Armani sportscoat? Versace wool pants? Two hundred dollar haircut? Obviously, those are not the correct answers. On the other hand, much of what many potential patients consider to be the correct answers are not really very important at all.
While we trust this won't shock you, be aware that not every cosmetic surgeon is competent, especially when it comes to performing delicate surgery around the eyes. And when it comes to the more advanced eyelid procedures or revisional surgery, be forewarned that the large majority of general plastic surgeons have a rather meager experience. Just because you've seen photos of nice results from a dedicated super-specialist, don't be naive enough to expect a similar outcome from a novice getting started or even a long-established practitioner who dabbles in the field. As with any discipline in life, there are wide quality differences between practitioners; only a few will ever practice at the top of their fields.
Following is a list of items you may find helpful as you search:
• The three most important criteria for selecting a surgeon are:
1. Experience,
2. Experience,
3. Experience.
If a surgeon performs blepharoplasty a few times a month in between tummy tucks or LASIK operations, that is not 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.
Innate talent, high intelligence, and completion of a top-notch training program are not the same thing 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.
Now, here are some secondary factors you may wish to consider, grouped roughly in terms of their value:
• Waste of Time (and possibly counter-productive)
A few doctors are superb, most are average, and some are clealy sub-par. Using the methods below, however, are not good ways to sort them out:
Commercial directories: If you've run across 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 doctors listed may be excellent, while others are simply willing to "buy" their way in. It's like on the web. There are a zillion web directories entitled something like "Best Plastic Surgeons--Find Them Here for Only $29!" Would you fall for this? Probably not. So why think a printed version is fundamentally any different?
Online message boards: Whatever you read on these plastic surgery "tabloids" should be taken with a big grain of salt if not totally discounted. While originally well-meaning, most message boards have become sad examples of commerce masquerading as education, having turned themselves into toxic "free-for-alls" where anonymous users feel emboldened if not cheered on to talk up or talk down their (sometimes imaginary) experiences, commit blatant libel against an excellent doctor, or put forth a free advertisement for the doctor they are or they work for. Sure, you may at times stumble upon a nugget of sound advice. However, most message boards are parts of bigger websites designed to sell you surgical supplies you probably don't need and so encourage rumor, gossip, and controversy to attract and entertain potential customers while hiding behind a mantle of "free speech." Be forewarned: Once your mind is poisoned, it can be very hard to ever see things straight.
'Rate Your Doctor' websites: They're sprouting up everywhere these days and are mainly vehicles to serve paid ads. Take what you just read about the cosmetic surgery message boards and multiply it many times over. Less than worthless.
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 concerned only about the financial solvency of a potential client and not at all with surgical outcomes. Any doctor can maintain (or share with ten others) a luxury office on Park Avenue. The only thing you can be absolutely sure about when visiting a surgeon at an exclusive address is that his business overhead is very much higher than that of his peers and that you are the one who is going to pay for it.
Television appearances: Almost any doctor with a telephone, plenty of spare time, and the willingness to make him or herself freely available to the media can secure a sound byte on the evening news. Interestingly, many are relatively new in practice and may even employ a publicist. Most seasoned experts tend to prefer their operating rooms to a television studio.
• Minimally helpful
Marginally important, there factors may help you to discover your prospective surgeon's real interests:
Advertising: Advertising (newspaper, Internet, radio) has become the norm in cosmetic surgery. As long as advertising is undertaken in an ethical fashion, there is nothing wrong with it and it can help a consumer sort through so many possibilities. Beware, however, of doctors who make 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.
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 (see What is a True Eyelid Specialist?). Simply because a doctor is a 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' (for example, 'associate professor') and typically indicate a full or near full-time appointment on a university staff. 'Clinical' appointments, on the other hand, are often handed out to private practitioners willing to help volunteer by teaching a beginning resident how to put on sterile gloves (not something a busy academic has time for) or give an occasional short lecture in return for the accolade. Sometimes, the involvement might entail as little as 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 full-time staff, there may be ten times (or more) that many 'clinical' appointments.
• Helpful
Okay, finally some factors that actually mean something:
Reputation: Clearly, this is a big one because it takes years of hard work to earn and maintain. If a surgeon has a sterling reputation for good results with eyelid surgery among other doctors, nurses, former patients, and your beautician who studies face after face, he or she most definitely gets a giant gold star next to his or her name.
First phone call: First impressions are important. If you call an office to ask about eyelid surgery and the receptionist acts lost, a big red flag should go up.
The waiting room and office: While the office should be well-kept and comfortable, it does not need to mimic a glamorous European museum (think plaster Grecian columns and fake old masters) or an upscale sports bar (think plasma television monitors hanging from the walls and ceiling). After all, you are visiting a medical establishment in search of serious professional services. If the office seems inappropriately glittery or gaudy, you might want to think twice about the proprietor's sense of good taste.
The staff: The staff should be well-groomed, polite, friendly, and knowledgeable. Plastic surgeons can afford to hire better-than-average employees. Remember that you are a potential customer seeking premium services at a high price. If you find yourself being treated as if your HMO reluctantly approved a ten minute visit to check out your chronic cough, be wary.
The doctor's credentials: Pay attention to where your doctor received his or her training, but don't stress over it or let yourself be too easily overwhelmed. While lots of certificates on the wall may look reassuring, they may say little more than the artwork does about a surgeon's current skills (plus many of the most "impressive" certificates can be bought by simply paying annual dues). Just because your surgeon is smart, by the way, doesn't mean he's dexterous or has a refined sense of taste. Just because he graduated from Harvard Medical School thirty years ago doesn't mean he's kept up to date. Board-Certification in an appropriate specialty (Plastic Surgery, Ophthalmology, Dermatology, ENT) should be expected, but be aware that even this says little about a surgeon's current level of competence. To learn more, see The "Myth" of Board-Certification.
The doctor: Finally! While the specifics of what to expect during the actual consultation are covered in the next chapter, let's concentrate more on the person who may be cutting on your eyelids very soon. He or she should be well-groomed and neatly dressed. Three-piece designer suits are for show only; being a cosmetic surgeon is a hands-on job and at times messy or even bloody. A white lab coat is truly the most appropriate garb.
Look for personal traits that you would admire in any person with whom you intend to do serious business: intelligence, a smile, a willingness to listen, an ability to express thoughts and concepts, thoroughness in any actions or answers to questions, a lack of aggressive salesmanship, and so on.
Is this somebody who you think you can trust? Is this somebody who seems smitten with himself? Are you being treated with respect or in a condescending manner? Do you feel comfortable with this person or do you already sense a clash of personalities?
All such Gestalt matters now (and may matter much more after surgery). Ask yourself: Do you feel confident placing your face at this person's mercy (which is, after all, exactly what you will be doing)?
Remember that you have not been "assigned" to this doctor by some uncaring insurance company. If you feel the least bit uncomfortable, try out another surgeon. While the good ones don't exactly grow on trees, there is always more than a single choice.
We all know how difficult it is to make reliable judgments about a person's true nature and integrity based upon only a single meeting. Unfortunately, that's how it goes.
So, pay attention to the hints found here and elsewhere in this Guide. At least you can then feel confident that you've given the task your best shot and met your responsibility to your eyelids.
