher rate of infection, skin separation, skin death,
and anesthesia complications. One major study found that the
risk of losing a significant area of skin (also called necrosis,
or skin death) due to poor oxygen supply with a facelift is
increased by 1500% in active smokers.
Good candidates for cosmetic surgery are close
to their ideal weight (within 30%), non-smokers, emotionally
stable, with low stress, exercise and maintain a healthy lifestyle.
It is also wise to drink less than 5 ounces of alcohol a week
and limit caffeine. It is important to have realistic expectations
and not expect plastic surgery to change your life. A good candidate
also accepts the disadvantages of plastic surgery (cost, inconvenience,
discomfort, and medical risk). Recovery is much easier with
a good support network. If you do not meet each criteria, it
does not mean you won't be a good candidate for plastic surgery.
If you meet none of them, it's more likely your doctor may want
you to make some lifestyle changes before surgery.
It is important to let your doctor know your complete
medical history including:
Medications as well as aspirin and vitamins
Hormones (oral contraceptives and estrogen replacement)
Herbal medications
These products can interfere with blood clotting or interact
with medications used during surgery and could increase your
surgical risk.
Ask yourself:
Are your expectations realistic?
How will you handle unexpected results?
Do you feel fully informed about the risks?
Can you afford the cost of plastic surgery?
Will the cost of the procedure add too much financial
stress?
Are you hiding your plans from friends and family?
Are you having surgery to please yourself or someone else?
Do you have a support network to help you during recovery?
Do you have the time in your schedule for proper recovery
time?
Step
1 - Find a board certified plastic surgeon
You will want to find a board certifieddoctor;
this means that they are certified in plastic surgery and have
met the following requirements:
They have earned a degree from an accredited medical school
They have completed 3 years of general surgery
They have completed 3 years of residency in plastic surgery
They have had at least 2 years of professional practice
They have passed rigorous written and oral exams (only
about 70% of physicians who take the test pass it).
By choosing a doctor that is board certified you are not guaranteed
to have any disappointments, complications or risks, but it
is a good starting point. You can at least be assured that your
doctor has the basic training and education required.
You will also want to find out if your doctor has hospital
privileges. Even if the procedure will not be performed at
the hospital (and 53% of cosmetic surgeries are not), some
feel it is important to know that your doctor is qualified
and has the necessary training to be accepted. The ASAPS states
that "it is important to find out if the doctor has operating
privileges in an accredited hospital for the same procedure
you would like to have performed. Before granting operating
privileges, hospital review committees evaluate a surgeon's
training and competency for specific procedures. If the doctor
does not have hospital privileges to perform your procedure,
look for another surgeon."
The American Medical Association (AMA) will provide biographical
information on 4 doctors for $60. Your local library may also
have The American Medical Directory (published by the AMA)
which lists the affiliations of its members. Contact: AMA,
Department of Physician Data Services, Dept. P, 515 N. State
St. Chicago, Illinois 60610.
The surgical facility is also important. An ASAPS news bulletin
in February 2002 states "Published data show that accredited
office-based facilities have a safety record comparable to
that of hospital ambulatory surgery settings. Ambulatory or
office-based facilities should be accredited by a nationally
or state-recognized accrediting agency, or be state licensed
or Medicare certified."
To research a hospital setting, go to www.ahd.com.
To research a surgical center, first ask the center who they
are accredited by. They should be accredited by one of three
main organizations:
The American Association for Accreditation of Ambulatory
Surgery. You can call the AAAASF at 888.545.5222 or 847.949.6058
or look at their website at www.aaaasf.org.
The Accreditation Association for Ambulatory Health Care.
You can call the AAAHC at 847.853.6060 or at www.aaahc.org.
The Joint commission on Accreditation of Healthcare Organizations.
You can call JCAHO at 630.792.5005 or www.jcaho.org.
You can also call The American Society of Plastic and Reconstructive
Surgery (ASPRS) at 800.635.0635 to find out which of its members
have accredited surgical centers in your area.
