People are exposed to ambient solar ultraviolet (UV) radiation throughout their daily routines, both intentionally and unintentionally. Cumulative and excessive exposure to UV radiation is the primary behavioral cause of skin cancers, skin damage, premature skin aging, and sun-related eye disorders. In the United States alone, more than one million new cases of skin cancer were diagnosed this year.
UV radiation can reach the skin from all directions, as it is diffusely scattered by various environmental and atmospheric conditions. Even when a person is situated under a covering, such as the roof of a car or house, they are not completely protected from the sun’s rays. As shade structures do not effectively protect against UV radiation, there have been significant advancements in the photoprotection of glass through the development of specially designed photoprotective windows and films.
Low-emittance (low-E) coatings, which are microscopically thin, virtually invisible metal or metallic oxide layers deposited on window or skylight glazing surfaces, reduce the U-factor by suppressing radiative heat flow and limiting UV radiation. The exclusive Thermaflect coating utilizes the most advanced, double-layer soft coat technology to deliver top performance for UV protection and prevent heat loss in homes. This product blocks 87% of UV radiation and has an Energy Star certification in all climate zones.
Tints and films have also been an essential advancement in glass photoprotection, particularly in automobiles. High-quality window film products are high-tech laminates of polyester and metallized coatings bonded by distortion-free adhesives. The International Window Film Association provides members with accreditation in solar control films, safety films, and automotive films to increase consumer awareness and demand for professionally installed film window products. The Skin Cancer Foundation has also played a leadership role in certifying window films that limit UV transmission, with the Panorama Designer and Safety Films currently recommended for UV photoprotection.
Given these innovative scientific and industrial advances in window and film photoprotective products, the study recommends their use in all residential, commercial, and school facilities to provide photoprotection and reduce the risk of skin cancer.
To learn about non-invasive and minimally invasive ways to reverse sun damage and rejuvenate your skin, please see our award-winning services, ranked the best in Orange County, California, at BioSpa and Pacific Center for Plastic Surgery. Dr. Nichter and his team are dedicated to helping patients achieve healthier, more youthful-looking skin through the latest advancements in skin care and plastic surgery techniques.
Citation:
Edlich RF, Winters KL, Cox MJ, Becker DG, Horowitz JH, Nichter LS, Britt LD, Long WB, Edlic EC. Use of UV-protective windows and window films to aid in the prevention of skin cancer. J Long Term Eff Med Implants. 2004;14(5):415-30. doi: 10.1615/jlongtermeffmedimplants.v14.i5.70. PMID: 15479155.
MiraDry Sweat Reduction is a non-invasive, FDA approved technology which reduces underarm sweat through the use of an electromagnetic energy source to target the sweat glands. During the procedure, the doctor uses local anesthesia to numb the area to be treated and then places a temporary tattoo with square diagrams on the skin to mark the area. The doctor places the treatment device on each of the treatment squares so the energy waves move through the skin and dermis to hit the fat and bounce back. The energy waves collide with each other, creating heat at the fat and dermal junction. This destroys the eccrine and apocrine sweat glands as well as the hair follicles within the dermis. The skin itself remains undamaged because it is simultaneously being cooled through the device.
Am I A Candidate for MiraDry Sweat Reduction?
The ideal candidate for MiraDry Sweat Reduction is anyone who suffers from excess sweat or odor in the underarm area that comes from eccrine glands that cause wetness and apocrine glands causes bacteria that creates odors. People who can greatly benefit from this procedure includes firemen, military personnel, and police officers due to the fact that they must wear heavy uniforms in the heat.
Botox has also been used in sweat reduction treatment but it is only effective on eccrine glands and the results will not be as great if both sweat glands are not treated. A patient also needs to be treated twice per year with Botox to maintain the results at $1,000 per treatment, or $2000 total. MiraDry typically requires one treatment in a lifetime and the cost is between $2,000–$2,500.
MiraDry is also good for patients who want to reduce their amount of underarm hair. Although it can benefit patients of various hair colors, it is most useful on patients with light colored hair. For a woman with light hair, it might take two or three treatments to remove all the underarm hair. In general, this procedure is ideal for a woman looking to have less sweat, less odor and less hair.
Recovery and Downtime of MiraDry Sweat Reduction
The procedure is really a minor one so most patients can drive themselves home after their appointment. Although the downtime and recovery is minimal with this procedure, everyone heals in their own way. Some patients may require a little more recovery while others are playing golf two days later. Either way, a patient should expect some swelling and soreness for two or three weeks. Over the counter medications can be used to treat any discomfort. Some patients may experience a little numbness around the treated area that could last up to twelve weeks.
