Membership in a professional society means that a surgeon has agreed to maintain certain professional standards. Many physicians belong to one and sometimes to several societies. Even though the AMA is the most well known physician organization, specialists tend to be more active in societies devoted to their field of interest. Although professional organization names may be confusing or the information overwhelming, there really is a simple rule to follow when evaluating society memberships of a cosmetic surgeon: Place the most value on a surgeon’s membership in professional organizations that require a certification by an ABMS-recognized Board that makes sense for the body part and the procedure that you are considering.
Plastic Surgeons
The ASPS is the largest plastic surgery specialty organization in the world, with more than 5,000 member surgeons, and represents 94 percent of the board-certified plastic surgeons in the United States and Canada. Membership requires board certification by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons in Canada; regular participation in continuing education activities; maintenance of a strict code of ethics; and agreement by the surgeon to perform all surgeries requiring anything more than minor local anesthesia in an accredited, licensed, or Medicareapproved facility. Plastic surgeons may also belong to the ASAPS, which has similar membership requirements. Because these wellestablished organizations now require their members to operate in accredited facilities, a surgeon’s membership in one or both of them implies that he or she is committed to a higher standard of care.
Other Cosmetic Surgeons
Cosmetic surgeons from backgrounds other than plastic surgery may belong to one of the following professional organizations:
American Academy of Ophthalmology
American Society of Ophthalmic Plastic Surgery
American Academy of Otolaryngology—Head and Neck Surgery
American Academy of Dermatology
American Society for Dermatologic Surgery
American Academy of Facial Plastic and Reconstructive Surgery
American Society for Maxillofacial Surgeons
American Association of Oral and Maxillofacial Surgeons
American College of Surgeons
More information about cosmetic surgeon professional organizations can be found on their Web sites .
Hospital Privileges
Even if a surgeon has an offi ce-based operating room, anyone doing major cosmetic surgery will have some patients that need to be in a hospital. Find out where the surgeon has privileges to do surgery. Be concerned about a physician who does not have privileges in any hospital in your area, especially a surgeon who does not have surgical privileges. This may mean that the physician does not qualify for privileges, wants to avoid peer review, or has had problems and has chosen or been forced to leave a hospital staff. Any of these circumstances should make you think twice about picking that surgeon.
Some physicians do not carry liability insurance, which makes them ineligible for staff membership at most if not all hospitals. In any case, it bears repeating that a physician who has no admitting privileges at any hospital is not subject to the peer-review structure that helps identify and control bad doctors.
Experience
As in all of medicine, but particularly for surgery, your surgeon’s degree of experience is the best predictor of a good result. What if you don’t know which of several options is best for you or even if surgery is the best choice? Look for a surgeon who has a broad practice and is also experienced with both surgical and less invasive cosmetic procedures. It is perfectly acceptable to ask a surgeon directly how many of a partic ular operation he or she has performed. Also inquire about experience when evaluating providers of nonsurgical cosmetic medicine. Keep your antennae up when listening to the answers. Use common sense. If you were to develop a complication, you could fi nd yourself facing a serious medical problem that warrants no less attention than any other medical problem. You want to pick a provider who has the experience to manage complications appropriately.
References
Assuming that you have identified the cosmetic providers in your community who have satisfactory qualifications and experience doing the procedure you are considering, your best next step in choosing a physician is to seek out references from multiple sources.
Other Physicians
One of the best sources of information about a surgeon is another surgeon who has actually worked in the operating room with the provider you are considering. Because someone like that may not be available to you, ask your family physician or other physicians you know for a recommendation. Many cosmetic surgeons do other kinds of surgery as well, and your family doctor may have some insight into the surgeon’s abilities through mutual patients. Likewise, avail yourself of any opportunity to ask the physicians you know about the reputation of anyone you are considering to perform a nonsurgical procedure.
Previous or Current Patients
If you know or can arrange to meet someone who has been treated by the physician you are considering, you will get a lot of information about that physician. It helps to have more than one reference in case you happen to meet someone who seems excessively unhappy or even excessively happy with her result. The physician may be able to provide you with the names of patients who would be willing to talk to you about their experience, so ask about this at your consultation. Naturally, these will be happy patients selected by the doctor, but that does not mean that they cannot share a lot of helpful information and answer many of your questions. A few words of warning here since you will likely get a firsthand look at someone else’s result: everyone’s circumstances are unique, and your outcome cannot be fairly predicted based on that of another patient.
