Doctors who practice awake breast augmentation utilize a numbing fluid called a tumescent solution, which is composed of lidocaine, an anesthetic, and epinephrine, which controls bleeding, to numb the operative area.  Patients, who remain awake throughout the procedure, can actively communicate with their surgeons while undergoing the operation.  Advocates of awake breast augmentation argue its safety because of its avoidance of general anesthetic, but as Yale School of Medicine reported, the overuse of tumescent anesthetic can result in seizures and irregular heartbeats.  Moreover, as a recent article in The New York Times pointed out, this surgery is frequently performed in offices that have not been vetted by an accrediting organization while breast augmentation that requires general anesthetic or IV sedation is generally performed in accredited hospitals and surgical centers.

In addition, awake breast augmentation is riddled with other unnecessary complications that can and should be avoided.  In fact, the risks are intrinsically linked to the training—or lack thereof—that doctors receive to perform this kind of surgery.  Generally, physicians who have neither trained as plastic surgeons nor been certified by The American Board of Plastic Surgery (ABPS) participate in a two-day seminar to learn how to perform this type of breast enlargement surgery.  Only a few of these hours focus specifically on the kinds of challenges that may arise during awake procedures as well as on how to analyze patients’ needs and to choose the most appropriately sized implants for them.  A woman who chooses an implant that is too large may suffer a visible rippling effect in her breasts, but those who perform awake procedures are many times unskilled in providing patients appropriate guidance and counsel about the best size implant to select.

“Plastic surgery weds the medical and the aesthetic, and must therefore strike a careful balance between science and art,” says Dr. Stevens.  “Circumventing education and certification in favor of performing quick-fix surgery is no solution to what requires careful analysis and considerate technique to both achieve optimal outcomes and to safeguard the patient’s well-being–before, during and after surgery.”

As you begin your search for a plastic surgeon, here a few helpful suggestions:

• As I discussed in my last post about what to look for in a plastic surgeon, seek care from only surgeons who are certified by the American Board of Plastic Surgery (ABPS)
• Be certain the surgeon is also a member of the American Society of Plastic Surgeons (ASPS) and the certificate is displayed at his/her office. This certificate verifies they are a member of ASPS, the largest plastic surgery society in the world. The organization not only mandates its surgeons to be trained in both general and specialized techniques, but they must also keep abreast of current trends and practices in the field
• Seek care from surgeons who have several years of surgical experience, including in plastic surgery. While your surgeon may be highly reputed for excellence in specific techniques, the doctor should be trained in all aspects of plastic surgery including breast, body, face and even reconstructive procedures
• Critical evidence of any plastic surgeon’s commitment to ethics is his/her willingness to practice only at medical facilities accredited by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), the Accreditation Association for Ambulatory Health Care (AAAHC) or the Joint Commission on Accreditation of Health Care Organizations (JCAHO)
• Verify that the facility the surgeon practices at is licensed by the state in which it operates

It is also helpful to remember that while many health care providers now list plastic surgery procedures among their suite of skills, not all are truly qualified.

If you have any questions about choosing a plastic surgeon that I may not have listed above, you may post a comment below. You may also follow me on Twitter @DrLeslieStevens or Facebook for updates.

Given this anticipated upswing, I can’t say enough how critical it is for individuals to find a surgeon who is highly skilled.

Your care should be in the hands of those whose reputation precedes them. People who understand the best cosmetic surgery – those who couple safety with good outcomes – will hold their surgeons to the most stringent of standards.

The next time you are looking for a plastic surgeon, I want you to take confidence in knowing that the ASPS has developed a careful and thorough list of the training the physician in whose hands you place your beauty.

Here are five qualifications you should look for:

(1) Possess, at minimum, six years of surgical training and practice, at least three of which should be specifically in cosmetic surgery;

(2) Demonstrate knowledge in all plastic surgery procedures of the face and Body as evidence of a thorough understanding of human anatomy and surgical aesthetics;

(3) Practice only in an accredited medical facility;

(4) Maintain the highest of ethics and standards to guarantee patients’ safety; and

(5) Be certified by the American Board of Plastic Surgery (ABPS).

Another tip you can use to determine if a plastic surgeon is qualified is by seeking reliable sources. This includes not only speaking with past patients with whom your physician may be able to put you in contact, but also conducting an Internet search on the doctor you have selected.  And be certain not to forget one of the most valuable resources at your disposal—yourself!  Gather information about your doctor’s academic and professional training by asking  questions during your consultation so you can be as comfortable with the decision you make.

If you have any questions about choosing a plastic surgeon, you may post a comment below. You may also reach me on Twitter @DrLeslieStevens or Facebook.

Dermatologists and plastic surgeons learn to inject Botox and fillers as part of their formal residency training programs and inject-ables are an essential part of a cosmetic practice.

However, on the other hand, gynecologists and other doctors, do not get formal training in injecting fillers, and do not learn any facial anatomy during residency. So why are many people running to these professionals for their fillers? Most start injecting fillers once they are already in practice and have not had any supervision in injection techniques. This can make for a scary cocktail of disaster.

Immediate Past President of the American Society for Dermatologic Surgery, Dr. Jeffrey S. Dover warns, “Patients need to be vigilant about having an experienced, board-certified dermatologist or plastic surgeon directly overseeing their injections. You can greatly minimize the chance of complications, or worse, by doing some research.”

Choose the wrong, unqualified doctor to administer your injections and you run the risk of:

• Bleeding
• Bruising
• Infection at the injection site
• Itching
• Migration of filler material away from the original site
• Necrosis (skin death)
• Redness
• Skin rash
• Skin sensitivity
• Swelling
• Temporary numbness
• Temporary paralysis of facial muscles
• Under- or over-correction of wrinkles

Want more information or have additional questions? Contact me to set up a consultation to learn more about filler injections.