How to pick a surgeon?

Question

Hello, It has been really hard for me to pick a surgeon because every surgeon has their pros and cons and I'm realky data driven not really the type to go with someone for their demeanor. I was sure of a doctor but realized he only has 2 years expericence as a board certified surgeon (he did do 6 year residency as a ps and 2 year fellowship after). Does anyone have a college in Houston texas that you would feel comfortable recommending or is that not common to do?

Joe Gryskiewicz, MD, FACS · Answer

Hello,
While I am based in Minnesota not around Houston I do have some recommendations to ensure you pick a surgeon you trust. I suggest reading reviews, seeing their before and after's. etc. I would suggest picking a surgeon who is board certified in general and plastic surgery. You want to make sure you are comfortable with the surgeon as well as ensuring the surgeon feels like they can meet for expectations. 
All the best,
Dr. Joe

Luis A. Mejia, MD · Answer

Dear Enthusiastic923585, thanks for sharing your concerns, pick a Doctor is the most challenging step in this process, I can suggest to do your research and evaluate who provide you tha confidence and like his/her work. Ask to the surgeon or coordinator all the questions you have till you have a clear idea of everything going on in your head. Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.

Daniel Barrett, MD · Answer

Dear Enthusiastic923585,
finding the right Dr. is extremely challenging especially with the number of online platforms and resources available. There a lot of great Dr's available. Make sure he/she is a board-certified plastic surgeon. Definitely check to make sure your choice specializes in the procedure you want and spend the time to read through patient testimonials. There is a number of different sites where you can check for reviews (Realself, yelp, google, etc.).You can always pick up the phone and call around also, find an office you feel comfortable with and set up a few consultations. 
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

Choosing a surgeon that is right for you can take going on more than one consult. Also checking out a surgeons’s website and reviews will give you more information  regarding which surgeons you might want to consult

Ted Eisenberg, DO, FACOS, FAACS · Answer

Above are recommendations in addition to your own research. Then, I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Camille Cash, MD · Answer

I encourage you to visit my website!  I'm a double board certified plastic surgeon here in Houston.  I'm serving as an executive board member of The Aesthetic Society and the Texas Society of Plastic Surgeons.  I am proud of my work and invite you to review my before/after photos and schedule a consultation.  When selecting a surgeon you want to ensure they are board certified, meet your credentials, and that you feel comfortable and confident in their skills. I would love the opportunity to help you achieve your aesthetic goals!

Connie Hiers, MD, FACS · Answer

If you are comfortable with this surgeon and like his photos, then go with him. Do ask to see photos so you can have a better idea of what you may expect/

Serkan Kaya Ekinci, MD · Answer

I leave the decision-making process of choosing a surgeon solely to you. If he gives you confidence when you meet him, only you can decide.

Richard R. Orr, MD · Answer

I have been in practice over 30 years.  I have very devoted patients.  But when they leave the area, they often ask me how to find a good plastic surgeon.

The best way I have found is for them to ask someone who works in a surgery center.  Most plastic surgeons will work in surgery centers.  Those people work with the doctors and see their work.
Hope this helps!