Friends and Family Members
Even though it is possible that no one you know personally has had a cosmetic procedure, you should still be able to find people who have experience with at least some of the cosmetic providers in your community.
Directories
You can find many lists of cosmetic surgeons and other providers, and they tend to fall into two categories: professional medical organization lists and commercial lists. The former can be obtained from the organizations (see Resources) and are generally more informative because they automatically tell you if a physician is a member of those organizations, that is, an ABMS- approved Board or a professional society that requires ABMS- approved board certifi cation. Commercial lists include listings in a telephone book, most referral services, “physician finders,” and many lists on the Internet. Physicians often buy these listings; there may not be any partic ular requirements as to credentials, and the lists give you no reliable information about quality of care.
Advertisements
In most markets, both good and bad cosmetic providers advertise. The occasional experienced, well-regarded surgeon may be so busy that advertising is unnecessary. By the same token, the physician who does little cosmetic work may decline to advertise for practical economic reasons. Therefore, you should never choose a provider based on the existence or lack of advertising alone. However, feel free to avoid a practitioner who puts out tasteless or obviously misleading ads. Likewise, beware of a clinic that sends out cosmetic surgery patients to display and market its services. For example, a Florida businessman, who compared his cosmetic surgery clinic to a used car lot, reported paying women who had undergone breast augmentation a 20 percent to 25 percent commission on new “sales,” often captured after a “show-and-tell” session.
THE CONSULTATION
Whose Agenda Is It Anyway?
Let’s face it: Doctors who perform cosmetic procedures want to sell them to you. That part of the consultation is not about your health: It is about the health of their businesses. The first meeting between a potential patient and a cosmetic medical provider is the setting for the sales pitch. Both parties are motivated to close the sale and, as a result, neither the patient nor the physician cares to dwell too much on the negatives. The fact that most cosmetic procedures are performed in an office or spa environment reinforces the idea that the procedures carry little risk. Dr. Goldwyn, in The Patient and the Plastic Surgeon, put it well: “If the office and the demeanor of the doctor and staff resemble more closely a beauty parlor than a medical facility, the patient will conclude that no ‘real operations’ with real risk are being done here.” One can substitute the more contemporary term “spa” for “beauty parlor” and easily see his point. Dr. Goldwyn goes on to point out that the surgeon “whose image is that of a highly skilled cosmetician may be surprised that patients do not consider him or her a ‘real doctor.’ ” That many patients continue to have this impression of cosmetic surgeons has been amply demonstrated in recent surveys, confirming suspicions that the public does not hold cosmetic surgeons to the same standards of knowledge or overall capability as it does other physicians. Glossy photo albums in the doctor’s waiting room showing nothing but amazing results (and by whom? you might ask) contribute to the red-carpet, fairy-tale ambiance. When you go to your consultation, arrive prepared with a written list of questions. This will allow you to listen to the doctor without worrying that you will forget to ask something. You may meet the physician only once before having surgery, and minimally invasive procedures are often performed during the first visit. If you are considering a more extensive procedure, you want to leave your consultation feeling confident that you have been given enough information and having a good sense of the doctor’s ability to meet your needs. Good physicians will go out of their way to try to provide patients with comprehensive information and will strive for the ultimate good result, a happy patient. These physicians will not try to convince patients to have more done than they need or to choose the one and only procedure (which the doctor personally invented) that will work for them. A patient should avoid a surgeon who makes her feel like an operation waiting to happen.
Consultation Fee
Some cosmetic providers give free consultations. Others charge a fee but may apply it to the cost of treatment or surgery. You should ask in advance; if there is a consultation fee, expect to pay it at the time of your first visit. Most offices take credit cards. History and Physical
The history and physical evaluation of a patient before a cosmetic procedure is usually quite focused on the partic ular concern for which the patient has made the appointment. But because psychological concerns can play a critical role in determining the patient’s eventual satisfaction with the outcome, obtaining a good history is an important challenge for providers. Physicians may not ask the right questions and patients may not volunteer helpful information. Patients should try to be honest and resist the temptation to give the “right” answer to questions in order to be perceived as a “good” patient. Practically every person seeking a cosmetic procedure has some degree of fantasy about the outcome, and these thoughts do not in themselves mean that person should be rejected as a candidate. On the other hand, patients cannot help bringing their personal value systems into the equation, and even though they assume that a physician would put a patient’s interests first, they should not assume that every physician shares their values.
