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What is a Plastic Surgeon?

A Plastic Surgeon is one who specializes in reducing scarring or disfigurement that may occur as a result of accidents, birth defects, or treatment for diseases, such as melanoma. Many plastic surgeons also perform cosmetic surgery that is unrelated to medical conditions, with the goal to aesthetically enhance various parts of the body and face.

The techniques employed in aesthetic surgery are derived from those used in reconstructive surgery. In fact, aesthetic surgery is an extension of reconstructive surgery. It requires competent surgical skill, a sense of harmony of the body parts and good aesthetic judgment on the part of the surgeon.

It is common for many plastic surgeons to devote their time to cosmetic surgery procedures. Typical cosmetic surgery procedures include Rhinoplasty (cosmetic surgery on the nose), Blepharoplasty (cosmetic surgery on the eyelids), Face Lift (cosmetic surgery to tighten facial tissue) and other cosmetic procedures that reducing and enlarging the breasts.

How Plastic Surgeons Were Selected

Consumers' Research Council of America has compiled a list of Top Plastic Surgeons throughout the United States by utilizing a point value system. This method uses a point value for criteria that we deemed valuable in determining Top Plastic Surgeons. 

The criteria that was used and assessed a point value is as follows:

Experience: 

        Each year the Plastic Surgeon has been in practice

Training:

        Education and Continuing Education

Professional Associations:

        Member of Professional Medical Associations

Board Certification:

        Completing an approved residency program and passing a
        rigid examination on that specialty
                                                                                                                                                

Simply put, Plastic Surgeons that have accumulated a certain amount of points qualified for the list. This does not mean that Surgeons that did not accumulate enough points are not good health care professionals; they merely did not qualify for this list because of the points needed for qualification.

Similar studies have been done with other professions using a survey system. This type of study would ask fellow professionals on who they would recommend. We found this method to be more of a popularity contest, for instance; professionals who work in a large office have much more of a chance of being mentioned as opposed to a professional who has a small private practice. In addition many professionals have a financial arrangement for back-and-forth referrals. For these reasons, we developed the point value system.

Since this is a subjective call, there is no study that is 100% accurate. As with any profession, there will be some degree of variance in opinion. If you survey 100 patients from a particular physician on their satisfaction, you will undoubtedly hear that some are very satisfied, some moderately satisfied and some dissatisfied. This is really quite normal.

We feel that a point value system takes out the personal and emotional factor and deals with factual criteria. We have made certain assumptions. For example, we feel that the more years in practice is better than less years in practice; more education is better than less education, etc.

The Top Plastic Surgeon list that we have compiled is current as of a certain date and other Surgeons may have qualified since that date. Nonetheless, we feel that the list of Top Plastic Surgeons is a good starting point for you to find a qualified specialist.

No fees, donations, sponsorships or advertising are accepted from any individuals, professionals, corporations or associations. This policy is strictly adhered to insure an unbiased selection.

Finding a Plastic Surgeon

 Choosing a Plastic Surgeon is an important decision. The Surgeon you are looking for should be qualified at performing the procedure you need as well as understanding the particular circumstances of your case. The Plastic Surgeon should provide you with realistic information about the procedure and the outcome of your results. We strongly recommend finding a Plastic Surgeon that is board certified and whom has received surgical instruction, training and experience in the procedure you need. Thus, our goal is to assist you in making that decision.

First of all, when selecting a Plastic Surgeon, you may want to begin your search several different ways:

Ask a family physician. He or she is in constant contact with all kinds of healthcare professionals and will be able to point you in the right direction.
Ask family, friends, neighbors and/or co-workers.
Contact your local hospital and speak to surgical nurses that do a lot of the procedures you are having done. These nurses take care of the end results of all Plastic Surgeons.
Contact your city, county or state medical agencies for names of qualified Plastic Surgeons. Contact and ask for referrals from medical associations. Many are listed in this book.

