1. Do your homework- know your surgeon and his/her credentials.
Before you have your surgery, make sure you've chosen the right specialist. Do they perform the procedure you are considering? How many of these procedures do they perform? Do they actually specialize in that procedure, or have a special interest in that procedure? Are you trusting them because they did a prior procedure on you with success? Are they as expert at the procedure you are considering as the one you originally came to them for?
Board certification in some surgical subspecialty is reassuring. There are many boards, and not all of them are recognized by the American Board of Medical Specialties. Specialties that are included are the American Board of Plastic Surgery, the American Board of Facial Plastic and Reconstructive Surgery, and the American Board of Ophthalmology, and in Gynecology if you are considering vaginal rejuvenation surgery. Specialties that are subjected to rigorous documentation of training, written and oral examinations, and observation of qualifications that are no recognized by the ABMS such as the American Board of Cosmetic Surgery, the American Society of Ophthalmic Plastic and Reconstructive Surgeons, the American Board of Physician Specialties, and the National Board of Osteopathic Medical Examiners, or the American Society of Dermatologic Surgeons also certify specialists.
Google your surgeon. See if they've published or presented on the procedure you are considering. You can also access the national online medical malpractice data base, or the state or local medical society to investigate if many complaints have been registered. Personally, I would not pay much attention to rating systems on-line, because it is too easy for competitors or a single dissatisfied patient to downgrade someone's reputation. But if the opinions are overwhelmingly negative and there are a lot of them, you should be careful...
But Board Certification is still no guarantee. Your meeting with your surgeon should settle some of the other issues raised in numbers 2-10.
2. Use your consult as an opportunity to get to know your surgeon. And ask a lot of questions.
Your meeting with the surgeon is the time when you assess your doctor, and your doctor assess you as a candidate for the procedures you have in mind and he/she has in mind. Obviously, you want a surgeon that is technically capable. But you also want a surgeon that is compassionate and that will be capable of caring for you if there are any complications requiring long term follow-up. How extensive is their preoperative examination?
Once they've formulated a diagnosis and a proposed plan, ask about alternatives. Ask about the risks, and the number of times they've seen the complications they describe in their practice. Ask them if they've taken advanced courses in that particular procedure. It always helps to learn the risks beforehand by doing a little research.
3. Or get a second opinion.
By the time you get your second opinion, you should be becoming an expert in the procedures that you have chosen. Often the second opinion is not the same as the first opinion, and may either contradict it completely, or be partially the same, and partially different. Remember, there is more than one way to cook an omelet, and that a variety of techniques can be employed that will obtain similar results. Ask the same questions in your second consultation. And the third or fourth if it comes to that till you understand what's proposed and what you want done on your face or body. You will soon master the terminology and begin to understand what's being proposed!
4. Look at before and after pictures-talk to other patients.
It always amazes me when I hear a patient tell me that they went to another surgeon and that they declined to show them before and after photos because it might violate "privacy issues". Most surgeons have obtained releases from some of their patients that exemplify typical results. Most surgeons also only display their best results, so that you can discount these best results. But if a surgeon doesn't have any good results, or doesn't have any results to show, you really ought to be careful.
As for talking to happy previous patients, what surgeon would ask you to talk to a dissatisfied patient? The only reason to talk to another patient about your previous procedure is to ask them what the postoperative period was like, and what they think of their surgeon's care in general. Rarely will you have anything other than a very positive review.
5. Avoid being upsold
So you come in for breast implants, and suddenly you are having a breast lift, an abdominoplasty, liposuction of the thighs, and a face peel. Remember what you came in for. Unless there is a clear reason to do more than what you wanted, wait. You can always do it later. In some cases, such as when a chin implant really needs to be performed to improve the results of a rhinoplasty, (and this does happen), make sure your specialist has shown you why this is the case with photographs, or by imaging you and showing you how these changes would look with and without the additional proposed procedures.
6. Beware the latest procedure.
Some patients want to be the first in their area to try a new procedure. Sounds great, right? The latest solution to an age old problem discovered by a pioneer-a surgeon in the community who has adopted or help develop a new technique.
Many of those procedures turn out to be procedures that are either temporary, or that have other, additional problems associated with them. The FDA helps to determine whether devices and drugs are safe for use in humans. It doesn't necessarily warrant that the results will be long lasting, or as good as current surgical techniques. Wait till a procedure has stood the test of time before you put your money and/or your face and body on the line.
