Cosmetic Surgeon, Plastic Surgeon, and Credentials

Saturday, March 21st, 2015

A woman was found dead, lying on a massage table with bloody gauze on her buttocks inside a business that performs eyelash extensions in Dallas on February 19th. It appears that this woman had paid about $520 to have something injected into her buttocks as a buttock enlargement procedure. Exactly who injected exactly what is not clear at this point, but arrest warrants have been issued for Denise Ross, who goes by the name of Wee Wee, and her transgender companion Jimmy Joe Clarke, who goes by the name Alicia, for practicing medicine without a license (both are pictured above). This is such a tragic story, and unfortunately it's not all too uncommon. News reports keep popping up about people who have silicone injected directly into their buttocks or breasts, the procedure being performed by someone who may be in the area only for the weekend. Complications occur, and the injector has long-since vanished.

It is precisely because of tragedies like this that credentialing is so important. One type of credentialing is word of mouth. A friend or colleague went to this place or that place, had something done, was happy with the result, and she tells you about it or posts a positive review online. That type of credentialing can be very helpful and may (or may not) come from a trustworthy source. In medicine, another type of credentialing comes through certification by a Board recognized by the American Board of Medical Specialties (ABMS). This is an entity composed of 24 medical specialty Boards. The American Board of Plastic Surgery is one of the twenty-four. Doctors who are Board Certified by one of the 24 ABMS member Boards and who participate in the Maintenance of Certification program are part of a demanding process that repeatedly assesses and enhances their professionalism, judgement, medical knowledge, and clinical techniques.   ABMS and its member Boards establish lifelong learning standards that ensure physicians keep abreast of the latest practices and treatments.  Before becoming Board Certified by the American Board of Plastic Surgery, a candidate must have completed a plastic surgery training program at an accredited institution.  A list of those institutions reads like a Who's Who, including essentially every major university medical center you have ever heard of.  A surgeon cannot become Board Certified by the American Board of Plastic Surgery without completing training at one of these 100+ member institutions.

From time to time I'll Google some key words, like 'breast augmentation Fort Worth', just to see what pops up.  Occasionally I run across something unexpected, like a website of a surgeon that is new to the area, or at least new to me.  So, I'll look at the website and try to find out a bit about the doctor.  Who is he/she?  What type of practice is it?  Where did the doctor do his/her training?  What types of certification does he/she (I'll just use 'he' or 'his' from this point forward) have?  Sometimes the information is easy to find on the site.  Sometimes it's almost impossible.  As consumers we all want to know as much as possible about the products and services we buy.  With something as important, even 'intimate', as surgery, we have a right to know what qualifications a person who may be operating on us has.  One thing I've found as I've looked at these various websites is that a doctor who trained in plastic surgery will display that training proudly on the first page of the website and on his biography page.  It's not hidden in the website somewhere; you don't have to dig through pages of the site to find it.  A surgeon who is certified by the American Board of Plastic Surgery displays that information on page one.   On the other hand, another thing I see a lot on websites relates to doctors who say they are 'Cosmetic Surgeons'.  Frequently those sites look great.  Lots of animation on the site, lots of color, lots of pictures, even some nice testimonials.  All of this sounds and looks just great, and often these are very good doctors and surgeons.  Something that bothers me about many sites like this, however, is that it's often hard to find out the details.  What is the doctor's background, and where did he do his training? It may be surprising to learn that often these doctors originally did their training in something like family practice or radiology, then decided to start doing cosmetic surgery. In situations like that, it might be worth knowing how exactly the doctor got into doing particular procedures, for instance, liposuction or breast augmentation. Did he attend a weekend course and start doing it? On many of these types of websites that information just is not displayed. The websites look great, but the depth of content regarding training is lacking. And that, at least to me, raises questions.

I am not comparing these doctors to the unknown, non-physicians who inject unknown substances into people, similar to the situation mentioned at the beginning of this blog. To be a licensed physician in Texas, a doctor has to have undergone verified training and passed specific examinations. On the other hand a random person injecting unknown substances into buttocks in a nail salon...well let's just say his or her training is more suspect. What it really comes down to is this: credentialing matters. Word of mouth and positive online reviews are helpful. Board certification in Plastic Surgery or Cosmetic Surgery is, at least in my opinion, essential.

Plastic Surgery Board Certified

Wednesday, September 11th, 2013

Board certification in plastic surgery is not easy. To become Board certified a surgeon initially has to pass a written examination. If he (she) passes the written examination he is then asked to take an oral exam. Each of these exams typically has a failure rate of about 20%. Put another way, for each 100 surgeons going through the process, only 64 are successful the first time around. This failure rate is the highest among all the surgical specialties' certification processes, indicating that certification in plastic surgery may be the most difficult of all Boards.

After becoming certified, the plastic surgeon then has to submit information to the American Board of Plastic Surgery every two or three years indicating what scientific meetings he (or she) has attended, what types of cases he has performed, and even examples of the advertising he does. This year (2013), for instance, I had to submit a list of every case I performed from January 1st through June 30th to the Board (names of patients were removed). The information included how long each case took to perform, what hospital or surgery center was used, what complications (if any) took place, and the number codes used for each diagnosis and each procedure. That's pretty detailed information that other Boards often do not require.

