What do plastic surgeons often overlook before they operate?
They don’t know enough about their patients.
What do you find out about your patients and why is it important?
I think about the patient as a person, and I think this is important in deciding which plastic surgery procedures are indicated and in obtaining the best results. I want to know not just about what part of their appearance they want to change and why, but about the whole patient as an individual, including her lifestyle and daily activities, how she eats and exercises, her family and work environment and stresses, whether she’s in a stable relationship or recently separated or divorced, her current pertinent circumstances, both good and bad.
Surgery is one component of a patient’s life and her mental state can affect her ability to heal properly and to appreciate the results. Surgery releases the hormone cortisol as part the body’s response to a stressful situation, and it’s important that the body returns to normal following the stressful event. Many processes are involved in healing and it is important to optimize patients before surgery so their recovery is smooth and uncomplicated. There are benefits of anti-oxidants in foods and of stress reduction for both combating aging and boosting the immune system to help with healing.
So you interview your patients?
Yes, we have an initial consultation that lasts about an hour, and then a second or third visit depending on patient needs. I think patients appreciate that I take the time with each one of them individually.
Do you ever decide not to operate?
Absolutely. If I feel the patient has unrealistic expectations, or our aesthetic ideals do not match, or there are issues in a patient’s life that make her an unsuitable candidate, then I won’t operate. In some cases medical, psychological and social concerns can be addressed so patients eventually undergo surgery.
Can you give me an example?
I started seeing one patient six months before her surgery. During the second visit, I noticed that something was worrying her. She was very upset and emotional, but not because of her potential surgery. While chatting with her she revealed she was having a problem with her son. They began seeing a therapist I recommended and their relationship steadily improved. If we had not addressed this problem, she would most likely have been unhappy and disappointed with the results of her surgery because the issue with her son would have persisted unresolved.
What procedures are popular today?
For the face, eyelid lifts, fat injections, neck lifts and facelifts. For the body, mommy makeovers, which include breast lift, augmentation or reduction, a tummy tuck and liposuction. I specialize in minimally invasive procedures with limited incisions and short scars.
When is the best time to have mommy makeovers?
A woman should have stable weight and appropriate BMI, and should no longer be lactating. I’ve performed a variety of these procedures on women in their 50’s and 60’s, when their children are grown and they have time to refocus on themselves.
I’ve read that a woman who has liposuction, on her tummy, for example, can expect the fat to show up instead on other parts of her body.
This is a misrepresentation of what happens. Once fat cells are removed by liposuction, they’re permanently removed and the body doesn’t regenerate them. But if a woman gains weight, the existing fat cells that are left in her body will expand with the added fat. So although it may appear like the fat has shifted location in fact fat cells just increase or decrease in size with weight gain or loss.
What are your observations about FOF women and plastic surgery?
FOF women want to look better longer, and are interested in procedures that produce results. Some may be considering a change of lifestyle or a new career, and are looking to improve their appearance. They may feel they look tired, or are bothered by wrinkled skin, or want their external looks to reflect their inner youth. Some may only need a small treatment, such as skin rejuvenation and injections of fat to targeted areas. The nice thing today is that we have a whole slew of techniques and modalities to address a woman’s concerns. These can be mixed and matched to address each person’s particular concerns.
We have a range of laser treatments to tighten skin and reduce wrinkles. Our aesthetician offers photo facials, chemical peels, and in-office laser skin rejuvenation treatments with no downtime. We also offer more extensive treatment with the Fraxel laser, which resurfaces skin, reduces fine lines and wrinkles and acne scarring, and reverses sun damage.
Tell me, honestly, do I look like an old woman? (I figure I might as well get some advice along the way.)
Not at all, you have great skin tone, but you could use some fat injections to add volume to your cheeks and a lift to tighten your neck.
Dr. Olivia Hutchinson
121A East 83 Street
New York, New York 10028
Tel: (212) 452-1400
Fax: (212) 421-3435
Click here to view Dr. Hutchinson’s profile.
A screenshot from “Anyone can wear a white coat,” an alarming PSA about plastic surgery, courtesy of the ASPS. Click here to see the complete video.
“In many ways, plastic surgery is still the Wild West in this country. Any physician can legally call him or herself a plastic surgeon. Your family doctor can decide, ‘I think I’ll do facelifts today.’ It’s vital to do your homework to get the best doctor, best procedure and best outcome.”
—Dr. Malcolm Roth, plastic surgeon and President of the American Society of Plastic Surgeons
This year, we’re partnering with the American Society of Plastic Surgeons (ASPS), a not-for-profit authority on plastic surgery and plastic surgeons—and an organization we trust—to bring you the very best information on this topic.
