We have all seen those creepy images on magazine front covers of celebrities and wondered, why on Earth did they ever do THAT? These are rich and powerful people, and if they turned out like THAT what chance do I have of getting a good result from cosmetic surgery?

This is a topic that we Plastic Surgeons sometimes cringe at (and sometimes secretly enjoy in a competitive schadenfreude, knowing that we have never had results that bad). Some patients are the authors of their own misfortune, when repeated complaining about a really minor issue that is out of all proportion to objective reality, finally results in a surgery that is just ‘way too much’. Surgeons are human and have the basic human desire to want to make people happy, and if you keep complaining about some small issue, you will eventually get the operation that you want, but it may not turn out to be what you had imagined beforehand. “The enemy of good is perfect” means that by trying to get to ‘perfect’, something unexpected happens, and you end up with something awful. Biological systems are complex, chaotic systems, just like the story of how a butterfly flapping its wings in the jungle can result in a hurricane on the opposite side of the Earth. The same surgeon, doing the same technique on similar patients will not always get exactly the same results. That’s just the way it is.

Some so called ‘cosmetic surgeons’ may not be surgeons at all- it is buyer beware, just like with anything else in the marketplace. Surgeons in third world countries are no different than local surgeons: They may be excellent, artistic gifts to humanity, or they may be total hacks. or they may be just average. Some surgeons may be great at marketing, but not so great in the operating room, where it really counts.

So how can a consumer find out? The web may or may not be helpful, since some agenda driven, disgruntled patient may be a prolific blogger, and may paint even the most angelic surgeon as a child of Lucifer. The rules of medical confidentiality prevent the doctor from defending themselves, so the angry patient always has the upper hand- the doctor can’t say anything. I am not saying you should ignore the one complaining patient, just take it with a grain of salt. Understand that you are only hearing one side of the story, and that the law prevents you from hearing the surgeon’s side of the story.

Rating sites may or may not be helpful, since the most vocal patients may not be representative of the entire group. The patient who glorifies their surgeon should be taken with the same grain of salt as the patient who villifies him. Just because they turned out great does not mean that you will.

Marketing scams are also a problem in the free-for-all that is Web 2.0. Physician rating services also do not necessarily check or verify that the writer is an actual patient. Some marketing services actually use fake patients to raise the profile of their client- the surgeon. So when you read how Dr. X is a fantastic human being and loves babies and kittens, you don’t really know who wrote that. It could just be a marketing scam, where paid collaborators have simply elevated their client’s standing with a bunch of fake positive reports.

In the most competitive markets, I have heard about how the competition has been hurt by fake negative reports. Yes that’s right, fake negative reports by people that were never seen or operated by the surgeon that is getting trounced. If the surgeon tries to get the false postings off the rating site, that creates a whole new bunch of problems. It will look as though the surgeon is trying to silence bad publicity, won’t it? Proving that a negative report is a fake is difficult to do, and removing a negative story from the internet is kind of like trying to remove pee from a swimming pool. It can’t be undone. Keep these in mind when you read really positive or negative reviews from any rating service. It can be a horrible mess trying to find out the truth, especially in really competitive markets.

What can a prospective patient do? Should you ignore all these different sources of information? NO, exactly the opposite, you should collect all the information that you can. Read on…
Check Qualifications: First, you can check your doctor’s qualifications on line. In Canada for example, all surgeons are listed in their Provincial College of Physicians and Surgeons website (for example, the Ontario College of Physicians and Surgeons), along with their diplomas and qualifications.

http://www.cpso.on.ca/docsearch/

http://www.cpso.on.ca/docsearch/details.aspx?view=1&id=%2052985

Online Search: Google can be a friend here. The problem is that many peripheral doctors have created official sounding groups that are not approved medical boards or real designations. For example, there is no official board with the term “Cosmetic” in it, so if you see someone listing membership in something like “Fellow of the International Board of Cosmetic Liposuction” or something of that nature, it is puffery, an intentional misdirection for consumers. These groups are not listed in the official American Board of Medical Specialties (http://www.abms.org/), which is the real certification body in the USA or the Royal College of Physicians and Surgeons of Canada (http://rcpsc.medical.org/). The unofficial boards are not listed in these directories because they are not official boards, so it is buyer beware. Canadians can search their provincial boards to see if their doctor is certified ( http://www.cpso.on.ca/docsearch/). American consumers should look at http://www.abms.org/ to see if their doctor is Board Certified in the USA.

How did you feel during your consultation with the doctor? In his book “Blink”, Malcolm Gladwell wrote that people make their decisions fairly quickly, in a ‘Blink”. Although these decisions are sometimes wrong, your feelings do make a difference in your possible outcomes. If you have a bad feeling about your doctor, why would you submit to surgery? Be honest with yourself and don’t ignore your gut feelings, because they are often right.
Check with your Friends: This is sometimes a tricky proposition, since many patients try to keep their private lives, well, private. Some patients are willing to share their experiences. The information you gather may or may not be helpful to you, but any information is probably better than no information.

Cheap Prices: It costs money to provide good care. If someone is providing really inexpensive surgery, my first thought is that they must be they cutting corners somewhere. Although there is a some variability in how much things cost, the prices have to be above a certain minimum in order for it to make sense for both parties. A really low price is a red flag that something is not quite right. When comparing the prices from different surgeons, you should also be looking at the value that you are getting. Does the clinic belong to an accrediting body that inspects it? Are the inspections done by biomedical engineers that check each piece of equipment and signs a document indicating that inspection was done? I do investigations for the College of Physicians and Surgeons of Ontario. In the past year, I have seen clinics that were operating without ever being inspected. I have seen sterilizers that were purchased, second hand no less, years ago and never tested, ever. Thankfully, all that will be changing with new Ontario legislation mandating that all clinics must be inspected, but check with your local state or provincial medical authorities to find out what the law is where you live. The term ‘Buyer Beware’ has never been as important when it comes to your health and safety.

Mosaic Theory Intelligence Gathering: You can collect a bunch of information from several different unrelated public sources, online, personal, official documents, web searches, etc, and put together a pretty good picture of the doctor you are looking into. This is what Intelligence officers do to put together a profile of the person of interest. All it means is that you can collect a series of facts from several different unrelated sources and after checking how well all the facts seem to fit with one another, you can get a pretty accurate picture of the doctor in question. While you are doing your research, you are essentially using this technique. Now you know what its called.

Remember the Three Golden Rules: These are time tested rules of engagement with respect to doctors and patients. Problems always arise when one of these rules is broken or ignored.
You must like the doctor.
The doctor must like you.
The doctor must be confident that they have the skills to fix your problem.

In summary, I hope that these comments help you in your quest to find the best surgeon for your problem. The most important thing for you to do is to actually see the doctor and listen to him or her. Although it is a scary world out there full of scams and hucksters, there are thousands of lovely caring people who can and do provide excellent surgical care for their patients every day, everywhere in the world. If you use care and diligence in finding your surgeon, chances are you will have a great experience.