Picking a Plastic Surgeon

As you are considering plastic surgery, perhaps the most important thing you can do is to pick your surgeon wisely. Many Arizonans are surprised to hear that any physician licensed as an MD or DO can do any surgical procedure he or she wants, without any surgical training whatsoever! Of course, most physicians are ethical and responsible, and limit their practice to those activities for which they are trained, but there have always been a few who take a weekend course (or no course at all!), and set up shop.

Of course, most shocking are those with no surgical training, such as family practitioners, doing surgery in their offices. Indeed, in Arizona, a family practitioner, with no surgical residency at all, did surgery in his office resulting in the deaths of three patients! You may ask why anyone would let someone with no surgical training do surgery on them, but it happens. As this is written, there is no regulation in Arizona preventing any licensed physician from doing any procedure he wants in his own office. The medical board is considering regulations regarding the equipment that must be available, but even if those regulations are adopted, they will not affect DO's, and they will not prevent physicians without surgical training from doing surgery.

You should also be concerned about those with some surgical training, but who are not trained in the procedure they want to perform. Sometimes these are trained in other specialties, such as oral surgery or general surgery, but sometimes they were trained in a plastic surgery residency but could not complete the arduous process to obtain board certification by the American Board of Plastic Surgery.

For example, recently, the mother of a rock star, an obviously bright PhD, went to a surgeon who had been on Oprah and who had his own plastic surgery show on the Discovery Channel. However, surgery was performed in a strip mall, not at a hospital. After she died, it was reported that the surgeon was not certified by the American Board of Plastic Surgery, was not a member of the American Society of Plastic Surgeons or the American Society for Aesthetic Plastic Surgery, and had had multiple DUI's. How could she have made such a mistake?

Adding to the confusion is that anybody can create a "Board" and give it a name that is similar, but not the same, as an existing board. For example, once the American Board of Plastic Surgery was estabilished, others created boards with confusingly similar names, such as "The American Board of Facial Plastic Surgery" and "The American Board of Cosmetic Plastic Surgery". However, those boards do not have the same standards for certification as The American Board of Plastic Surgery, and will give certification to physicians who would not qualify for certification by the American Board of Plastic Surgery.

So, what can you realistically do to pick a good plastic surgeon? Actually, if you are willing to do a little homework, it is not as difficult as it seems, now that we have the Internet.

The first thing is to realize that charisma and bravado are not the same thing as competence. While your surgeon should be confident in his abilities, the qualities that make a good television star are not the same qualities that make a good surgeon. Oprah and Discovery are primarily entertainment venues. They cannot be criticized for selecting an unfit surgeon, as that is not the business they are in.

At a minimum, you should ensure that your surgeon is both well trained and board certified. However, it matters which board he is certified by. It is easy to check using the Internet. You can check whether he is certified by the American Board of Plastic Surgery using their website, www.abplsurg.org. The link on that page will lead you to the American Board of Medical Specialties website (ABMS). The ABMS is an organization of the 24 main medical specialty boards, such as Internal Medicine, Surgery, and Plastic Surgery. Thus, their website will tell you whether your surgeon is certified by any of the top tier of specialty boards.

Dr. Nachbar is certified by both the American Board of Plastic Surgery, and the American Board of Surgery, both ABMS member boards, as you can verify with the above link.

You should also check that your surgeon is a member of the appropriate specialty society. This, again, is a minimum requirement, and ensures that your surgeon has been reviewed by his peers, is certfied by the appropriate board, and has agreed to take continuing education and to abide by an ethical code that goes beyond legal requirements. In Plastic Surgery, the appropriate societies are the American Society for Aesthetic Plastic Surgery and the American Society of Plastic Surgeons. Dr. Nachbar is a member of both organizations, as you can verify with those links.

Another important check, among the most important, is that the surgeon has privileges to do your surgery at an accredited hospital. You will know this automatically if the surgeon is planning to do your surgery at a hospital, but it is something you should check if he or she wants to do it either in his office or in a freestanding surgery center. You need to check both that he has privileges at the hospital, and also that he has privileges to do your procedure at the hospital. It is easy to check: call the hospital and ask for the Medical Staff office. Dr. Nachbar has full plastic surgical privileges at Scottsdale Healthcare Shea, Scottsdale Healthcare Osborn, and Scottsdale Healthcare Thompson Peak, as you can verify by calling the hospital at 480-323-3000. He does his surgery at surgery centers run by those hospitals.

If the rock star's PhD mom had done even one of the above checks, she would have known what she was getting into.

Once your surgeon has passed those minimum checks, you have to use your intuition and judgment. How well can you communicate with your surgeon? Does he understand what you want? How long has he been doing these surgeries? How much experience does he have? How do you like his results? While nobody can guarantee a specific result, you boost your chances by doing your homework!

The Minimum-Qualifications Checklist

1. Arizona Medical Board Doctor Search - To see Dr. Nachbar's page on that website, Click Here
2. American Board of Plastic Surgery - Note that Dr. Nachbar is listed as "Subspecialty Expired" for Hand surgery -- I let my Hand Surgery certification expire since I only do cosmetic plastic surgery
3. American Board of Medical Specialties - Dr. Nachbar is certified by both the American Board of Plastic Surgery and the American Board of Surgery.
4. Specialty Societies: American Society of Plastic Surgeons, The American Society for Aesthetic Plastic Surgery, and The American College of Surgeons.
5. Hospital Privileges, including privileges to perform the planned procedure at a hospital. Call the main number and ask for the "Medical Staff Office"

The Questions You Were Afraid To Ask (also see the Why Dr. Nachbar Page)

1. Lawsuits: In all the years I have been in medicine and surgery, I have never lost or settled a lawsuit. The only two lawsuits in which I was named were at a university, were emergency room patients, not cosmetic surgery patients, and I believe I was just one of many participants who were named. I was also named in a third lawsuit where I was only observing, but I was quickly dropped from that lawsuit.
2. Alcohol, Tobacco, and the Law: I don't drink, smoke or use drugs, and have never had a DUI. I've never been arrested, or even had a traffic ticket. If you need me after surgery, I will not be impaired.
3. Have any of my patients ever been unhappy with surgery? Yes. Any plastic surgeon who says otherwise is either lying or inexperienced (or both). If the result is not everything we were hoping for, I will do everything I reasonably can to try to improve it. If additional surgery is required, there may not be a surgeon's fee, but there will be costs for using the operating room and anesthesia. If the surgery I did was to try to improve the work of another surgeon, then additional procedures will typically carry additional surgeon's fees as well, due to the additional complexity of those cases. However, to qualify for additional surgery, I do ask that you keep your follow-up appointments so that you have the best chance for a great outcome. There is never any charge for follow-up visits.
4. How much does it cost? Click Here to see our ballpark prices. Of course you will need to come in for a consultation to give you an exact price.