Plastic Surgery Techniques

Breast Implants

A plastic surgeon is able to form a breast mound by using an implant or by using tissues from another part of your body. Breast implants are silicone sacs filled with saline (salt water) or silicone gel. The sacs are placed under your skin behind your chest muscle. Your body type, age, and cancer treatment will determine which type of reconstruction will give you the best result.

Saline and Silicone Implants

Saline-filled breast implants are available for anyone who wants them.
Some scientists are concerned about possible short-term and long-term health problems associated with silicone gel-filled breast implants. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in an FDA-approved clinical trial. Your surgeon can determine if you are eligible and can make arrangements for you to join the study.

Possible Problems:

 As with any surgery, you may have some pain, swelling, bruising, and tenderness. These problems should disappear as you recover. Scars will fade over time. You should let your doctor know immediately about any fever, infection, or bleeding.

Side effects that could appear later include rupture, leakage, deflation or shifting of the implant, or interference with mammography readings. Breast implants age over time and may need to be replaced.

For more information about Breast Implants:

* Contact plastic surgeons and other medical experts.

* Call NCI's Cancer Information Service (CIS), 1-800-4-CANCER.

* Call the Food and Drug Administration (FDA), 1-800-532-4440.

* Call the American Cancer Society (ACS), 1-800-ACS-2345.

* Talk to breast cancer survivors who have had reconstruction.

* Contact your health insurance company.

Reconstructive Surgery

 Reconstructive surgery is a type of plastic surgery. This type of surgery is performed to reshape abnormal structures of the body to improve function and appearance. Reconstructive surgery is different than cosmetic surgery, which is performed to reform or reshape normal structures of the body to improve a patient's appearance and self-esteem. It is to also allow a person to have a more normal appearance. Abnormal structures of the body that are corrected during reconstructive surgery may be the result of birth defects, developmental abnormalities, trauma or injury, infection, tumors, or disease. The three most commonly performed reconstructive surgeries in the United States are tumor ablation (removal) and reconstruction, hand surgery, and breast reconstruction.

Reconstruction with Tissue Flaps

A flap (section) of skin, muscle, and fat can be moved from another part of the body to the chest area where it is formed to create a breast shape. This tissue can be taken from the lower abdomen, back, or buttocks.
This flap of skin, muscle, and fat is moved while still connected to its blood supply. It is then shaped to form a new breast mound.

Choose a plastic surgeon who has been trained in this procedure and has performed it successfully on many women. Of course, you will need to have regularly scheduled follow-up care and mammograms.

Possible Problems:

Tissue flap reconstruction is a major operation, resulting in large surgical wounds. If there is a poor blood supply to the flap tissue, part or all of the tissue in the breast area may not survive the transplant. Infection and poor wound healing are possible problems.


What You Should Know

 Most women who have breast reconstruction are happy with their decisions. A woman starting this process, however, should know that breast reconstruction requires more than one surgery. Extra steps may include:

      

* Adding a nipple.

* Changing the shape or size of the reconstructed breast.

* Surgery on the opposite breast to create a good match.

With most of these extra surgeries, you can go home the same day as the operation.

Questions to ask your Plastic Surgeon about Breast Reconstruction 

      

What is the latest information about the safety of breast implants?

How many breast reconstructions have you done?

Which type of surgery would give me the best results?

How long will the surgery take? What kind of anesthesia?

When do you recommend I begin breast reconstruction?

How many surgeries will I need?

What are the risks at the time of surgery? Later?

Will there be scars? Where? How large?

Will flap surgery cause any permanent changes where tissue was removed?

What complications should I report to you?

How long will my recovery take? When can I return to my normal activities?

What activities should I avoid?

Will I need follow-up care?

How much will it cost?

Will my health insurance pay for breast reconstruction?

Rhinoplasty

Rhinoplasty is plastic surgery of the nose. This procedure is very common and you are a good candidate for this procedure if:

     

Your nose is crooked or off center

Nostrils are excessively wide or flared

A bump or high point on your nasal bridge

Your nose is too large for your face

The nasal tip is sagging or thickened / enlarged

 

Many Plastic Surgeons prefer not to operate on teenagers until they have completely stopped growing. Each case is individual and needs to be discussed in detail with your Plastic Surgeon.