This week, we interviewed Dr. Malcolm Roth, Chief of Plastic Surgery at Albany Medical Center, and the president of ASPS, who explains exactly how to find the right doctor, and why it can be confusing. “It’s vital for every FOF to do her homework before she chooses a doctor or a procedure,” says Dr. Roth. Our advice: If you’re considering any cosmetic procedure (including injections, lasers or even hair removal) read this first.
Why is it so confusing when it comes to choosing a qualified plastic or cosmetic surgeon?
In this country, any physician can legally call himself a plastic surgeon, even though he may not be board certified in plastic surgery. In most states, he can even advertise that he’s board certified and a cosmetic or plastic surgeon (though he may not be board certified in plastic surgery). So your gynecologist or family doctor can decide, “I think I’ll do facelifts today,” or “I think I’ll do liposuction.” As long as you have an office where you can perform the procedure, you can do what you want to do. There are some exceptions to this rule in a handful of states, but generally speaking, all you need is a facility and a medical license to perform surgery.
Wow. Why would a doctor who is not trained in plastic surgery decide to do it?
It’s difficult surviving in the world today as a physician. Insurance companies are decreasing their payments for procedures and making it more difficult to get paid. It’s easier to say, ‘Why not just do plastic surgery? My patients will pay me cash up front, and it looks easy.’ A cosmetic procedure can sound simple, but, even something like liposuction, in the wrong hands, is very dangerous. We’re hearing more and more about serious problems, and all ASPS members are seeing unhappy patients who need reconstruction, or are even beyond the point of reconstruction, due to surgery performed by unqualified physicians.
What is ASPS and how are its doctors qualified?
We are the largest plastic surgery specialty organization in the world. Our 7,000 cosmetic and reconstructive plastic surgeons are board certified by the American Board of Plastic Surgery. That means they have completed 6 years of surgical training with at least three of those years specifically devoted to plastic surgery. To qualify for ASPS, you must operate only in accredited medical facilities, adhere to a strict code of ethics and fulfill continuing medical education requirements to stay up to date, especially on patient safety. We are a non-profit, and our mission is to advance quality and, most importantly, safety, in plastic surgery.
Why is this important to FOFs?
You know the old expression, if the only tool you have is a hammer, everything looks like a nail? Our surgeons have all the tools in the tool chest. If you’re a family doctor who has taken a weekend course in injectables, you’re going to recommend injectables to your patients, even if there are better options. Our members understand all the options, appropriate facial aesthetics, and most importantly, safety. They know what to do when something goes wrong.
For our society and our members, this isn’t a turf war. This is about trying to make sure patients understand that they have a choice and a responsibility to do their homework.
Okay, so how does an FOF do her “homework?” How do you choose a doctor who is skilled, safe and has the maximum amount of training?
Here are the key questions every woman should ask a plastic surgeon she is considering:
- Are you board certified by the American Board of Plastic Surgery? Are you a member of ASPS? What is your training in the field of plastic surgery? A certificate on the wall that says a doctor completed a weekend course to learn how to do lipo is not sufficient training.
- Do you have hospital privileges? That means that a hospital has granted that doctor the right to do a specific surgery in its facility. The hospital credentialing committees look at the doctor’s training, and, if they don’t feel that person meets the standard held by that institution, they won’t allow him to do surgery there. If the doctor says yes, ask, which hospitals? And check with the hospital to make sure.
- Is your surgery facility accredited by a national or state accrediting agency? Or is it state licensed? If the doctor performs surgery in his or her office, you want to make sure that facility has all the bells and whistles for the rare occasion when something does go wrong. For example, don’t you want to know that there’s a crash cart with all the medication, and all the monitoring devices that can anticipate and prevent something going awry?
- How many of these procedures have you performed?
- Am I good candidate for this procedure? What other options are there? Your doctor should be able to help you make a decision based on your budget, your comfort with doing something invasive versus noninvasive, and your anatomical needs. A qualified plastic surgeon has the training to talk to you and perform all of those things.
- What happens if I have complications? How long a recovery period can I expect and how will you help me through that? Who covers your practice if you’re not around?
- What happens if I’m not satisfied with the outcome of my surgery? Will I have to pay for it?
- Do you have before-and-after pictures that I can look through? I suggest this question with the following caution: Today, doctors can use Photoshop and other tools to make their before and after pictures look very different. And I can tell you of instances where I’ve been made aware of people putting images on their website that were not even their own. So don’t let it be your sole determining factor.
- Can I talk to another one of your patients who has experienced this procedure?
For facelifts, lipo and other surgical procedures, it makes sense to use a plastic surgeon. But what about injectables? Is it okay to go to a dermatologist for that?
