Thanks to advancing technology, surgery is safer and more effective than ever before. Recovery time has been drastically minimized due to evolving research, less invasive procedures and new techniques. A range of varying disciplines that provide surgical procedures include both medical and dental specialties. This fact is also true for cosmetic facial surgery. Cosmetic surgery is more popular and more affordable than ever. Many specialties have contributed to the advancement of a whole host of surgical procedures, including aesthetic surgery, over the years. The fact that many similar procedures are practiced by a host of different specialties is often a source of lack of knowledge and confusion to patients trying to find a qualified surgeon.

Patients need to understand that it is imperative to consider asking critical questions when considering the doctor that will perform their surgery or procedure. Any well-trained, reputable and confident surgeon will welcome all patient questions, and will want you to be completely truthful and comfortable with his/her qualifications.

The following questions should be asked about the surgeon’s credentials:

  • 1) What medical/dental school did the surgeon attend?
  • 2) In what disciplines is he/she board certified in?
  • 3) Where and what residency did he/she study?
  • 4) What is the surgeon’s training with regard to the specific surgical procedures you are considering including cosmetic surgery?

Keep in mind the surgeon’s original disciplines and certifications may be in dermatology, head and neck surgery, general surgery, oral and maxillofacial surgery, ocular plastic surgery, plastic surgery and a variety of other surgical specialties. There exist subspecialty training within many specialties, and quite few have overlapping areas among several specialties; such is the field of cosmetic surgery. Training in cosmetic surgery is usually received after a completion of a residency in an underlying discipline. Some doctors may have gone on to post-graduate training and taken a board examination specifically in cosmetic surgery administered by the American Board of Cosmetic Surgery.

Ask how many times the surgeon has performed the desired procedure and how long he/she has been performing the procedure. Experience is extremely crucial information. It is generally true that the more procedures and the longer time a doctor has been doing them, the lower the complication rate as compared with those with less experience.

Combining lengthy procedures into one surgery may not be the safest method of achieving your desired results. While combining procedures into one surgery may save costs on surgical, anesthesia and facility/hospital fees, safety must always be the primary concern. Whether combining procedures is appropriate will depend on individual circumstances and the procedures sought. Discussion of these issues with your potential surgeon, as well as inquiry as to the safest method to achieve a desirable outcome for the surgical procedure that you might be considering is a must.

Keep in mind that a surgeon who gave your friend a fantastic facelift may not have experience in hair transplant, liposuction or breast augmentation. This is the biggest and most important fact finding information that patient’s need to realize and understand to avoid later regrets. There are a huge variety of cosmetic procedures. Most cosmetic surgeons are not experts in every cosmetic surgical procedure. Find out which cosmetic surgeon does more procedures of those that you are considering in having.

Discuss the various options regarding the manner in which to achieve your desired outcome. In most instances, there may be several techniques available to achieve improvements in your appearance. Your surgeon should be willing and able to provide and discuss various options with the understanding of what each option can potentially achieve, recovery time for each, and the surgeon’s corresponding recommendation and why he choose such option.

Find out the different anesthetic options for your chosen procedure and who will administer the anesthesia.

If you are to have surgery in a surgical facility, ask if the facility is accredited. Cosmetic surgery is performed in various locations such as hospitals, surgical centers/facilities and office settings. An accredited facility must meet certain minimal standards to obtain accreditation. Discuss with your surgeon where the contemplated surgery/procedure will be done and whether the facility is accredited.

Look at before and after photos of the surgeon’s results. Seeing photos of the procedures can be extremely important in your decision-making process. All results are not the same and many factors determine the final result of any aesthetic procedure. Looking at photos together with the surgeon can provide a valuable perspective on his/her work, and an opportunity to discuss what you hope to achieve. It will also give you a perspective of how realistic your expectations are and if you are in agreement with what constitutes a good result/outcome, and therefore realize whether your respective ideas and goals are in sync with that of the surgeon.

Make sure there is a certain comfort level and rapport with the surgeon. If you feel the doctor is not adequately addressing your concerns, you should consider another surgeon. A competent, reputable, well-versed surgeon should be more than happy to have a well-informed, well-researched patient; no question should go unanswered. Get a second opinion.

Need to be comfortable with the office and staff. It is important you are comfortable with the surgeon’s office staff as they will be an integral part of your cosmetic surgical experience. Are they responsive to your questions? Are they knowledgeable, and is there a free flow of information? Will they make you feel at ease contacting the office before, during and after surgery with any questions or concerns?

The doctor will go over what type of anesthetic should and can be used with you either at your first consultation or during your pre-surgical visit. Generally, many of the procedures performed can be performed under local anesthesia. However, there are several aspects of surgery which have to be taken into consideration; some of these include:

1) The patient’s desire to be awake or asleep
2) The length of the procedure and the area that is being operated on (i.e. accessibility of surgical site location)
3) Medical and dental condition of the patient
4) Behavioral management of the patient

All anesthetic options will be discussed since in several instances there is more than one option available. Fear, anxiety and inability of the patient to sit still by are generally considerations to anesthetize the patient completely

The following are the definitions of sedation & general anesthesia from the American Society of Anesthesiology (ASA), also adopted by the American Dental Association (ADA), and the American Dental Society of Anesthesiology (ADSA), and the Florida Board of Dentistry:

Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.

Moderate Sedation/Analgesia (“Conscious Sedation”) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Reflex withdrawal from a painful stimulus is NOT considered a purposeful response. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.

The Advanced Aesthetic Center for Oral and Maxillofacial Surgery (AACOMS) wants you to be informed before you have surgery in any surgical office. Here are some questions that will help you make the right decision if you are considering having an anesthetic other than local anesthesia.
The State of Florida requires that a dentist’s office be inspected and certified if they provide sedation or general anesthesia.
This is significant and very important for the same reasons as described in several of the questions above. It also means that the anesthesia provider has had the required amount of experience, with no adverse incidents.
The dental anesthesiologist/surgeon not only ensures that the most up to date equipment is available, but that it is functioning properly. The facility should have a minimum requirement the following equipment monitors: Blood pressure, heart rate, electrocardiogram (ECG/EKG), respiratory- breathing monitors (capnograph and precordial/pretracheal stethoscope) and temperature. Oral and maxillofacial surgeons and dental anesthesiologists have the most training with this advanced equipment.
The surgeon can ensure this, as well as a surgeon whose office has been inspected and accredited. Frequently, the medications and equipment are all maintained in a medical cart in one location in which it is easily mobilized.
The dental anesthesiologist and/or surgeon are responsible for overseeing the patient before, during and after surgery. His/her presence ensures that your recovery is as smooth of a process as possible and that you go home only when it is safe to do so.