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BLEPHAROPLASTY 101

Topic 6 - 1
Eyelid Surgeons Are
Not All The Same - Part 1
blepharoplasty definitions   oculoplastic surgeon


plastic surgeons

"Plastic surgeons are always making mountains out of molehills."
-- Dolly Parton


Over the last decade, the number of plastic and specialty cosmetic surgeons offering aesthetic eyelid surgery has approached exponential growth. In many cities, there now exists a clear oversupply of doctors offering to perform blepharoplasty. Competition between surgeons has grown intense, and some have succumbed to the temptation to "exaggerate" credentials, experience, and results.

medical exaggertion

So, what sort of distinguishing features should you be looking for when searching for a blepharoplasty surgeon? Armani silk sports coat? Versace wool pants? Three hundred dollar haircut? While those answers are obviously incorrect, much of what some potential patients consider to be important is nearly as frivolous.

When applied to large groups, the bell curve below desmonstrates the statistical distribution of many variables, in this case, expertise.

bell curve

While we trust this will not shock you, not every cosmetic surgeon is an expert, especially when it comes to performing delicate surgery around the eyes. And when it comes to more advanced eyelid procedures or revision surgery, the majority of general plastic surgeons have a rather meager experience.

Just because you've seen photos of great results from a dedicated super-specialist, don't expect a similar outcome from a novice getting started or even a long-established practitioner who only dabbles in the field. As with any discipline in life, there are wide quality differences between practitioners, and only a few will ever practice at the top of their fields.

With the growth of the Internet and social media, it has become harder, not easier (as discussed later in this section), to determine which surgeons rank truly among the best. Following is a list of points to consider as you go about your search:


Three Most Important Criteria

The tree most important criteria when selecting an expert surgeon are:

blepharoplasty surgeon

1. Experience,
2. Experience,
3. Experience.

If a surgeon performs blepharoplasty a few times a month in between tummy tucks or LASIK operations, that isn't much in the way of experience. If a surgeon performs cosmetic eyelid surgery three, four, or ten times a week, week in and week out, year in and year out, that is experience.

Ask any expert: Innate talent, high intelligence, and completion of a top-notch training program are not the same things and do not provide the wisdom gained from years of hands-on treatment and decision-making on lots and lots of patients with routine to extremely complex needs. In every line of human endeavor, it takes real time and practice to even be able to recognize (let alone, understand) the nuances of any challenge and then more time yet to become accomplished enough to actually act upon this insight.

Experience alone, however, is not enough to create a top specialist. If it were, the world's oldest practicing surgeon would automatically be its best. Plus, the experience mentioned above needs to consist of "quality" work rather than just one bad operation after another.

So what about age? Airline pilots are required to retire at age 65, while surgeons can operate for as long as they like (and more than a few seem to like it far longer than they should). At a certain point, age becomes an increasingly negative factor, first trumping experience and then overwhelming it (i.e., diminishing cognitive attention, fine motor skills, reaction times, stamina, sharp vision, etc.). How old is too old? While that loaded question has no one set answer, here's a reasoned take on the subject from NPR.

Still, for the layman not in a position to evaluate a surgeon's knowledge and skill through interrogation or direct observation, a history of substantial experience remains a most reliable distinguishing trait.

Now, here are some secondary factors to consider, grouped roughly in terms of their value.


WASTE OF TIME
(if not counter-productive)

While a few doctors are superb, most are average and some are clearly sub-par. Using the methods below, however, are not very good ways to sort them out:


Commercial directories

If you've been spammed by mail-order directories of doctors' names entitled something like "Best Plastic Surgeons in the Universe," understand that most such publications are basically schemes by marketing companies to generate income for themselves and their participants.

Despite official-sounding titles, the selection process used in most is very limited. Some of the listed doctors may be excellent, while others are simply willing to "buy" their way in. It's like on the web. There are a zillion online directories entitled something like "Best Plastic Surgeons--Find Them Here for Only $29!" Would you fall for this? Probably not. So why think a version printed is fundamentally any different?


