A plastic surgeon helps you respond to the questions he tells patients to ask

In my book Secrets of a Beverly Hills Cosme­tic Surgeon, I give patients the 15 smartest questions to ask their prospective surgeons.1 If your potential patients heed my advice and ask these questions, you should be prepared to respond.

1) Do you practice aesthetic surgery exclusively? What percentage of procedures are performed on the face versus other parts of the body?

The likelihood of success is a function of the practitioner’s degree of specialization. It is very difficult to conduct a hospital-based reconstructive practice and an office-based aesthetic practice simultaneously. The answer to the second question gives a hint as to whether or not the surgeon focuses on a particular body region.

2) If you don’t perform aesthetic surgery exclusively, what percentage of your practice is dedicated to aesthetic versus reconstructive surgery?

This allows the patient to determine whether or not the practice is broad-based or more focused on the aesthetic or reconstructive arm of plastic surgery.

3) How long have you been performing the procedures I am considering? How many of them do you perform per year?

Surgeons with 5 to 10 years’ experience with a given procedure will more likely have mastery of it. Frequency of performance also generates mastery.

4) Do you have hospital privileges to perform the procedures I am requesting?

Hospitals conduct rigorous credentialing. Freestanding surgical facilities or office-based facilities may not have stringent credentialing in place.

5) Did you serve a fellowship in aesthetic surgery? If yes, how long was it? What types of cases did you perform, assist in, or observe during the fellowship?

Fellowships enhance the practitioner’s capabilities. Whereas they are not a guarantee of competence, fellowships indicate a strong commitment to excellence in aesthetic surgery. A 1- to 2-month fellowship is not as valuable as one that lasts 6months or longer. The longer fellowship provides the opportunity for more patient observation, including final results, complications, and untoward effects. The focus of the fellowship may indicate the value of the particular procedure the patient is considering.

6) Have you written books or authored journal articles on aesthetic plastic surgery?

Ideally, the surgeon should be a student of the procedure the patient is considering.

7) Do you teach other surgeons your aesthetic surgery techniques?

There is wisdom in the saying, “When one teaches, one learns.”

8) May I receive a copy of your professional biography summarizing your training, qualifications, and credentials to perform the procedures I want?

The professional biography, or curriculum vitae, is a register of one’s professional interests and accomplishments.

9) Can I speak to a patient who has had a similar procedure performed by you?

This is a very valuable benefit for a pro­spective patient who has concerns and worries—unrealistic or legitimate—that may be allayed by a discussion with a patient who has undergone the entire presurgical, surgical, and postsurgical experience.

10) Where will the surgery take place? Your office? An outpatient surgery center? A hospital? Wherever it is, is it licensed by the state or US government? Or is it accredited by The Joint Commission on Accreditation of Ambulatory Health Or­gani­zations, the Accreditation Association for Ambu­latory Health Care, or the American Association for Accreditation of Ambulatory Surgical Facilities?

These questions explore the surgery location’s suitability and safety. An uncredentialed facility may be the habitat of the unqualified rogue practitioner.

11) Will I need to have a physical examination and lab tests prior to surgery? Who does them—you or my primary physician?

Having the patient’s primary physician clear him or her for surgery is wise. That physician has no vested interest in whether the patient has a surgical procedure. The operating surgeon is not as qualified to conduct a complete preoperative medical-clearance examination as an internist or family physician.

12) What type of anesthesia can I expect: local anesthesia only, local anesthesia with sedation, or general anesthesia? Why do you choose that type? Who will administer the anesthetic: a physician anesthesiologist, a nurse anesthetist, or you? How long will I be “under”?

All prospective patients have concerns about anesthesia issues, whether or not they state them. They deserve to know who will be responsible for their welfare in the operating room beyond the scope of the actual procedure. The surgeon may allow the patient to choose either a nurse anesthetist or a physician anesthesiologist. All options should be known to the patient.

Patients are often concerned about how long the surgery will last and need to be reassured that the surgery’s length is less important than the safety measures in place during the procedure. As we often tell pa­tients, “You are safer in an accredited operating room under an anesthetic given by an anesthesia specialist than you are on the freeways getting to the facility. There are no drunk drivers weaving through the operating room.”

13) What are the most common complications of this procedure? Which are the most serious? How would these be anticipated and corrected?

These are important questions that should be clearly addressed “up front” during the consultation. The patient should know that if things do not go well, appropriate fallbacks are in place.

14) What if I need a redo or a touch-up procedure? Will there be additional charges by the surgeon? By the surgery center? By the anesthesiologist?

All financial issues must be explained to and understood by the patient prior to surgery. Much damage can be done to the physician–patient relationship when “add-on” charges are presented to the patient.

15) What stages of healing can I expect? How long is each of them? When can I resume my daily activities? What follow-up can I expect from you and your office?

The postoperative period should be outlined in writing. Patients are less anxious when they understand what lies ahead and know what to expect. PSP

Robert Kotler, MD, FACS, is a plastic surgeon in private practice in Beverly Hills, Calif. He can be reached at [email protected]


Reference

1. Kotler R. Secrets of a Beverly Hills Cosmetic Surgeon: The Expert’s Guide to Safe, Successful Surgery. Beverly Hills, Calif: Ernest Mitchell Publishers; 2003:85–86. Several questions have been paraphrased for this article.