Dr. Armando Soto on Fox's Good Day Orlando!

I wanted to recap for readers the essentials of my discussion with Michelle of Fox 35 Orlando this morning, as well as elaborate on the important things to know and ask before allowing anyone to do any kind of elective plastic surgery procedure on you.

This discussion was of course brought about by the recent events in the Phoenix area, where a local ER doctor was accused, indicted, and then convicted of second degree murder and manslaughter after 3 of his patients died while undergoing (or shortly thereafter) liposuction.

The case is noteworthy not just because of the fact that 3 human beings unfortunately lost their lives during procedures that should have been very safe for healthy people like them, but because the doctor was found guilty of MURDER, and not just of malpractice.

To review, the prosecutors successfully argued that as Dr. Peter Normann was intelligent enough to complete medical school and training in Emergency Medicine, he should also have been intelligent enough to understand that his complete lack of legitimate training in plastic surgery and liposuction (he took a weekend course) constituted an untoward risk for his patients. In other words, Duh! You're an ER doctor- probably shouldn't be doing liposuction on people.

Furthermore, they reasoned that he should also have had the wherewithal to know that his advertising a level of expertise in these procedures that he clearly did not have, along with his lack of training, and the fact that he performed the procedures in a facility without appropriate accreditation was fundamentally wrong...

Therefore, they concluded that he clearly showed more regard for his income than for his patient's safety, and displayed what they (the prosecutors) called an "extreme indifference" to human life, which met the guidelines for murder in the second degree.

Scary.

So- what should we all take away from this?

Well first of all, as a plastic surgeon, clearly it would be wrong for me to offer to do heart surgery on a patient- as cool as it would be to be able to say I do heart surgery AND plastic surgery, I know it would be wrong.

The amazing thing is that it would NOT be illegal.... At least not if I could talk someone into letting me do it on them in my office under local anesthesia.

And that's a big part of how so many unfortunate patients wind up injured or dead after cosmetic surgery.

Historically, what kept doctors "honest" and prevented them from trying to do procedures on people that they were incompetent to perform, was the hospital credentialing system.

We'll use myself as an example... If I (as a trained Plastic Surgeon certified by The American Board of Plastic Surgery) wanted to obtain privileges at a hospital for the performance of liposuction, I would need to submit a great deal of paperwork to the hospital's Credentialing Committee proving that I had received legitimate, ACGME approved training in plastic surgery and liposuction.

The ACGME, or Accreditation Council for Graduate Medical Education, is the body that judges whether residency training a doctor receives is adequate and appropriate before letting them say they are trained in the discipline. From their website:
    

• The Accreditation Council for Graduate Medical Education is a private, nonprofit council that evaluates and accredits medical residency programs in the United States.
  


• The ACGME was established in 1981 from a consensus in the academic medical community for an independent accrediting organization. Its forerunner was the Liaison Committee for Graduate Medical Education, established in 1972.
  


• The mission of the ACGME is to improve health care by assessing and advancing the quality of resident physicians’ education through exemplary accreditation. 

If I, on the other hand, asked for privileges performing heart surgery in the same hospital, my request would be quickly denied (and I would probably even be denied privileges in procedures I can prove competence in- just for asking to do something so far outside my area of training) because I would be unable to provide proof of ACGME accredited training in this discipline.

But here's the thing.... What if I could convince people to let me try doing heart surgery on them in my office under local anesthesia? 

By avoiding the hospital, I've also avoided the Credentialing Committee. 

And there is no law to stop me from doing whatever I want to patients in my office, as long as I have their (the patient's) permission to do it. 

It's true- if you were dumb enough to let me charm you into having heart surgery under local anesthesia in my office, I could legally do it. The outcome may not be so good, but I could do it.

And that's why I always tell people that if you could only ask your provider one question, the most important one would be, "Do you have privileges to perform the operation you are proposing for me in a hospital?" (but don't take their word for it- call the hospital and check).

Now heart surgery in an office setting is so obviously ridiculous that there are probably very few people alive who would consent to it (although someone probably would).

But what about if we were talking about liposuction? How hard would it be to distract you from the fact that I might not have the proper training in the procedure and fool you into letting me do it on you?

What if I were able to convince you that the machine I use in my office makes it so easy that you're not really having surgery at all, but rather a "minimally invasive" fat removal? 

What if I convinced you that I'm the only one in town who knows how to do it- by giving my procedure a cute name? 

What if I (fraudulently) advertised that my procedure was fundamentally different and better than liposuction, and that there was minimal or no downtime? 

What if I (falsely) told you that having it done under local anesthesia was "safer" because you don't need general anesthesia? 

Now it's not so hard to understand how otherwise intelligent people might put their happiness and safety in the wrong hands, is it?

