, it's hard to know what questions to ask.
First, you have to decide whether to have the surgery at all. Then you must choose a surgeon.
We asked two experts,
cosmetic surgeon Paul Wigoda and Miami personal injury attorney Sarah Steinbaum, to answer questions from readers across the country in an online discussion. The following is an excerpt from that exchange:
What's the first thing to think about when deciding whether to have cosmetic surgery?
: Do it for the right reasons. They should be doing it for themselves, as opposed to for anyone else or to serve any other purpose, such as saving a relationship, getting a job or promotion, etc. Often patients decide to have surgery based on whether or not they can afford it. This should not be the primary focus.
They then need to do it only if they are a good candidate both from a physical and psychological standpoint. A competent surgeon will need to assess this with each patient.
: The most important thing is to investigate the qualifications and experience of the plastic surgeon you are considering using.
How many consultations do you recommend and what is the best way to pick [a surgeon]?
: I would suggest at least two, if not three consultations. You should first research each doctor as thoroughly as you can. You then will need to meet the doctor, see how comfortable you are with them and see their before-and-after photos. You can ask to speak to other patients who have had a similar procedure. There are websites that list board-certified plastic surgeons, but none that will tell you which are good and which are not.
: State medical boards let you search doctors to find credentials and sometimes disciplinary history. The
Board of Medicine is at http://www.doh.state.fl.us/mqa.
Is there a way to see if a plastic surgeon has been sued for a bad job?
: Most of the [county court] offices where the doctor practices are online to see if suits have been filed against them. In Florida, insurance companies are required to report malpractice settlements. The link is http://www.floir.com/Liability.
: In general, I would stay away from most procedures that are called "weekend" anything. With any surgical procedure that is going to have a long-lasting result, it is going to take more than a weekend to recover. Different doctors will name a procedure a gimmicky name, but you have to be careful about what you are really getting. The cost will vary depending on what the surgeon is really doing.
: Generally, liposuction is not covered. However, gastric bypass may be if a doctor has deemed it medically necessary for things such as
and hypertension. But every policy is different. Aside from reviewing the policy yourself, you can have your physician's office verify it for you.
Patients are supposed to get cleared by a doctor in advance to make sure they are healthy enough for cosmetic surgery. Is it OK to have that done by a doctor at the place where you are getting the surgery?
: I would strongly recommend you get clearance from your own primary care doctor and not the center, which may have an interest in clearing you for surgery despite health problems that may otherwise prevent it.
: Generally speaking, if you are healthy without medical problems, the plastic surgeon will determine what sort of pre-operative testing you need, and the surgeon along with the anesthesiologist will determine if the person can have surgery. If there are medical issues, it may be wise to be fully evaluated by an internist prior to surgery.
: Procedures can be done under local [topical anesthesia], local with sedation or general anesthesia. Which type of anesthesia is used will depend on the procedure, and in some cases the patient's preference. In some cases, if you are deciding between sedation and general, it can be actually safer to be under general because your airway is controlled.
Also, under general, there is an anesthesiologist present whereas in some cases of sedation, it's only the surgeon present. If you are under sedation and are given too much, you can stop breathing, and then it becomes an emergency to put an endotracheal tube into your airway. Not a good situation.
What should people expect to see in the contracts they must sign to have cosmetic surgery, and what should they look out for?
: Every physician who does surgery will require you to sign a consent form. The consent should be thorough and explain to you the risks of complications of the procedure. The consent should not be [used in place of] a conversation with the surgeon about the risks of the procedure but rather in conjunction with it. The patient has the right to "informed consent."
Additionally, you should be very wary of any part of the contract that requires that you waive your right to file a lawsuit for medical negligence if it occurs, waive the right to a jury trial or forces you to go the arbitration.