Choosing a Cosmetic Surgeon – Character Counts.

View from Irvine Plastic Surgery Center
Photo by Donald Altman, M.D.
“Within the first three to
five minutes of meeting someone new, that person will have formed a strong
feeling about who you are, how much they will like, trust and have confidence
in you, and whether they will want to form a relationship with you.” 1
There have been numerous
lectures and publications stating how to choose your cosmetic surgeon. Many
agree that training and dedication on the part of the physician are a good
start, but few references mention how important it is for the patient to assess
the character of the surgeon and the style of his or her practice as part of
the decision. Whereas it is absolutely important that the surgeon is capable of
achieving excellent results, I believe that surgeons and patients alike
underestimate the importance of the process, by which patients consider the
personality of their surgeon in making a selection.
The character of the surgeon defines how decisions are made and the manner in which care is
In theory, all
interactions with the doctor’s practice should be in the best interest of the
Careful observation on the
part of a prospective patient is invaluable to making the right choices in
their caretaker.
The surgeon must always
abide by the Hippocratic Oath taken in medical school, “first do no harm,” a
confirmation to practice in an ethical manner. He or she must determine how to
get the patient from A to Z in the safest manner with the fewest risks. The
plastic surgeon is in a position to know much more about his craft than the
patient undergoing treatment. In business practice this is known as information
asymmetry. It is the responsibility of the surgeon to determine the procedure
and limit the scope of risk in any session.
A professional should
resist the temptation to operate only for financial gain. Far too many cosmetic
surgeons avoid suggesting to patients that it may take two or more steps /
stages / surgeries to complete a surgical process in fear that the patient will
be lost to a competitor who will offer multiple procedures in a single session.
The patient must also
determine his or her risk tolerance in helping to determine the plan. It seems
that no one has time to have their surgery performed in stages, but everyone
finds time to go to the hospital with complications.
A word about technical
advances in cosmetic surgery: Beware of the flavor of the month marketing in
plastic surgery. The public is bombarded daily with news about new devices and
proprietary procedures that can be used to perform miracle transformations over
the lunch hour. A conservative surgeon will probably not be the first or last
in town to try something new. A high performance racecar doesn’t make a safer
driver anymore than a “smart” laser or liposuction machine should appreciably
improve surgical results.
With that in mind the
prospective patient should understand that:
Cosmetic Surgery is about improvement and not perfection
Individuals in good mental and physical health tend to do better than
those who are not.
Healing is not always predictable.
In most cosmetic surgery
practices a time period exists for elective consultations which runs somewhere
between 30 and 60 minutes. During this time, the patient is typically
introduced to staff members, the surgeon, a consultant, and someone to discuss
A separate time is not
designated for the patient to evaluate the character of the surgeon and the
practice. It is the responsibility of the patient to make this determination
during the consultation period.
Observations and
interactions might include the following:
Does the doctor demonstrate
humor or creativity? 2 Humor exhibited tastefully can help create a
bond in a new relationship. Creativity, like artistry, is probably a very good
indicator of an individual’s ability to perform in a field like plastic
Are patients called on the
phone when the office is running late? Medical practices, by definition, offer
care, which is often unpredictable in terms of time. A practice, which attempts
to call patients when the schedule is delayed, reflects a respect for the
patient’s time.
Are the patient’s in the
waiting room generally happy? Keep in mind that the office staff and the
consultative environment are a direct extension of the surgeon’s personality.
Is there open and friendly
exchange between patients and staff members upon arrival and departure from the
office? Are the patients allowed to socialize or are they locked in exam rooms
for long periods of time waiting to be seen. Often times this type of patient
isolation is defended as attending to issues of HIPA compliance. Most patients
are overjoyed to share positive experiences.
Does the office seem
clean? Does the doctor wash his hands before examining a patient? It may seem
like a simple matter, but cleanliness and attempts to avoid infection imply a
certain respect for the well being of the patient.
Is there a medical
assistant or chaperone in the room during exams?
How does the doctor treat
his staff?
It might be awkward but
worth asking, how long has his or her longest staff member been present?
Physicians that work well with staff have the ability to work well with the
public. I’ve had one employee that has been with me for 23 years. Four others
remained with me for more than 10 years.
Does the doctor offer a
holistic approach to the interview or does he just ask about the body part
involved? It is nice to know that the surgeon appreciates the patient as
someone’s mother, daughter, or sister.
Does the doctor give
enough time to ask questions?
Perhaps ask the physician
how he got interested in cosmetic surgery. The interview might give added
insight into the personality of the doctor.
Does the doctor or the
staff provide before and after pictures upon request? Are patients in the
practice willing to share their experiences? All of these behaviors reflect on
the attitude that the physician has created with staff and patients.
Does the doctor seem
cavalier or arrogant?
Does he seem to encourage
the patient undergoing multiple larger procedures in a single session or taking
smaller safer steps?
Ask the doctor if he ever
turns patients away? Under what circumstances does this occur?
Does the doctor every
consult colleagues for assistance or a second opinion? A wonderful quality in
any individual is one that acknowledges that often times two heads are better
than one or possibly in the surgical realm four hands may be better than two.
Rarely, complications