Certain body parts—breasts, noses, and penises—are more symbolically loaded than others, and for some patients surgical alteration of these parts can be dramatically rewarding or psychologically damaging. A patient’s motivations, desires, fears, and expectations need to be identified and communicated to the doctor. Physicians know that you are more likely to be satisfied if you want a facelift so that you can look younger and compete in the job market than if you want a facelift so that you can feel more youthfully energetic or get a younger boyfriend.
Most cosmetic medical patients are healthy and their medical histories short, but be wary of a physician who does not request a thorough history. If your health history is extensive, write down the details at home, including the names of your other physicians, and bring the list with you. Especially important is any history of the following:
• Current medications: prescription medicines, vitamins, overthe- counter medications, occasional medications, inhalers, topicals, eye drops, nutritional supplements, and herbals • Use of steroids within the past year
• Current or recent (within six months) use of Accutane or topical retinoids
• Drug allergies, intolerances (including to pain medications), and reactions
• Latex allergy
• Allergies to foods, tape, dyes, iodine, or other substances
• Use of tobacco, alcohol, or recreational drugs
• Psychological problems, psychiatric treatment, or counseling for any reason
Your physical examination will include body areas pertinent to your symptoms and proposed surgery. Photographs may be taken. Some physicians use patient photographs for marketing purposes and are required to obtain your consent before doing so. Although you may be reluctant at first to have photographs taken, they can be extremely helpful to both you and your physician should you later have concerns about the results of your procedure.
Discussion
In conjunction with your exam the physician will ask about your goals and explain your options. If your goals are not realistic, now is the time to find out. At this point you should learn about risks, potential complications, and the anticipated long- term results of the procedure. You should be made aware of what specifi c characteristics you have that may affect your outcome, such as your current body part shape, your age, your medical conditions, and the condition of your skin. A thorough physician will point out existing asymmetries, as not all asymmetries can be entirely eliminated. If you are to have surgery, the surgeon will emphasize the extent of scarring that you can expect. You will learn what type of anesthesia your surgeon recommends, your options as to the facility at which the surgery will be performed, and your financial obligations. You and the surgeon (plus your spouse or parent, if present) should discuss these issues until you feel that your concerns are understood and that you are fully informed.
Do not be shy about getting the information that you need. When discussing cosmetic procedures, remember that you are hearing the “Botox talk” or “facelift talk” that the physician has given dozens of times, whereas you probably are listening nervously to it for the fi rst time. Physicians do not always pick up subtle clues that a patient does not understand some aspect of a proposed treatment. You should be concerned if the physician downplays or does not discuss any risks. If you have done some advance research, you will know if you are not getting the straight story. If you are not ready to make a decision, go home, think about it, and do more reading. Some physicians, especially surgeons, use computer imaging during consultations. Keep this fun technology in proper perspective. The computer is rearranging electrons, not human tissue. Computer images can be helpful educational tools but are at best an example or approximation of what your results might look like. Other doctors may show photographs of previous patients. Looking at pictures of other patients’ results is very dicey, in my opinion. Assuming that they are legitimate, they only demonstrate what was possible for that partic ular patient, which may have little to do with you.
Whereas some physicians rely on office staff, videos, or brochures to convey information to prospective patients, you should be sure that you are still given a face- to-face opportunity to ask questions of the doctor. You obviously cannot develop a comfort level with a physician if you do not spend time talking to him or her. Be wary if the doctor or the staff seem to be giving you a sales pitch for procedures other than what you came for. For the same reason, take note if your consultation is monitored or recorded. You may be told that this is for documentation or training purposes, but it may also mean that you are getting an extra sales pitch with your consultation. It should be a red flag if you feel rushed during the consultation. Some doctors view every minute the patient spends in the offi ce as an expense. You don’t want to feel like just another “case” on the schedule.
A consultation has been successful if at its conclusion you can answer at least the following questions:
• Is there a medical or surgical solution to my concern?
• What are the options?
• What are the risks associated with each option?
• Am I at any increased risk compared with a typical patient?
• How much benefit am I likely to achieve with the proposed treatment, and how likely is it that I will see no benefit?
• Where will the treatment/procedure be performed? Is the facility accredited?