The actual procedure usually takes between one and two hours. Rhinoplasty can be performed under local or general anesthesia depending on what procedure you and your Surgeon have decided upon. The skin of the nose is separated from the bone and cartilage and then is sculpted to the desire shape. Many times the incisions are made on the inside of the nose and it depends on each particular Surgeon and what needs to be exactly done.

Your face will experience discomfort for the first twenty-four to forty-eight hours. It is common for your face to feel swollen and to have a headache. It is usually recommended to stay off of your feet for the first 24 hours and get proper rest. By applying cold compresses, swelling and aching will be reduced to a minimum. Slight bleeding will occur and blowing your nose is a no- no for the first week.

What is Liposuction?

Liposuction is a surgical procedure intended to remove fat deposits and shape the body. Fat is removed from under the skin with the use of a vacuum-suction canula (a hollow pen-like instrument) or using an ultrasonic probe that emulfsies (breaks up into small pieces) the fat and then removes it with suction.

Persons with localized fat may decide to have liposuction to remove fat from that area. Liposuction is a procedure for shaping the body and is not recommended for weight loss.

Liposuction may be performed on the abdomen, hips, thighs, calves, arms, buttocks, back, neck, or face. A liposuction procedure may include more than one site, for instance, the abdomen, back, and thighs all on the same day.

Liposuction is also used to reduce breast size in men with large breasts (gynecomastia) or to remove fat tumors (lipomas) but it is most commonly used for cosmetic body shaping.

Who Performs Liposuction & Where is Liposuction Performed?

Many liposuction surgeries are performed by plastic surgeons or by dermatologists. Any licensed physician may perform liposuction. While some physicians' professional societies may recommend training before performing liposuction surgery, no standardized training is required. As a result, there will be differences in experience and training in physicians performing liposuction. You can ask your physician to tell you whether he or she has had specialized training to do liposuction and whether they have successfully done liposuction before. But remember, even the best screened patients under the care of the best trained and experienced physicians may experience complications as a result of liposuction.

Liposuction may be performed in a

       * doctor's office.
* surgical center.
* hospital.

Because liposuction is a surgical procedure, it is important that it be performed in a clean environment. Emergencies may arise during any surgery and access to emergency medical equipment and/or a nearby hospital emergency room is important. These are things that you should ask your physician before the liposuction.

How can I find the right doctor for me?

The FDA cannot recommend physicians to you. However, there are some things that you may consider:

       *  Ask questions. If you decide to take the step to talk to a doctor about liposuction, be sure that you ask questions and understand what happens during the liposuction procedure and what you can expect. Your physician should also answer any and all questions you have about potential problems with the procedure. Remember that you are purchasing a service when you pay a physician to do a liposuction procedure and you shouldn't feel embarrassed to ask hard questions about the procedure or about the physician's experience in performing liposuction.
* Advertising. Be wary of advertisements that say or imply that you will have a perfect appearance after liposuction. Remember that advertisements are meant to sell you a product or service, not to inform you of all the potential problems with that service.
* Don't base your decision simply on cost and remember that you don't have to settle for the first doctor or procedure you investigate. The decision you make about liposuction surgery is an important one but not one that you must make right away.
* Read. You should learn as much as you can about liposuction. It is important for you to read the patient information that your doctor provides.
* Don't be pressured. Do not feel that because you speak to a physician about this procedure that you must go through with it. Take your time to decide whether liposuction is right for you and whether you are willing to take the risks of undergoing liposuction for its benefits.

Tummy Tuck (Abdominoplasty)

 Abdominoplasty is a cosmetic surgical procedure designed to remove excess skin and fat from the lower abdomen and to tighten the abdominal muscles. You may be a prime candidate if your abdomen is affected by obesity, skin laxity following pregnancy or weight loss, or scars from previous surgery. The overall body appearance is improved by reducing and recontouring abdominal skin and fat. It is not a substitute for weight reduction nor a cure for obesity.