Fillers and neurotoxins and other minimally invasive procedures are within the scope of dermatologist training, and it’s certainly reasonable to go to a dermatologist for those things. However, remember that dermatologists are not trained to do the surgical procedures that our members are trained to do. So if your dermatologist offers you filler, that’s probably fine. If, on the other hand, they suggest, “Well, how about I do a facelift?” that’s not in the scope of their training and a better option would be for you to consider an ASPS member surgeon.
Also, a plastic surgeon is going to know every nook and cranny of the face—where the nerves are, and what the ramifications are if you injure a nerve you’re not supposed to. An ASPS member will know how to minimize the risk of injury to vital structures. Injectables aren’t just a “skin procedure,” and it’s valuable to have somebody who has full understanding of the underlying anatomy.
What is the ultimate “red flag” that should send you running from a doctor’s office?
If they’re not trained in plastic surgery, you’ve got to be crazy. Run away. And if they are trained, but you don’t feel like you and the surgeon are connecting… that’s not a good sign. Find someone else. There’s no rush—this is your life you’re talking about.
Visit plasticsurgery.org to start your search for a qualified plastic surgeon in your area.
Is there an advantage going to a woman plastic surgeon for breast augmentations or lifts?
I hear from patients every week that they feel more comfortable talking to women doctors than with male surgeons. They say they can more easily express themselves and be understood. We can also identify with them and with the changes in their bodies. For example, some male surgeons think every woman should get implants. In some cases they also tell patients how big they should be.
How does a woman decide whether she should have implants or just a breast lift?
Some women are small and know they need implants to be bigger. But if you’re wearing a C cup, you’re filling it out and you think it looks pretty good, you probably should just have a lift.
Are there many female plastic surgeons?
No, women account for only 10 percent of all plastic surgeons.
I am sure there are many factors. Traditionally, there’s been a prejudice against women in the world of general surgery. We weren’t considered tough enough to go through the grueling surgery training programs.
I studied general surgery for five years, followed by a two –year residency program in plastic surgery and then a six-month fellowship in breast surgery.
Why did you choose breast surgery as your specialty?
It’s creative and I find it rewarding to deal with so many different patients. We often have interaction afterwards since I see my breast patients for yearly follow-up visits. I also believe in specializing. I don’t do rhinoplasty. However, I do injectables, facelifts, neck lifts and eyelid surgery (blepharoplasty).
What advice do you give FOF women when choosing a plastic surgeon?
Don’t look for reviews on Google and don’t imbue doctors with abilities they don’t have. If your friend had a beautiful facelift by a doctor who is genius at facelifts that doesn’t mean he or she is a genius at performing breast implants. Talk to some of the doctor’s other patients and absolutely ask a surgeon about her background and training. Someone may have trained at an excellent institution for general surgery but has only a mediocre reputation in plastic surgery. Find out also about their breadth of experience. I’m 50, so I have a great deal of experience in breast surgery.
Once we choose a doctor, should we leave everything in her hands, so to speak?
Before your surgery, you should understand exactly what the surgeon intends to do. It’s a little scary when I read online sites, such as www.Realself.com, where doctors answer questions posted by patients. Patients sometimes indicate they’re going into surgery in a few days without any idea what’s going to happen.
Give an example of what can happen if you don’t do enough research on a surgeon or on the procedure you’re about to have.
Let’s say a woman over 60 wears a C cup and has lots of volume, but she’s lost volume in the upper half of her breasts due to gravity. It’s not enough to simply work on the drooping skin because it will start drooping again before too long. A top surgeon will work with the internal tissue so the lift lasts more than a couple of years. Sometimes I insert Strattice (a piece of sterilized pig skin) into the breasts, to reinforce the lift, which can help prolong the longevity of the result. Not all plastic surgeons have experience with advanced breast surgery techniques.
Are many FOF women having work on their breasts?
Breast reductions are quite commons among women who are 60+. They tell me they’ve always wanted smaller breasts, but their father or husbands didn’t want them to do it. The surgery totally changes their lives.
That’s exciting, but many women who’d love to have breast surgery can’t afford to do it. It’s so costly and medical insurance doesn’t pick up the cost.
It is a common misconception that insurance doesn’t cover breast reduction, when, in fact, it does in the majority of cases. We try to accommodate patients who don’t have insurance or whose insurance will not cover the procedure, as well as those who prefer to use a plastic surgeon who doesn’t accept insurance. We will let a patient pay over time. I also like a financing program that Care Credit offers for plastic surgery. The patient can pay off the loan over 12 months without interest.
Dr. Tracy Pfeifer
969 Madison Avenue
New York, New York 10028
Tel: (212) 860-0670
Click here to view Dr. Pfeifer’s patient before and after.