And believe it or not, there are ER doctors, gynecologists, and an eye doctor here in Central Florida making all of these claims.

So let's all realize the following:

1. All liposuction is surgery. It doesn't matter what machine is being used, or how you're anesthetized. If someone is removing fat from your body through an incision, however small, you're having surgery.


2. All surgery has risks (just ask the families of the 3 patients who died in Dr. Normann's OR)


3. You can minimize your risks by choosing the right surgeon, the right facility, and the right anesthesia provider- and all 3 are important.


4. Conversely, your risks of a bad outcome are much greater if you let yourself be fooled into having plastic surgery performed by someone who does not have legitimate, ACGME training in plastic surgery.

And with regard to the last point- make no mistake about it, Dr. Normann was not an isolated numbskull. Every large community in America now has ER doctors, gynecologists, family doctors, and even an eye doctor (here in Orlando) calling themselves liposuction experts, despite a lack of ACGME accredited training in the procedure.

How do you protect yourself and those you love? 

• Do as much research as you can


• Research the surgeon


• What was his training in?


• Is he Board Certified- and just as important- by WHICH BOARD?


• Where was his training?


• Research the facility in which the procedure is to be performed


• Is it accredited? Ask to see the certificate


• By whom? Make sure the facility is accredited by The AAAASF or JCAHO


• Research the anesthesia provider


• Who is taking care of you while you are having surgery is just as important as who is doing the surgery!


• Is it an anesthesiologist (a doctor of anesthesia)?  PREFERRED


• A certified nurse anesthetist? LESS IDEAL


• The surgeon himself or a nurse??  BE VERY CONCERNED

Finally, where can you look for these important answers?  Here you go...

1. Check the website for the State Medical Board in the state in which you live. You can learn about the doctor's training (or lack thereof) and much more. For Florida, the link is:  http://ww2.doh.state.fl.us/IRM00profiling/searchform.asp


2. You can also check reputable doctor review sites. The word reputable is critical here... more on that later. The very best is www.RealSelf.com


1. What makes it the best? Quite simply:


2. It is complete- there is a wealth of information about doctors, their training, and their outcomes


3. It is fair- Realself balances doctor's legitimate concerns against patient's in the most fair fashion of the sites out there right now. As I will write about in the near future, there is no perfect site, but this is as good as there is at the present time.


4. Realself requires doctors market honestly, and only in the specialty in which they actually are trained. Critical.

And finally, if you are still uncertain about a doctor you have seen, email me and I can help you figure out what their training was all about- 

And for those cynics out there-- this is not about me feeling competitive. As long as you are in the hands of a Board Certified Plastic Surgeon, I'm good. 

It's the damage done to the reputation of ALL plastic surgeons and plastic surgery itself by injuries and deaths caused by non-plastic surgeons that I'm trying to prevent here.

Plastic Surgery by a Non-Plastic Surgeon?

Reprinted from The Arizona Republic:



Liposuction deaths: Phoenix area doctor convicted of murder, manslaughter


by Michael Kiefer - Jul. 15, 2011 10:28 PM
The Arizona Republic


An Anthem physician who had three patients die during plastic-surgery procedures in his clinic was found guilty of murder and manslaughter Friday in Maricopa County Superior Court.


Dr. Peter Normann was pronounced guilty of second-degree murder in the deaths of Ralph Gonzalez, 33, of Scottsdale, and Leslie Ann Ray, 53, of California, and of manslaughter for the death of Alicia Santizo Blanco, 41, of Gilbert.


Throughout the trial, which began June 10, Normann's attorneys, John Johnsonand Vikki Liles, maintained that the deaths were accidental, the result of known risks of plastic surgery, and claimed that if Normann, 50, were found guilty, it would mean that all doctors would be liable for procedures gone wrong.




Autopsy findings had listed the deaths as accidental.


But in her closing arguments earlier this week, Deputy County Attorney Jeannette Gallagher said the "combination of incompetence and arrogance in trying to cover up his (Normann's) incompetence led to their deaths."


Gallagher claimed that two of the deaths constituted second-degree murder because of Normann's "extreme indifference to human life," and the third death was manslaughter because of Normann's "conscious disregard of substantial and unjustified risk of death."


After a day and a half of deliberation, the jury came back supporting Gallagher's side of the story.


Normann's friends and family were surprised at the verdict.


"He is not the monster he's been painted to be," said his friend Cindy Jones. "He's a pure, sweet man."


Liles said she and Johnson plan to file a motion for a new trial, claiming that Gallagher had committed perjury in insisting that Normann did not have inventory of a drug that could have saved the lives of one or more of the patients.


Normann had been an emergency-room physician, certified as an internist, and had never done a residency in plastic surgery or anesthesiology.


