IN THE FALL OF 2017, A petite woman in her 30s asked Dr. Rady Rahban, a board-certified plastic surgeon in Beverly Hills, California, for a breast lift and augmentation, up to a D-cup. Rahban told the woman her frame was too small for such an enhancement and suggested she consider enhancing to a C-cup instead. The woman went elsewhere for her procedure but was back in Rahban's office several weeks after her surgery. One of her breast lift incisions had separated, leading to poor healing and an unsightly scar, he says. Also, the blood supply to about half of one areola (the circular pigmented area around the nipple) had been disrupted, causing necrosis – the death of tissue in that part of her body. Consequently, that areola healed poorly and created an oblong rather than a circular shape, Rahban says. And there was nothing he could do to fix it. "You can try to reconstruct it or tattoo it, but neither will lead to an optimal cosmetic outcome," he recalls telling the woman. In recent years, Rahban and other plastic surgeons have been seeing more patients who ask them to conduct corrective procedures (also known as revision surgery) to correct botched breast lifts and enhancements, nose jobs, tummy tucks and other cosmetic operations. Rahban, who's been in private practice for 14 years, estimates that a quarter to a third of his patients come to him to correct previous surgery. During the early years of his practice, 10 to 15 percent of his patients came in for revision surgery, he says. Many of the botched procedures were conducted by cosmetic surgeons, who don't have the same level of training and experience as board-certified plastic surgeons, Rahban says. Meanwhile, cosmetic surgeons who aren't board-certified in plastic surgery are promoting themselves abundantly on Instagram, which could be confusing to consumers, a study published in September 2017 in Aesthetic Surgery Journal suggests. The study notes that 42 percent of facial plastic surgeons surveyed by the American Academy of Facial Plastic and Reconstructive Surgery reported that they had patients who sought cosmetic procedures to look better "in selfies, Instagram, Snapchat, Facebook Live and other social channels." That annual survey was released in January 2017. In 2016, U.S. consumers spent more than $16 billion on cosmetic plastic surgeries, according to the American Society of Plastic Surgeons. Breast augmentation procedures, usually breast implants, accounted for the largest number of cosmetic surgeries that year: nearly 300,000. And there were 223,018 nose reshaping procedures and 235,237 liposuction operations, according to the ASPS. These operations are pricey and typically aren't covered by insurance; for example, the average cost of breast augmentation in 2017 was $3,719, according to the ASPS. Despite the high cost of such procedures, many consumers fail to do their due diligence in finding the right physician for their operation, Rahban says. In recent years, a growing number of doctors who aren't board-certified in plastic surgery have started doing cosmetic procedures, and many of them are good at marketing, Rahban says. "Now, everyone and [his or her] mother is doing cosmetic surgery," he says. "General surgeons who had been removing gallbladders are doing tummy tucks. OB-GYNs are doing liposuction." Doctors can tout themselves as cosmetic surgeons without undergoing the same level of training that a board-certified plastic surgeon undergoes, Rahban says. "If tomorrow, I wanted to deliver a baby, theoretically I could," Rahban says. "In America, if you have a medical degree, you can do pretty much whatever you want." The vast majority of cosmetic procedures are conducted in private facilities, which means that doctors don't even need to have privileges at a hospital to conduct such operations, he notes. Some doctors not trained in plastic surgery take weekend courses in cosmetic procedures, and some study for a year or so under a cosmetic surgeon in a kind of apprenticeship, Rahban says. Dr. Joe Niamtu III, a cosmetic surgeon in Midlothian, Virginia, and a fellow of the American Academy of Cosmetic Surgery, agrees that board certification is important in any specialized field of medicine. He also says that there are many cosmetic surgeons who aren't board-certified in plastic surgery who are experienced, safe and good at what they do. "Saying you should only go to a board-certified plastic surgeon is like saying the Lexus is the only safe car," he says. "For example, I've done 1,100 face-lifts, and I'm good at them. It's my passion." Many doctors who do cosmetic procedures and who aren't board-certified in plastic surgery are