How Do You Know if a Surgeon is Really Good at What He Does?

I'm interested in multiple plastic surgeries, but I guess this question in particular could go for tummy tuck or vaginal rejuvenation. With vaginal rejuvenation there's no before and after pics other than the labioplasty, but I'm not interested in that. I want to know how do you know if the doctor is really tightening it up down there?

Doctor Answers (7)

Picking the best Surgeon for your procedure, and how to find out what was done.

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Picking the Best Plastic Surgeon: Finding Dr. Right
Posted on April 26, 2012
The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced and talented, that is the best, plastic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon.

My Background

Dr. Larry Nichter
I have been a practicing plastic surgeon for more than 25 years, having trained scores of plastic surgeons as a tenured professor of plastic surgery at USC, and I have had a private practice in Orange County since 1993. Speaking from all this experience, here is my advice and the criteria I would use to find the best plastic surgeon in Orange County, Los Angeles, California, or anywhere in the United States. These are the criteria I would use to select a plastic surgeon for my friends, my family, or myself.

First, I want to stress some general observations I have found to be true over the years.

Caveat Emptor: Buyer Beware
The longer a surgeon trains at his craft, the finer his skills and the better his judgment become. Board certification in Plastic Surgery (see below) is a bare minimum. Board certification in an additional surgical field recognized by the American Board of Medical Specialties, or for that matter “triple-board certified,” attests to a doctor’s advanced training and skill and judgment. It also means that they have attained Chief Resident Status in more than one field during their training which means they essentially ran a large departmental service and had senior decision-making and independent operating responsibilities. It is this step that is most maturing for a surgeon.

The institution where the surgeon trained is also important. More renowned schools usually attract the best faculty.

You can use the internet to research the background of a prospective plastic surgeon quickly. Please do this prior to making an appointment. “Just because you wear a baseball cap it doesn’t mean you are a good ball player.” The same applies to anyone wearing a white coat—it doesn’t make you a plastic surgeon, much less a great one.

Caveat Emptor in Latin means “Buyer Beware.” In most states, including California, any physician with a medical school diploma and state license is viewed as a doctor and a surgeon—even without any formal surgical training. In some cases even doctors who have completed only the minimal requirements (medical school, licensing examination, and a one-year internship that need not include surgical training) are touting themselves as “cosmetic surgical experts.” They make these claims of expertise despite the fact that they are only formally trained as family practitioners, OB/Gyns, emergency physicians, dermatologists, or ear-nose-throat specialists. Even physician assistants and nurses have made such claims.

7-Step Process for Finding the Best Plastic Surgeon
The following are my screening guidelines and criteria for picking the best plastic/cosmetic surgeon.

1. Board Certified Plastic Surgeon by the American Board of Plastic Surgery
The American Board of Plastic Surgery is the only certifying board in Plastic Surgery that is a member of the American Board of Medical Specialties. Use these links to look up a prospective surgeon’s status.

To become a plastic surgeon certified by the American Board of Plastic Surgery requires a minimum of five years of surgical training with a minimum of two years of training specifically in plastic surgery. Then the applicant must also pass a comprehensive written board exam. If successful, the candidate must present his/her clinical cases for critical review by board examiners (I was one such board examiner) and if accepted will take a series of oral examinations.

Since the 1990s, the American Board of Plastic Surgery Certification is only valid for ten years. To retain your board certified status, a plastic surgeon must complete a Maintenance of Certification including written testing and case review. This means that all who pass are trained and experienced in all plastic surgery procedures including facial procedures, breast, and body; essentially all cosmetic and reconstructive procedures.

If a Plastic Surgeon is additionally board certified by another surgical specialty recognized the American Board of Medical Specialties, then this also marks additional expertise and training at the highest level. For the labiaplasty procedure this would also include the American Board or Obstetrics and Gynecology  However, or example, The American Board of Facial Plastic Surgery (ABFRS) is not a licensing body nor an educational institution and the certificates it issues are not legal licenses to practice facial plastic and reconstructive surgery. The ABFRS is not recognized by the American Board of Medical Specialties (although it does note additional specialty training/interest in facial aesthetic surgery).

Likewise, beware of physicians armed only with certification from other non-ABMS recognized boards or special society memberships other than those I have recommended (eg. “Cosmetic Surgery Board,” “Lipoplasty Society of North America,” etc.).