Gallagher maintained he had undergone six days of training in liposuction and had done some "hands-on training" in liposuction and breast augmentation. He had never done training in fat augmentation, Gallagher said.


Furthermore, she said, his operating room lacked proper oxygen and monitoring equipment, and he worked without anesthesiologists or nurses, relying on a massage therapist and a former restaurant worker with little or no training as medical technicians.


The massage therapist, who assisted in surgery, has already pleaded guilty to eight counts of unlawful practice of medicine and was sentenced last year to five years in prison.


Gonzalez stopped breathing during liposuction in December 2006, due to what Gallagher called a lethal dose of lidocaine, which is used in the procedure. Then, she claimed, Normann mistakenly inserted a breathing tube into Gonzalez's esophagus instead of his trachea, depriving him of oxygen.


When paramedics arrived, they noted that Gonzalez's belly was distended because of the oxygen being pumped into his stomach instead of into his lungs, and they maintained that they tussled with Normann, who insisted on riding in the ambulance and refused to let the EMTs reinsert the tube correctly.


David Duarte, one of the paramedics, told The Republic after the verdict, "He physically was holding onto it, from the get-go."


Duarte threatened to break Normann's arm and then tricked him into letting go of the tube so he could pull it out. Normann insisted on reinserting another.


Duarte said he filed complaints against Normann with the hospital and the state medical board.


Santizo died in April 2007 during multiple procedures, including repositioning a badly placed breast implant, liposuction and an attempt to inject fat into her buttocks to enhance its shape.


During the fat augmentation, Gallagher said, Normann injected the fat directly into a vein, which carried it to her lungs and killed her.


As had occurred during Normann's attempts to resuscitate Gonzalez, Normann was unable to properly insert a breathing tube.


Duarte, coincidentally, was in the hospital when Santizo was brought in, and he filed another complaint.


After the second death, Normann agreed to a voluntary suspension of his medical license and he hired a homeopathic physician, Gary Page, to do liposuction. Gallagher maintained that as a homeopath, Page was not qualified or licensed to perform such procedures.


Ray had traveled from her home in Blythe, Calif., for the surgery in July 2007, which Page performed with no assistance, serving as surgeon, anesthesiologist and monitor.


After the surgery, Page left the clinic, and Ray was left in a recovery room, where later that night, Normann discovered her in respiratory distress because of a reaction to the combination of drugs she had been given. Normann was again unable to insert a breathing tube when she stopped breathing.


Page was charged with manslaughter in Ray's death, but on Friday, he pleaded guilty to the lesser felony charge of endangerment.


Normann will be sentenced Aug. 19 by Judge Paul McMurdie.

Over the past few years, several things have become clear to me about this significant patient safety issue:

1. There are some people who will always knowingly and willingly put themselves at risk if doing so will allow them to save a few dollars... These patients probably cannot be helped.
2. Some physicians are inherently more ethical and moral than others... in other words, and as I have stated many times in the past, the days when it was safe to assume that all doctors were honest professionals with high levels of moral character and integrity are unfortunately over
3. Doctors with questionable ethics, morals, and training are capable of amazing acts of deceit (if not fraud) in order to attract patients and convince them to have surgery.
• The eye doctor here in Orlando who advertises heavily as an expert in liposuction even gives procedures long established in the legitimate plastic surgery community cute, trendy sounding names ("Naturalfill") to make it seem to patients that he is the only one knowledgeable in the technique, and that he has somehow captured magic in a bottle. This violates the code of ethics of the American Society of Plastic Surgeons- but because he is an eye doctor and not a plastic surgeon, he does not have to comply with this important ethical code.
• The same eye doctor advertises himself as "Board Certified", without saying in what or by whom. I believe this is actually a violation of Florida law- but again, no one will do anything about it until and unless there are complaints.
4. The tragic truth (at least so far) has been that when patients are injured or deformed as a result of surgery performed on them by an ER doctor, Eye Doctor (or anyone else without plastic surgery residency training) they almost never complain to the appropriate authorities.
5. Many Central Florida women don't realize that this problem is prevalent in their backyard. In Orlando alone, there are ER doctors, a urologist, and the eye doctor I describe (!) all claiming to be liposuction experts.

These last 2 facts are what I hope to contribute to changing.

I have found that for patients who have experienced the trauma of misplacing trust for their safety and happiness in someone other than a Board Certified Plastic Surgeon, the only thing that they believe could make their situation worse is to have to talk about how they ended up making the poor decisions that lead to their terrible outcome.

I've seen it over and over again in patients who come to see me for correction of problems resulting from surgery performed by local ER doctors and especially the local eye doctor... They want to have their problems corrected, but usually cringe at the notion of having to re-hash the experience as they would have to do if they complained to the authorities with the power to stop these untrained practitioners from practicing plastic surgery. I believe they behave very much like victims of sexual abuse...

