In our last discussion, I talked about the concept of cosmetic surgery, and who might consider it. As promised, let’s now talk about some things to think about when finding a surgeon and office to meet with. Aside from the decision to think about cosmetic surgery, this is the most important decision you can make, and will dictate the success (or failure) of your operation. I’m going to give you the goods, and will also give you some insight into what your surgeon is thinking during your consultation as well.
All successful relationships are two-way streets, be that the relationship you have with your best friend, your family, your partner, your children, or even your car mechanic. When you select a plastic surgeon to work with, you are entering into a very unique relationship. Some of us like to approach relationships with great caution, others are more spontaneous, some of us like to do our research first, and some of us like lots and lots of relationships! Think about who you are, and how you like to interact with people, and what characteristics are important to you when entering into these relationships. This insight can help you when approaching a consultation with a surgeon, to make sure that you each get what you want from the interaction.
This doesn’t mean that anything goes when you are selecting a surgeon. I think that there are some necessary characteristics that all plastic surgical practices should have. Number one is experience and skill in the procedure that you seek. While this sounds obvious, it is important to understand your plastic surgeon’s chief interests and experiences. Plastic surgery is not just cosmetic surgery. In fact, cosmetic surgery is a very small niche within the world of plastic surgery. We are broadly trained surgical problem solvers, who operate from head to toe, and participate in all disciplines of surgery in general. This means that some plastic surgeons can replace a lost thumb with your big toe, some can fix a hole in your head after cancer surgery, some can reroute nerves from one part of your body to another to correct serious injuries, and some can rebuild lost structures from trauma or cancer, to name but a few. All of these reconstructive operations share elements of cosmetic surgery, and in fact, I feel that all reconstructive surgery procedures that we do are cosmetic, and vice versa. There is no distinction between the two aspects (cosmetic/reconstructive) of plastic surgery. Having said that, it would be optimistic to ask a surgeon who has defined their expertise as fixing hands to do a complex cosmetic breast operation, or to ask a surgeon whose main interest is facelifts to do said toe-thumb transfer. Many of us are generalists, and can perform many different procedures, but it is fair to ask your prospective surgeon what their particular interests and abilities are. For example, though my practice focuses solely on cosmetic/aesthetic surgery, I don’t do every cosmetic operation that there is to do. I used to do rhinoplasties (nose jobs), but my passions have moved elsewhere and I refer prospective patients seeking nasal surgery to a colleague that I feel is more expert than I, in that particular field. As well, check your surgeons’ credentials. In Canada, plastic surgeons are certified specifically to practice plastic surgery by our provincial colleges, such as the College of Physicians and Surgeons of Ontario. In the United States, plastic surgeons are certified by the board of medical specialties, and the American Board of Plastic Surgery. Each of these bodies has rigorous inclusion criteria and ensure that your surgeon has done the appropriate and extensive residencies needed, and have successfully passed a series of examinations to attest to this certification. I am certified in Canada and the US, and was also certified in general surgery prior to plastic surgery, in the US. I also think that it is desirable for your surgeon to be associated with academia and a university affiliation. While this is not absolutely necessary, this indicates that your surgeon is current, and still has the passion to contribute to the specialty in general. For example, I have an academic appointment at the University of Ottawa, where I regularly teach the next generation of plastic surgeons in aesthetic and cosmetic surgery.
Speaking of passion, I think that this is a critical characteristic that you should seek as well. Though this can be more difficult to identify, you should get the sense that your surgeon enjoys their work, and always brings their A game to the table. We have all undergone many years of training and sacrifice to gain our skills, and most of us do our work because we love what we do. As well, many of us are type A perfectionists, and we strive for the best outcomes for our patients because of this. Even when things don’t go perfectly (more about this later) your surgeon probably is as upset, if not more upset, than you are.