2. Fellow of the American College of Surgeons: FACS
The American College of Surgeons is dedicated to improving the care of the patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.

To be a member you have to:

be board certified in a surgical specialty recognized by the American Board of Medical Specialties
be in practice in one location for a number of years, with a background check, nomination, and interviews which verify that you are an ethical and safe surgeon among other criteria.
Hint: Look for the “FACS” (or “FRCS,” see below) after the “MD” in a doctor’s title or in his/her Curriculum Vitae to see if he/she is a “real surgeon.”

Note for patients in Canada: The equivalent of FACS in Canada is the Royal College of Physicians and Surgeons of Canada, FRCS.

3. Member of the American Society of Plastic Surgeons (ASPS)
The American Society of Plastic Surgeons is the largest organization of plastic surgeons in the United States and one of the largest in the world. ASPS members are uniquely qualified because of the society’s membership requirements:

Members of the American Society of Plastic Surgeons must be Board Certified by The American Board of Plastic Surgery complete at least 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. The more years of Plastic Surgical Training the better – this includes fellowships in a plastic surgical field.
American Society of Plastic Surgeons members are required to adhere to a strict code of ethics and must fulfill rigorous Continuing Medical Education (CME) requirements including patient safety issues.
Lastly, ASPS members are required to operate at accredited surgical facilities certified by one of the following USA organizations: American Association for Accreditation of Ambulatory Surgical Facilities, Inc., Accreditation Association for Ambulatory Health Care, Inc., or the Joint Commission on Accreditation of Health Care Organizations.
Beware of physicians without this membership but belonging only to similar-sounding societies as their claim to excellence eg. “American Society of Cosmetic Surgery,” “Lipoplasty Society of North America,” etc.

4. Member of the American Society for Aesthetic Plastic Surgery (ASAPS)
This is the most elite society in the United States and perhaps the world for Aesthetic Plastic Surgery. To be a member means that your career is focused in cosmetic surgery at the highest level. Among the requirements for invitation and election to ASAPS membership, a plastic surgeon must:

Be certified by the American Board of Plastic Surgery (or in plastic surgery by the Royal College of Physicians and Surgeons of Canada);
Be in at least the third year of active practice following board certification;
Participate in accredited Continuing Medical Education (CME) to stay current with developments in the field of cosmetic plastic surgery and patient safety;
Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate wide experience;
Be sponsored by two ASAPS-member plastic surgeons to help ensure that the applicant’s professional reputation meets the high standards required by ASAPS;
Adhere to current ethical standards for professional conduct as outlined in the Code of Ethics observed by all ASAPS-member surgeons;
Operate in accredited surgical facilities; and
Be elected by at least 80% of the Active Membership.
Find an ASPS member online.

5. Hospital privileges to perform the same type of surgery
Hospitals often examine qualifications of doctors applying for hospital staff privileges and restrict privileges to only surgeons best trained and qualified to do certain procedures. For example, in order for surgeons to be granted plastic surgery privileges in most hospitals in Orange County, California, that surgeon must have completed plastic surgery residency training and must be board-eligible or -certified in plastic surgery to be allowed to perform plastic surgical operations in that hospital.

Non-surgeons and other physicians that are not plastic surgeons circumvent this process by performing surgery in their offices or in outpatient surgery centers where the credentialing process is less rigorous or nonexistent. In these settings non-plastic surgeons perform procedures in which they have no formal residency training.

I am not warning against use of outpatient surgery centers or in-office procedures. I am only recommending that you check that your physician has hospital privileges for these same procedures.

6. Surgical Experience in the procedure you are having
Few patients ask how long doctors have been doing a certain procedure or how many they have performed. When you consult with a plastic surgeon:

Ask to see typical “before and after” photos;
discuss the details of the procedure in a manner that is clear to you;
review benefits and potential complications;
get full answers to your questions.
7. Evidence of Excellence, Experience and Commitment to the field of Plastic Surgery
Here are some additional criteria to look for in your plastic surgeon.

