July 13, 2008 – Careful research yields best results By Michal R. Abramowitz Barry Hirshfield once weighed 600 pounds. In 1998, he decided enough was enough, so he went under the knife to have bariatric surgery to shed the obesity. The operation was a success. After patiently waiting a year for the fat content in his body to disappear, he needed plastic surgery to rid the flaps of skin on his stomach that still overhung from the weight-loss procedure. This was not unusual, considering that Hirshfield had dropped 420 pounds, to weigh in at a svelte 180. But in November 1999, Hirshfield, then 48, of Coconut Creek, went to a Fort Lauderdale plastic surgeon, based on a referral from his gastric doctor. Hirshfield wanted his stomach flattened and contoured. “I realized I was never going to look like Arnold Schwarzenegger, but I did have some expectations,” he said. Hirshfield had the surgery and went home from the hospital. That night, despite being warned by his surgeon not to do so, Hirshfield bent over to pick up something. He felt a pop in his stomach. That pop served as a prologue to a tidal wave of problems, Hirshfield said, including staph infection, massive leakage from the incision, intense pain, and a botched follow-up procedure. Last year, desperate for help, Hirshfield went to Dr. Jason Pozner, a Boca Raton plastic surgeon, to find a solution. It would take two surgeries – one major, and a second touch-up procedure in which Pozner removed a substantial amount of scar tissue. Hirshfield repeatedly credits Pozner for saving him from the abyss of plastic surgery gone bad. All told, Hirshfield spent more than $15,000 on his plastic surgeries. While Hirshfield’s situation is extreme, patients need to understand that they need to do their homework when shopping for a plastic surgeon. After all, plastic surgery is a surgical procedure, even if the insurance companies classify it as merely cosmetic. “You should not shop like it’s a pair of shoes,” cautioned Dr. Rod Rohrick, chairman of plastic surgery at the University of Texas Southwestern, In Dallas. “You have only one face.” Any doctor can perform plastic surgery, but only those who are board-certified plastic surgeons – certified by the American Association of Plastic Surgeons – have had full training in all aspects of it. What makes matters confusing is that doctors who are not trained as plastic surgeons can legally form a board and claim they are board certified as cosmetic surgeons. “A doctor could be an internist and call themselves a plastic surgeon,” said Dr. Michelle Copeland, an assistant professor of the School of Surgery at Mt. Siani Scholl of Medicine in New York, and author of Change Your Looks, Change Your Life. With any doctor or medical professional able to run an advertisement in the paper, it’s critical to shop around and not go with the cheapest price you find. “When people get their stomach stapled, they think like they are going in for a shoe shine or for their clothes hemmed,” said Hirshfield. “But it’s much more than that – it’s major surgery.” Plastic surgeons are divided on whether patients should allow other doctors, such as dermatologists, ear-nose-throat specialists, and dentists who have specialized training in certain procedures, to perform plastic surgery. Some say its fine, as long as the doctors stick to their specialty. For example, an ENT should not perform liposuction, but a rhinoplasty (nose job) makes sense. Other plastic surgeons worry that some specialists might not have enough training to treat a patient, should a major problem occur. For example, a dermatologist typically does not have the proper training to treat you should if you go into shock. “Anyone who says they are an expert on the skin and says that qualifies them as a plastic surgeon is really missing the beat,” said Dr. Louis Villar, a Stuart plastic surgeon. Anyone with a medical background can legally perform plastic surgery in his or her own office. Worried about the dangers that legal loophole creates, plastic surgeons strongly encourage patients to make sure that their doctor is admitted as a staff member to a fully accredited hospital for the specific procedure he or she will perform on you. If a doctor is admitted to a hospital for that procedure, he or she is board certified to perform that particular plastic surgery. After Hirshfield had enough with his original doctor, he learned a valuable lesson in choosing a plastic surgeon. “Oh, boy!” he said. “Make sure the doctor has worked before on your specific problem.” How to find a plastic surgeon Dr. Louis Villar, a board-certified plastic surgeon in Stuart offers these tips:
- Look for training. Talk to two to three surgeons. Find out which one has the best training – which one went to the best medical school and internship program.
- Personality is important. When you interview a doctor, does he or she speak to you in a manner you understand? Typically, avoid doctors who act pompous. If they are personable, they usually are not in the business just to make money.
- Check for hands-on work. Make sure you know that your doctor will do his or her own sutures and postoperative care. If the doctor delegates the work to purses because of high volume or multiple operating rooms, watch out. “It’s perfectly legal, but you are likely not getting quality care,” Villar said.
- Find out how the doctor handles patients after surgery. “After you pay $14,000, does he blame mistakes on the patients?” Villar said, “Will he take out his own stitches? Will he redo his own procedure if you are not satisfied?”
- Find out the surgeon’s malpractice history. Doctors who have multiple malpractice lawsuits will often swear they did nothing wrong. Check with the Office of Insurance Regulation and the Florida Department of Health at https://www.floridahealth.gov/ to find out a doctor’s track record.
- Get a second and third opinion. Get several opinions on whether the surgery is truly necessary. “If a surgeon doesn’t want you to get a second opinion, that is a really bad sign,” Villar said.
