Choosing a doc...what is most important?

I think I have made a decision. The doc I liked best made me feel very comfortable. He has many years of experience. Chief of plastic surgery at a hospital. Teaches. He is well respected in the community. The only thing that concerns me is he didn't have many pictures to show me of his eye work. This somewhat concerns me. Why would this be and is it enough to not choose him as my surgeon?

Doctor Answers 12

What is most important when selecting a surgeon?

Photos alone are not enough to make a decision about selecting a surgeon. But, it is critical to see evidence of results. Photos can provide evidence of surgical skills, additionally, photos can help a patient to determine whether or not they share an aesthetic ideal with their surgeon. Some patients actually like a more "done" severe looking result. My aesthetic ideal is a more natural looking result. 

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 113 reviews

Seeing samples of a surgeon's work is important in seeing their experience and their personal aesthetic style

Thank you for your question. You’re looking to have eyelid surgery and you think you have found a doctor you feel comfortable with to perform the surgery. However, you’re concerned your doctor does not have many examples of his work in eyelid surgery, and you’re wondering if this is enough basis to not choose him as your surgeon.
This is an interesting question, and it is one that has frequently resulted in inter-specialty rivalry in our field. I can certainly give you some perspective on this issue, and I certainly do have my own personal bias, but first let me give you a little information about my background. I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I was first trained in ophthalmology before pursuing specialized training in plastic surgery, and then eventually cosmetic oculofacial plastic and reconstructive surgery. I perform complex eyelid surgeries, including ptosis, eyelid retraction, and reconstructions, very frequently in my practice — almost every day of the week. I have also dealt with many complications from eyelid surgery and other cosmetic surgeries.
I think it is a very responsible thing to ask a doctor for before-and-after photos. With 20 years of experience and practice, I have certainly operated on a lot of eyes and a lot of complicated eye cases. When people come to my practice and don’t already know about me, I have albums upon albums of before-and-after pictures that are available for their perusal. This is mainly so they can look for people who look somewhat like themselves, and they can see the kind of results are possible, as well as the kind of style that I have, so before-and-after photos are very important.
It is important to point out that cosmetic surgery is different from plastic surgery. Cosmetic surgery is a unique specialty where the training is emphasized on cosmetic surgery alone. General plastic surgery is a two-year residency that covers everything from head to toe. Now, this is not necessarily relevant when a doctor has reached the level that your doctor has reached and they are Chief of Plastic Surgery or chief of a department at a hospital. However, I must say that in the past, I have also performed revision surgery on patients who had gone to the “best plastic surgeons” who were well-established in their field, and most of the time, I see there were opportunities for those procedures to be done slightly differently so the patient could get their desired result. There were also many situations where patients had quite advanced concerns.
Keep in mind that if a doctor performs the procedure extremely well and specializes in it, they are going to have better judgment and mastery of the procedure in comparison to those who don’t specialize, simply because they perform these procedures more frequently. This does not mean that oculoplastic surgeons are better than general surgeons, but rather that every doctor who did their residency, pursued specialization and Fellowship, has a special level of competency and expertise.
In addition, cosmetic surgery is an art, and each surgeon has their own signature style. What you want to look for is comfort with their personality, which you already have; and comfort with their style, which you yet have to establish. It is very important that you ask to see your doctor’s before-and-after photos, and I would assume that someone who has reached this level in his field would have volumes of before-and-after photos. Do not be afraid of offending your doctor, because asking questions is your right as a patient. Ask your doctor how frequently or regularly they perform eyelid surgery, and again, ask for examples of their work. You should not be made to feel like you should simply go along with how your doctor wants to do the procedure, because if eyelid surgery is only a small percentage of what they do in their practice, then I would doubt that they have the same level of expertise as someone who does it frequently, and this applies to any specialty, regardless of the procedure.
Open communication and full disclosure is vital. In my practice, for example, if I adopt new technology that I haven’t used for very long, I always make sure to tell my patients this technology is something new, and I will be using it for one of the first few times ever. This ensures that my patients make an informed decision and makes them feel more comfortable.
Meet with your doctor again, ask the questions you need to ask, and also request for before-and-after photos. I understand it can be hard to keep before-and-after photos updated, especially with the volume of surgery I do, however I try to do as many as I possibly can so I can give my patients updated samples of my work. If you are still not comfortable, then seek additional opinions from other doctors, and look into meeting with specialists in oculoplastic surgery as well, to see if you will be more comfortable there.
I hope that was helpful and I wish you the best of luck!