Because there is a perceived stigma associated with being "duped" into compromising your safety and appearance, most of these patients won't complain...

But here's the problem... Unless and until patients injured and disfigured complain to authorities, the only way to stop untrained non-plastic surgeons from harming (or indeed killing) more patients is to wait for someone to die- this is the only circumstance that would require the state to investigate without a complaint. 

So unless someone dies, without people affected complaining, these doctors can go on performing procedures they are ill-trained to perform on unsuspecting patients- injuring more of them over time.

Please don't let yourself or someone you love be the victim of doctors practicing outside their training. And if you are, please contact the Florida Board of Medicine.

Don't Let Marketing or a Low Price Cloud Your Judgement in Aesthetic Surgery Decisions

from The American Society for Aesthetic Plastic Surgery

You've Got Mail: Online Promotions May Not Be Safe Medicine

New York, NY (January 18, 2011) – Every day email inboxes get bombarded with coupons for movie tickets, restaurants, fitness memberships and spa packages. Frequently, non-surgical medical procedures are promoted on websites like Groupon, Lifebooker and Living Social, but it is important for prospective-patients to keep in mind that procedures like microdermabraison, Botox injections, chemical peels, and laser hair removal, while not surgical are still medical procedures. 


“Patients must do their homework when choosing where and with whom to have any medical procedure,” says Felmont F. Eaves, MD, President of the American Society for Aesthetic Plastic Surgery. “Cost is always a factor, but it should never be the deciding factor in cosmetic surgery. Safety and quality are always the key issues.”


As advocates for patient safety and healthy outcomes, the American Society for Aesthetic Plastic Surgery (ASAPS) have created the following questions you should ask before purchasing any procedure or medical treatment in a spa or non-traditional facility.

It is important that you do your homework as you should on anything that can affect not only your appearance but your health and safety as well.

We suggest obtaining the following information:

About the facility:
Is the Medi-spa located within a physician's office?
While problems are infrequent, physician's offices generally have medical personnel available if a problem develops.

Is the Medi-spa located outside of a doctor's office in, for example, a mall or salon? 
If so, ask the name of the physician responsible for oversight and when they are available for consultation or questions before having any injectable, deep peel or laser treatment. Also ask about the training of any other medical personnel. This is vital to protect your health and insure an optimal outcome. These are generally safe procedures with minimal recovery, but do have real risks.

About medical supervision and personnel training:
Does your medi-spa have a physician who can help in determining your goals, provide a treatment plan and direct your care, and will you meet with them before treatment?

What are the credentials of the physician supervising your treatment in the medi-spa? 
Injectables(such as Botox and tissue fillers), skin treatments (such as laser, intense pulsed light, and radiofrequency) and deep peels should be under the supervision of board-certified plastic surgeons. Ask to see these credentials. Doctors in other specialties, designating themselves as “cosmetic medicine physicians” may lack the comprehensive training that is needed for administering drugs and treatments to the deeper levels of the skin and lack the experience necessary to achieve optimal aesthetic results or to manage potential complications.


Just as you wouldn't see an allergist if you were having a baby, it's in your best interest to see a physician who specializes in plastic surgery and dermatologic care when seeking cosmetic medical procedures.

Who is performing the injection? 
Depending on the State you're in, injections and deep peels may be performed by a nurse, physician's assistant or nurse practitioner (in Florida, they are only supposed to be injected by a nurse practitioner, a PA, or an MD). However, never allow a non-medical, unlicensed person to perform a medical procedure and be sure that the procedure is supervised by a physician board-certified in plastic surgery. Your health and safety depend on it.

About efficacy and risk of procedures and realistic expectations:
How effective are facial injectables and what is the right product for me? 
Injectables are generally very safe and effective treatments. There are a wide range of products on the market that are FDA approved and provide good outcomes. However, be sure to ask your provider the following questions:

Is the product FDA approved? Is it approved for this use?
If your provider is reluctant or does not directly answer this question, don't proceed with the treatment. Don't be afraid to ask to see the manufacturer's label for any injectable product.

Can a medication, filler, or a device be used for a purpose different from which the FDA originally approved it? 
In the United States, FDA regulations do not prohibit physicians from prescribing approved medications, fillers and devices for other than their original intended indications.
Good medical practice and the best interests of the patient require that physicians use legally available drugs, biologics and devices according to their best knowledge and judgment.
If physicians use a product for an indication not in the approved labeling, they have the responsibility to be well informed about the product, to base its use on firm scientific rationale and on sound medical evidence, to fully inform the patient that it is being used “off-label” and to maintain records of the product's use and effects. 


Will injections last and prevent the need for a facelift in the future?
In most cases injectables are temporary solutions and will not give the long-lasting outcome of a surgical procedure.

