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Guest post about cosmetic surgery consultations by board-certified plastic surgeon Robert Singer, MD, the Facility Director and Surgeon at the Singer Surgery Centre in La Jolla, California.  Dr. Singer has published over 150 publications or national presentations at national and international surgical meetings. He is a member of the American Society for Aesthetic Plastic Surgery and a prior president of the organization.

I’m often asked, “What is the secret to a good consultation with your doctor?”

My response: there is no secret.

Common sense and being a very, very cautious consumer are the elements that will help make your consultation a success.

1. Recognize that you get what you pay for

Before the consultation, make sure that the physician is fully trained , ideally a surgeon certified by the American Board of Plastic Surgery. Check with the State Medical Board Web site about the physician’s license status.

Thanks to a catchy name and lots of media attention, Smart Lipo has become a popular form of liposuction.  Smart Lipo is often considered by women who aren’t quite looking for a Tummy Tuck, but aren’t quite satisfied with their shape.

After paying $4,500 for Smart Lipo, RealSelf.com reader Kristi, faces disappointing Smart Lipo results—we interviewed her to find out what she expected, and what she learned from the experience.

RealSelf (RS): I have to be honest—you don’t exactly look like you need lipo—you look great! What made you decide to go for it?

Kristi: Well, I have a son who’s 16 and a daughter who is 7. I’m 37, about 5 feet tall and around 110 lbs. I work out every day. But I’ve always had that little “pouch”…and I just had that insecurity. I was going through a divorce as well, and feeling very insecure. Maybe I was being too much of a perfectionist. But I thought that Smart Lipo would give me that “20-something” stomach. I wanted that hip-hugger jeans look.

Below is an interview with a RealSelf community member, Cherita, about her tummy tuck

RS: once you were ready, how did you go about finding a doctor?

Cherita: I probably researched my Tummy Tuck for about 3 years. I got referrals fromweight loss doctor. I checked out every doctor online; I Googled them, checked to see if they had any complaints filed against them, found out if they were board-certified—all that. Then, when I met with them, I asked how many Tummy Tucks they had done, and whether they had pictures I could see. I did have a budget in mind, but I didn’t want it to dictate which doctor I chose. I asked a lot of questions—and I didn’t want to feel rushed. If I did—or if the doctor didn’t seem to want to answer some of my questions, I was out of there—and you should be, too!

One doctor recommended liposculpture for me, but I wanted the skin off—so that wasn’t for me. The doctors I met with also stressed that many patients have totally unrealistic expectations about Tummy Tuck surgery. You know, they can remove skin, but not the weight. If you’re pear-shaped before, you’ll be pear-shaped after. So many t.v. shows make it look like you get the surgery, and after the commercial you’re fine. It’s not like that—this is major surgery. You really have to think of why you’re doing it.

RS: Speaking of, did you have any surprises? Was there anything that you wish you knew before the surgery that you know now?

Cherita: Yes! The doctors said that it usually takes about 2 weeks (after surgery) and then people are up and around. Well, I just went back to work at 4 weeks after, and I’m still not great. You should probably plan to take 4-6 weeks off for recovery. It could be in part because I’m 52—but it has definitely taken more than 2 weeks. I just thought they’d cut this big smiley face and take the skin away and stitch me up! It wasn’t that simple. And you really should have some help afterward—I was lucky to have my daughter home from college—she was such a help!

RS: So now that you’ve gone through your Tummy Tuck surgery—and I realize it’s only been 4 weeks—how would you say your life has changed? What’s different now?

Cherita: It sounds silly, but even though I’m still swollen and have some pain, I get such a kick out of stepping out of the shower and not seeing that big ol’ bag of skin hanging down. It’s a joyous thing—I’m pleased as punch and thrilled with how I look. I wasn’t trying to look 20 again. And I didn’t just have a little blub of skin from being pregnant—that’s a badge of honor! I had a lot of excess skin that just wouldn’t go away. Now I’m happy with myself. It’s a dream come true. Oh, but now that I can see my thighs….