Another absolute prerequisite is the environment in which your surgeon works. A tidy, organized office is a good start. This relates that your surgeon cares about your well-being, and wishes to present this concern to their patients. You should understand whether your surgeon does their surgeries in an accredited facility, be that a hospital or private clinic. I personally prefer to do my work in a community hospital environment. This allows my patients the security of a full-service facility that can deal quickly with any unforeseen medical complications, surrounded by other health care providers as well. Working in the community also minimizes exposure to bacteria that may be more prevalent in major hospitals where critically ill patients are routinely cared for. On the other hand, private clinics can offer efficiency and personalized care that can be very tailored to the individual patient. Private clinics in Ontario are regularly and carefully inspected by the College of Physicians and Surgeons of Ontario, so ensure that if you are to have surgery in a private clinic, it has been properly certified. Both types of venue are fine, depending on the nature of the procedure that you are seeking. More extensive procedures where prolonged recovery is anticipated are perhaps better done in the hospital environment.
You should also understand whether the surgery you are being offered is safe and appropriate. For example, some patients seek multiple operations. While it is convenient to bundle surgeries together, this might prove to be an overly ambitious plan and it is your surgeon’s responsibility to ensure that a safe operation has been planned, and that potential complications have been discussed. Most very serious, or even fatal, outcomes from plastic surgery involve very prolonged operations, trying to do too much at once. In an effort to please the patient who wants only one recovery, some surgeons are tempted to push the envelope on this one. I personally prefer to limit operations to about four hours. Not only do the risks start to climb, but I know that I start to fatigue after that length of time. While not all surgeons feel this way, it is a good question to ask and understand when considering either a very lengthy surgery, or multiple combined surgeries.
Those are some of the absolutes. The rest comes down to personality and how your relationship with your surgeon gels. You should feel a strong sense of trust in your surgeon. You are placing a great amount of faith and trust in your surgeon, and your surgeon should be aware of that. This means that they have listened to you carefully, have explained themselves well, and will be available to you if things don’t go as well as you had hoped. It is ok to ask your surgeon what will happen in this eventuality as well, and you should be comfortable with the response. However, this is a two-way street as well. Just because you want something, doesn’t mean that it is possible, or appropriate for you! I often run into this when patients request overly large breast implants (topic of a future blog). It is your surgeon‘s responsibility to listen to you, and to plan a proper and safe procedure, based on their skill and experience. While patients can gain a tremendous amount of knowledge from online research, they cannot have the same level of understanding and experience that a surgeon who performs the operation has and must be open to allowing the surgeon to do their job safely and well. It is important for us to know that our patients are open to receive our input and are reasonable. We surgeons look out for patients that we feel have unrealistic expectations, and that are not listening to us! I would be wary of a surgeon who will do whatever you ask them to, regardless of the consequences. While on the surface this seems agreeable, it is disrespectful to you and shows a lack of concern for your ultimate outcome and satisfaction.
There also must be trust in the bond that you form with your surgeon, in that you will be able to work together if things do not go as perfectly well as you had hoped. Surgery is an inexact science, and everyone heals differently. You and your surgeon should be on the same page approaching the surgery, and both hopefully expect similar outcomes. You should feel comfortable that your surgeon will do his/her best to meet your needs if possible and will consider revisions if necessary. Discuss this with your surgeon, as well as financial expectations should such problems occur after surgery. By the way, your surgeon will be assessing you as well. Anyone can accept a perfect beautiful result, but what if things don’t go as planned? If your surgeon feels that you will not cope well if all is not perfect, then they may recommend no surgery, as we can never promise that complications will not occur.
Lastly, you should feel comfortable with your surgeon, and your surgeon should feel comfortable with you. Your relationship will often last many years. I often see patients that had their surgeries almost two decades ago! This characteristic is harder to quantify and comes down to individual personality. I really like my patients and learn something new from them every day. It makes for a pleasant experience, and makes my work fun. Hopefully you will enjoy your office visits and encounters, and look forward to ongoing contact with your surgeon over time. That goes for the office staff as well, as you will be dealing with the whole surgical team. Try to find a surgeon that you like!
I think that I could talk about this topic for hours, but am going to call it quits for now, as my flight is landing and I have been told to put my tray table up. See you next time and let me know what you would like to talk about!