Results of MiraDry Sweat Reduction
Since the body has no way of regenerating the glands that are destroyed during the MiraDry procedure, this procedure is permanent for around 80% of patients. The other 20% will have a significant improvement but will need to have a second procedure to gain their ideal results by taking care of the sweat glands which were left untreated. This 20% of patients will attain lasting results as well with the second procedure.
MiraDry Sweat Reduction will not make the underarm area look or feel too dry. There will still be some moisture so that the underarm feels normal to the patient. However, the dripping is alleviated and there are no sweat stains to worry about.
Limitations and Risks of MiraDry Sweat Reduction
Even though a person might suffer from sweaty hands or other sweaty areas, MiraDry Sweat Reduction is limited to the armpit area. There are too many risks of nerve damage when using MiraDry in other areas of the body due to the nerves being close to the surface of the skin.
During the earliest MiraDry Sweat Reduction procedures, only small amounts of local anesthesia were injected. This small amount caused incredibly thin patients to experience temporary nerve weakness as well as pain and discomfort. As the procedure developed and improved over time, a tumescent technique similar to the technique used during liposuction was adopted and greatly reduced the risk of pain and nerve weakness
Sweating Elsewhere in the Body
Dr. Larry Nichter
MiraDry Sweat Reduction has been used by doctors on patients in over 55,000 treatments all over the world. It’s important to note that humans are born with almost 2-million sweat glands located throughout the body. The underarm area only contains around 2% of the 2-million sweat glands in the body. Even though this procedure helps patients achieve relief by giving them dry underarms, they will continue to perspire as normally as before elsewhere in the body.
Written by Cosmetic Town Editorial Team -SP
Based in an exclusive interview with Larry Nichter, MD in Newport Beach
Hitting newsstands today and Monday is an interesting article featuring Dr. Nichter and his patient, written by Joel Stein for Time Magazine, discussing the evolution of cosmetic surgery and it’s undeniable relevance in today’s world. The article titled “Nip. Tuck. Or Else” points out how thanks in part to social media we are now on the red carpet 24/7 posting pictures of ourselves on Facebook, Instagram, SnapChat, Vine, and more, so it’s imperative to look our best at all times. The social media frenzy is one reason why there has been a spike in the number of non-invasive procedures performed on the younger demographic. It can certainly be said that no longer are cosmetic procedures just for the aging population.
Here is the full article – Nip. Tuck. Or Else.”
by Joel Stein
You’re going to have to do it. And not all that long from now. Probably not a full-on, general-anesthesia bone shaving or muscle slicing.
But almost definitely some injections into your face. Very likely a session of fat melting in some areas and then possibly moving it to some other parts that could use plumping. Not because you hate yourself, fear aging or are vain. You’re going to get a cosmetic procedure for the same reason you wear makeup: because every other woman is.
No, it’s not fair that–in 2015, with a woman leading the race for the Democratic nomination for President–in addition to dieting, coloring your hair, applying makeup and working out, you now have to let some doctor push syringes in your cheeks just to look presentable. It’s not fair that you have to put your surgery on your credit card just so the other moms on the playground don’t overestimate your age. It’s not fair that you may risk your life going under general anesthesia just to keep up.
Then again, maybe it’s not fair that some women are born straight-nosed and full-breasted. That some people don’t have trouble staying thin. That workers with above-average looks will make $230,000 more over their lifetime than people who are in the aesthetic bottom seventh, as a study by University of Texas economics professor Daniel Hamermesh found. Maybe it doesn’t feel fair that a man is writing about this, even if more and more males are starting to feel the same kind of pressure that women have dealt with for decades.
“It’s becoming harder and harder to say no without being read as irrational or crazy,” says Abigail Brooks, the director of women’s studies at Providence College, who recently completed research comparing women who undergo antiaging interventions and those whom she calls “natural agers.” The former group described the latter using phrases like “let herself go” and “not taking good care of herself.” Brooks worries that that pressure is not only exhausting but also keeps women forever 21 emotionally. Continue reading “Dr. Larry Nichter featured in Time Magazine’s Article “Nip. Tuck. Or Else.””→
As you age, skin cells lose their ability to make collagen and progressively die off rather than reproducing themselves (“DNA programmed cell death with age”).The Sciton Laser Platform allows multiple laser types and wavelengths to achieve both dramatic improvements of your skin but also maintaining its youthful appearance by reversing this process.
