I will admit it proudly: I am a plastic surgery addict. Which is not to say that I've actually gone under the knife. I've been neither nipped nor tucked. I've never been enhanced or augmented. I feel artificial just wearing contact lenses. I am, however, utterly fascinated by the concept of bettering oneself through surgery. I devour the plastic surgery specials on the Learning Channel, where they find new and unique ways to film these gory procedures in close-up. I've spent hours online staring at before-and-after photos of gastric bypass surgeries, liposuctions, and face lifts. I've even bookmarked sites like www.celebritydoctor.com, which features some pretty grisly footage of comic John Byner's facelift. Other sites even feature celebrity spokespeople: Singer Carnie Wilson found a new career hosting segments on www.adoctorinyourhouse.com, the website that aired her gastrointestinal-bypass surgery to thousands of viewers in 1999.
But in making cosmetic surgery so mainstream, is the media doing a disservice to potential candidates? Choosing a good plastic surgeon and forming realistic expectations about what they can do for you is vital to a positive outcome. Having been the subject of numerous surgical consultations, I can attest that they can be the most depressing, ego-crushing, soul-deflating experiences in the world. Out of five plastic surgeons I've consulted to discuss liposuction, four tried to add on "extras"--suggesting I needed everything from a nose job to cheek implants. That's what happens when you cruise the Yellow Pages for a surgeon.
So where are you supposed to find the right physician to trust your body with? According to Dr. Susan Downey, faculty member in the Division of Plastic Surgery at USC, start by asking around. "Most of my referrals are patient-to-patient," she said. "Talk to people you know. Nurses are a great source of referral. A lot people will know someone who's a nurse and ask them who they would go to." Downey has spent 13 years on the faculty at USC, and her practice focuses primarily on bodywork, including breast augmentation/cancer reconstruction/reduction, liposuction, and abdominoplasty. Downey does no advertising; she found her client base steadily building on its own over the years. "Your practice just starts developing as you spend time in the ER and as people get to know you," she stated.
If you have trouble getting a personal referral, call a respected area hospital for a list of physicians who have privileges to operate there. In addition the American Society of Plastic Surgeons (ASPS) offers several services. Its toll-free number (1-888-PLASTIC) and website (www.plasticsurgery.org) feature the names of surgeons in your area who are board certified. Several specialized directories can help. The ASPS recommends The Directory of Medical Specialists and The Compendium of Certified Medical Specialists, available in public libraries. Downey was featured in The Best Doctors in America, a resource book that was compiled based on recommendations by other physicians. "They asked doctors who you would go to or send patients to," Downey explained. "It's been a very good source for a lot of people."
Buyer Beware
As for those giant color ads you find in local papers--or, worse, radio spots--it's probably best to proceed with caution. "It's always a concern when you see a lot of expensive ads," said Downey. "The concern would be that doctors might be more willing to operate on someone who's not a great candidate if they have a high overhead." Also keep in mind that doctors can list themselves under any category or special heading, regardless of their credentials.
Once you've compiled a list of names, do some research on each one. Dr. Peter B. Fodor, a plastic surgeon on the UCLA teaching faculty with more than 20 years' experience, warned that some physicians might appear more qualified than they are. "It's not enough for a patient to ask if the doctor is board certified," he said. "You have to make sure they're board certified by the plastic surgery board." A certification from the American Board of Plastic Surgery guarantees that a physician is a graduate of an accredited medical school, has practiced plastic surgery for a minimum of two years, and has passed comprehensive oral and written exams.
It's also important to know not only where the doctors went to school but also what type of training they received. Societies like the ASPS have access to this information, as do many hospitals. Downey advises candidates to look for someone who does the procedure commonly and is board certified in plastic surgery. Downey also recommends asking doctors what hospitals they use, then contacting the hospital directly. "They will check on credentials to make sure somebody is who they say they are," she said.
Right Fit
Beyond qualifications, Downey stated, you have to feel comfortable with the surgeon you choose. "There's a lot of very qualified people on the boards, so once you've got past that step, it's talk with the surgeon and make sure you have realistic expectations. There has to be a match of surgeon to patient, personality-wise." Even if you really like the first physician you meet, keep talking to potential surgeons. "In the long run, having more than one consult is only going to give you more information," said Downey. "Even if you hear the same things, you're going to hear it said different ways, and maybe you'll catch onto something about the procedure."