• What kind of anesthesia will I have?
• How long does the treatment take and how much pain is involved?
• What complications could I have and how would they be treated?
• How long will the effects of treatment last?
• Will the treatment have to be repeated? How frequently?
• What will I look like after surgery?
• How much time will I need to be off work, and how much help will I need?
• How long will it be before I can resume all normal activities, play sports, wear makeup?
• Is this a good time for me to be undergoing this operation?
• How much does the procedure cost, including the expense of repeated treatments? Can I finance the expense?
• What is my financial risk if I have a complication? Should I purchase complications insurance?
The ASPS also recommends that you ask these additional questions of a surgeon:
• Are you an ASPS member surgeon?
• Are you certified by the American Board of Plastic Surgery?
• Do you have hospital privileges to perform this procedure? If so, at which hospitals?
• How many procedures of this type have you performed?
I recommend that you ask similar questions of anyone that you are considering to perform any procedure on you.
Decision Making
Decision making should come only after research and education, and if you did not research your options before your consultation, you should do it now.
Are you prepared to accept a complication? The greater the magnitude or risks of a procedure, the more time you owe yourself before making decisions about the physician and the procedure. Just as important, you need to have sufficient information about the circumstances under which the procedure will be performed (see page 149, Facility, Staff, and Anesthesia). Find out how available the physician will be after your procedure and how you can reach him or her if need be. Avoid the temptation to schedule surgery tomorrow just because the doctor had a cancellation.
An interesting and largely unresolved question regarding the relationship between a patient and a cosmetic provider is how much the physician’s opinion should enter into the patient’s decision as to whether to undergo a procedure. I am not referring to the physician’s technical opinion: Clearly, a physician should do only what can reasonably be expected to produce the desired physical change. (An unscrupulous practitioner, however, may not abide by even those constraints.) By opinion I am referring to the physician’s professional and personal judgment as to the wisdom of performing a partic ular procedure on a particular patient. Into this area of decision making comes a degree of psychological analysis (for which most physicians are not particularly well trained) and a measure of personal prejudice. Physicians must, if they are to do their jobs well, make some assessment of a patient’s motivations and psychological health. The teasing out of motivations requires a degree of time, patience, and skill that not all providers possess. On the other hand, a prospective patient might feel that questions designed to elicit motivations are intrusive and unnecessary. Experienced physicians know, however, that one of the biggest reasons for patient dissatisfaction after a cosmetic procedure is a discrepancy between expectations and results, even if the results are considered by the physician to be good. For this reason, a little extra time and care taken at this juncture can be invaluable.
Sometimes someone who is obsessive about cosmetic surgery shows up on a reality television show, and it is scary to watch a surgeon allow himself or herself to be talked into performing yet another operation, often with significant risks, on a patient who clearly could use a psychiatrist more than another procedure. These episodes remind me of time I spent in the late 1970s on the plastic surgery service at a well-known New York City hospital. One of the most memorable patients was a longtime customer of one of the attending physicians. This time she was requesting another in a series of forehead lifts and cheek enhancements for perceived irregularities in these areas. All I could see was a middle- aged woman who looked like a squirrel because her cheeks were strangely full, and her hairline, after so many forehead lifts, was on top of her head. I thought that she was more than a little unbalanced, but what was most disturbing was that the surgeon was agreeing to perform the new surgery she was requesting.
Financial Obligations
Even though price should not be the reason you choose a physician, it pays to do a little price shopping. Price matters because it can give you clues about your provider. Prices well below the average are a warning sign: You are likely to get only what you pay for and maybe more than you bargained for. Prices well above the average are suspicious also: This is someone who is willing to charge whatever the market will bear. Nobody is that much better than every other qualified provider, no matter what they say.
You may decide to pay for your treatment with cash or a credit card, and financing plans are available, most through outside companies. Because cosmetic medical care is always prepaid, you need to find out what happens to your money or how much you will owe the financing company if you cancel or reschedule, especially late in the game. You should also find out what penalties may accrue if you fail to meet the payment schedule.