Here are some of the incredible treatment options available:
Forever Young BBL (Broad Band Light) Optimally delivers and visible light of many wavelengths to the epidermis and dermis. This increases the lifespan and ability of skin cells to produce more collagen and elasticity similar to a more youthful cell by making changes at the DNA level. A Stanford University Groundbreaking Research Study, the first of its kind , demonstrated that BBL treatments can restore gene expression pattern of aged human skin to resemble young skin. Results: Over 1,000 gene expressions became “rejuvenated” to be more like youthful skin resulting in more elasticity and more uniform collagen deposition; leading to improvements in fine wrinkles and pigmentation. – This increases the lifespan and ability of skin cells to produce more collagen and elasticity similar to a more youthful cell by making changes at the DNA level. Clinically the skin looks and feels smoother and more youthful.
In addition to the BBL using the SkinTyte settings also Optimally delivers Infrared and visible light to the epidermis and dermis. Infrared light is used to heat the dermal collagen which responds by becomes thicker. This in turn reduces wrinkles and causes skin firming. Typically a series of treatments weeks apart give the best results and maintained with yearly treatments. The best news is that there is no down time and easily tolerated with by itself or with topical anesthetics.
Additional filters and adapters allow selection of specific frequencies of the broad band light to treat specific problem areas. For example the smaller wavelengths are great for acne, vascular and pigmented spots like broken capillaries and red spots, rosacea, sun and age spots where some of the longer wavelengths can be used for darker skin types. A built in special temperature controlled Thermoelectric cooling at the treatment area decreases discomfort greatly
Skin Tightening with Sciton® SkinTyte
SkinTyte is the newest Sciton laser technology to tighten and firm skin without downtime.
Common conditions that benefit from this therapy include:
Sagging skin face jowls
Smile lines
Sagging skin on the neck, arms, abdomen, legs, and knee
SkinTyte is safe for all skin types and can be performed on any area of the body.
Frequently Asked Questions About Skin Tightening Laser Treatment
The Sciton SkinTyte system tightens the skin in the following manner:
The Sciton SkinTyte system delivers infrared light deep into the dermis. The heat from the special light:
Causes the collagen and elastic fibers to shrink and thicken. This process stimulates the deeper tissues to remodel collagen. The remodeled collagen responds by filling in wrinkles and restoring elasticity to sagging skin.
The powerful cooling system maintains the outer surface of the skin at cool temperatures before, during, and after each pulse making the treatment comfortable and safe with no downtime. The SkinTyte technology can be applied anywhere on loose skin, from your face to your legs. The best results come in the face and neck area, especially the:
Cheeks
Jowls
Nasolabial folds
SkinTyte laser treatment can also help tighten and improve the appearance of loose skin on the:
Arms
Breasts
Abdomen
Knees
It has proven beneficial in post pregnancy or after significant weight loss.
The Sciton SkinTyte system technology is FDA-approved and documented to be safer and more comfortable than the bulk heating approach of other systems because it is highly selective and more advanced in targeting collagen and elastic fibers in your loose skin.
Patients experience mild redness in the treated area immediately after treatment. This will last only a short time.
SkinTyte: Since the SkinTyte procedure is noninvasive, you can resume your normal activities immediately following treatment. There will be minimal discomfort during the SkinTyte laser procedure and topical anesthetics and local cooling will minimize any discomfort. The Sciton BBL hand piece has a large cooling sapphire crystal that keeps the skin cool and protects against discomfort. In addition, a range of energy and adjustments can be made to your comfort. The more energy you can tolerate, the better the results will be. During your treatment, there will be heat applied specifically to the dermal skin layer and you may feel a slight sunburn effect. Immediately afterwards, a tight feeling may be noticeable but no significant discomfort will be felt.
The SkinTyte system is the most advanced tissue tightening device available on the market today. A tightening effect will be visible immediately and skin will continue to firm throughout the month. A series of three to five treatments at four to six week intervals will deliver the most noticeable results of smoother, tighter skin. Improvements in the skin’s elasticity will continue over the next six months.
The Sciton MicroLaserPeel focuses on removing a thin layer of damaged skin to improve texture and provide a more youthful appearance. Being a laser it provides superior results by controlling precisely the depth of the laser. The procedure is performed our office and is custom tailored to your specific skin conditions and desired outcome with minimum down time.