If you have general anesthesia, be sure your anesthesiologist
is certified by the American Board of Anesthesiology (ABA).
You can call the ABA at 1-919-881-2570 to verify certification.
If your doctor uses a nurse anesthetist, call the American
Association of Nurse Anesthetists (AANA) at 1-847-692-7050
to see if they are ANAA certified.
It is important that the emergency equipment and anesthesia
monitoring devices in your surgical facility are equivalent
to those in a hospital or freestanding ambulatory surgery center.
You'll also want to be sure that arrangements are made for hospital
admission in the event of a complication.
Step
2 - Schedule an appointment
When scheduling an appointment it is important to
ask:
Is the doctor certified in plastic surgery?
What is the doctor's area of expertise?
Can I have a surgical estimate for the total price? (Be
sure this includes surgery fee, operating room, anesthesiologist,
etc.)
Step 3 - The Consultation
After you've found several doctors who are board certified,
you'll want to set up appointments to determine which plastic
surgeon you're most comfortable with. Be very specific about
what you want changed and how. Look for confident and realistic
answers.
Ask the doctor:
What are my choices in techniques and procedures?
Explain what usually happens during the surgery.
How long does the procedure last?
Where will the incisions be made?
How often do you perform these procedures?
What type of anesthesia is used? If general anesthesia
is to be used, who will be my anesthesiologist? Are they
certified by the American Board of Anesthesiology (ABA)
or the American Association of Nurse Anesthetists (AANA)?
What are the side effects of the sedation? (The three types
of anesthesia used are general, sedation and local. With
general anesthesia you are in a deep sleep, with sedation
anesthesia you are awake but relaxed and drowsy, and with
local anesthesia you are mentally alert but the area being
worked on is numbed).
Where will the procedure take place? (If in the doctor's
office, ask to see the surgical room).
If at the doctor's office, is the surgery center affiliated
with a hospital or licensed by the state or accredited?
How much pain can I expect after surgery?
What are the risks involved with this procedure?
What are the possible complications after surgery?
How common are these complications?
Have you ever had a patient with these complications?
How was it handled?
Can I speak with your previous patients? (While doctors
want to respect the privacy of their patients, they should
be able to provide some contacts. You'll only be referred
to patients with a good result, but it can be helpful.)
Can I see before and after pictures of your other patients?
(Request pictures of patients who have had the same procedure
as you are planning. You may only be shown their best results.
This is still informative, as you'll get an idea of what
your doctor's best work is).
How long is the recovery period? How will it be before
I will be able to: be seen in public, return to work, resume
exercise?
How long does it take to see the full effect of my surgery?
How long will my results last?
When can I schedule surgery?
How involved are you after surgery?
What are the costs and payment terms? What fees will I
be charged by other facilities
Are there extra fees for before and after pictures?
What happens if the results don't match my expectations?
Will I be charged for any revisions? How likely is it
that I will need another surgery? Are only surgical fees
waived or are all fees waived (operating room, anesthesia,
etc)? (Revisions due to deformity or asymmetry done in the
first year should be free of charge; ask about additional
fees for anesthesia, hospital stay, etc. According to The
Smart Woman's Guide to Plastic Surgery, "Following
rhinoplasty or liposuction, 15-20% of patients seek revision.
Following face-lift or eyelid surgery, revision is sought
by fewer than 2%. many deformities self-correct as they
mature.").
What type of medication will I be on after surgery? For
how long?
What are the possible side effects, complications of the
drugs?
What is the worst-case scenario for this procedure?
Find another surgeon if:
The doctor dismisses the risks involved in surgery
The doctor doesn't recommend a preliminary physical examination
The doctor refused to show before-and-after pictures of
other patients
The doctor is willing to submit fraudulent paperwork to
your insurance
The doctor does not routinely perform the procedure
You did not feel comfortable with the staff or cleanliness
of the office
The doctor tries to convince you to have a procedure that
isn't related to the area or problem you've come to him
for
