Credentials: Selected surgeons should be certified by the American Board
of Plastic Surgery (ABPS). Any doctor (even one from a nonsurgical
specialty) can legally perform surgery. On the other hand, certification by
the ABPS ensures at least five years of surgical training, including two
years of training specifically in plastic surgery.
Patients undergoing a cosmetic procedure should select a member of the
American Society for Aesthetic Plastic Surgery (ASAPS) to help ensure that
their surgeon has extensive cosmetic surgical experience and has met ASAPS
requirements for continuing cosmetic surgery education.
Hospital privileges: Cosmetic plastic
surgery is often performed outside the hospital in an office-based
surgical facility. Wherever the surgery is to be performed, selected
surgeons should have hospital privileges to perform the specific
procedure in an acute care hospital.
Facilities: Published data show that
accredited office-based facilities have a safety record comparable to
that of hospital ambulatory surgery settings. Ambulatory or
office-based facilities should be accredited by a nationally or
state-recognized accrediting agency, or be state licensed or Medicare
certified.
Health: Candidates for cosmetic surgery
should be in generally good physical health and must be candid with
their physician about any drugs they are taking. The medical history
should include hormones (oral contraceptives and estrogen replacement)
and even aspirin, vitamins, and herbal medications since these
substances can interfere with blood clotting or interact with
medications used during surgery and could increase surgical risk.
Patient education: Before surgery,
patients should be educated about all aspects of the planned surgery,
including whether to discontinue certain medications and stop smoking.
Postoperative care should be thoroughly discussed with the surgeon, as
surgery is not truly over until the patient is ambulatory and has
returned to a relatively normal routine.
Risks: Most cosmetic surgery is
extremely safe in the hands of surgeons certified by the American Board
of Plastic Surgery. However, even with the highest level of care, every
surgery carries risks as well as benefits, and these should be discussed
thoroughly before surgery is undertaken. For example, multiple
procedures performed at the same time may increase the risks of surgery.
There are risks associated with anesthesia, analgesics and antibiotics.
Smokers are at greater risk of complications including delayed wound
healing, skin loss, scarring, and poor surgical outcome Other risks
include deep vein thrombosis (DVT) [formulation of blood clots in the
veins] and pulmonary embolism (PE) [a blood clot that goes to the lungs
preventing the lungs from exchanging air].
Factors such as general anesthesia and prolonged operating time appear to
increase the risk of DVT. Both DVT and PE are unpredictable and can occur
outside the surgical setting, as the result of certain medical conditions or
from immobilization; for example, individuals have developed DVT following
long airplane trips.
Postoperative monitoring and home care: In the immediate postoperative
period, any patient undergoing cosmetic surgery should be monitored by
qualified medical personnel and discharged from the surgical facility only
after evaluation by the surgeon.
Usually, cosmetic surgery is performed as an outpatient procedure;
occasionally, the surgeon may recommend an overnight stay. Patients should
arrange to have someone available for assistance for the first day or two
following surgery.