Here is a synopsis of the procedure: The MicroLaserPeel’s beam is scanned over a treatment area to remove a very thin layer of the problematic skin. Removing the top layer eliminates some of the damaged cells that can give skin a tired, aged look. As the skin heals, fresh cells grow and resurface the treated area. This results in a healthier appearing skin, with reduced fine wrinkles and improved texture with color evenness. From tired looking skin to vibrant is the expected outcome. Depending on the depth of treatment the recovery time is usually 3-4 days (“week end peel”).
The following conditions can be treated with MicroLaserPeel:
Mild wrinkles
Scars
Keratosis (scaling lesions)
Sun damage (e.g. sun/age spots, freckles)
Pigment irregularities (dyschromias)
Most skin areas can be treated with the face, neck, chest and back of the hands most commonly treated. Your laser specialist will determine. under our Plastic Surgeon’s protocol, the best treatment choice and schedule for you to look your best. Both improvement and maintenance of your results will be discussed. These procedures can also be coupled with filler injections or Botox/Dysport if required or desired to complement your non-surgical rejuvenation.
The Surgeons at Pacific Center for Plastic Surgery have combined efforts and created a medically based program for patients to look their best. Although many dermatologist are trained in ways to keep your skin looking the best it can, Plastic Surgeons have the unique ability to know the limitations of skin care and offer aesthetic surgical correction as needed to complement the improved texture, tone and color blending that skin care affords.
At Pacific Center for Plastic Surgery, we have developed a medical skin care program called BioSpa. BioSpa has the highest trained and experienced plastic surgeons, nurses, and medical aestheticians. Doctors Larry S. Nichter, MD, FACS and Jed H. Horowitz, MD, FACS are the medical directors of this program. Strict guidelines for care using physician approved protocols are crucial to providing efficacious and safe treatment outcomes. Our goal is to provide medical grade skin care in a spa setting in a safe manner with results not obtainable by non-medical aestheticians.
We are committed to becoming the gold standard exceeding patients’ expectations whenever possible. Our care and treatments are to be contrasted with the multitude of skin care programs that are not directly supervised by a Plastic Surgeon or Dermatologist and cannot use the prescription-strength products, injections, or lasers that we utilize. We work in concert with these centers rather than compete with them, and often refer our clients back to them for routine maintenance care such as facials or microdermabrasion.
When should an Aesthetician refer to a Medical Aesthetician working with Plastic Surgeons and Aesthetic Nurses?
Aestheticians and Medical Aestheticians need to work hand-in-hand to develop a successful skin care program. Each offers different levels of services. Identification of those conditions requiring advanced services or medical products are key to the success of this program.
Clients with the following conditions should be referred to a medical aesthetician:
Hyperpigmentation and irregular pigmentation, age spots
Acne and its complications – e.g. scarring, hyperpigmentation, and large pores
Rosacea
Rhytides (Wrinkles) treatment
Patients with medical conditions such as Diabetes, Exzema, history of cold sore, shingles, psoriasis, rosacea, or steroid use
Scar Management
Previous chemical peel or laser treatment
Severe sun damage (actinic changes of the skin)
Plateau of results by conventional spa services requiring more aggressive medical based protocols
Patients with a history of Skin Cancer or pre-cancers ( e.g. Actinic Keratosis, pigmented sores, or scaling lesions)
The following constitutes some of the treatment tools restricted to Medical Aestheticians:
All products consisting of skin care lotions, ointments, liquids, substances, creams, powders, preparations, tonics, antiseptics, and other skin care items and products which the manufacturers or distributors will make available only to a physician or to persons who are working under the guidance of a physician as to their proper use. For example these include all products within the Obagi and / or Biomedic lines, as well as retinoids (e.g. RetinA), antiviral agents, 4% or greater hydroquinones, TCA, etc.
Medical procedures and use of medical equipment which must take place by physician protocol and/or oversight:
Depth of Treatment as solo procedure with a non medical machine based on a more thorough treatment determined by number of passes or time per area; any procedure which requires recovery time because of redness (erythema).
Medical Grade Machine, e.g., limited distribution to medical professionals, options for increased power settings, or medication delivery systems.
Treatment of Patients with Medical Problems Acne, Roseacea, scars, stretch marks, non-uniform pigmentation (dyschromias), history of skin cancer, herpes, diabetes, hepatitis, HIV, previous laser or chemical peel prescription, etc.