It's a lot of work to obtain all the information requested by our Board. I'm proud of our Board, however, because they really do have our patients' best interests in mind. The American Board of Plastic Surgery wants to make sure that its members are practicing safe surgery, obtaining excellent outcomes, and are doing this in an ethical way. I have been Board Certified since 1996 and have never failed a Board exam. Maintaining certification in plastic surgery indicates a high level of commitment to our specialty, and ultimately to our patients. Make sure you visit with a surgeon certified by the American Board of Plastic Surgery. Certification matters.

To Smush or Not To Smush...are Mammograms Necessary?

Sunday, August 28th, 2011

As we approach Breast Cancer Awareness month (October), I think it's informative to assess mammogram issues.  In 2009 a government-sponsored study was reported by the US Preventive Services Task Force.  The outcome of this report was that mammograms are overused and really almost never needed until a woman reaches age 50.  The recommendation was that women not receive mammograms until they reach age 50, then they should decide whether they want to have them or not.  At most, according to this report, women should have mammograms every two years beginning at age 50.

That report was, and is, in stark contrast to recommendations by The American College of Obstetricians and Gynecologists, The American College of Radiology, and the American Cancer Society.  All of these groups recommend that women begin receiving mammograms at age 40, and that they continue having mammograms yearly after that.    For women in their 20's and 30's, clinical breast examinations should be performed every three years. (Here is an interesting link: ob-gyn-group-recommends-annual-mammograms-in-40s).

I work with a lot of breast cancer patients.  Many of them are in their 20's. I am not a statistician but rather just a practical practicing plastic surgeon.  Whether the government or a government-sponsored agency reports data, or whether a medical group reports data, there will probably be some hidden (or maybe not so hidden) bias.  To me it gets down to, who do you trust more, your government or your doctor?  Use common sense, be aware and be vigilant, and be your own strongest advocate.  Keep "abreast" of your health!

Plump up the volume!

Tuesday, July 12th, 2011

I have been doing some landscaping around my house.  This spring I put a great plant in my backyard, a Japanese aralia.  This plant has a tropical look to it.  In the summer heat, however, it quickly lets me know when it needs to be watered.  It wilts and looks a bit sickly.  With just a little water, however, it perks right back up.

How is this relevant?  It reminds me about people, about what really happens when we need water.  Our cells crave water.  The right amount of water allows all the cellular processes to take place normally.  Losing just a little bit of water causes cells to shrink and all the things in them to become more compacted.  The machinery just doesn't work the same.

We have had so many 100 degree days and so little rain here in North Texas this summer.   Just starting your car will cause you to work up a sweat.  It's easy to fall behind on your hydration.  By the time you become thirsty you have probably already lost 2% of your total body fluid.  Your best protection is to try to remember to drink water frequently through the day, rather than waiting until you become thirsty.  This will protect you and all of your cells, particularly through this heat.

Now, imagine yourself as that Japanese aralia.  Picture your skin as those drooping leaves.   Maybe the best thing you can do to maintain your normal, healthy appearance this summer is to keep hydrated. Moisturizers will help, but there really is no substitute for healthy, well-lubricated cells.  Don't wilt in this parched North Texas summer!

Texas safe!

Monday, July 4th, 2011

As the heat cranks up the deeper we go into summer here in North Texas, I am reminded of my first weekend on-call during my plastic surgery training. Entering the training program, I remember thinking that there probably wouldn't be too much need for a plastic surgeon in the emergency room, other than a few lacerations. That way of thinking changed quickly.

My pager went off (cell phones were in their infancy and few people had them) that first Saturday afternoon, and it was the University Hospital emergency room telling me about a patient. He was a young man, about 23, who had been on a boat with some friends. They were having fun, water skiing, having a few beers. As the day wound down and the last skier was climbing back into the boat, this young man did what anyone who skis has done many times. He started to pull the rope in. As he did that, he wrapped the rope around his upper arm and the 'V' between his thumb and index finger, going around and around. After he had done this wrap a few times the guy driving the boat, who incidentally had only had "a couple beers", punched the throttle forward. The boat lunged forward while a bunch of the ski rope was still dragging behind the boat. In an instant the entire rope jerked tight, snapping around the young man's upper arm and severing it. The entire arm was yanked off in the middle of the upper arm, and it fell into the water. Someone dove in after it, retrieved it, and somehow they managed to bring the man and his arm to the emergency room.

Let that scenario sink in for a second.

There are just so many things that we do that we take for granted. Water skiing and drinking beer? It almost seems like there is some sort of statute here in North Texas that says you can't go skiing without having a cold one around. Wrapping the ski rope as you pull it in? How else are you going to get the rope into the boat? This was another situation where everyone was having a good time but someone just didn't pay attention for a second. And that second meant the difference between a nice day versus losing an arm (we couldn't save the arm).

We have a severe drought in North Texas this year and the lakes are low. Tree stumps lurk close to, but below, the lake surfaces. Be careful if you're out on the lakes in the next two months. Take that extra second or two to be aware, to be safe. And remember, if you're the one driving the boat, you shouldn't be drinking cocktails (or beer!).

By the way, the same is true with fireworks. Some day maybe I'll write about my experience with those from a plastic surgeon's perspective.

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