Plastic Surgery Choices

WebMD Live Events Transcript

Now more common than ever, cosmetic surgery has become an option for people of many different ages with many different reasons for considering a procedure. We discussed what you need to know about changing, repairing, or rebuilding with plastic surgery when James Zins, MD, was our guest on Aug. 11, 2004.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome, Dr. Zins. What should we look for when choosing a plastic surgeon?

ZINS:
Well, I think that's a very important question, and one that should be researched thoroughly. This is an important relationship and a serious one. I think that you should feel comfortable with the plastic surgeon you choose, and feel that you can communicate your concerns with the surgeon comfortably. There are some very good tips that I can give you in making this selection.

First, the plastic surgeon should be board certified by the American Board of Plastic Surgery. There are a number of other surgical specialties that do cosmetic surgery; however, board certification by the American Board of Plastic Surgery will make certain that your plastic surgeon is best qualified in a wide variety of cosmetic and reconstructive procedures.

In addition, word of mouth and standing in the community are extremely important. A plastic surgeon that is generally respected for his or her work will be so recognized by individuals in the community. If you have had friends or family members who have had a good experience with a plastic surgeon who has done a similar procedure in which you are interested, this is also very helpful.

In interviewing the plastic surgeon, and I think an interview is essential, there are certain questions that I think are important to ask such as:

• How many operations of a given procedure does that plastic surgeon do in a year? If the plastic surgeon does a large number, it's much more likely that he will be adept at that procedure.
• I would also be very specific and ask the plastic surgeon how many surgeries of a given procedure that he does; that is, the specific procedure that you are interested in.

Finally, you should come out of the conference and interview with a feeling of confidence and positive feelings about your surgeon before undertaking the procedure.

MEMBER QUESTION:
Please comment on tummy tucks (partial or full), and/or liposuction of the tummy. How effective, how involved is the procedure, downtime, pain, cost. Who is the best CCF doctor to do the procedure?

ZINS:
What you are asking is what are the best procedures for what we call body contouring. In the abdomen these procedures fall into two categories.

First, liposuction is an excellent procedure for the right candidates, but these candidates need to be carefully screened. The ideal candidate for liposuction is a patient with good skin elasticity and one who is of relatively normal body weight. This generally means that the patient is in his or her 20s, 30s, or 40s, and has no stretch marks and no overhanging skin. While patients who are not ideal candidates may also undergo liposuction, compromises in the ideal result need to be accepted.

Liposuction recovery is generally uneventful and relatively rapid. The patient may be sore for several days to perhaps a week. Complications in well-selected patients are infrequent and are generally related to under removal or over removal of fat.

The next procedure, abdominoplasty, is generally performed in women after child bearing or in middle age and sometimes later. While liposuction requires small incisions, abdominoplasty requires longer ones, and this length of incision depends on the amount of tissue or excess skin the patient may have. Therefore, the abdominoplasty may be accomplished through a relatively short incision in patients who have predominantly loose muscle after children, or it may require a very long incision from above the pubis virtually all around to the back for patients who have a large amount of excess skin. An example of this type of patient would be one who lost 100 pounds or more.

In abdominoplasty, extra skin, extra fat, and loose muscle can be treated. This is characteristic of a middle-aged woman after she has had several children. Liposuction, on the other hand, removes fat only, and the skin must be elastic enough to contract on its own.

Cost varies with the degree of complexity of the operation. Miniabdominoplasty will cost perhaps $3,500, whereas an abdominoplasty, which extends almost to the back (incidentally, this is called a circumferential abdominoplasty) will cost much more, in the range of $7,500. These prices vary from surgeon to surgeon and from location to location in the United Sates.

At The Cleveland Clinic we have five plastic surgeons that are adept at this type of surgery. We would be happy to discuss the surgeons with you over the telephone. You could also visit our web site for a bio of each surgeon.

In general, for any of these cosmetic procedures, weight loss prior to surgery is preferred to weight loss after surgery. That's true for any plastic surgery procedure, cosmetic or plastic. That's a general recommendation for any cosmetic or reconstructive procedure, weight loss first. The reason that is preferred in an abdominoplasty or face-lift is that the weight loss may create additional loose skin that could be removed at the time of the procedure, whereas weight loss after surgery would create loose skin in the postoperative period, and have negative effects on the surgical results. Now, when we talk about weight loss, however, I'm talking about significant weight loss. I would be talking about 15 pounds or more.