It is important to clarify exactly what is included in a treatment package. For example, fees for surgery usually include follow-up care within a certain time frame. Find out how long that period is. Later “touch-up” procedures or treatment of complications may not be covered by the fee or by your regular health insurance. Look into this. Procedures such as laser treatments and injections may be sold in packages of multiple treatments that are discounted over the cost of the same number of individual treatments. Find out if there is a refund policy—it will probably be a partial refund for unused treatments. If you purchase a package that permits unlimited treatments within a time frame, think and calculate carefully before buying. Many types of treatment should be spaced out over a certain period of time in order to maximize benefit, so you may not get your money’s worth in an “all-you-can-eat” arrangement, especially if personal issues prevent you from keeping all of your appointments. The effects of some treatments last longer for some patients than for others. You may put yourself at a disadvantage if you purchase, let’s say, a year of hair removal laser treatments as opposed to a package of three or four that you can undergo whenever it is convenient. Total costs to you will include the procedure charge, possibly a separate facility charge, a fee for the services of an anesthesiologist if applicable, and in some cases a charge for the recovery facility. You may also be charged for drugs and wound- care supplies. In rare cases a patient may have a condition that is usually considered a cosmetic issue, but for whatever reason, treatment is partially or entirely eligible for insurance coverage. In this situation it is usually best to obtain advance confirmation of insurance coverage in writing through the standard preauthorization process. If you choose a surgeon who does not carry liability insurance and who is not on staff at any hospital, you may in effect remove yourself from eligibility for insurance coverage for that partic ular treatment.
Coverage of Complications Treatment
Most cosmetic medical patients will not develop a complication that requires hospitalization, but it does happen. Many health insurance plans do not pay for the treatment of complications that are the result of cosmetic interventions. In addition, most surgeons will not accept financial responsibility for hospital costs associated with the treatment of complications. In some cases medical responsibility for your care may be transferred to other physicians.
If you develop a complication, your physician may not waive fees for treating it, depending on the circumstances. These additional fees could be considerable, especially if you have to be hospitalized or undergo further surgery. You should discuss with the surgeon in advance how any complications will be handled fi nancially. Some surgeons provide patients with information from companies who offer complications insurance, or you can research that option on your own. Typically, this type of insurance covers treatment of medical complications related to a cosmetic procedure only if the patient requires more surgery or hospitalization. It generally will not cover the cost of extra doctor visits or more surgery performed to treat a patient’s dissatisfaction with an outcome.
Informed Consent
If you decide to proceed with a cosmetic medical treatment, you will be asked to sign an informed consent document. Before signing, make sure that you truly are informed; that is, the physician has explained and you understand the reasoning for the proposed treatment, the nature of the procedure, the risks, the benefi ts, and any alternatives. Informed consent is one of most difficult aspects of the contract between a physician and a patient; neither may feel entirely satisfied with the pro cess despite considerable effort. Physicians do not always do a good job of informing patients of the potential outcomes of the procedures and of the pain involved. On the other hand, it is widely known that patients retain very little of what they are told during a consultation; if asked later, they will often deny having heard certain information (despite documentation to the contrary) and many times will claim they learned about a subject from an entirely different source.
Doctor greets patient, who has come in for a laser hair removal consultation. Patient:“I liked your ad on television.” Doctor:“Maybe you heard our radio ad. We have never advertised on tele vi sion.” Patient:“No, it wasn’t on the radio. It was definitely on TV.” Doctor:“Oh, well, maybe you saw an ad for Dr. So and So.” Patient:“No, it was definitely you and it was defi nitely on television.” Informed consent is the cornerstone of good medical care, and nowhere is this more important than in the arena of purely elective cosmetic medicine. Obtaining informed consent is a professional, ethical, and legal obligation of physicians. However, patients must understand that by obtaining informed consent the physician has not guaranteed a partic ular result.
Some facilities, in line with accreditation rules, require that informed consent documents be signed within a certain time period before surgery, so you may not be asked to sign your consent form at the initial consultation. Nonetheless, be sure that you get the information that you need before you give consent.
FACILITY, STAFF, AND ANESTHESIA
If you decide to have a procedure, you want assurances that you will be cared for in a safe environment by well-trained professionals. One of the most important things you need to know is where the procedure will be performed and under what conditions, especially if you are to receive drugs. Your facility options may include a hospital, an outpatient surgery center, or an office surgery suite. Lesser procedures may be performed in an office, exam room, or medical spa treatment room.