Have you been fully informed of the possible benefits and side effects of the proposed treatment and have you been apprised of possible options? 

Have all of your questions been answered and are you are fully aware of the risk and rewards of the procedure? 
All medical procedures, whether they are injections or surgery carry some risk. If you are not fully informed of all risks and requirements for after care, find another provider.


These procedures should never be performed in someone's home, hotel room, or at a party. This is not only unethical and legally risky for the injector but unsafe and potentially dangerous for you.

About taking control of your own treatment options:
What do I expect from my medical procedure?
Discuss your expectations with your provider. If you are promised unqualified, 100 percent success it is probably best not to proceed. If it sounds too good to be true, it probably is!

Am I taking the procedure seriously? 
Surgical deep peels and injectables like soft fillers and Botox are not the same as getting facials or other superficial beauty regimens. Make sure you have done your homework on the treatment you seek and be aware that these are medical procedures.

Am I basing my decision on the best treatment option and not on price? 
Medical care of any kind is not a commodity. Be sure you have based your decision on the credentials and experience of the practitioner, not on price.

Have you asked to see before and after pictures? 
They can be very helpful in determining with your provider the right treatment for you.

What if I'm unhappy with the result? 
A qualified practitioner can provide you with appropriate revisional or after-care. Make sure you ask this question before the injection or treatment.

Have you been told who holds financial responsibility for any revisions or if complications arise?
You don't want any surprises later!

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.
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Survey of America's Most Experienced Plastic Surgeons Confirms Many Newer Liposuction Devices are Marketing Gimmicks

This piece, summarizing the findings of a recent peer-reviewed article in one of our specialty's major journals, makes all of the points I've been writing about for some time now... With regard to ANY new technology (especially where your safety and happiness may be at stake), the appropriate questions to ask before allowing it to be used on you are:

• Is it BETTER than existing alternatives- that is, is it going to be more likely to help me and my surgeon achieve my goals?
• Is it SAFER than existing alternatives?
• Is it LESS EXPENSIVE than existing alternatives? Bear in mind that this is only important if the answers to the first two questions are "yes".

From The American Society for Aesthetic Plastic Surgery:

Survey Extracts Surgeons’ Preferences on Liposuction

Results published in the February Issue of the Aesthetic Surgery Journal

New York, NY (February 14, 2011)– 

With an array of new innovations in liposuction and other forms of fat removal, which do plastic surgeons prefer, and which do they perceive as the safest? 

To answer these questions, the American Society for Aesthetic Plastic Surgery (ASAPS) recently conducted a survey of its membership to uncover their experience with liposuction, new fat removal technologies and the management of complications.  

The survey revealed that suction-assisted lipectomy (SAL), or “traditional” liposuction, was the preferred method of fat removal for over half of respondents; power-assisted liposuction (PAL) and ultrasound-assisted liposuction (UAL) were also popular. Laser-assisted liposuction (LAL) and external noninvasive devices, such as external ultrasound and laser, were the least popular methods for fat removal.  The full results of the ASAPS Current Trends in Liposuction Survey have been published in the February issue of the Aesthetic Surgery Journal (ASJ).

“In a field that is so rapidly advancing, it is essential to continually evaluate new technologies and methods to ensure that we maintain the safety of our patients,” said Jamil Ahmad, MD, lead author of the survey, “Our survey found that ASAPS members tend to more frequently employ the fat removal methods that have the longest track records and the most data to support their efficacy and safety. In the future, we may notice preferences shift as we see additional prospective data comparing techniques, and as we gain more experience with newer methods. These factors will also help us continue to improve safety-related standards of care.”

The Aesthetic Society survey consisted of 17 questions pertaining to the application of liposuction and other fat removal techniques, management of complications, and experience with newer fat removal technologies. The survey was distributed via email to 1,713 ASAPS members, of whom 492 (28.7 percent) responded. Highlights of the survey include the following findings:

Most respondents perform between 51 and 100 liposuctions per year.

Most currently employ or have previous experience with SAL (92.7 percent), UAL (59.6 percent), and PAL (44.7 percent). Fewer have experience with LAL (12.8 percent), mesotherapy (5.7 percent), or noninvasive devices (12.8 percent).

