Doing Due Diligence (Certification)

Just how does one perform due diligence when selecting a cosmetic surgeon? Being an informed consumer seems more difficult than ever, given the bewildering display of high-profile disasters.

Michael Jackson, at the peak of his earning power and fame, repeatedly received very poor value for his surgical dollar. (And no, boys and girls, that's not a prosthesis; it's surgical tape on the tip of his nose.) If having more than enough money and unlimited access doesn't ensure a good outcome, what does?

The common online sentiment casts the ethical cosmetic surgeon as paternalistic gatekeeper. Most of the public expects these and all physicians to at a minimum abide by primum non nocere (not actually part of the Hippocratic Oath). It's safest to stick with caveat emptor: "let the buyer beware."

The most often hyped consumer advice is to choose a board certified surgeon. This is what Kanye West's dead mother did not do, having apparently evaluated her surgeon's credentials based an Oprah appearance.

For the prospective patient, board certification is the most readily accessible confirmation of a surgeon's training and experience. This is different than state licensure, ie, is the doctor behaving, which is confirmed here.

The vast majority of safe elective cosmetic surgery is performed by board certified plastic surgeons and otolaryngologist–head and neck surgeons. There is plenty of bad territorial ju-ju between the two specialties arising from intense competition for cash. It colors and distorts most of what is published about how-to-pick-a-surgeon. What makes these two kinds of cosmetic surgeons different from one another? There are two divergent training and certification pathways.

Here, along with the alphabet soup, is a set of cliff notes and links so you can be an informed consumer.

All physicians with M.D. after their name complete the basic 8 years post-high school education of undergraduate and medical school.

Cosmetic plastic surgeons go on to an additional 7+ years of training and certification in:

• General Surgery Residency - 5 years
• Plastic Surgery Residency - 2 years (some combined programs are 3 years of each)
• ABPS board written and oral examination in Plastic Surgery

If passed, the surgeon (and about 6,600 others) now has a ABPS-recognized specialty certificate in plastic surgery and joins the member society ASPS.

• optional Fellowship - 1 year
  
• ABPS board subspecialty examination (Plastic Surgery Within the Head and Neck)

This surgeon will continue to identify him/herself as a plastic surgeon or cosmetic plastic surgeon. More societies will be joined: ASAPS. These specialty societies are the sources of the yearly continuing education of the surgeon.

Cosmetic otolaryngologist–head and neck surgeons go this direction for 5+ years:

• General Surgery residency - 1 year
• Otolaryngology - Head & Neck residency - 4 years
• ABOto board written and oral examination in Otolaryngology - Head & Neck Surgery
  

If passed, the surgeon (and about 12,000 others) now has a ABOto-recognized specialty certificate in Otolaryngology and joins the member society AAO-HNS for continuing education in the field.

• optional Fellowship - 1 year
  
• ABOto board subspecialty examination (Plastic Surgery Within the Head and Neck) or the ABFPRS subspecialty exam

This fellowship-trained surgeon will now refer to him/herself as a facial plastic surgeon. More societies will be joined: AAFPRS. More continuing education.

The American Board of Medical Specialties (ABMS) is the major examining organization whose Member Boards (of which the ABPS and ABOto are two) certify physicians in more than 130 specialties and subspecialties. For a chart listing the current certificates offered by ABMS Member Boards, go here. (There are other, overlapping certification organizations as well.)

These board certification exams are probably the most difficult, stressful part of the not-so-young physicians training experience. The written boards are all-day specialty-specific computer-based examinations (completing the more general knowledge exams taken at the end of the first residency year). If passed, an excruciating oral examination takes place where senior physician examiners interrogate the candidate and pass judgment on the ethical and technical aspects of his/her practice.

Subspecialty certification is not required in order to practice cosmetic surgery. It's important to physicians preparing to practice because it is a recognition of exceptional expertise and experience specifically in that field.

What's important for the consumer is that board certification under the ABMS umbrella brings with it an requirement for continuing education and re-testing every 10 years. That makes these surgeons a safer bet for you and me.



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Looking Your Age

Trawling dating websites looking for an appealing late-40s to early-50s man can be a depressing experience. Most of them are older, uglier, and less fit then the women who are looking for them, yet those same men specify wanting women who are younger than themselves. What's up? What on earth do they see in the mirror?

Women that same age see something entirely different in every reflective surface they pass by. And they feel pressure to do something about the changes they see. The mere availability of procedures has heightened the pressure on women to consider a level of intervention that until recently was indulged in by only the famous or the rich. Women in America are involved in an internal debate, a negotiation with appearance, about how much they are willing to intervene.

Even AARP, the bastion to combat ageism, is jumping on the bandwagon with this month's magazine: Look Younger Now: Erase Ten Years (or More)! Is looking one's age something to be disdained, just on principle? Or a matter to be treated like shaving or a manicure? And where do you draw the line and why? Hip haircut? color? teeth whitened? veneers? or the blue plate special: head-to-toe surgery?

Three of the most recognized women in power today, Hillary Rodham Clinton (59), Oprah Winfrey (52), and Condoleezza Rice (53), have each answered the question in different ways.

Hillary Clinton has long been accused of having plastic surgery performed on her face, most loathsomely by John Spenser. Clinton adviser Howard Wolfson says she has had no plastic surgery or similar work. As an elected official, she's very well styled, her makeup and hair are perfect, and with good lighting she photographs well. Or not. She shows no obvious signs of a traditional cut and drape facelift. She did, however, seek out plastic surgery consultations and a lot is possible without obvious scarring. The surgeons' gossip is that work was done during & after the impeachment period when she was out of the public eye. If she has chosen an intervention, it was done very discreetly.

Billionaire Oprah Winfrey (52) can afford anything. While she has explored the topic on her show, Oprah categorically denies having any plastic or gastric surgery. Given her brilliant smile and difficult childhood, she most likely has had her teeth capped and probably subscribes to the usual Hollywood upkeep of botox. Her on-air and covergirl personna is carefully crafted to make the most of her looks. But remember, it takes hours, hours, of prep at the hands of professionals to achieve that glamour.

Condi Rice (53) is often caricatured for her gap tooth smile & famously furrowed glabellar scowl. But she's a natural: that's all original equipment there and she does her own hair and makeup. (None of these three women wear their hair naturally.) Her African-American heritage gives her an edge: her skin is thicker and less prone to wrinkling at any age, even with the cares of state.

At 50 you don't feel old. Where do you draw the line about looking your age? The Dove Pro-age campaign wants you to embrace middle age, even if broadcasters won't. Pro-age is about aging in the best way possible. Bobbi Brown in her new book Living Beauty advises that drastic changes are not needed. You are not walking the red carpet nor appearing on prime time media outlets, so "let go of some of the pressure," says Brown. Use any of the options available that you feel comfortable with– but remember, it's not about defying age, turning back the hands of time, or looking 10 years younger.

It's about looking good at the age you are.



Want this look? According to technique a facial plastic surgeon may charge: standard face lift $6,000-$15,000; midface lift $4,000-$10,000; threadlift face lift $2,000-$6000. In addition, eyelid surgery, brow lift surgery, and facial liposuction can be performed and increase the cost of treatment.