Cosmetic surgery is on the rise. According to the American Society of Aesthetic Plastic Surgeons’ annual statistics, 8.3 million cosmetic procedures were performed in 2003, with a 293% increase since 1997! Procedures to enhance appearance are becoming more acceptable in society and patients are being more open their surgery. Media coverage has been extraordinary. Television shows, such as "Extreme Makeover" and Discovery Channel’s "Plastic Surgery: Before & After," have brought these procedures into the living rooms of every household. These shows make plastic surgery tangible to the average person by following average people, not movie stars, throughout the process. Non-invasive procedures, such as BOTOX® Cosmetic and lip augmentation, have shown the greatest increase in popularity due to the quick effects, short recovery and low expense (when compared to surgery).

How does the patient choose the right physician to perform cosmetic procedures? With the increasing demand of plastic surgery and declining insurance reimbursement, more physicians who do not have formal training in cosmetic procedures are offering cosmetic procedures. Buyer beware! Ask the physician what medical board has certified him or her. Choose a physician who is board certified in one of the following specialties:  dermatology (skin), facial plastic and reconstructive surgery (face and neck), ophthalmology (eye), otolaryngology — head and neck surgery (ear, nose, and, throat), oral-maxillofacial surgery (facial bones), and plastic surgery. All of these specialties, except plastic surgery, are considered “regional specialties.” Regional specialists have many years of training in a specific area of the body, but not training for the entire body. For example, it is appropriate to consult with a facial plastic and reconstructive surgeon for a facelift or rhinoplasty. Be aware of surgeons who are performing procedures outside of their area of expertise, such as a facial plastic and reconstructive surgeon who is doing breast augmentation. While this makes common sense, many patients believe that the surgeon must be qualified if he or she is offering the procedure. Again, buyer beware! Ask the surgeon if he or she has privileges at a hospital for the procedure that you desire. If he or she does not have privileges, then seek another surgeon.

Some of the television shows and magazine articles give the impression that plastic surgery is not “real surgery,” or that the recovery from surgery is minimal. Cosmetic surgical procedures have the same surgical and anesthesia risks as medically necessary procedures. Choose to have your procedure done in an accredited ambulatory surgery facility, not in a physician’s office. A recent study in Florida (Archives of Surgery. 2003; 138:991-995) revealed that patients are ten times more likely to die or have a complication in an office than in accredited ambulatory surgery center. Who delivers your anesthesia is also very important; the options include your surgeon, a nurse, a nurse anesthetist, or an anesthesiologist. An anesthesiologist is a medical doctor who has had years of training to put patients asleep for surgery, and is the most qualified for the job. A quality surgeon will not sacrifice safety for financial gain or convenience.

Before actually having a cosmetic procedure, you should feel comfortable with the surgeon you have chosen and the procedures you have discussed. If you are unsure, return for another appointment or seek another opinion. View before and after photographs of patients who have had similar procedures by your surgeon. Ask to speak with his or her previous patients if you are going to have a significant procedure such as a facelift. While most cosmetic surgery is successful and very safe, trust your instincts and do your homework to ensure the best result possible!