Before Surgery: See Several -- or More -- Plastic Surgeons

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The mark of an excellent plastic surgeon -- one who is committed to the best care possible for the patient -- is he or she who will encourage you to see a second, or third, surgeon about the procedure you have in mind.

When you visit Michigan plastic surgeon Richard Hainer, M.D. for a consultation, he will recommend one course of action immediately:

See another plastic surgeon about the procedure you want. Or perhaps a third.

Like many other physicians, Dr. Hainer recently put up a website ( about his practice. Consumers can see before-and-after pictures of former plastic surgery patients, read about procedures and email the doctor for an initial consultation.

But the most important part of the website is not a hard sell on himself and his services. Instead, Dr. Hainer's website concentrates on how a patient can select a competent and highly qualified surgeon and what to expect from the plastic surgery process.

Plastic Surgery

"It's important for a patient to get additional viewpoints on a desired plastic surgery procedure," says Dr. Hainer. "I am not threatened by local colleagues because there is plenty of work for qualified surgeons. The important thing is making sure the patient receives top care and is seen by a surgeon with appropriate training."

But what constitutes "appropriate" training?

The situation in the world of plastic surgery can be confusing. Because, in virtually all states, there is a huge disconnect between what is allowed and what is needed.

Most states allow any licensed M.D. to advertise under "Plastic and Reconstructive Surgeons" without being certified by the American Board of Plastic Surgeons (ABPS) or equivalent. Moreover, in most states, physicians may perform any procedures they choose, whether or not they've had training in that operation.

So consumers need surgeons who have had many years of plastic surgery training.

If a surgeon is ABPS certified, he or she has at least five years of extra training in general surgery after receiving the M.D. degree. Then, the physician usually undergoes another two years of intensive plastic surgery training.

"To become board certified in plastic surgery, a board of highly experienced surgeons examines all operations done by the candidate/surgeon in the second year of practice," Dr. Hainer says. "The examiners scrutinize everything."

Plastic Surgery Board

The next hurdle is a three-day oral exam. When the candidate passes, he or she can then advertise the certification by the American Board of Plastic Surgery.

Any consumer can check on any doctor's certification type by going to, logging in and typing in the name of the surgeon he has in mind for his procedure.

However, the waters can be muddied by quasi boards which exist only to promote their members. Many such boards are not recognized by the American Board of Medical Specialties because they don't test the surgeon's skills and knowledge.

"Any person or group can create a board and issue certificates," Dr. Hainer says. "Currently, there are about 102 such self-designated boards." Examples include: The American Board of Aesthetic Plastic Surgeons; The American Board of Laser Surgery and The American Board of Plastic Esthetic Surgeons.

If ever there was a situation where an ounce of prevention was worth a pound of cure, it's found in plastic and cosmetic surgery.

Potential patients can save themselves endless grief and expense by checking on a surgeon's qualifications and training before surgery. One ray of light is found in Florida, where a surgeon must say which board does the certification. Thus, a genuine plastic surgeon in Florida would advertise, "certified by the American Board of Plastic Surgery."

Surgical Revisions

"'Board certified' means little unless the board itself is named," says Dr. Hainer.

As time goes by, the surgeon's certification must be renewed through continuing testing and reviews by the board.

Another major clue to a surgeon's abilities is found in local hospital privileges. Hospitals have credentials committees -- composed of other local physicians -- who grant permission for surgeons to perform only the procedures for which they are qualified. The physician's performance is then subjected to peer review by the committee. If the quality of care is found to be lackluster, privileges can be withdrawn.

Office Procedures

Any consumer can check on hospital privileges by asking the surgeon in the initial consultation where he has privileges to perform a particular procedure. The consumers can then call the hospital, ask for the medical staff office and ask about the physician's privileges.

A surgeon wants to perform an in-office procedure, make sure the doctor also has privileges to do that operation in the hospital

"You have only one body so a little homework is important before you go under the knife," says Dr. Hainer.


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Richard Hainer, M.D.
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