10 Things Your Cosmetic Surgeon Won't Tell You

Thanks to the increased demand, the number of doctors performing these procedures is surging too. But in most states, any MD can perform plastic surgery without board certification. That means anyone from your gynecologist to possibly even your dentist may be able to legally perform cosmetic surgery procedures.

The bottom line? "It's important to find out what kind of training your surgeon has," says Christopher Godek, a Toms River, N.J., plastic surgeon. Nearly all physicians are "board certified," but make sure your plastic surgeon is certified by the American Board of Plastic Surgery. ABPS qualification includes graduation from an accredited medical school and completion of five years of additional training as a resident surgeon, three in general surgery and two in plastic surgery. Doctors must then pass both a written test and an oral exam. To verify a surgeon's certification, visit the American Board of Medical Specialties Web site.

2. "That's not my specialty."
Just because a doctor is certified by the ABPS, that doesn't mean he's the right doctor for your procedure. A board-certified plastic surgeon who trained in reconstructive surgery and specializes in hand reconstruction, for example, probably isn't the best person to perform your face-lift.

Robert Kotler, a Beverly Hills cosmetic surgeon, recommends finding what he calls a "superspecialist" to perform your procedure. That means selecting a surgeon who has had additional training beyond board certification, in the form of fellowships. "Ask what their fellowship was in, and then what they specialize in," he says.

He also suggests calling a prospective surgeon's office and asking what procedures they perform most often. The surgery you're looking to have should rank at least in the top five, Kotler says — and preferably in the top three. "One of the dilemmas the medical world has is, there are so many procedures you can't master them all," he says.

You should also ask how many of those procedures the surgeon has performed throughout her career, says Jean Loftus, a Cincinnati-based plastic surgeon. Unless a particular procedure you require is especially rare, she says, "you don't want someone who only does a few of what you want done."

3. "This won't last forever."
Plastic surgery isn't as permanent as you think. "You're [still] better off 20 years down the line, but it's not a complete solution," says Z. Paul Lorenc, a New York plastic surgeon. "You continue to age. . . . And that's not discussed with patients to a great extent."

Certain procedures are more likely than others to need additional surgery. Breast implants from one of the two U.S. manufacturers, for example, have a 21 percent risk of needing another operation within two years of the initial surgery. "If you have breast implants, you must expect to have another surgery in your lifetime," says plastic surgeon Loftus. "Defiation, infection — just about anything can happen." Less invasive procedures can also have less-than-lasting results. Laser hair removal, for example, while often touted as a permanent solution to hair removal, "is not permanent," says Godek.

When consulting with your physician, ask how long your results will last. "A bump taken off a nose isn't going to come back," Godek says. "But for facelifts, even with the newer technology, most of us say they'll last about seven to 10 years." Maintenance is also important: Liposuction patients can't stop exercising or eat poorly and expect to stay slim; people who've had face-lifts need to stay out of the sun.

4. "It's the anesthesia you need to worry about."
With so much focus placed on the surgeon performing your procedure, the person performing the really dangerous part — administering anesthesia — is often overlooked. "I've been in practice for 16 years, and maybe five or six people have asked questions about the qualifications of the anesthesiologist," says Lorenc. But complications from anesthesia are far more likely to harm a patient than the surgery itself, as was the case with The First Wives Club author Olivia Goldsmith, who died last year from anesthesia complications at the Manhattan Eye, Ear and Throat Hospital.

Ask whether your surgeon uses a nurse-anesthetist or a board-certified anesthesiologist. "An anesthesiologist is a fully trained professional who is dedicated to that patient and doesn't have to be supervised," Lorenc says. But in many states, nurse-anesthetists do require supervision, and oftentimes your plastic surgeon will be the one doing the supervising.

That's not to say nurse-anesthetists aren't competent, but it does mean you should ask additional questions — like what the anesthetist's experience is with outpatient aesthetic surgery. If your physician uses nurse-anesthetists and you prefer a board-certified anesthesiologist, ask if it's possible to have one.

5. "My office may not be the best place for surgery."
Increasingly, plastic surgery procedures are taking place outside of hospitals. The American Society of Plastic Surgeons reports that 56% of all cosmetic procedures were done in an office in 2003 — a 6% increase over 2002. Another 16 percent were performed in ambulatory (nonhospital) surgical facilities.

The move away from hospitals isn't necessarily a bad thing, but it does mean you should ask additional questions. First, ask whether the facility is accredited by the Accreditation Association for Ambulatory Health Care or the American Association for Accreditation of Ambulatory Surgery Facilities. Both define hundreds of standards that address everything from safety procedures to patient selection. "Accreditation assures the public and the state that a given facility has met standards of care and is appropriately equipped and staffed," says Gerald Edds, president of the AAAHC and a facial plastic surgeon in Owensboro, Ky.

Accreditation is often the only way to ensure safety standards are being set — and met. Most facilities are not held to state licensing requirements, says Edds, and only a small percentage of offices performing plastic surgery are accredited. To find an accredited facility in your area, visit aaahc.org or aaaasf.org.