Choosing a Cosmetic Laser Surgeon?
By Dr Daniel Fleming

Cosmetic Surgery is not an officially recognised medical speciality so it is often difficult for patients to judge the bona fides of doctors offering cosmetic laser procedures.

Cosmetic Surgery is performed successfully by doctors from a range of different specialities including general surgery, general practice, dermatology, plastic surgery, ENT, gynaecology and maxillo-facial surgery. They are bound together as “cosmetic surgeons” because they have obtained further training and experience in cosmetic surgery techniques. The problem for patients is establishing if a particular cosmetic surgeon is experienced in the procedure they are considering.

This is exacerbated by the misleading claims made by certain medical specialty groups. In attempting to monopolise the market for their own commercial gain, these groups are trying to convince the public that cosmetic surgery should only be performed by them. In fact advances in cosmetic surgery techniques have come from cosmetic surgeons from all of these backgrounds and wise doctors realise that cosmetic surgery is better for this.

Cosmetic surgery is not the same as plastic surgery

Plastic and reconstructive surgery treats patients who have suffered the effects of accidents, injury, disease or birth defects and tries to restore them to normal. Cosmetic surgery on the other hand helps patients who are not injured or disfigured but who wish to either change some aspect of their appearance or want to reverse the signs of ageing.

The title a doctor uses cannot be relied upon to give any guide to training

For example, the title “plastic surgeon” applies only to doctors trained in plastic and reconstructive surgery. However, a plastic surgeon usually qualifies having had little or no training or experience in most of the commonly requested cosmetic surgery procedures such as facelifts, laser resurfacing, cosmetic breast implants and liposuction. Also, many plastic surgeons perform little or no cosmetic surgery. So the title “plastic surgeon” is no guarantee of either training or experience in cosmetic surgery. The title “cosmetic surgeon” is not a guarantee of this either since all doctors performing cosmetic surgery call themselves “cosmetic surgeons”. Doctors calling themselves “plastic” or “cosmetic” surgeons may or may not be expert in the cosmetic procedure you are considering depending on their training and experience in that procedure. Therefore, relying on the doctor’s title is risky. If you feel the doctor is using his title or membership of a particular medical group, society or association, rather than his own proven experience in your procedure, to convince you of his expertise then get another opinion.

How many times has the doctor performed the procedure you are considering?

This is the key question. Do not be fobbed off by answers such as “many” or “often” or “I’ve done three this week” (they might be the only three the doctor has ever done!) It is your right to get a specific response. Remember doctors themselves consider that they are past the beginners stage once they have performed a procedure about 100 times and even then they would not consider themselves “very experienced”. After several hundred cases or more a doctor might be considered “very experienced” by other doctors. For less commonly requested procedures e.g. ear reshaping or lip lifts these figures should be reduced.

Patients often don’t realise that doctors are not equally expert in all cosmetic surgery procedures. The doctor who is a good choice to perform your facelift may have no experience in breast implants or liposuction. An expert in laser resurfacing or eyelid surgery may have no training at all in nose reshaping. Hence, the importance of insisting upon checking the doctor’s experience in your chosen procedure.

How often does the doctor perform your procedure?

Establish with your doctor that he has been performing your procedure regularly over the last 12 months. A doctor who has performed 100 breast implant operations but the last time was five years ago may not be the best choice.

Ask to see plenty of before and after photographs of your procedure and make sure they are the work of the doctor who will be operating on you

Also ask if you can speak to previous patients and ask to see photographs of complications. If a doctor claims he doesn’t have any complications – run. Since all surgery, including cosmetic surgery has a small complication rate, even when it has been performed expertly, either the doctor is not telling you the truth or he performs so few procedures that he hasn’t had any complications – yet.

Ask the doctor what percentage of his patients are satisfied with their results and how he measures this

Is it just the doctor’s impression or are the patients surveyed to check satisfaction levels? If they are surveyed is it done in-house (where those who are known to be dissatisfied might be omitted) or are external, independent assessments made?

If you need corrective or further surgery to achieve your expected result, how much will it cost including any theatre fees?

This could range from zero to the full cost of the original procedure!

Will your doctor be contactable 24 hours a day if needed during your recovery period?

If not, what aftercare arrangements are provided?

More than one opinion can be helpful

But don’t fall into the trap of getting multiple opinions. You’ll just end up confused.

Beware of doctors who are critical of other doctors in cosmetic surgery

It is unethical, does not help you and is usually done for commercial gain or to prop up the criticising doctor’s ego. The doctor should provide you with objective information about your choices and his experience. If all doctors offering cosmetic surgery do this you will be able to make your own mind up which, of course, is how it should be.

Use your intuition. Do you feel comfortable with this doctor?

Do you feel you have been given balanced information to help you make an informed choice or do you feel like you have been sold a procedure? Are you convinced that the doctor has the necessary experience in your procedure? If you have the slightest impression that you are being pressured or rushed into a decision go elsewhere.

If you have significant doubts about whether to proceed – don’t

Wait, until you feel ready.

Free patient information, mini-seminars, before and after photographs of actual patients, educational literature and the opportunity to talk to previous patients are all provided by the Franklynn Centre.

You must feel that you have been given balanced information to make an informed choice and be convinced that the doctor has the necessary experience in your chosen procedure.