Location

Is a surgeon from, say, Beverly Hills necessarily better than a surgeon from, say, Fresno? Real estate agents marketing office space in high-rent districts are interested only in the financial solvency of a potential client and not at all with his or her surgical outcomes. While any doctor with a checkbook can sign a lease (sometimes shared with ten others) for luxury office space in Manhattan, the only thing you can be absolutely sure of when visiting his exclusive address is that his business overhead is much higher than that of his peers and you are the one who will be paying for it.


Prices

Are higher prices a sign of a better surgeon? Discussed in more detail here, the important thing to know is the short answer: No. Are lower prices a sign of a less talented surgeon? That depends on how low you're talking about. If it's 10% less, no. If it's a third or a half lower than the going price in your area, something may be out of kilter. Comparing prices, however, can be tricky because there are more variables to consider that you might now imagine, as explained in later chapters.


Television

Looking to Oprah or Dr. Phil for help in finding the perfect surgeon? Nearly any doctor with a cell phone, plenty of spare time, and the willingness to make himself freely available to the media can secure a sound byte on the afternoon talk show circuit or the evening news. Interestingly, most are fairly new in practice and many employ a publicist. Busy experts tend to prefer their operating rooms to a television studio.


Magazines

Surely you've run across the home pages of surgeon websites decorated by a colorful slew of glitzy magazine logos. How do you suppose all of these publications' lay editors managed to find the same doctor's name? And are the two sentence quotes tucked deep inside these articles written for fashionistas really so impressive? If seeing a surgeon's name in print is important to you, you'll do better to consult a professional resource like PubMed.


Social media

For now, suffice it to say that user-generated reviews and comments posted on the "Wild West" marketing platform known as the Internet have been shown time and again to be notoriously unreliable. You can read much more about plastic surgery social media in just a few pages.


MINIMALLY HELPFUL


While only marginally important, these factors may help you discover your prospective surgeon's real interests:


Advertising

Advertising (newspaper, Internet, radio) has, like it or not, become the norm in cosmetic surgery. As long as such marketing is undertaken in an ethical fashion, there is nothing wrong with it and it may help a consumer sort through so many choices. Unfortunately, adversting tends to present the most superficial possible view on a subject, and once you scratch the surface, you may be in for a surprise.

Beware, however, of doctors who make unsubstantiated grandiose claims about being "world renowned," exaggerate about "teaching other doctors," and so on. Ads to promote name recognition and availability are standard business practice, while ads intended to deceive or talk you into something are not.

No practitioner can rightfully crown himself "America's Plastic Surgery Expert" or the "Ultimate Blepharoplasty Surgeon" because there are no professional organizations that bestow (or even sell) such unprovable superlative titles. Doing so is a breach of the American Society of Plastic Surgeons Code of Ethics, not that enforcement seems to pose much of a risk. A doctor who tells you that he or she is "the best" is actually telling you something very different.


Yellow pages

There is an old saying that goes something like this: "The surgeon who specializes in everything specializes in nothing." If a doctor lists himself in the phone book as devoting his practice to eyelid surgery, such a clear emphasis gets a big star. If a doctor claims to specialize in twenty-two cosmetic surgery procedures involving the face, breasts, and buttocks, then no star for him or her. While this doesn't, of course, prove that he or she isn't a fine eyelid surgeon, it does show that eyelid surgery is not emphasized in the practice.

By the way, simply because a doctor is a "Board-certified plastic surgeon" does not mean that he or she specializes in cosmetic eyelid surgery or can do the operation well. Plastic surgery on most other parts to the body - from scalp to breast to thighs - bears no relationship to blepharoplasty.


University affiliation

'Assistant Clinical Professor' does sound nice, but what does it signify? In many cases, less than you probably think. Most serious academic appointments come without the word 'clinical' in the title (for example, "assistant professor") and typically indicate a full or nearly full-time appointment on a university staff. Clinical appointments, on the other hand (for example, "clinical assistant professor"), are most often awarded to private practitioners willing to volunteer by teaching a beginning resident how to put on sterile gloves (not something a busy academic has time for) or deliver an occasional short lecture in return for the accolade. Sometimes, the involvement might entail only a few hours a year at an affiliated county hospital located a hundred miles away from the main program. While a major university medical school may have one or two active oculoplastic surgeons on its full-time staff, there may be ten times (or more) that many 'clinical' appointments.

(Continued in Part 2)

Next: Eyelid Surgeons Are Not
All The Same - Part 2


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