The preferred method of fat removal from most to least popular was:

SAL (51.4 percent)

PAL (23.0 percent)

UAL (20.9 percent)

LAL (3.9 percent)

Noninvasive devices (0.8 percent)

Respondents felt that newer fat removal technologies including LAL and mesotherapy were associated with a disproportionately higher rate of complications compared with more established methods (ie., SAL, PAL, and UAL). (emphasis added)

Respondents felt that marketing (68.3 percent) was the most common reason that influenced patients to choose newer treatments such as LAL. (emphasis added)

Members support education of physicians with appropriate aesthetic surgery training and similar ethical practice but are concerned with industry marketing to physicians without appropriate aesthetic surgery training, practicing outside of their scope of practice. (for example, the Orlando area eye doctor who heavily markets Naturalfill and Aqualipo)

“Evaluating the opinions of our members is an excellent way to identify industry trends and determine how to improve the field for both surgeons and patients,” said Felmont Eaves III, MD, ASAPS president.   “It is important for us to conduct surveys such as these, not only regarding liposuction and other forms of fat removal, but for all facets of aesthetic surgery.”

Liposuction, also called lipoplasty, removes deposits of excess fat from specific areas of the body including the face and neck. It is the second most popular surgical cosmetic procedure in the U.S., with 283,735 liposuction surgeries performed in the U.S. in 2009, according to ASAPS.

About ASJ

The Aesthetic Surgery Journal is the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS) and is the most widely read clinical journal in the field of cosmetic surgery, with subscribers in more than 60 countries.

About ASAPS

The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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Being The Empowered Patient.. What it Means, and What it Doesn't

We've come a long way from the days of Marcus Welby (I realize I'm aging myself here)... When patients thought of their doctor as an all-knowing demigod worthy of our complete and implicit trust. Someone we relied on to tell us what to do, and when they did, we simply agreed without (or with very few) questions asked.

The change toward patient-centric care and patient empowerment has been mostly positive for patients- although in some ways it could be argued that these changes in the doctor-patient relationship have had a few unintended consequences.

 I prefer to approach interactions with my patients from a perspective of equality and mutual respect, and believe this natural, not contrived or paternal approach has been very effective in giving my patients the sense of comfort and confidence they desire, knowing that they are being given the tools and information necessary to decide for themselves what is in their best interests.

Occasionally though, I meet someone who is confused about their role in the modern doctor-patient relationship... who either wants me to tell them what to do, or who mistakenly believes that decisions about plastic surgery are similar to ordering dinner at a restaurant- where it is their job to decide where to eat and what to order from the menu, and it is the job of the restaurant to provide them exactly what they asked for. Or worse, someone who thinks that surgery is a "drive-through" experience in which they choose what they want, the surgeon then provides it, and they drive away to choose how their postoperative management should go. It seems these particular patients have mistakenly concluded that being an educated, empowered patient means having an absolute distrust of all physicians...

To some extent therefore, I think that the patient empowerment movement has endangered the patients it meant to protect by eroding trust in physicians beyond what is healthy or appropriate. To be clear, I realize better than most that some of my colleagues have done more to erode trust in doctors than any other group or movement. Not all doctors are worthy of our trust.

But being too distrustful of your health care providers (once you've entered into the relationship) because you think that is the best way to be your own advocate is probably not going to be helpful if your goal is truly to be safe and happy- the relationship you develop with your surgeon will be very important to your safety and happiness, and you (and your surgeon) should approach it with the respect and goodwill you would any other important relationship in your life.

So here is my best, most sincere effort to clarify how you can best approach your relationship with your chosen, Board Certified Plastic Surgeon in order to maximize your safety, enjoy the most pleasant experience, and also maximize your chances of achieving your aesthetic goals.

It should be noted that I will not be discussing how to choose a plastic surgeon, as this has been covered in other posts on this blog. I will also not be reviewing the types of doctors to avoid, as this has also been covered in many of our Monthly Safety Reports. Generally, you should not have liposuction performed by an eye doctor.

So what does it mean to be a truly empowered patient? How can you be sure you're making decisions that are truly in your best interests and not those that are in the best interests of the surgeon? What behaviors might compromise your care or your relationship with your surgeon?

Being an empowered patient, in the simplest terms, means being a well-educated and compliant patient. 

Being well educated is the easy part, right? In this day and age, it truly is the rare exception when I meet a patient who doesn't know everything about my education, training, experience and approach- indeed most have even been in contact with a few former patients- all thanks to the internet. 

But it should always be kept in mind that the internet is a largely unregulated environment, and unless information is being dispensed by a reputable, authoritative body (for example, The American Society of Plastic Surgeons or The American Board of Plastic Surgery), it should be subject to verification- at the very least. Board Certified Plastic Surgeons are held to a very strict code of ethics, but some among us do go astray from time to time in our advertising. In other words, take what you read with a grain of salt... especially if you only read it in one place.

Furthermore, the internet is a great place to gather general information about physicians, procedures, what most patients experience during recovery,.. But you should never allow yourself to think that you can use the internet to make all of your treatment decisions before meeting with a qualified surgeon. 