We suggest you set up a consultation with your plastic surgeon and discuss abdominoplasty. You should tell the physician your goals and expectations. You should always keep in mind that the desired result is improvement, not perfection. Abdominoplasty can improve your appearance and renew your self-confidence; the rest is entirely up to you.

The procedure is usually performed under general anesthetic. Excess skin and fat is removed from the lower abdomen and the abdominal muscles tightened. In some cases the navel is repositioned. Scars are common in this type of procedure but your surgeon will make every effort to make the scars as inconspicuous as possible. In some circumstances the scars can be hidden inside the bikini line where they may be easy to conceal. Scarring is an individual characteristic and can vary from patient to patient.

The best results are obtained in patients of near normal weight with some laxity of the abdominal skin or a slight excess of fat or bulging of the abdominal muscles. The result is usually permanent although of course excessive weight changes or future pregnancies may undo some of the benefits of the surgery. Your surgeon can discuss with you your expectations and let you know if they are surgically possible.

Facelift

A facelift is a cosmetic surgical procedure to improve and sometimes eliminate evidence of aging on the face and neck. A consultation with your plastic surgeon is advised when you are considering a facelift. You should discuss your goals and expectations about looking and feeling better after surgery.

You may wish to have a facelift to correct signs of aging such as facial lines and wrinkles, sagging facial skin or a sagging neck. Only you can decide the best time for a facelift, as it is a personal decision and your options will become apparent at the time of your consultation.


In most cases, an incision is made commencing in the hairline at the temple, extending in a skin crease down in front of the ear, around the ear lobe and then behind the ear finishing in the hairline of the scalp. This provides enough access for your surgeon to separate skin from the underlying fat and muscle. The skin is then stretched upwards and backwards, and the excess skin removed. In certain cases additional procedures such as removal of the fat under the chin and tightening of the underlying muscles is performed. A facelift may be performed under local anesthetic or general anesthetic. Depending on the extent of the procedure, facelift surgery may last from 2 to 4 hours.

The aim of facelift surgery is to leave scars that are as inconspicuous as possible. Most scars fade considerably with time although there is an individual variation in healing time and scar formation. Occasionally thickened scars may develop which require specific treatment by your surgeon.

A successful facelift operation will make you look refreshed and more youthful. A facelift performed to correct sagging skin before lines and wrinkles have developed will often prevent the formation of these lines and wrinkles for many years and thus preserve a more youthful complexion.

What does the FDA Regulate?

In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices, such as the equipment (canulas, pumps, collecting containers, ultrasound probes, etc) and drugs (anesthesia) used for liposuction.

Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the "indication." Once a device is approved, other similar devices may be cleared by the FDA for use. This requires less information since an equivalent device has already been shown to be safe and effective. In some cases, devices that were on the market before FDA started regulating medical devices may be cleared. Once the FDA has approved or cleared a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved or cleared device for other than its FDA-approved indication is called "off-label use."

The FDA does not have the authority to:

       * Regulate a doctor's practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.
* Set the amount a doctor can charge for liposuction surgery.
* "Insist" that patient information be provided to the potential patient.
* Make recommendations for individual doctors, clinics, or liposuction centers. FDA does not maintain nor have access to lists of doctors performing liposuction.
* Recommend a physician to you.
* Conduct or provide a rating system on medical devices it regulates.

Newest Surgical Procedures

Robotic Surgery
Robotic surgery is a new and very promising type of surgery. These mechanical marvels lend a helping hand to Surgeons performing delicate and intricate surgeries. Robotic Surgeons require a human Surgeon to operate them and input instructions via voice activation and various computer interfaces.

Robotic technology is being introduced in the medical field because they allow for unprecedented control and accuracy performing surgical procedures. Robotics decrease the fatigue that many Surgeons experience during long and tedious operations. When Surgeons get tired it is common for them to experience hand tremors, twitching and shaking. Robotics eliminate this by the mechanical arm keeping steady.

The Food and Drug Administration approved the first robotic system that is allowed to be used in American operating rooms. It is presumed that robotic technology could be used in over three million surgical procedures per year. As this technology advances we believe that this will be a common instrument in operating rooms throughout the country.