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 59 reviews

Beautiful results in Aesthetic surgery are a mixture of Science and Art !

Plastic surgeon is generally well-trained, highly educated and highly respected,  and could demonstrate excellent before and after photos or patient reviews.

Plastic surgery is a very difficult job when one wants to help patients to enjoy a better life. 

But what about unrealistic demands from patients who dream about perfect results?

Roger Amar, MD
London Plastic Surgeon
4.0 out of 5 stars 2 reviews

Choosing a Plastic Surgeon

A personal referral is always best when choosing a surgeon.If you know someone who has gone through the process they can let you know about their experience with the process.If you don’t have a personal contact or even if you do, you should make sure the doctor is board certified in their field.It is also important the surgeon listens and understands your concerns so you both have the same goals in mind.Before and after photos are also quite important to understand your surgeon’s aesthetic and results.

Jill Hessler, MD
Palo Alto Facial Plastic Surgeon
5.0 out of 5 stars 23 reviews

Who to choose as your surgeon

Thank you for sharing your question. I agree with the other doctors that you should select an experienced, well-trained, highly educated, highly respected, highly reviewed surgeon who has many before and after photos to show you and makes you feel comfortable. The doctor should also have a conservative approach to surgery. There should be many photos to showcase his work. With a lot of experience come a lot of patients photos. Many do not mind the use of their photos to show to other patients.
Good luck,

Finding the right surgeon

Hello and thank you for your question. It is very important that you thoroughly research your surgeon before committing to surgery. It is a good idea to research your surgeon's educational background, online reviews, before & after pictures, and speak with anyone who you may know who has had surgery with that surgeon. During your consultation, make sure that you don't feel rushed and make sure that you have adequate time with your surgeon and not just their patient coordinator or nurses. If the majority of your consultation is spent with someone other than the surgeon, this is usually not a good sign. The most important aspect is to find a surgeon you are comfortable with.

With all that being said, you must see before & after pictures, bottom-line. 

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Richard G. Reish, MD
New York Plastic Surgeon
5.0 out of 5 stars 67 reviews

I think photos are very important

Any doctor in practice long enough should have a library of before-and-after pictures. They should include a wide range of ages and facial variations. If you are lucky they will have pictures of some patients who had similar problems to yours with nice results.
If they don't have pictures of anyone who is remotely like your eyelids or face, maybe they don't have experience with your kind of problem.
There are a few patients in my practice don't want their photos shared with other patients, but the vast majority do not mind, so if a doctor uses the privacy issue to explain why they don't have many pictures, I think that might suggest they don't have much experience with your kind of problem.. I have a digital picture frame showing before and after photos in the waiting room,  and many patients will tell me they want their pictures to be featured there after their surgery. 
By the way, the pictures should be taken with the same lighting before and after. Flash photos can erase shadows and hollows, and so the if the "before" pictures show shadows but the "after" photos do not, then the photos may not reflect the reality of the post-op results.. 
And of course feeling comfortable with and confident in your surgeon is another very important aspect of choosing a surgeon.

Jeffrey Schiller, MD
Staten Island Oculoplastic Surgeon
5.0 out of 5 stars 10 reviews

Photos and surgeon

I wouldn't get too worried about not having photos on his site or in person. If the guy is good, has experience, and you like him, that should be most important. Many patients do not allow photos to be posted. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Choosing a surgeon for eyelid surgery

 When choosing an eyelid surgeon, it's important to look at a large  Amount of photographs of patients that  the surgeon has  performed cosmetic eyelid surgery upon. Many  eyelid surgeons specialize in reconstructive eyelid surgery, especially at a academic institution. In addition to their blepharoplasty photo gallery, make sure they have dedicated a significant component of their practice to the discipline of cosmetic blepharoplasty, performed  the procedure often on a weekly basis and have excellent ratings and reviews for that procedure.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 126 reviews

The website has become a very important factor in deciding on a surgeon.

Plastic surgeons come in all sorts of shapes and sizes.  Some are phenomenal reconstructive surgeons.  Have a burn, need a free graft, or some other bizarre and highly specialized reconstruction, they are who you want in your corner.  That does not mean they are your cosmetic surgeon.  True cosmetic surgeons will have tons of photographs demonstrating their experience and approach to the work.  You will have to decide for yourself if this missing element is a deal killer or not.  It should be a factor in your choice.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
4.9 out of 5 stars 23 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.