I've said it to a great many of my friends on the web- choose a great surgeon first, then worry about the what and the how. Learning about your options is great- making firm decisions and then shopping for someone willing to do what you've decided you want is not. Why? Because you cannot be expected to understand the nuances of your own anatomy, the details of how different options might alter your appearance, and other important aspects of the decision making process without the guidance of a well qualified, Board Certified Plastic Surgeon.

Entering the consultation process- or worse, the postoperative period- without an open mind and without a spirit of mutual good faith is disrespectful of your surgeon and truly will compromise your own ability to be safe and happy. We can all agree that treating your doctors like gods is not necessary or appropriate- but it should be equally obvious that (as long as you know the doctor is appropriately trained in the specialty) their many years of education and training do make them worthy of your respect and open-minded communication. Don't be rude and think that hours spent on the internet will make you as knowledgeable as your surgeon.

So learn as much as you can- but keep your mind open. And always spend more time and energy finding a great human being and qualified surgeon to entrust with your safety and happiness FIRST.

Okay, so what does it mean to be compliant? 

Does it mean you should be soft and pliable, abandoning what is important to you to the recommendations of the surgeon? No, it doesn't. 

But it does mean that once you and your surgeon have identified (together) the best course of action to follow- one that maximizes your safety (taking unnecessary chances in cosmetic surgery doesn't make any sense) and likelihood of being happy, that you need to trust them to "do their thing", and once surgery is performed, follow all of their instructions and restrictions in every detail. 

The postoperative period is not the time to start second guessing your surgeon's advice- or worse yet, asking your friends what their surgeons told them to do when they had the same procedure. 

Only your surgeon understands the details of your procedure and the implications these details will have on your recovery, restrictions, and needs. Complicating your doctor-patient relationship by introducing information from well-meaning friends and doctors unfamiliar with your procedure and care can only harm you- and almost ensure you will not achieve the best outcome you could have. 

The plastic surgery experience is supposed to be about being as happy as you can be- achieving maximum self-esteem, right? If this can be agreed on, then it should be easy to understand that doing anything that makes it more likely your experience is negative (even if you look great) or compromises your safety or outcome should be avoided at all costs.

So, following the KISS principle and keeping it simple:

1. Do your homework and find the very best surgeon you can
2. Investigate not only the surgeon, but also the facility and the anesthesia provider
3. Learn about your options but keep an open mind
4. Be as educated as you can, but remember your Board Certified Plastic Surgeon will still know more about your options and the details- listen carefully
5. The relationship between you and your surgeon will be very important to your safety, experience, and outcome- approach it with the care and respect you would any other very important relationship. Once you've decided who's hands you will trust with your safety and appearance- do trust them- follow their instructions carefully and completely.
6. If you do develop doubts, discuss them openly and respectfully with your surgeon.

I hope every patient achieves their very best sense of self this year- and that you are all smart and lucky enough to only have plastic surgery performed by surgeons certified by The American Board of Plastic Surgery.

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Making Wise Decisions in Aesthetic Care

Having developed the opinion that the mixed (and often irresponsible) messages in many advertising and media stories about Plastic Surgery (Lose 3 gallons of fat in an hour!) have unfortunately complicated the doctor-patient relationship on which safety and successful treatment depends, I think it would be valuable to describe a healthy and productive experience more likely to result in a safe and positive outcome.


Of note, I will not describe how to verify a surgeon's credentials, as I have covered this in other posts (see "Choosing a Plastic Surgeon").

I think it is worthwhile to emphasize that in engaging a Board Certified Plastic Surgeon, you are in fact hiring a highly educated and trained professional to intervene on your behalf- this part is no different than hiring an attorney or architect.

The major difference is that, because the work product of the Plastic Surgeon often involves surgery, your happiness and safety will depend on your choices and on you doing your part to achieve the best outcome and maintain a healthy working relationship with the professional you choose.

Step 1:  Spend some time and energy learning everything you can about the enhancement you may be interested in.

• Learn about the options, the outcomes, and the postoperative experience- realizing that your individual experience will greatly depend on your individual goals, the details of your procedure, and your surgeon's preferences.
• I would recommend against taking anything you read too much to heart at this stage- the best way to digest this kind of information is to take it all in and formulate an opinion based on all of it only after meeting with a professional for the proper perspective.
• Don't worry too much about making decisions at this stage either- it would be a mistake to commit to any particular way of doing things until you've gotten the advice of your Board Certified Plastic Surgeon (whether it is which liposuction machine is to be used or which breast implant might look best in you).
• Early in the process, I would also recommend a careful examination of your motivations and goals for the procedure...
• The happiest patients are those that are committed to the experience and who's goals are reasonable. They are not interested in looking better to please someone else.
• There's no such thing as "drive through" plastic surgery... Your aesthetic improvement should be thought of as a process, with necessary preparation and careful adherence to your surgeon's instructions and restrictions in order to achieve your best and safest outcome. Understand that without your cooperation, even the best surgeons would be limited in the outcome possible, and your chances of being happy are compromised.

