Orlando Style: What is the biggest culprit contributing to bad results/experience with plastic surgery procedures?
Dr. Newman: The biggest culprit has to be doctors who are performing procedures that they are not qualified to do. There is an important concept called “scope of practice.” We should go to an ophthalmologist for an eye exam and an obstetrician to deliver babies. Why would anyone go to either of these specialists for liposuction? Physicians who operate outside of their scope or area of expertise frequently have more problems and post-operative issues. It can be difficult to find out who is a true plastic surgeon and who may be trained in another specialty but may still be performing cosmetic procedures. So, I would tell your readers to ask their doctor point blank, “Are you board certified by the American Board of Plastic Surgery?” Don’t be embarrassed to speak up because the stakes are too high.
Having your procedure performed by a properly trained plastic surgeon does not guarantee a complication-free result, but does stack the deck in the patient’s favor. Further, when an unfortunate result does occur, the plastic surgeon is the one who is best trained to deal with the issue. To paraphrase a popular commercial, we know a thing or two because we’ve seen a thing or two. Residency and fellowship training provide years of fundamental knowledge in not just cosmetic procedures, but also trauma reconstruction, congenital cranio-facial issues, and breast cancer reconstruction just to name a few. The interplay between these diverse areas is immense and allows us to utilize a set of core principles to address sometimes complex differences in anatomy. This broad-based experience additionally gives unique insights to address the bad result from elective surgery.
Another important element in the equation besides surgeon selection is procedure selection. There are a lot of well-intentioned physicians in this community who purchase the latest laser or non-invasive body contouring machine to add a new revenue stream to their practice. The truth, however, is that not every patient is a good candidate for these modalities. Plastic surgeons can look at a patient’s abdomen and decide if they need a tummy tuck, liposuction, or perhaps just diet and exercise. Another common example would be a facial rejuvenation patient; for these patients I can offer a face lift, fillers, laser resurfacing, etc. Whereas other providers may have a “hammer” and only see “nails”, plastic surgeons simply have a fuller “tool box” compared to other cosmetic providers. We don’t subscribe to a one size fits all approach and can tailor a treatment plan to fit the individual patient’s needs.
Orlando Style: What are the top 3 most important things to look for when you’re researching a plastic surgeon to work with?
A mentor once taught me the three “A’s” of surgery: affability, ability, and availability. As a surgeon, you have to be likable, competent, and present when your patient needs you.
When researching a plastic surgeon, it can’t be emphasized enough, make sure they are not just board certified, but board certified in plastic surgery. Cosmetic surgery is not the same thing. As we tell our patients, “Do your homework.” Ask about their training and residency, years in practice and American Board of Plastic Surgeons status. Take the time to look not only at their online reviews but at their actual licensure and credentials from the Board of Health.
Make sure your physician has the experience necessary to handle your individual needs. Ask where they perform their surgeries. Many cosmetic surgeons generally do so within an office operating room because most of these physicians are blocked from getting actual hospital privileges. Most hospitals and accredited surgery centers grant privileges only within a physician’s area of core competency.
How does the physician make you feel? The doctor should be personable, professional, and a good communicator. You should have a clear understanding of the plan for surgery, pre-and post-operative visit schedule, and follow-ups. Will you be seeing the surgeon for these visits?
If the visit feels pressured or rushed, how do you think things will be handled if you’re having a problem? I am amazed when I hear stories of patients who did not meet their surgeon until the day of surgery. This should be a total red flag. Availability and access are of paramount importance.
Orlando Style: What do you suggest to a patient who has had bad plastic surgery performed by another plastic surgeon who may be scared to go through another surgery all over again to correct the problem. Any tips to help with the psychological scars?
Dr. Newman: Patience is the key to disappointment, as frequently problems at two weeks or a month disappear by three to six months. The body needs time to adjust to surgical alterations. For example, post-operative swelling following a nose job can influence the appearance for up to a year. During this post-operative period, try to maintain open lines of communication with your surgeon, express your concerns, and together formulate a game plan.
If there truly was a complication or a bad result, then the most reassuring sentiment I can offer my patients is revisional treatment options. It’s important for patients to realize that a change has been made from their original baseline so now we’re working to revise the current state of the body. In the case of breast implants, these may include doing nothing or may require temporary or permanent removal of the implants. Other times we need to release scar tissue; perhaps a change in implant volume would suffice. Fat grafting can mask irregularities and other devices can augment the soft tissue. Finally, a breast lift can often solve an asymmetric or less than ideal result. The key take home point is that there are solutions and the plastic surgeon can help offer the most prudent course of action.
Orlando Style: What are some of Newman Plastic Surgery’s success stories when it comes to repairing bad plastic surgery procedures done by other doctors?
Dr. Newman: Secondary and revisional procedures are some of the most common reasons people seek my consultation, with many coming from other parts of the state and far too many coming from other countries.
All too often I leave a consultation room, scratching my head and wondering to myself, “How could this doctor even get this result?” When I get to the operating room, the first goal is to undo what was performed improperly. To this end, I need to figure out where the primary surgeon went wrong, which is not always the easiest task.
One recent example is a face lift patient who was dissatisfied by another surgeon. The problem was that the surgeon put too much tension of the skin, which resulted in the tell-tale sign of pulled “pixie” ears and widened visible scars that migrated from their intended location. Revisional surgery entailed anchoring the deeper soft tissues to eliminate skin tension with an earlobe reduction. This was done in the office under local which saved the patient from having to go under general anesthesia a second time.
Another recent example is a patient whose implants were too large for her frame. This caused the dreaded “bottoming out” where the implants are mal-positioned, falling below the breast fold. For this patient we had to strengthen her soft tissues, raising the fold and reinforcing it with a mesh-type framework.
If people have questions or concerns about their specific situation, we take pride in providing quality service and advice.
Dr. Charles E. Newman Jr.
Newman Plastic Surgery
444 North Mills Ave., Orlando, FL 32803
407.481.9505 | newmanplasticsurgery.com