7. Have realistic expectations
Most of the time, it's not about the procedure, it's about the patient. The best results from facial procedures are seen in healthy and relatively young patients who are thin and who have good skin elasticity. Ask your surgeon realistic what you can expect. While nothing can be guaranteed, many surgeons can show you with imaging, a drawing, or with results in a patient with a similar facial structure or build to you what you could possibly look like.
The postoperative period is characterized by swelling, and endless anticipation that soon develops into impatience. Remember, you just underwent a significant surgical procedure, and it takes time for the wounds to heal and for the results to "settle". Initially there is often swelling, both in the face, and after liposuction, and even if the procedure is painless and you can go back to work, you are not feeling as optimistic about the surgery as you will. Small setbacks, like redness along suture lines, or lumps, can be discouraging, but they will resolve. Modify your expectations. And ask your surgeon, BEFORE the surgery, how long before you will look good enough to forget about being conscious of the fact that you had surgery.
Nothing is perfect. Details with your healing can be imprecise, despite beautiful surgical work. When the time comes, and it is usually around 3 to six months following the surgery, bring up these details for discussion. If you are realistic in your expectations of the results, usually your surgeon will have a solution.
8. Prepare yourself preoperatively and make sure you are in good health and are not taking anything that might jeopardize the results of your surgery.
The best way to prepare yourself for the operation and the postoperation healing is to obtain instructions from your surgeon and to follow them to the letter. Many surgeons will put you on a regimen of oral vitamins, nutrients, and homeopathic medications preoperatively. It is important to avoid all medications that your surgeon warns you to discontinue. These can include aspirin and aspirin containing compounds, nonsteroidals such as Advil, many herbals such as ginko, garlic, ginseng, ginger, St. Johnswort, Glucosamine/ Chondroitin, or feverfew. Many antioxidants are also blood thinners, and some green vegetables also can thin the blood! Discuss these issues with your surgeon.
It is important to visit your regular family doctor as well to make sure you are in optimum condition for the surgery. If you are taking Coumadin, Plavix, or another blood thinner, at this visit you should discuss the safety of its discontinuation and the optimum timing to reinstitute it with your doctor, and potentially you should be discussing this with your surgeon as well. We require a physical examination by your family doctor within three weeks prior to your surgery.
9. Take care of yourself postoperatively.
You just spent all this money and time going through a procedure. Hopefully it wasn't uncomfortable, and you were able to get through the early postoperative period with minimal difficulty. Now that you had the surgery, you want to preserve the result for as long as possible. Some common sense ideas:
a. Eat right to promote skin health and total wellness. This can mean many things and there are multiple superb books out which discuss the importance of "eating clean". A diet rich in green leafy vegetables, fruits, and antioxidants, natural omega 3's, wild or organic can improve skin health. Less gluten, less meat, less processed or preserved foods-all these elements are thought to add unnecessary calories and strain to our metabolism and eliminating them may improve your sense of well-being.
b. Drink plenty of water, and if you consume caffeine, which is a diuretic, be sure to drink even more water.
c. Avoid excessive alcohol intake, as it dehydrates the skin and is toxic to the liver and to brain cells.
d. If you smoke, stop smoking. Smoking constricts small blood vessels in your skin, your fat, and everywhere else as well. If you can't do that alone, find a psychologist, an acupuncturist, or a psychiatrist. We've seen hypnosis work in smoking cessation.
e. Ask your surgeon, or your dermatologist, to put you on a skin care regimen which should consist of Retin A or another Retinoid, some type of alpha Hydroxy Acid, or another acid, and a sun block that effectively blocks the sun's rays (SPF 30 or greater, UVA, and UVB.
10. Don't mortgage your future to pay for your surgery.
We've seen people spend their last unemployment check on looking good, and borrow huge amounts of money on their homes to undergo surgery. This was more true three years ago, before the new realities of this new economy struck many. There are many economical ways of improving your appearance, and many sensible ways of paying for the more extravagant costs of the larger procedures. Discuss these issues with your surgeon!
11. Enjoy the results!
For more information, please visit http://www.wcosmeticsurgery.com
For more information; please visit us at http://www.wcosmeticsurgery.com/. Dr. Allan Wulc is triple board certified and a pioneer in Cosmetic Surgery and Botox.
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