 
Laser Surgery

Lasers were developed in the mid 1960's for industrial applications. These lasers emitted a continuous beam of light and were non specific in their effects on tissue. For the first twenty years the use of lasers in the medical fields were limited, to say the least. In the early 1980's, lasers were developed that emitted pulses of light. This development made the use of lasers in medical applications popular due to the precise and effective results of this new technology.

Today, many surgical procedures are performed by lasers. Lasers are used to cut, coagulate, vaporize and remove tissue. Lasers are used are for open and laproscopic procedures, as well as breast surgery, gallbladder removal, hernia repair, bowel resection, hemorrhoidectomy, solid organ surgery and pilonidal cyst.

Dermatologists use lasers for many medical applications. These applications include:

Benign Skin Growths

Stretch Marks

Unwanted Hair

Enlarged blood vessels

Birthmark removal

Tattoo removal

Scar removal

Ophthalmologists use lasers frequently. The excimer laser is used to reshape the cornea and help the eye focus properly. Laser vision correction is used to correct nearsightedness, farsightedness and even astigmatism. Retina specialists are using lasers to help treat Macular Degeneration. Glaucoma and other diseases that cause pressure on the eye is now treated with lasers

Urologists are utilizing lasers in the treatment of diseases that affect the urinary and genital systems. Common diseases that are treated are urinary tract disorders, urinary stones, urothelial tumors, obstructions, tumors and warts. Podiatrists use lasers to treat fungal nails; ingrown nails; deformed nails; Plantar warts; skin fissures; certain types of cysts, and many other conditions.

With the continuing advancements of laser technology and the advantages minimal invasive surgery we expect see many new advances in this field.

Patient Rights and Responsibilities

Patients' Bill of Rights

I. Information Disclosure
 You have the right to receive accurate and easily understood information about your health plan, health care professionals, and health care facilities. If you speak another language, have a physical or mental disability, or just don’t understand something, assistance will be provided so you can make informed health care decisions.

II. Choice of Providers and Plans
You have the right to a choice of health care providers that is sufficient to provide you with access to appropriate high-quality health care.

III. Access to Emergency Services
If you have sever pain, an injury, or sudden illness that convinces you that your health is in serious jeopardy, you have the right to receive screening and stabilization emergency services whenever and wherever needed, without prior authorization or financial penalty.

IV. Participation in Treatment Decisions
You have the right to know all your treatment options and to participate in decisions about your care. Parents, guardians, family members, or other individuals that you designate can represent you if you cannot make your own decisions.

V. Respect and Nondiscrimination
You have a right to considerate, respectful and nondiscriminatory care from your doctors, health plan representatives, and other health care providers.

VI. Confidentiality of Health Information
You have the right to talk in confidence with health care providers and to have your health care information protected. You also have the right to review and copy your own medical record and request that your physician amend your record if it is not accurate, relevant, or complete.

VII. Complaints and Appeals
You have the right to a fair, fast, and objective review of any compliant you have against your health plan, doctors, hospitals or other health care personnel. This includes complaints about waiting times, operating hours, the conduct of health care personnel, and the adequacy of health care facilities.

Medicare Patients’ Rights

As a Medicare beneficiary, you have certain guaranteed rights. These rights protect you when you get health care; they assure you access to needed health care services; and they protect you against unethical practices. You have these Medicare rights whether you are in the Original Medicare Plan or another Medicare health plan.

Your Rights Include:

The right to protection from discrimination in marketing and enrollment practices.

The right to information about what is covered and how much you have to pay.

The right to information about all treatment options available to you.

The right to appeal decisions to deny or limit payment for medical care.

The right to know how your Medicare health plan pays its doctors.

The right to choose a women’s health specialist.

The right, if you have a complex or serious medical condition, to receive a
  treatment plan that includes direct access to a specialist.

The right to receive emergency care.

If you believe that any of your rights have been violated, please call the State Health Insurance Assistance Program in your State.

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