Your provider may be employed by a facility or may have a fi nancial stake in it. If you go to a spa to get a facial, it probably doesn’t matter if the landlord is a cosmetician, a stockbroker, or a boardcertified plastic surgeon. However, prospective patients should keep in mind that venture capitalists may not have quality of care as their first priority. Some entrepreneurs operate retail facilities that are very cleverly designed to look “medical”—the front office may have official looking charts in a rack and the employees may wear hospital scrubs or lab coats—but no one present has any medical training. Do not let convenience prevent you from investigating your options as you move from cosmetics to procedures. If you are to undergo a medical or surgical procedure, whether it be an injection, laser treatment, or surgery, it needs to be performed or directly supervised by a qualified physician in an appropriate medical environment.
Any major surgical procedure, which includes any procedures with significant risks, should be performed in a facility that meets at least one of the three following criteria: accreditation by a national or state- recognized accrediting agency/or ga ni za tion such as the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, or the Joint Commission on Accreditation of Healthcare Organizations; (2) certification to participate in the Medicare program under Title XVIII; (3) licensure by the state in which the facility operates. These requirements ensure that numerous safety measures are in place, including the availability of properly trained staff and adequate equipment to monitor you appropriately and to deal with complications or emergency situations. If your surgeon cannot provide you with this information about a facility, you can ask for a contact number so that you can make your own inquiries. You can also find out about a facility’s accreditation status by contacting accreditation organizations directly (see Resources). Not all states require accreditation of office and outpatient surgery suites, and some facilities do not want to pay the substantial costs associated with the accreditation process. However, many facilities fi nd it advantageous for insurance and public relations reasons to seek accreditation voluntarily. In addition to ascertaining facility accreditation, find out who will be administering your anesthesia or sedation. Anesthesia should be administered by skilled, licensed personnel acting under the direction of an anesthesiologist or the operating surgeon, and most professional organizations recommend that you avoid the situation where the surgeon is responsible for administering general anesthesia without a licensed certified registered nurse anesthetist or anesthesiologist present. You can check an anesthesiologist’s or a nurse anesthetist’s license status through your state medical board and his or her certification status through the Web site for the American Board of Anesthesiology or the American Association of Nurse Anesthetists.
Ask about the qualifications and number of medical personnel who will be in the operating suite during surgery. You should be assured that you will receive individual monitoring by skilled, licensed individuals who are trained in advanced cardiac life support. If the facility does not have overnight capabilities, there must be a transfer plan for patients who are not ready to go home by the end of the day. If the facility does have twenty-four-hour capabilities and there is a possibility that you will be kept overnight, you should expect to receive around-the-clock care and monitoring by two or more skilled and licensed staff members, at least one of whom is trained in advanced cardiac life support. Again, there must be a transfer plan in case you require hospitalization.
If you have a significant medical condition such as heart or breathing problems, you should have your surgery performed in a hospital so that appropriate resources are available to treat any problems that may arise.
The two major plastic surgery professional organizations most concerned with cosmetic surgery have adopted strict policies regarding the performance of office-based surgery. Both the ASPS and the ASAPS require their members to perform all but minor procedures that do not require more than local anesthesia only in accredited facilities. The ASPS and the American College of Surgeons have worked together to develop safety standards for offices. These standards can be viewed on their Web sites.
If you are considering undergoing any kind of medical procedure in a spa, be sure that a physician will be on-site, will participate in your evaluation, and will be able to perform or directly supervise the performance of the procedure. Only the simplest procedures should be delegated to a nonphysician and only then under good supervision. These are common-sense rules that will protect you even when inadequate state regulations do not. It won’t do you much good to choose the toniest spa in town if you develop a problem after a treatment and the doctor is nowhere to be found because he stops in only once a month. In the end, you must be satisfied with your answer to the question, Why should I submit to the care of a provider who is making a profit from unsafe and or illegal practices when there are so many well- trained and ethical providers and safe facilities from which to choose?
RECORD KEEPING
Physicians are expected to keep rec ords of patients and their treatments, but they do not have to keep those records forever. I recommend that everyone keep personal records of their medical care, especially of surgeries. You can ask your surgeon to provide you with a copy of the operative report from your surgery (you have a legal right to it) or you can keep your own notes.
Tags: American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Ophthalmology, American Academy of Otolaryngology—Head and Neck Surgery, American Association of Oral and Maxillofacial Surgeons, American College of Surgeons, American Society for Dermatologic Surgery, American Society of Ophthalmic Plastic Surgery, cosmetic surgeons, Hospital Privileges, Plastic Surgeons