Non-medical grade microdermabrasion coupled with other treatments, e.g., glycolic, TCA, lactic acid or Jessner Peel, 4% hydroquinone, Oxymist, Dermaplaning, Micro Peel, Cryotherapy, etc.
Chemical exfoliation (peels) within the scope of a cosmetologist’s license and affecting non-living tissue only, including Blue Peel, TCA peels and medical grade glycolic peels.
Dermaplaning living tissue only per protocol.
Laser treatments such Permanent Laser Hair reduction, IPL (photofacial) laser, vascular lasers (for broken capillaries or veins and red spots), color and scar improvement, and lasers for facial resurfacing.
All injectibles such as Jeuvederm, Restylane, Sculptra, Radiesse, Voluma, Botox, lipoinjection (fat transfer). Surgical procedures.
Best Scar Management is important to minimize or completely hide from view, the telltale signs of your surgery—namely, scars. Both you and your surgeon want you to have the most minimal scarring possible. There are many possible causes for scars that are enlarged or not healing well. Unsightly scars are most commonly due to genetics, underlying medical conditions, or improper scar/wound care. The last part is very important and patients can make a noticeable difference in their scars’ appearance by following best scar management practices. Here are some simple tips.
Scar Management tips:
Minimize tension on the scar. Steri-Strips and/or surgical tape are often placed in non-hair bearing areas at the time of surgery to minimize tension and keep pressure over the scar. This minimizes the stress that can pull the scar apart (dehiscence) creating a wound and delaying healing time, and can make the scar wider, or more “ropy”. In the first few weeks after surgery, I recommend the use of Embrace Scar Therapy which is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar.
Keep your incision site/scar clean to prevent infection. Follow your surgeon’s wound care instructions to the letter with out modification. Never apply different products then recommended without first discussing them with your surgeon. This is especially important during the first few weeks. If there are any signs of infection, contact your surgeon’s office right away and/or see your doctor or his nurse immediately. Typical signs of infection may include redness outside the immediate incision site, asymmetric swelling, and drainage, of pus, fever, chills, and “feeling sick”.
Protect your scars from the sun. Staying out of the sun is the best advice. Minimal exposure to sunlight is prevents hyperpigmentation (permanently turning brown) and other problems that can make the scar more noticeable. Sunscreen, at least 30 SPF and an overlying make camouflage make up additionally protects the scar from the suns harmful rays. This advice is especially important the first year following your surgery.
Use specific scar maturation products recommended by your surgeon. Patients seem to have their own opinions on this touting everything from Pure Vit E, Coco butter, to Aloe Vera, etc but most have minimal benefit other than keeping the scar hydrated. Although hydration is important there are better, scientifically studied products with greater efficacy. Most of the scientific articles written about this subject indicate that topical silicone gel or silicone sheets work the best. The best product available in my opinion is the Embrace Scar Therapy System by Neodyne BioSciences, Inc. available in many surgeons’ offices. Essentially this is an adherent silicone sheeting pre-stretched when applied so as to offload tension on the scar. For areas that are not applicable for this product (e.g. smaller areas or on the face), I prefer BioCorneum or Kelo-Cote products There are a lot of products to choose from, but silicone should be one of the key ingredients. Although Mederma, an onion extract derivative active ingredient rather than mainly silicone based may help, primarily silicone based products are better and many also contain other ingredients that may be synergistic (hydrocortisone or other steroid, Vitamin E, Sunscreen, etc).. If the reader has problems obtaining these they can call my office. Patient compliance is also critical – use often and according to directions or it will not work optimally. NEVER apply products without first discussing them with your surgeon.
Monitor to make sure your scar is progressing optimally. Keep your scheduled follow-up appointments with your surgeon to verify that your scars are maturing as expected. Occasionally if indicated you may need a topical steroid preparation or even a series of injections (5-FU and/or Steroids) or laser treatments to treat or prevent scar hypertrophy or keloid formation (red raised scars), or other topical medicines to treat post inflammatory hyperpigmentation (brown scars) with prescription creams and possible laser treatments.
The most critical decision to be made in achieving the best plastic surgical result is picking the most experienced and talented, that is the best, plastic surgeon possible. Too often, patients choose a physician based on a catchy ad, the brand name of a technique, the basis of one or two before and after photos, or their web site’s search engine ranking. These criteria will not find the most experienced and talented plastic surgeon.
