Consider the Aesthetics of the Office

Cosmetic surgery is art, and the cosmetic surgeon's artistry is reflected in the visual qualities of his office.

If the decor is 20 years out of style, if furniture is positioned haphazardly, if things looks disorganized, if the color scheme is irritating, or there's no art on the walls, then this may be an indication that the doctor doesn't have much aesthetic sense. You may not want him sculpting your hips, re-designing your eyelids or deciding where to position transplanted hair on your head. On the other hand, original art on the walls, for example, may be something you don't want to be paying for.

This may also apply to the way the doctor and his staff present themselves visually. How do they dress? Are they well groomed? Do the staff's area and consultation rooms look organized, well-designed, and clean?

A Checklist to Use During Your Consultation*

• Is the surgeon a true cosmetic surgery specialist (her whole practice is "beautification" surgery), or does she do reconstructive, hand, or other kinds of surgery?
  Does she claim to "operate from head to toe"? You are better off with a left finger specialist if you have a left finger surgery you want done.
• Has the doctor performed a minimum of several hundred cases of the type of surgery you are considering?
  International experts have performed many thousands of each surgery for which they are considered top-flight. This is much more critical information than any credential or training. Many fancy residency programs have been shown by studies (actually published in medical journals) to contain very little cosmetic surgery training experience.
• Is your doctor spending his time in hospitals doing all kinds of other work or does he do his work out of an outpatient surgery facility?
  Most modern cosmetic surgeon sub-specialists work almost strictly outpatient. Hospital privileges show that the hospital has checked the doctor's general credentials, but never purport to certify great expertise. And if your doctor is on the staff of many hospitals, he is likely more a generalist than a cosmetic surgery specialist. Hospitals usually remove inactive doctors from their staffs, so this doctor is certainly working actively at the hospitals. All this said, however, some very competent surgeons perform cosmetic surgery in hospitals or hospital-affiliated outpatient surgical centers.
• What boards, if any, has your doctor passed?
  Cosmetic, plastic, dermatology, and facial plastic are all acceptable, but you need to look much closer, whatever the answer is.
• Is your doctor involved with fellowships?
  If so, beware: beginning surgeons may be doing part or much of the work.
• What is your impression of the office and the staff?
  If you have a bad impression, get out. The office and the staff reflect directly on the doctor.
• How do you feel about the doctor?
  If you don't like him, leave. He should be able to make a good impression. You are marrying him in a metaphorical way when you have your surgery, and you must be willing to put up with him if you have a complication.
• Is the surgical center certified by a national organization which you can find on the Internet?
  There should be a diploma somewhere in the center that you can ask to look at.
• What kind of anesthesia is recommended, and are you comfortable with the choice? 
  This is a complex question, and Dr. Yoho's preference is for monitored anesthesia care — a step down from general anesthesia, for the reasons cited in this book and on my website: safety and comfort. And who's watching you while you are asleep?
• Speak with patients in the waiting room. What do they say?
  Previous patients who are referred to you by the staff won't ever say anything negative. Every doctor, no matter who he is, has at least a few fans.
• What do the before-and-after photos look like?
  If there are only a few, run. This surgeon has little experience. Be sure and ask if the photos are of the doctor's own work, and watch his response carefully. Ask the staff the same question. Believe it or not, there are sources from professional organizations that supply these photos for beginning doctors to use for "marketing." We think this is (to put the most charitable spin on it) consumer deception. In California, the law is that the doctor must tell you where the photos came from.
• Is there any part of the consultation that feels like a pressured sales job?
  If so, forget it. In particular, if the doctor is trying to sell something that sounds like a one-time total makeover, run. It's risky. Are you hassled by repeated calls from the office staff trying to get you to schedule? This is a sign of a sales and marketing organization rather than a real surgeon's office.
• Look at the doctor's biography and professional history information (CV).
  Ask questions about anything you don't understand. If this isn't available, go elsewhere.
• Has the doctor published any articles in journals?
  This generally lends some credibility, although there are physicians who spend more time writing and speaking than operating. While not strictly true, the saying goes, "Those who can, do. Those who can't, teach." And these days, the surgeon who doesn't have a lot of his work on a website for all to see may be inexperienced.
• What is the policy about touch-ups?
  If the doctor has his own (certified) operating suite, touch-ups often can be done very reasonably, often at no charge. However, if you have to go back to an expensive outpatient surgical center, the charge may be thousands of dollars even if the doctor takes no fee.
• Ask the doctor and the office staff what percentage of the patients are referred by other patients. Watch the response carefully.
  You can tell when someone is telling the truth. If the doctor has been in business for years and years, and has not been able to generate a primarily referral practice, there's something wrong. Some possibilities include: the service isn't great, the surgeon isn't skilled, there's pain during the surgery, the recoveries are painful or too long, the office staff is rude, or the follow-up might be careless. A primarily advertising-based practice isn't standing out above the crowd enough to become a referral-based practice.

* Thanks, and a tip of the hat to Robert Kotler, M.D., one of the most experienced nose surgeons on the planet. This is not wholly his list and is not meant to reflect his opinions. See his book, referenced in the credits, for somewhat different ideas about what is important.