occur when all of the steps and precautions have been taken. Can the patient
discuss how he or she might deal with a complication? Exploring how a surgeon
might handle this situation is critical to the decision of moving forward with
this individual. Most unfavorable outcomes can be improved over time. It
requires a special skill set for a doctor to take a patient through unplanned
problems with healing.
Ask how the patient might
communicate with the doctor after surgery? Does the doctor give out cell phone
# or participate in email or texting? Does he make house calls or meet after
hours if necessary? Remember the three A’s of being a good doctor include –
affability, availability, and ability.
Is there some transparency
in pricing? After all, plastic surgery is very expensive and it would be nice
to understand the costs. Does the surgeon discuss the risks of revision and how
the costs might be handled?
Review the surgeon’s
record on State Medical Board. Ask the doctor about their medical legal record.
A physician who is proud of his track record should encourage a patient of the
opportunity to discuss a difficult issue. The medical malpractice carriers have
no problem assessing the personality of risky physicians and likely charging a
premium for their coverage.3
Review the surgeon’s
ratings on internet opinion sites. Realize however, that one angry patient has
tremendous power to dissuade public opinion and that many happy patients
refrain from posting their experiences.
Are the surgeon’s
credentials posted on a website or somewhere that is readily available to the
Is there an opportunity to
see the surgical facility?
Many cosmetic procedures
can be safely performed under local anesthetic. In cases where sedation is
offered is the facility accredited, certified, or licensed?
Can one meet the
anesthesiologist, the nurses circulating room nurse or the recovery room nurse?
Does the surgeon take patients with more extensive procedures or higher
surgical risks to a hospital? Are these patients required to be reviewed and
cleared for surgery by appropriate internists, such as cardiologist for those
who might be in certain risk categories?
A word about training:
Since the definition of
cosmetic surgeon is largely undefined, considering the individual’s training
and scope of practice further complicates the question. The surgeon should know
his or her areas of comfort, as well as limitations. Adhering to one’s level of
competence when it comes to providing healthcare of any nature should entail
more than a casual appreciation of the Peter Principle. 4
After 4 years of medical
school, I underwent hospital based residency training for two years in General
Surgery, three years in Otolaryngology – Head and Neck Surgery, two years of
Plastic and Reconstructive Surgery, 6 months in cosmetic surgery, and another 4
months in pediatric plastic surgery. This amounted to a total of 12 years of
education after college. This training culminated with rigorous examinations
and certification by the American Board of Otolaryngology – Head and Neck
Surgery and subsequently by the American Board of Plastic Surgery.
Remaining in a mentor /
hospital based traditional education system brought me the greatest exposure
and the greatest depth to my experience that I could offer my patients.
Such a rigorous
traditional course of training fit my personality. Maybe I am overly cautious,
but the need to be overly prepared is a reflection of my character. I am
reasonably risk- averse, particularly when it comes to treating other
Most of my surgical
personality, however, developed and evolved during the 25 years of private
practice after completion of my formal training. Through trial and error and
continuing education I developed the judgment and style of practice that
represents my present craft.
Having said this, can one
achieve excellence in practice delivery with a different background, training,
or experience? The simple answer is yes. There are many types of training and
experiences that differ from my own, any of which are capable of producing
excellent cosmetic surgeons. Just as there are great basketball stars that
became professional right out of high school and leading CEO’s that never went
to college, there are individuals who may achieve excellence in their careers
without traditional academic training. Such excellence, however, might prompt
the consumer to subject the surgeon to a heightened level of review.
Conversely, there are physicians
with extensive training that may or may not be good surgeons for any number of
reasons, one of which may be related to character flaws. The issue probably
extends outside the scope and purpose of this paper. A formal discussion on
subjecting cosmetic surgeons to uniform credentialing and peer review have been
intentionally avoided in this paper as they are complicated and involve
economic “turf wars,” between physicians sometimes thinly veiled as attempts to
establish standards for patient safety. Simply stated, if a cosmetic surgeon,
traditionally trained or not, proposes an operation or procedure, it behooves
the patient to take the time to understand how the professional arrived at this
station in his or her career. Do your homework, ask questions, and above all
trust your intuition – because character counts.
A patient should expend
just as much time and energy learning about the character of the surgeon as he
or she would dedicate to trying to understand the details and nuances of a
surgical procedure. This includes being absolutely certain he or she was
pleased with the overall communication, relationship, and rapport with the
doctor and his practice.
At the end of the day, a
decision to move forward with a procedure in a plastic surgery practice, like
most choices in life, depends on a gut reaction. Trust your intuition. Do you
feel good about the physician’s character? Ask yourself if this individual will
be there to provide care through thick and thin, in good times and bad? If this
answer is apparent, you have found your doctor. The surgery should be the easy

Cosmetic surgery should be
a positive experience that lasts a lifetime.

Donald Altman, M.D.
Irvine, California
“Contact: The First Four Minutes: A Practical Approach to Meeting
the Right Person” (Ballantine Books, 1994). Posted by Jim Gray in the
Daily Pilot on June 26th, 2011
2.,0,6530535.story Article
written by Jim Gray in the Daily Pilot on June 26th, 2011
Blink, The Power of Thinking without Thinking, written by Malcolm
Gladwell, Little, Brown, and Company, Copyright 2005


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