My Background
Dr. Larry Nichter
I have been a practicing plastic surgeon for more than 25 years, having trained scores of plastic surgeons as a tenured professor of plastic surgery at USC, and I have had a private practice in Orange County since 1993. Speaking from all this experience, here is my advice and the criteria I would use to find the best plastic surgeon in Orange County, Los Angeles, California, or anywhere in the United States. These are the criteria I would use to select a plastic surgeon for my friends, my family, or myself.
First, I want to stress some general observations I have found to be true over the years.
Caveat Emptor: Buyer Beware
The longer a surgeon trains at his craft, the finer his skills and the better his judgment become. Board certification in Plastic Surgery (see below) is a bare minimum. Board certification in an additional surgical field recognized by the American Board of Medical Specialties, or for that matter “triple-board certified,” attests to a doctor’s advanced training and skill and judgment. It also means that they have attained Chief Resident Status in more than one field during their training which means they essentially ran a large departmental service and had senior decision-making and independent operating responsibilities. It is this step that is most maturing for a surgeon.
The institution where the surgeon trained is also important. More renowned schools usually attract the best faculty.
You can use the internet to research the background of a prospective plastic surgeon quickly. Please do this prior to making an appointment. “Just because you wear a baseball cap it doesn’t mean you are a good ball player.” The same applies to anyone wearing a white coat—it doesn’t make you a plastic surgeon, much less a great one.
Caveat Emptor in Latin means “Buyer Beware.” In most states, including California, any physician with a medical school diploma and state license is viewed as a doctor and a surgeon—even without any formal surgical training. In some cases even doctors who have completed only the minimal requirements (medical school, licensing examination, and a one-year internship that need not include surgical training) are touting themselves as “cosmetic surgical experts.” They make these claims of expertise despite the fact that they are only formally trained as family practitioners, OB/Gyns, emergency physicians, dermatologists, or ear-nose-throat specialists. Even physician assistants and nurses have made such claims.
7-Step Process for Finding the Best Plastic Surgeon
The following are my screening guidelines and criteria for picking the best plastic/cosmetic surgeon.
1. Board Certified Plastic Surgeon by the American Board of Plastic Surgery
To become a plastic surgeon certified by the American Board of Plastic Surgery requires a minimum of five years of surgical training with a minimum of two years of training specifically in plastic surgery. Then the applicant must also pass a comprehensive written board exam. If successful, the candidate must present his/her clinical cases for critical review by board examiners (I was one such board examiner) and if accepted will take a series of oral examinations.
Since the 1990s, the American Board of Plastic Surgery Certification is only valid for ten years. To retain your board certified status, a plastic surgeon must complete a Maintenance of Certification including written testing and case review. This means that all who pass are trained and experienced in all plastic surgery procedures including facial procedures, breast, and body; essentially all cosmetic and reconstructive procedures.
If a Plastic Surgeon is additionally board certified by another surgical specialty recognized the American Board of Medical Specialties, then this also marks additional expertise and training at the highest level. The American Board of Facial Plastic Surgery (ABFRS) is not a licensing body nor an educational institution and the certificates it issues are not legal licenses to practice facial plastic and reconstructive surgery. The ABFRS is not recognized by the American Board of Medical Specialties (although it does note additional specialty training/interest in facial aesthetic surgery).
Likewise, beware of physicians armed only with certification from other non-ABMS recognized boards or special society memberships other than those I have recommended (eg. “Cosmetic Surgery Board,” “Lipoplasty Society of North America,” etc.).
2. Fellow of the American College of Surgeons: FACS
The American College of Surgeons is dedicated to improving the care of the patient and to safeguarding standards of care in an optimal and ethical practice environment. Members of the American College of Surgeons are referred to as “Fellows.” The letters FACS (Fellow, American College of Surgeons) after a surgeon’s name mean that the surgeon’s education and training, professional qualifications, surgical competence, and ethical conduct have passed a rigorous evaluation, and have been found to be consistent with the high standards established and demanded by the College.
To be a member you have to:
be board certified in a surgical specialty recognized by the American Board of Medical Specialties
be in practice in one location for a number of years, with a background check, nomination, and interviews which verify that you are an ethical and safe surgeon among other criteria.
Hint: Look for the “FACS” (or “FRCS,” see below) after the “MD” in a doctor’s title or in his/her Curriculum Vitae to see if he/she is a “real surgeon.”
