SAUL R. BERGER   M.D.
818.990.4545
PLASTIC, COSMETIC AND RECONSTRUCTIVE SURGERY
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9 Essential Steps to Successful Cosmetic Surgery

July 2017

With an ever-increasing number of options for looking better, younger and healthier, it’s no wonder people think about having plastic surgery and non-surgical cosmetic treatments. If you are considering this for yourself, have you thought about the BEST way to go about it? In other words, aside from booking an appointment at the doctor’s office, have you thought about the process itself, and how to get the best results? Here is your essential guide to getting the best results from your cosmetic surgery:

1) ESTABLISH CLEAR GOALS. Before you jump in, it is best to establish clear goals of what you want to achieve before having a consultation. The more specific your goals are, the more likely your doctor can create an effective plan to meet your needs and the less likely you will fall short of your ideal results. Try to be as specific in your goals as possible! Examples of very specific goals are wanting a straighter nose profile, wanting to remove “bags” from under your eyes, or wanting your tummy to look flatter and tighter. Nonspecific goals, such as wanting your tummy or eyes to “look better,” leave too much open for interpretation, and are less helpful in designing the best treatment plan. Only if your doctor can understand precisely what you are seeking, can he/she determine if the result is realistic and the best way to get there.

2) CONSULT WITH A REAL EXPERT. Plastic surgery and cosmetic treatments require having knowledge of the procedures as well as the skills to provide them safely. Because of the local laws that apply in your state, it is technically possible for health professionals who are not specifically trained in cosmetic surgery or therapies to perform these treatments while remaining within legal boundaries. In the state of California where I practice, for example, any licensed physician can legally perform a facelift or breast augmentation even if he/she was never trained in plastic surgery at all! Yes . . . this is a scary thought. Thankfully, there are ways in which you can methodically go about the process of finding a great doctor. One of the best and most popular criteria to consider is board certification in plastic surgery. Certificates hanging on office walls claiming that the doctor is certified by some “cosmetic” board can fool many people. In truth, there is only ONE legitimate certifying board for plastic surgeons: The American Board of Plastic Surgery. So, be sure to know that the board certification is legitimate. Beyond board certification, membership in the ASPS (American Society of Plastic Surgeons) signifies both board certification as well as other additional characteristics. If you seek more selective “status” in your plastic surgeon, look for a physician who is a member of ASAPS (American Society for Aesthetic Plastic Surgery). ASAPS doctors are automatically screened for board certification while also demonstrating a focus on cosmetic procedures along with ethical integrity and other parameters. These following web sites can assist you in locating practitioners and verifying their board certification: www.surgery.org (American Society for Aesthetic Plastic Surgery – arguably the most “elite” society of cosmetic plastic surgeons), www.plasticsurgery.org (American Society of Plastic surgeons), and www.abplasticsurgery.org (The American Board of Plastic Surgery – you can check whether your doctor is board certified here). Once you find a doctor, recognize that there are varying policies as to how offices handle fees for a consultation. Some doctors offer complimentary consultations, others charge a fee, and yet others charge a fee initially and subsequently credit the amount back to upon booking a procedure. While you may have your own opinion about consultation fees, always remember that treatments and surgeries are far more important than the issue of a consultation fee in most cases. Consequently, I encourage people to avoid putting too much emphasis on the consultation fee. Often, the best-qualified doctors charge a consultation fee because of the time and expertise that they bring to the table for patients. So, in the long run, if you look for quality over these smaller financial issues, you will have access to a wider selection of potential doctors.

3) FIND THE RIGHT FIT. Ensure that you have a comfortable fit with the treating doctor and office, and have confidence that you will be able to communicate with them as well as obtain the information you need. As with any process, it is important to have excellent communication with your treating team, and always recognize that doctors vary in their work style and personality. If you are comfortable that your doctor understands your goals and can formulate a plan that seems to be a good fit, you increase the odds of having a great experience. As with any situation that offers you a choice as to where you receive your care, getting a second opinion may help clarify where you feel the most comfortable. Any doctor who has his/her own surgery center would be among an elite group of physicians who have dedicated the energy and resources to managing the surgical process with a “hands on” approach. I have a policy of providing a tour of my surgery center to all new patients so that they have an immersive and thorough experience before they undergo surgery. Most patients are intuitive and savvy enough to recognize top-tier quality when they tour an office and surgery center.

4) LEARN. Learn as much as you can about the procedure(s) as part of the process called “informed consent.” It is wise to be aware of the options available for your situation, the way in which the treatment will be given, and the risks or side effects associated with treatment. In spite of the remarkable capabilities of the Internet these days, it can be counter-productive to simply use Google to randomly search for information. In fact, I have seen patients become overwhelmed and even “stressed out” about information that they read on the Internet from questionable sources. This almost always occurs as a result of reading about bad complications that someone (often a celebrity) had suffered. Always remember that the “horror” stories get most of the media attention, even if they are based on avoidable or rare problems. I have found that my patients get much more reliable information from well-designed brochures, such as those from ASAPS, or by navigating to web sites of high integrity. You can refer to the web sites listed above for the ASAPS and ASPS resources.