Surgical Board Certification in more than one field
Plastic Surgical Fellowships in addition to Plastic Surgical Residency.
Number of years practicing.
Peer Review Honors in their own board certification from groups such as Best Doctors, Top Doctors, Super Doctors.
Current or Prior position denoting excellence in the field or high regard by their peers such as:
Prior or present Professor or Faculty affiliation with a University Plastic surgical program (the higher the rank the better)
Chairman of a Department of plastic surgery at a regional hospital
Honors from surgical societies of which they are members such as Board Examiner, etc.
Published Plastic Surgical papers in peer review journals are also a good sign that they are committed to being on top of their field.
Feel Comfortable with your choice
It is very important that after you have done this screening and met with your potential surgeon that you feel confident in your choice.

Complications are not common in cosmetic surgery, but if one did occur are you confident that this surgeon would take charge and handle just about any problem?

Do you feel that he listens to you and communicates well by answering your questions completely, doesn’t rush you in to a decision but rather makes you part of the decision-making process? You should truly feel that it is a combined effort.

Does the surgeon’s office run smoothly? Do the staff take good care of you? If you answered in the affirmative and have gotten this far in your screening guidelines then I think you have found your “Dr. Right.”

To find out exactly what was done during your procedure ask for the operative report which will detail all aspects o the surgery.


Orange County Plastic Surgeon
5.0 out of 5 stars 47 reviews

Surgeon qualifications

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While many plastic surgeons do labiaplasty procedures, few of them actually do vaginal rejuvenation (tightening).  Some plastic surgeons work with a gynecologist who does the vaginal tightening during the procedure if that is what you desire. 

Leonard T. Yu, MD
Maui Plastic Surgeon
4.0 out of 5 stars 18 reviews

Selecting a surgeon

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In general nothing speaks more about a surgeon than his/her reputation.  A referral from another satisfied patient is one of the best ways to get started but you need to arm yourself with more than just that.  A great place to look for "how to choose your surgeon" can be found by Googling the American Society of Plastic Surgeon's website.  Glad to have helped...RAS 

Ryan Stanton, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 19 reviews

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Finding a labiaplasty surgeon in Los Angeles

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Sites like realself.com can provide valuable insight into cosmetic surgery and plastic surgeons.  Review the forums which will allow you to judge the extent of your surgeons reputation.

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 47 reviews

Choosing a Surgeon

+1

Choosing a good surgeon is not the same is choosing a surgeon who is right for you...both are important. First and foremost, you should trust your surgeon, and they should be board certified. RealSelf is an excellent resource for the questions you will have as you move forward. My colleagues here have a lot to offer as you choose! Hopefully, however, after surgery you will feel one hundred percent confident that the surgeon who operated knows you best.

Some questions to ask are:

-Are you board certified with the American Board of Plastic Surgery?

-How many procedures do you perform annually?

-What is your complication rate and how does it compare?

Recommendations from other physicians, patients and surgeons are also helpful. 

Next, finding the right match for you:

-Do you want someone local? (Some of my patients travel from across the country, and others live blocks away.)

-What style do you prefer? (I am very patient centered and compassionate. I care about my patients, take a lot of time to understand their expectations, and often give hugs.)

-What kind of office setting suits you? (My surgery center has two operating rooms and four clinic rooms; I am also on staff at four hospitals.)

-Most importantly, you must trust your surgeon, and enjoy working with them. 

 

 

A pleasure to be a part of your process!

 

Dr. Barbara Persons

 

Barbara Persons, MD, FACS
Lafayette Plastic Surgeon
5.0 out of 5 stars 4 reviews

Selecting a Surgeon

+1

A good place to start in selecting a Plastic Surgeon is with the American Society of Plastic Surgeons (ASPS).  Make an appointment with a couple of highly trained Plastic Surgeons in your area, and see who you are the most comfortable with.  As for the vaginal tightening, a gynecologist may need to get involved.  Many times, these surgeries are scheduled at the same time.  Consult with a Plastic Surgeon to discuss your needs and expectations.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 25 reviews

Choosing your surgeon

+1

is not a simple thing to do.  So many variable to consider, especially the skill and judgment of your doctor.  If you are thinking of 'tightening' up the area, you are talking about vaginal rejuvenation as Dr. Yu mentioned.  In choosing your doctor, you should be able to talk to happy and maybe not so happy patients of theirs to find out how good the surgery was for them.

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.