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated using Word recognition.
Let me apologize for any potential grammatical errors, run-on sentences, or other evidence of poor writing.
Choosing the right plastic surgeon is inherently difficult and most patients don’t do a very good job at it.
I like to make things as simple as possible.
To start with quality plastic surgery outcomes are usually based on two variables.
If you just start with those two, then it can make things easier.
The first is the procedure you’re having and your candidacy for that procedure.
 Understanding your own candidacy for the procedure is critical in order to have a good understanding of what the surgery can or cannot accomplish.
Most people seeking cosmetic surgery are neither perfect or non-candidates.
Most individuals fall somewhere on spectrum of being a typical or average candidate.
 Individuals who are excellent candidates have the potential for very high-quality outcomes if the procedure is done well. if the procedure is done poorly, then that individual can also have a low quality outcome.
Individuals were not good candidates for a surgical procedure. Do not have the potential of getting a quality outcome regardless of who does the procedure.
Many people go into cosmetic surgery having no idea what type of results are possible or what they should be expecting.
When an individual is the less than perfect candidate than this may end up with low patient satisfaction, even if the procedure was done perfectly.
This happens all the time.
The second variable is provider selection, or choosing a surgeon who has sufficient skill and experience.
I recognize this is the variable you are asking about, but I cannot emphasize the importance of also understanding your candidacy.
The right plastic surgeon will explain your candidacy and this is typically done when reviewing before and after pictures.
Explaining your individual candidacy for the procedure is a key part of the consultation, and this is one of the variables you should be using to judge which surgeon to choose for your procedure.
The ability to accurately predict outcomes, with skill and experience, and not all plastic surgeons are very good at assessing patients or delivering predictable outcomes.
Providers who skip explaining candidacy are often not the right surgeons to choose.
This is a really important part of the process. 
The next step I recommend is getting a set of proper pictures for whatever procedure you are contemplating having.
If it’s facial work then get facial pictures and if it’s bodywork, then get body pictures.
Look at how plastic surgeons take before and after pictures to get an idea.
 You basically want to have your own set of “before pictures” before you start consulting surgeons.
Bring those pictures with you to use as a reference during any consultation or anytime you are reviewing before and after pictures.
Having high-quality pictures that are taken correctly will be helpful in this process.
Avoided taking pictures such as selfies, using mirrors or wearing clothing for bodywork.
Look at how plastic surgeons take the pictures and try to emulate those.
Next make a list of plastic surgeons in your community who seem to have a solid track record for the procedure you’re interested in.
Some plastic surgeons do more of certain procedures than others.
For some procedures, you should be looking for someone who specializes.
Anytime you find a plastic surgeon who specializes exclusively in the procedure you’re interested in you’re probably likely to be dealing with a good contender.
Most plastic surgeons do not specialize because they don’t want to limit what they do.
You cannot be a specialist and a generalist at the same time.
Whenever a plastic surgeon specializes, it means they say no to other procedures.
That’s what it means to specialize.
The best plastic surgeons, I know have very little Internet presents and put very little effort in self promotion.
They generally do not have the most number of reviews, and they usually do not spend time promoting their practice on social media.
When I look in my community at the plastic surgeons that have the most number of reviews, they are usually average or lower than average plastic surgeons.
 The same is true for those who plaster social media with self promotion.
These providers typically are not busy enough to sustain a practice and are usually driven by self promotion than Patient advocacy.
Do not ignore providers, but don’t have the most number of reviews.
In many ways, using Internet, searching well often, steer patience towards providers who may not be the ideal surgeon for your needs.
The best surgeons typically have busy practices based on word of mouth and are busy taking care of patients not promoting themselves.
Providers who have very large number of reviews are promoting reviews.
The number of reviews at typical practice will obtain by organic means it’s usually very low.
If you don’t ask customers or patients to write reviews, they typically don’t.
My dentist is at the end of his career.
He is one of the best prosthetists in the United States.
He taught at prestigious dental schools and has a strong loyal following and currently does not accept new patient despite having virtually no social media presence or advertising.
I think he has seven reviews on yelp.
Look for providers who have at least one or two decades of experience.
Getting good at plastic surgery takes time and this is usually measured by decades and not years.
After residency plastic surgeons still don’t know what they’re doing and there is a finishing school or steep learning curve once we start our practice after training I would not go to somebody who has two years of experience after residency or fellowship.
The sweet spot seems to be about 15 years out of residency. I don’t think I hit my prime until I was in my mid-50s.
Young surgeons tend to operate too much and be overconfident.
Once you have a list of five or six surgeons, then schedule in person consultations with each of them.
You can use objective criteria, but the effort they put forward during the consultation will tell you a lot about the effort they will put into your surgery.
Quality work takes time and surgeons who do quick and dirty consult will typically do quick and dirty surgery.
This means always avoid plastic surgeons who use commissioned sales people to do their consultations.
Never rely on virtual consultations.
Always meet the provider in person.
I cannot emphasize this enough.
During each in person consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had the same face or body characteristics to your own for whatever procedure you are having.