adept at advertising on Instagram, which could be confusing for patients, the 2017 Aesthetic Surgery Journal study suggests. That, combined with the fact that an increasing number of patients use Instagram to search for a physician for an aesthetic operation, is "worrisome," researchers wrote. "Though having a trained and qualified surgeon perform such procedures is paramount for patient safety, patients may be confused as to what constitutes such a surgeon," the authors wrote. The researchers found that 1,789,270 posts on Instagram on Jan. 9, 2017, had hashtags popularly used by physicians and lay people for plastic surgery procedures. These included #plasticsurgery, #breastlift and #boobjob. The vast majority of these posts – 67 percent – were promotional in nature, rather than educational, according to the study. Overall, physicians eligible for membership in the American Society for Aesthetic Plastic Surgery accounted for 18 percent of the top posts among the 21 hashtags; on the other hand, doctors not eligible for ASAPS membership provided 26 percent, the study said. Posting on Instagram is "a way to do marketing with a lower budget," says Dr. Clark Schierle, senior author of the study and a Northwestern Medicine plastic surgeon. He's also a faculty member at the Northwestern University Feinberg School of Medicine. "People who are good at marketing aren't necessarily good at surgery. If they're really good on Instagram, it means they're really good at Instagram." If you're looking for a physician for cosmetic surgeon, experts recommend these five strategies: 1. Do your homework. If you were about to get a heart transplant, "you'd research the hell out of your surgeon," Rahban says. "You need to be just as diligent when it comes to looking for a plastic surgeon. You cannot be passive." Look for a physician who's board-certified in plastic surgery, says Dr. Anne Peled, a board-certified plastic surgeon at Sutter Health's California Pacific Medical Center in San Francisco. You can start by consulting the American Board of Plastic Surgerywebsite, she says. Use the website to verify whether a particular doctor is certified by the ABPS. The website also provides a link to The Federation of State Medical Boards, where you can check for formal patient complaints against doctors. "When a surgeon has been certified by the ABPS, you can be confident [he or she] has completed the appropriate training, passed comprehensive exams covering all plastic surgery procedures and demonstrated safe surgical techniques," Peled says. If a surgeon touts that he or she is board-certified, ask whether that board certification is specifically in plastic surgery. 2. Ask to see plenty of "before" and "after" photos. Most physicians who offer plastic surgery post "before" and "after" photos on their website or make them available on request. Ask for at least 25 to 30 photos showing outstanding results in the specific type of surgery you're considering, Rahban says. "Even a poorly trained surgeon can get lucky two or three times," he says. 3. Don't be misled by a strong social media presence. It may seem impressive if a surgeon has hundreds of thousands of followers and likes on Twitter or Instagram, Rahban says. But you should keep in mind that being popular on social media has no connection to surgical competence, he advises. Besides, it could be illusory, since people can purchase Instagram and Twitter followers. "If you think you can find a good surgeon on Instagram, you should think twice," Schierle says. 4. Consider reviews – in context. Many surgeons have reviews on sites like Yelp, where patients can post about their experiences. But there's no verification process for such sites, so anyone can post. Positive online reviews "are one piece of data," Schierle says. "I wouldn't rely on them entirely." Also be wary of multiple positive reviews that are shallow and similarly worded, Rahban says. Such reviews may not be authentic. You shouldn't rely on online reviews to tell you all you need to know about a surgeon, Rahban says. 5. Ask who will close the incision. Some plastic surgeons have their surgical technician close the incision rather than doing it themselves, Rahban says. That's like having a paralegal show up for a court hearing rather than the lawyer you hired, he says. Closing an incision is a crucial part of surgery; an improperly closed wound could lead to poor scarring and possibly infection, he says. If a surgical technician closes, rather than the surgeon, "that's a sign of laziness, and a poor reflection of [the physician's] approach to patient care." Source
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