Choosing a Plastic Surgeon
Choosing a plastic surgeon can be difficult. You may feel, and you may be right, that your life depends on making the correct choice. The system is such that bad plastic surgeons (and there have been a few) usually get rooted out by a string of complaints and disciplinary hearings, and eventually get struck off. But some don’t, and even bad plastic surgeons can get good results while good plastic surgeons occasionally get bad results.
As a patient you may not be able to determine all the qualities that you need in your plastic surgeon. How do you test who has good hands and who operates beautifully? You can look at complications, but all surgeons get complications and complications may not necessarily be due to bad surgery – there may be patient or external factors. Complications only indicate when perhaps something has gone wrong, and you are aiming not just to avoid complications, but to get the best possible result. We don’t have plastic surgery competitions, there is no ranking system and there is no best plastic surgeon for the job. So what are the factors you can look at when making your choice?
1. Specialist Qualifications Firstly it is important to check that your plastic surgeon is actually a plastic surgeon. In South Africa the equivalent of board certification is being registered with the Health Professions Council of South Africa as a specialist Plastic and Reconstructive Surgeon. Specialist Plastic Surgeons will have undergone years of training and passed a number of exams, the exit exam being the Fellowship with the Colleges of Medicine of SA (FCS (SA) Plast & Recon Surg).
2. Member of Peer Groups In South Africa, you want to check that your plastic surgeon is a member of the Association of Plastic and Reconstructive Surgeons of South Africa. While membership is voluntary, if your plastic surgeon is not a member of the Association, there should be a good reason for this. Most good, experienced plastic surgeons will be a member of the International Society of Aesthetic Plastic Surgery. One can only join ISAPS after one has been in practice for 3 years. But merely checking on the certification of your plastic surgeon is not enough.
3. Experience You want a plastic surgeon who is experienced in the procedure you want. Many surgeons are generalists, Jack of all trades, and many are very good, but ultimately experience in the procedure(s) you want is important. If your surgeon has done many cases before it means that in a problem situation or with a difficult case, your surgeon is more likely to be familiar with the options available. His or her surgery has become standardised, usually updated in small increments as new knowledge and techniques become available. Experience is invaluable and with plastic surgery takes many years to develop.
4. Recommendations Recommendations from friends or family are a good thing, but many patients do not have that luxury. Someone else’s good result does not guarantee that yours will also be good, but it helps. Sometimes I put prospective patients in touch with a willing past patient, but this is not always possible due to confidentiality issues.
5. Price Price is frequently a factor and the most confusing factor at that. You don’t always get what you pay for. I know of good surgeons who are relatively inexpensive and I know of poor surgeons who are not afraid to charge! There is nothing I can do about that. What I can do is make sure that my prices are fair value. I know what procedures cost me because I operate in my own facility and I know what my colleagues charge. I have been in private practice since 1998, and I limit my practice to a few cosmetic procedures which I believe I now have considerable experience in. I am busy enough that I do not need to chase cosmetic surgery patients or push patients into surgery. I can dispense information and professional advice and I do not need to worry about my conversion (to surgery) rate.
6. Second Opinions How many plastic surgeons should you see? How many opinions should you get before you decide who is the one? A second and sometimes a third opinion can be useful, but the more opinions you get the more divergent and confusing will be the advice you receive.
7. Emotional connection At consultation you want to feel some kind of emotional connection with your surgeon. After surgery you are going to be relying on receiving support from your surgeon (all patients need this). Communication needs to be easy and comfortable, your surgeon needs to be open and honest, your surgeon needs to take you seriously and not fob you off. You want someone who is caring, kind and compassionate. You will want a good doctor as the surgery puts you, for a while, into a sick role. I work with a team. My team have all been with me a long time. They have the same caring, kind and compassionate attitude that I have and they follow all the principals mentioned above. I trust them implicitly. While I am available any time to all my patients I do rely on my team to assist me.
8. Aesthetic Sensibility Before and after photographs are useful. Previous good outcomes will hopefully result in yours being good too. Also, the viewing of before and after photographs allows you to determine whether the surgeon shares your aesthetic sensibility.
9. Facility You want to ensure that your procedure will be carried out in a facility suitable for surgery. This means a licensed hospital or ambulatory surgical centre. In my opinion, ambulatory surgical centres are preferable.
Who to Avoid
Because of the increasing popularity of plastic surgery (thank you media), many doctors and even some non medically trained people have jumped on the bandwagon. Gynaecologists are doing tummy tucks, liposuction and breast surgery. Ear, nose and throat surgeons are doing facelifts. And I do not mean to pick on these two specialities (at least they are surgically trained) as there are many specialists who are not plastic surgeons and who are performing, probably to the best of their abilities, plastic surgery procedures. General practitioners are not surgically trained beyond medical school (where you do not perform surgery) and yet some choose to do plastic surgical procedures. In South Africa it is illegal for non plastic surgeons to offer plastic surgery. And what of aesthetic medicine and aesthetic medicine practitioners? Many practitioners of aesthetic medicine like to proclaim themselves experts, particularly of non surgical procedures like Botox and filler injections. Some like to emphasise that plastic surgeons are surgeons, that surgeons just operate and that plastic surgeons specialise in reconstruction. In fact we train in anatomy, surgical principals, ethics, aesthetics and a broad range of subjects that encompass plastic surgery, including injectables. With our experience in surgery we know our way around the places that injectables (Botox, Dysport, fillers) go better than anyone. Further, because we can offer surgery when required we won’t stretch the indications for injectables, but will offer surgery when it is the best option. Aesthetic medicine is not a registered speciality in South Africa. Any GP can call themselves an aesthetic medicine practitioner without having done any further training whatsoever. Medical tourism companies, do they add value and are they worth it? Medical tourism companies are businesses that make money out of connecting you with a doctor and then assisting you with arrangements. They usually take a commission (you pay for that) and frequently you do not have direct contact with the surgeon or any choice as to who will do your surgery. If you are traveling for surgery you will need that contact with your plastic surgeon. Rather than alleviating risk I believe that medical tourism companies add to it.