 Being shown a handful of pre-selected images representing only the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures they have actually done.
 For commonly performed procedures and experienced plastic surgeon should have no difficulty showing you the before, and after pictures of at least 50 previous patients.
In reality they should have access to hundreds or preferably thousands of before, and after pictures to choose from.
This is really important.
You need to take an active role during the consultation process.
If they just show you their standard best pictures then you need to ask them specifically to show you more pictures or more pictures that look like you or pictures that have Various outcomes.
It’s not wrong to ask a plastic surgeon to show you 20 outcomes of whatever procedure you’re having unless it is an unusual operation.It’s not wrong to ask a plastic surgeon to show you examples of excellent outcomes, average outcomes, and outcomes that didn’t turn out as well as they had hoped.
It’s not wrong to ask a plastic surgeon to show you what some of their most recent outcomes look like.
For some procedures results will change substantially over time.
When that’s the case, you should always confirm the timeframe of when after pictures were taken.
One of the most notorious procedures for this is fat grafting, or fat transfer.
Results for this procedure can look very impressive during the first month or two, but these results do not represent final long-term outcomes.
It’s always a good idea to get a general idea of what the timeframe was between the before and after pictures.
This is especially true when you’re looking at procedures that leave significant scars like tummy tuck or breast reduction surgery.
Before even having consultations, you should be able to differentiate what quality results look like and understand why.
Most patients do not have a lot of experience consulting with plastic surgeons.
Doing a consultation from the patient’s perspective involves a certain degree of skill.
You’ll be a better patient if you have more practice consulting with plastic surgeons.
Recognize that plastic surgeons have consulted thousands of times and are usually pretty good at it.
 Have multiple consultations if for no other reason to get some practice on how to take an active role during the consultation process.
You are after all interviewing somebody that you were going to hire to perform a service for you.
Take an active role like you’re hiring somebody because you are.
Failure to take an active part in the consultation process, eliminates the ability to really vet the provider.
You should put the provider on the spot from time to time and insist that they answer all your questions.
This is especially true when reviewing before, and after pictures.
Ask them to show you more pictures than what they typically present during their typical consultation.
Reviewing carefully before and after pictures and making sure that the Pictures being shown to you are people who have the same candidacy as you do as the most accurate and best way to select a provider.
To do this accurately you need to have pictures of yourself with you to use as reference.
This is why it’s so important to bring pictures of yourself with you during the consultation and why you need to understand what quality results look like.
This is also why you need to understand your own candidacy for the procedure.
If you don’t understand your own candidacy, and you can’t interpret before and after pictures, then you are not going to be good at selecting a provider by reviewing there before and after pictures.
Since you’re not a plastic surgeon, this is all actually very difficult.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely you are to find the better provider for your needs.
The biggest mistake I see patients make is having only one consultation, then scheduling surgery.
An even worse mistake is having only one virtual consultation, then scheduling surgery.
 The absolute biggest mistake a patient can possibly ever make is having a virtual consultation with a professional commission sales person without having ever met their surgeon.
Most plastic surgical procedures are permanent and irreversible.
It’s pretty much like getting a tattoo and for certain procedures it’s like getting a tattoo on your face or neck.
The time to be critical of plastic surgeons is during the vetting process while you’re doing consultations.
Surgeons are responsible for the surgical out, but patients are responsible for selecting the provider.
Delivering consistent quality results for plastic surgical procedures is often much more difficult than most people realize.
The second biggest mistake I see patients make is assuming that being board-certified and plastic surgery with a few years of experience and a handful of good reviews means that somebody has mastered most plastic surgical procedures.
This is simply not true not even close.
The work that is presented, especially when searching online represents the tip of the iceberg.
These are usually the 99th percentile or 1st percentile, depending on how you’re looking at it.
Average results are usually not posted anywhere near where patients can have access to them.
Bad results can be viewed when patients put disastrous complications online.
Finding the right plastic Surgeon is much much more difficult than most people realize.
Most patient would do better with names on a dartboard than how most people go through the process.
Without being rude, I would say most patients are clueless when it comes to how to properly select a plastic surgeon.
To summarize plastic surgery outcomes are based on two variables.
The first is patient candidacy and the second is provider selection.
Breast augmentation is an exception because with that procedure implant choice is also an important variable.
In my opinion, patient should plan on having at least three or four in person consultations and preferably five or six.
Think of the process as it requires two or three consultations before you even get comfortable having a consultation.
Get a set of quality pictures taken the same way plastic surgeons take before and after pictures and bring these preferably imprinted format with you to each consultation.
Understand your own candidate for the procedure
This includes understanding the variables that change candidacy.
Learn to recognize why quality results are good and why bad results are bad.
When in doubt , slow down and schedule more consultations.
Best,
Mats Hagstrom MD

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