Note for patients in Canada: The equivalent of FACS in Canada is the Royal College of Physicians and Surgeons of Canada, FRCS.
3. Member of the American Society of Plastic Surgeons (ASPS)
The American Society of Plastic Surgeons is the largest organization of plastic surgeons in the United States and one of the largest in the world. ASPS members are uniquely qualified because of the society’s membership requirements:
Members of the American Society of Plastic Surgeons must be Board Certified by The American Board of Plastic Surgery complete at least 5 years of surgical training with a minimum of 2 years of training specifically in plastic surgery. The more years of Plastic Surgical Training the better – this includes fellowships in a plastic surgical field.
American Society of Plastic Surgeons members are required to adhere to a strict code of ethics and must fulfill rigorous Continuing Medical Education (CME) requirements including patient safety issues.
Beware of physicians without this membership but belonging only to similar-sounding societies as their claim to excellence eg. “American Society of Cosmetic Surgery,” “Lipoplasty Society of North America,” etc.
4. Member of the American Society for Aesthetic Plastic Surgery (ASAPS)
This is the most elite society in the United States and perhaps the world for Aesthetic Plastic Surgery. To be a member means that your career is focused in cosmetic surgery at the highest level. Among the requirements for invitation and election to ASAPS membership, a plastic surgeon must:
Be certified by the American Board of Plastic Surgery (or in plastic surgery by the Royal College of Physicians and Surgeons of Canada);
Be in at least the third year of active practice following board certification;
Participate in accredited Continuing Medical Education (CME) to stay current with developments in the field of cosmetic plastic surgery and patient safety;
Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate wide experience;
Be sponsored by two ASAPS-member plastic surgeons to help ensure that the applicant’s professional reputation meets the high standards required by ASAPS;
Adhere to current ethical standards for professional conduct as outlined in the Code of Ethics observed by all ASAPS-member surgeons;
Operate in accredited surgical facilities; and
Be elected by at least 80% of the Active Membership.
5. Hospital privileges to perform the same type of surgery
Hospitals often examine qualifications of doctors applying for hospital staff privileges and restrict privileges to only surgeons best trained and qualified to do certain procedures. For example, in order for surgeons to be granted plastic surgery privileges in most hospitals in Orange County, California, that surgeon must have completed plastic surgery residency training and must be board-eligible or -certified in plastic surgery to be allowed to perform plastic surgical operations in that hospital.
Non-surgeons and other physicians that are not plastic surgeons circumvent this process by performing surgery in their offices or in outpatient surgery centers where the credentialing process is less rigorous or nonexistent. In these settings non-plastic surgeons perform procedures in which they have no formal residency training.
I am not warning against use of outpatient surgery centers or in-office procedures. I am only recommending that you check that your physician has hospital privileges for these same procedures.
6. Surgical Experience in the procedure you are having
Few patients ask how long doctors have been doing a certain procedure or how many they have performed. When you consult with a plastic surgeon:
Ask to see typical “before and after” photos;
discuss the details of the procedure in a manner that is clear to you;
review benefits and potential complications;
get full answers to your questions.
7. Evidence of Excellence, Experience and Commitment to the field of Plastic Surgery
Here are some additional criteria to look for in your plastic surgeon.
Surgical Board Certification in more than one field
Plastic Surgical Fellowships in addition to Plastic Surgical Residency.
Number of years practicing.
Peer Review Honors in their own board certification from groups such as Best Doctors, Top Doctors, Super Doctors.
Current or Prior position denoting excellence in the field or high regard by their peers such as:
Prior or present Professor or Faculty affiliation with a University Plastic surgical program (the higher the rank the better)
Chairman of a Department of plastic surgery at a regional hospital
Honors from surgical societies of which they are members such as Board Examiner, etc.
Published Plastic Surgical papers in peer review journals are also a good sign that they are committed to being on top of their field.
Feel Comfortable with your choice
It is very important that after you have done this screening and met with your potential surgeon that you feel confident in your choice.
Complications are not common in cosmetic surgery, but if one did occur are you confident that this surgeon would take charge and handle just about any problem?
Do you feel that he listens to you and communicates well by answering your questions completely, doesn’t rush you in to a decision but rather makes you part of the decision-making process? You should truly feel that it is a combined effort.
Does the surgeon’s office run smoothly? Do the staff take good care of you? If you answered in the affirmative and have gotten this far in your screening guidelines then I think you have found your “Dr. Right.”
