Choosing your cosmetic plastic surgeon, aka an aesthetic surgeon, is a difficult decision. Especially now, as physicians are tactically using social media, advanced marketing, and often exaggerated credentialing to attract business. How do we sort through all the noise and choose the best surgeon for our personal wants and needs? This is a question many of my patients ask during their initial consultation. 

Granted, my opinion may be biased as I am a double board-certified facial plastic and reconstructive surgeon, but I pride myself in being honest and transparent. And in the spirit of sharing my insider’s perspective on the aesthetics industry, the following are the top six factors I would strongly recommend you consider when choosing your plastic surgeon:

1. Board Certification: 

It goes without saying that ideally your surgeon should be kind, empathetic, competent, present, and honest. But at the very least, they should be certified by their respective governing board (Ex: American Board of Facial Plastic & Reconstructive Surgery). This demonstrates that they have completed the necessary requirements deemed appropriate for performing surgery.

Common Board Certification Requirements:

  • Graduation from an accredited medical school
  • Required number of years in residency training at an accredited institution
  • Required number of key indicator surgical cases during residency
  • Formal approval by residency department chair and program director
  • Successful completion of numerous written and oral board examinations
  • Letters upon letters of recommendation
  • Successful completion of required number of surgical cases following graduation
  • An active and unrestricted medical license
  • Surgical privileges at accredited facilities
  • In some instances, an additional subspecialized fellowship training 

2. Results & Longevity:

What you are paying for is ultimately the end result. Therefore, be certain your surgeon has plenty of before and after photos/videos of the procedure(s) you are considering. Keep in mind they will be posting or sharing what they think are their best results. If these photos are not that great, it is unlikely they are performing high quality surgery and are unable to critique their own work at a superior level.

Before and After photos should be standardized within the following parameters:

  • A full set – Frontal, Oblique, Profile, Bird’s eye, Worm’s eye
  • Up to date – consistently updated database with recently consented patients. Photographs from 30 years ago are often not representative of the surgeon’s current results.
  • Quality – full frame and HD
  • Consistent - position, size, angle, light, background, and makeup should be consistent between the original and final sets. 

3. Surgeon’s experience:

Obviously, surgeons of all ages, experience levels, and backgrounds are practicing and available to you. They each offer a unique perspective, patient experience, and surgical results. Here is what you will want to consider:

a. Training

 Patients often ask me if surgical training programs and fellowships matter. In general, I would say yes, but the world of plastic surgery is slightly different. People may be attracted to surgeons who train at Ivy League residency programs or big-name institutions. In reality, these are usually great surgical training programs, but may not be focused on the specialty of aesthetics. Typically, the best aesthetic surgery fellowships are within private practices.

b. Seasoned vs Unseasoned

It is no secret that a surgeon’s knowledge, skillset, and aesthetic eye will evolve over time. Their results will be different from the beginning to the end of their career as well. In fact, I have observed three general phases within a surgeon’s practicing timeline: 

Phase I is usually within the first five years when surgeons are fresh and getting acclimated to operating on their own, learning how to consult with patients, and developing the surgical skills that work best for them. As long as a Phase I surgeon is qualified and safe, they may be a great option for patients looking for less invasive or less complicated procedures, lower costs, or expedited care. Every surgeon must start somewhere. 

- Phase II is generally when surgeons are gaining their stride (year 5-15). They have produced great results and are trying to gain more patients and increase their surgical load. These surgeons are likely still working to perfect their craft, are up to date on all the latest information, and are still reasonably priced. This is usually the sweet spot for most patients.

-Phase III is typically when surgeons have already achieved success. Depending on their career goals, they may have perfected their own techniques and are less pursuant to learning new ones. They are more likely to be highly priced and possibly slowing down their surgical volume. It is important to make sure Phase III surgeons are present and still dedicated to providing exceptional patient experience and surgical results.

c. Number of Surgeries

Would you rather have a surgeon who has done 50 outstanding facelifts or one who has done 1000 mediocre facelifts? There is your answer. Today’s level of education and collaboration of ideas/techniques has allowed surgeons to shorten the learning curve. Having an extraordinarily high number of procedures performed is not as significant as it once was. 

d.  Academic vs Private Practice

Going to an academic vs a private practice typically does not present a difference regarding the actual skillset of a surgeon. I do, however, think it does impact the patient's experience. For example, going to an academic center may offer a certain level of quality assurance. On the other hand, you may also have to encounter rotating medical students, residents, fellows, and other training providers, which may not be what appeals to you. The level of privacy may also be different between the two. Physicians at large institutions may have less control over the patient experience due to overriding administration.  Whereas a private practice can tailor the patient's experience to their preference. Private practice surgeons often operate out of accredited surgery centers, which generally offer a more private and efficient process.

4.  Patient’s experience

If you are interested in a particular surgeon or practice it is important to get an in-person consultation. Obviously, you want to make sure your surgeon is kind, empathetic, knowledgeable, and honest. You should also pay close attention to the office and staff. The office should be clean, with minimal traffic. I might even suggest that the practice décor should be consistent with that of a person who pays attention to aesthetic details. The staff should be courteous, attentive, informative, and discreet. Make sure you check out reviews, social media, and the practice website. All of these should be consistent.

5. Personal

 Personal referrals often go a long way. Make sure you are asking trusted individuals where to go. Spend some time finding more information about your surgeon and their style or bedside manner. You may find you are attracted to certain personalities more than others based on shared perspectives or common interests. 

6. Price

Elective surgery should be accessible but not cheap. Seeking the cheapest price for a particular surgery is typically not the best strategy for achieving exceptional results. Surgery pricing is often based on the demand in that geographic area and directly correlated to the surgeon's skillset and/or how far out their surgery schedule is booked. Those surgeons with a higher demand will typically be able to increase their prices. Nevertheless, everyone has different budgets and aesthetic goals. If you find you are working within a lower budget, it is more important to vet your surgeon prior to signing up for surgery. Value is an important concept to consider. No matter the price, just be sure you are getting what you expect to be paying for. 

In conclusion

This is an exciting time in plastic surgery, with A LOT of great surgeons to choose from. But do note, there are some not so great surgeons as well. Your best bet is to avoid the poorly performing surgeons and select a surgeon who you respect and connect with, while also within your budget. Lastly, always schedule multiple consultations. It is worth the extra time and money to get multiple expert opinions before you go jumping into any surgical procedure. Best of luck! Timothy Ortlip, MD, FPRS - OG Aesthetics – San Francisco Bay Area, Menlo Park, CA.

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