5) PLAN A BUDGET. Consider your budget and the costs, so that you are prepared. Most patients either pay directly for their procedure (with credit card, for example) or use a special line of credit, such as CareCredit (www.carecredit.com) and Alphaeon (www.alphaeon.com). Many offices are familiar with these companies, and can assist you in applying for a medical line of credit. With the help of these companies, it is possible for you to undergo treatment today and pay for it over time.

6) PREPARE. Once you have a treatment plan, prepare thoroughly for your procedure(s). For cosmetic surgeries, such as breast augmentation or tummy tuck, you will typically need up-to-date blood tests and a physical exam to ensure you are ready for any anesthesia required. Also, there are a number of additional steps to prepare for surgery that can reduce your risk of side effects or complications. Of course, you should always get specific instructions from your own doctor, and some of the list that follows may not apply to you. Examples of advice often recommended before surgery include (1) Avoid pills that may increase your bleeding risk, such as aspirin, ibuprofen, etc., (2) Avoid most herbal products or supplements as well as vitamin pills unless cleared by your doctor, (3) Avoid unnecessary extreme exertion just prior to your procedure so that you are not dehydrated, (4) Obtain as much of the materials you will need after surgery in advance, such as compressive garments for liposuction, post-operative bras, healing creams, etc., (5) Prepare your home for your return after the procedure by making sure you are well stocked with food, have clean clothes ready, and have your pets’ needs accounted for. If you require medications after your procedure, be sure to pick them up in advance whenever possible. Prescriptions may include pain medications, antibiotics, sleep aids as well as others. It is common to need ice to apply to surgical sites, for which many people use frozen peas, (6) Be sure not to drink any fluids or eat anything by mouth for at least the 8 hours prior to a general anesthesia you may be having (or as advised by your doctor), (7) Be sure to wear comfortable and loose-fitting clothes that are very easy to remove and put back on after surgery. A zip-up top, for example, is better than one that requires you to stretch over your head. Also, be sure to leave all of your jewelry and valuables at home, (8) Make sure your transportation is set up with someone reliable, such as a relative or good friend. If you receive any anesthesia or sedation, you will only be discharged in the custody of a reliable adult who can drive, (9) Make sure your driver receives all of the instructions from the medical staff, as you may not remember the details right after you awaken from anesthesia.

7) FOLLOW INSTRUCTIONS. Follow all of your post-procedure instructions carefully, and ask any questions of the staff for clarification. The results of a procedure can depend on both the surgery as well as the aftercare at home. Some instructions, such as taking a pill, can be quite straightforward, while other instructions, such as recording fluid output in a drain, require more detailed information so that it is done properly. I provide all of my surgery patients with a specific form that they take home and use as a reference for aftercare. It includes just about anything that they would need to know. I have also found it helpful to use specific instruction guides for non-surgical treatments when a procedure requires any detailed home care.

8) KEEP YOUR APPOINTMENTS. Every surgery or procedure has its own aftercare regimen. Surgeries generally have a longer list of aftercare instructions when compared with non-surgical treatments, although laser treatments and some injections need extra post-treatment care. There may be a need to remove stitches, and the timing for stitch removal will vary with the procedure and the kind of suturing. A drain may be used with certain plastic surgery operations, and the decision for the timing of drain removal must be made by the doctor. In the case of a rhinoplasty, (“nose job”), for example, there may be a splint placed over the nose or special material inserted in the nose that must be removed. Although most of these aftercare visits are short, they allow your doctor to monitor you closely for any problems and keep you on track.

9) BE PATIENT! Believe it or not, complete healing after surgery can take over 12 months! Of course, returning to work or activities occurs much sooner, while the softening of scar tissue and the reduction in scar visibility takes many months. So, patience is a virtue under these circumstances.

In summary, it is helpful to know what to expect if you want to consider cosmetic surgery, and, with the proper knowledge, you can stack the odds in favor of success. The key success elements are:

  • ✓ Establish clear and specific goals of what you want
  • ✓ Consult an expert, such as a plastic surgeon member of ASAPS
  • ✓ Ensure you have a comfortable fit with the doctor and office
  • ✓ Learn about the procedure and associated risks and alternatives
  • ✓ Consider your budget and the costs
  • ✓ Prepare thoroughly in advance so there are no surprises or problems
  • ✓ Follow the post-procedure instructions faithfully
  • ✓ Follow up with your doctor
  • ✓ Be patient!

Saul R. Berger, MD, FACS