Fodor agreed: "One of the best investments you can make is an additional one or two consultation fees in order to get more than one opinion." Fodor also recommended that you take your time with each physician. He warned of physicians who try to rush you out of the office before you can ask questions. A good surgeon should make clear the risks of surgery, answer questions thoroughly, and be open to discussing credentials. In addition, look at before-and-after books--but be aware that many offices carry libraries of generic images. "It's very important to assess that what you're being shown as a patient was done by that doctor," said Fodor.
Also beware of surgeons who try to talk you into other surgeries unrelated to your original request. Downey said it's perfectly ethical for a physician to suggest you may be a better candidate for a different procedure. For example, a patient who comes in looking for breast implants might be better served by a lift. Warned Fodor, "I don't think an ethical plastic surgeon would be openly soliciting and recommending numerous procedures unrelated to what you came in for."
Downey added that it's important for clients undergoing plastic surgery to have realistic expectations. She said she has turned some clients away who were not suitable candidates. She recalled patients who came in and said they were having liposuction only because their boyfriend wanted them to or were interested in implants because their agent had suggested it. "You don't want to do it because somebody's pressuring you into it," she stated. "You're not going to do well, you're not going to be happy, it's not going to be a good thing."
The Natural Look
We've all seen them: Bad plastic surgery jobs in Los Angeles are as common as jams on the 405 Freeway. Dr. Stanley Frileck, an L.A.-based plastic surgeon, recently told Entertainment Tonight that many surgeons lack aesthetic judgment. "That portion of my practice, fixing other doctor's work, has grown in the past four or five years to 20 percent to 30 percent," Frileck said.
Fodor emphasized finding a doctor who can produce natural-looking results. "There is a tendency to create results that don't normally occur," said Fodor. "Plumping up lips to the point where they look like a suction cup is just not something that looks natural. Some of those things happen because people are, for lack of a better word, on the greedy side. More is not always better."
Still, this surgical industry continues to thrive. The ASPS recently released a list of the top five surgical and non-surgical procedures. The most popular surgical procedures were: nose reshaping, liposuction, eyelid surgery, breast augmentation, and facelifts. Despite the scare over silicon breast implants, Downey said she's seen very little change in the number of women seeking to remove them. "There was a little blip right at the time of the silicon crisis a few years ago," she stated. "We all spent a lot of time talking to people, and my experience with my patients is that they were very well-informed."
Top non-surgical procedures included: chemical peels, micro-dermabrasion, Botox injections, collagen injections, and laser hair removal. While these procedures cost less upfront than surgical procedures, the results are not necessarily permanent. A Botox injection averages about $375, but the results last only three to six months. One of the reasons given for the popularity of "Botox Parties"--the modern version of a Tupperware Party at which several women are injected at once--is the discounted cost of buying Botox in bulk.
As for me, I'm still wary about going under the knife, lest I come out looking like the love child of Michael Jackson and Cher. I'm much more content rubbernecking the exploits of others. The Learning Channel recently began running the excellent series A Personal Story, which follows a person undergoing corrective or cosmetic surgery. I like to call it "Trading Faces," in honor of that other great TLC show, but it's a very informative and well-made series.
And I'm already primed for what is sure to be a fascinating television event--ABC's Extreme Makeover. This one-hour special airing in November will give three individuals the ultimate makeover with the help of stylists, trainers and, yes, plastic surgery. According to creator and executive producer Howard Schultz the response to the show was enormous, with more than 2,000 people applying. "After the show airs I have this feeling we'll be inundated with 25,000 people," said Schultz.
In casting the three individuals to be featured on the program, Schultz had very specific criteria: "The general thing we were looking for was we wanted happy, healthy individuals. We weren't looking for big sob stories. We wanted average, everyday people who were basically secure individuals with great support but got dealt a raw deck of cards in the looks department." The three individuals chosen are "healing as we speak" from a range of surgeries, and Schultz is prepared for the inevitable criticism the program will encounter. Still, Schultz said he and his staff made sure the show's participants were ready for such dramatic changes. "We have done more than any plastic surgeon would do to clear a surgery," he said. This included psychological evaluations, physical examinations, and meetings with friends and family of the individuals. While the show may be controversial, I can guarantee you one thing: My VCR is set. BSW