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Plastic Promises

Will the body you've asked for be the one you see in the mirror? With more doctors seeking cash-paying customers, more are performing cosmetic surgery. Here's how to tell who's qualified.


Ah, the price of beauty. Or as Dolly Parton once said, "It takes a lot of money to look this cheap." You gotta love Dolly. Cosmetic surgeons do--especially her spirit of self-improvement.

After all, while surgeons are improving bust lines, they also are improving bottom lines--their own. And in this era of managed care, as insurers put the squeeze on doctors' pay, more physicians have been offering cosmetic surgery in search of cash-paying customers.

"With reimbursement decreasing, the economics of health care are driving a lot of specialists not traditionally trained in plastic surgery into the field," said Achilles Demetriou, head of surgery at Cedars-Sinai Medical Center in Los Angeles.

Because medical insurance doesn't cover surgery deemed "cosmetic," doctors who perform such procedures can basically charge whatever people are willing to pay. That has enticed doctors ranging from general practitioners to obstetricians to perform procedures they probably shouldn't, experts say.

As a result, it's hard to tell these days who's really qualified--even in Southern California, which boasts some of the world's finest enhancers.

The trick is to find the good ones. But with patients, not health plans, left to choose from among the slick ads and marketing claims, the chances of winding up with bad results escalate.

Problems can arise when surgeons work outside areas they are trained for.

"I would send one of my family members to an [ear, nose and throat doctor] for plastic surgery of the head and neck, but not for a breast augmentation," said Dr. William Shaw, chairman of plastic surgery at UCLA Medical School. "Likewise, if an ophthalmologist wanted to do eyelid surgery along with laser resurfacing of the eyelids, that's probably OK. But when he moves on to do a forehead lift as well? Now I worry."

Because body liposuction, the fat-reducing procedure, is so popular, it seems like everybody is doing it--ear, nose and throat specialists, dermatologists, obstetrician-gynecologists and general surgeons. While these surgeons may have the technical skills, they haven't had as much aesthetic training as plastic surgeons. Most dermatologists aren't trained as surgeons, so they should limit themselves to liposuction of small areas, Demetriou said.

Even purists concede, however, that a competent doctor can learn two or three procedures outside his specialty.

"I'm not hatcheting all nonplastic surgeons who do cosmetic procedures," said Dr. Robert Amonic, a plastic surgeon at St. John's Hospital in Santa Monica. "Some are very good, even though they're technically not qualified."

The less complicated the procedure, the more people who can safely do it. Most experts agree, for example, that a plastic surgeon, a facial plastic surgeon or a dermatologist can probably successfully do laser resurfacing for wrinkles. And while an ophthalmologist and a plastic surgeon can probably both successfully perform eyelid surgery, the best bet is a board-certified ophthalmic plastic surgeon.

Guidelines to Choosing a Cosmetic Surgeon

Although doctors don't all agree on who should or shouldn't be doing what, here are some general guidelines to help you choose a cosmetic surgeon.

As a first step, narrow the field to a few qualified surgeons who frequently perform the procedure you want with good results. To find them, ask friends who liked their cosmetic surgeons or who work in the medical field, or ask a trusted family physician for a recommendation, said Dr. J. Regan Thomas, a professor of facial plastic surgery at St. Louis University School of Medicine.

Don't rely solely on advertisements.

"The size or amount of advertising is not correlated to skill," Thomas said. "In fact, there's possibly an inverse correlation."

After you have some doctors' names, check out their backgrounds before scheduling a consultation. Ask the doctor's office to send information about the surgeon's education and training. Here are some things to look for:

* Did the doctor go to a reputable medical school?

* Is the doctor board-certified (meaning he or she went through additional training and passed a rigorous exam) in a particular specialty related to the procedure you are considering? (He may be a board-certified psychiatrist, but what does he know about hair transplants?)

* There are two respected certifying groups for plastic surgeons: the American Board of Plastic and Reconstructive Surgery and the American Board of Facial Plastic and Reconstructive Surgery. Beware of vanity boards, groups with official-sounding names that don't require much in terms of training or membership qualifications.

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