Step 2: Having decided that the enhancement you've been considering might be right for you, I would then recommend researching the surgeons available to you. Keys to understanding meaningful differences include:

• The surgeon's education (medical school)
• Their training 
• Are they Board Certified by The American Board of Plastic Surgery? (If not, run away)
• What do their outcomes look like? 
• Don't worry that their outcomes may not look exactly like what you are hoping to achieve, but do ask yourself if they are attractive, consistently shapely outcomes... or do they just look funny?
• What do their prior patients say about them? Again- you'll want to digest this information as a whole... Read all of the reviews. 
• Don't be fazed if a surgeon has one or two negative reviews- even the very best among us might not be able to make every single patient happy (and some of this dissatisfaction may have something to do with unreasonable expectations on the part of the patient, or failure to follow postoperative instructions...).
• In other words, look for a pattern, not for individual experiences. 

Okay- so now you've decided you are interested in pursuing improvement, have educated yourself about the alternatives available, and have a few surgeons in mind... You're ready to schedule a consultation or two. 

What should you expect, and what do you need to do (and not do) to ensure the most productive communication?

• Have a firm grasp of your goals. Remember that no one will be able to achieve your goals if you do not understand exactly what you are hoping to achieve or are unable to communicate them. 
• Don't worry that you'll need to be super-articulate or able to draw a picture of what you want- experienced and well-qualified surgeons will be adept at interpreting your goals and re-stating them so you know they understand.
• Do not prematurely commit to the details. If your research led you to believe that a certain technique might work for you, but the professional you meet with believes a different technique would be better (after a careful examination and understanding of your goals), in almost all cases you would be best off following their recommendation. Remember that, while this is your first experience with the procedure, they have performed (hopefully) a great many of them and will have a better understanding of what would work best in your situation.
• Listen carefully to the surgeon.
• Pay attention to the way he talks to you and answers your questions. Do you think this is someone you can trust with your safety and happiness? Do you think the two of you will get along well through the course of treatment? This is an important relationship, and you will want to be as careful entering into it as with any other...
• Pay attention to the outcome he believes is reasonable for you and any limitations on the outcome that may or may not exist in your case. Ask if your goals are reasonable to expect, understanding that no responsible physician would give you a guarantee of outcome (if they do- again, run away).
• Pay close attention to the anticipated recovery and postoperative limitations, as well as the potential risks involved. 
• Plastic Surgery is real surgery. 
• If you are in good health and make smart decisions regarding who you let operate on you, where it occurs, and who is taking care of you from an anesthesia standpoint, the risks are very low... 
• If you let an eye doctor or ER doctor do liposuction on you in his office without a qualified anesthesia provider present (and yes, liposuction IS surgery), then all bets are off.
• This is another opportunity to review the surgeon's work, as most will show you before and after photos of prior patients.
• Be sure to ask if the photos being shown to you are of patients who were actually treated by the surgeon you are seeing, and whether they had the exact procedure you are interested in.
• Amazingly, some doctors show photos of patients operated on by someone else
• Equally amazing, it is now very common for you to be shown photos of patients who had one operation in order to "sell" you an another... For example- you would be shown a photo of a woman who had a Tummy Tuck (amazing outcome) and told she had SmartLipo... Hmmm...
• There's no two ways about it- this is fraud... but it does happen- although this is much less likely if you are dealing with a Board Certified Plastic Surgeon.
• Ask yourself about the quality of the outcomes you are shown, realizing that they represent the surgeon's best work (that's why they're showing them to you, right?)
• Ask to speak with a few prior patients. Most reputable surgeons will be able to put you in touch with a few patients who had the same procedure with them that you are considering.
• Pay attention to the staff- many of your interactions with the surgeon's office will be with his staff- friendly, courteous and professional demeanor and attention to their own appearance would indicate a productive and positive work environment, respect for their employer (the surgeon) and for the practice's patients.

So by now you should have all the information you need to make the decisions that are best for you... Remember- your part in the relationship is important if you want to be safe and achieve the best outcome- keep all of your appointments and follow your surgeon's instructions carefully.

For more information about how to verify the surgeon's, facility's, or anesthesia provider's credentials, email me or see our prior posts on "Choosing a Plastic Surgeon".

Visit Us:

www.DrArmandoSoto.com

www.MommyMakeoverOrlando.com

www.BrazilianButtLiftOrlando.com

www.CoolSculptingOrlando.com

www.NeoGraftOrlando.com

www.MixtoOrlando.com

Follow Us!

www.facebook.com/AestheticEnhancements

www.twitter.com/DrArmandoSoto