You may know where this is going… But Cherita seems to be very realistic about Thigh Lift surgery and Liposuction and what’s involved. So for now, she plans on trying out her Pilates class first…Thanks to Cherita for sharing her story with us.   -- Nancy

First you have to meet one, perhaps on an internet dating service, at the local gym, or in the vegetable section of your organic food store. Or, you can examine your face or body and decide to undergo elective cosmetic surgery; the process of engaging a plastic surgeon is very similar to that of matrimonial commitment.

Or, as I tell my patients, a trip through an operating room door is like a walk down the aisle.

While patients can stumble unto a good plastic surgeon and might end up with a good result by luck, it is not a very reliable formula for a successful mature relationship between doctor and patient in as serious an endeavor as cosmetic surgery. Some people will fall in love at first sight and head straight for the altar that same night - but not many, and not if they are sane.

Yet patients routinely sign up for surgery after one consultation, maybe spending as little as ten minutes with the person with a sharp scalpel in his hands before handing a deposit over to a surgical consultant who is not even a doctor and who is often referred to as the ‘closer’ for obvious reasons. If the doctor or ‘closer’ seems too eager to ask for a deposit on the first visit, think of it as a person requesting sex on the first date, and slow down. Better yet, run out of the office.

For many contemplating cosmetic surgery, there's a search for an answer to "Am I doing the right thing?"

Beyond concerns of being accused of vanity, those with strong religious views may face the concern that plastic surgery is a sin, concluding, "God made me this way, so changing myself is going against his wishes."

One of our site members recently reflected on her decision to get a nose job and whether it was going against God's intentions.

MissIlinois2009 started out believing cosmetic surgery was a sin, then later rectified it as in line with her beliefs.  In her own words:

While I acknowledge that God made us all unique in our own way, I no longer think that getting cosmetic surgery is in any way a sin, especially if it can have medical benefits or even just make you feel better about yourself.

God does not want us to suffer?

MissIlinois2009 continues, "I do not think God wants us to suffer but to reach our full potential and be happy."

Today RealSelf.com received its 20,000th answer from a doctor. Congrats to Dallas plastic surgeon Dr. Rod Rohrich for posting #20,000!

In less than a year's time, the doctors on RealSelf.com composed over 20,000 responses to consumer questions about everything from the best ways to get rid of forehead wrinkles to how to whiten teeth.

While very serious questions are being addressed by these professionals, every so often the community poses a somewhat unusual question. Despite being time starved, the doctors on RealSelf.com stepped up to lend their medical opinion.  Here are 3 examples that capture the diversity of our inquisitive community:

 o What can be done about injections placed in the foot pads, done to give the feeling of walking on pillows?

Dr. Jean-Louis Sebagh, the dermatologist and so-called Botox King to celebs is not comfortable disclosing names of his famous clientele.

His one exception is Cindy Crawford, who he's working with to promote a skin care line called Meaningful Beauty.  (Read about the Meaningful Beauty controversy and the active discussion on RealSelf.com).

Microdermabrasion is a popular way to exfoliate your skin and brush away the dead cells so new skin can come to the surface.  It's marketed as good for fine lines and minor sun damage.

There are many ways to do microdermabrasion. Most spas use the small diamond crystals on your face. It's like having your face sandblasted.

Microdermabrasion is one of those treatments where sometimes you see the difference, and sometimes you can just feel it, depending on the condition of your skin. I did it for years at my dermatologist's office and I was never really satisfied by it.

There are now microdermabrasion kits for home use, although experts on RealSelf.com don't recommend them, Instead, they say that glycolic acid and Retin A can do as well if you use them faithfully.

An article in the current issue (4/6) of Newsweek by Jessica Bennett discusses the increasingly young age at which girls are now starting to get into beauty products, and how this could potentially result in increasing interest in plastic surgery and/or other cosmetic treatments in their future. The most common cosmetic procedure for this age group today is laser hair removal, and according to the article, it’s safe to assume that additional treatments will be a given down the road.