Your final result from plastic surgery will be determined far more by your choice of surgeon than by which facelift technique is used or which breast implant you choose. Not only is this your most important choice, it is also the hardest one to make. One thing on your side is that this is elective surgery, and totally non-urgent. If you make a pact with yourself to wait until you are 100% comfortable, you will have the breathing space to choose the right plastic surgeon for yourself.

Realize that there are two sets of issues to look at, one objective, and the other subjective. Objectively, you must determine that the plastic surgeon is safe and well-trained. Only after they have cleared that hurdle, can you look at the subjective criteria, namely whether the doctor's ability, aesthetic, style, and approach is a good match for you.

To "clear" a doctor, you must do the following:

1. Assure that the doctor is certified by the American Board of Plastic Surgery. This is the only board recognized to credential plastic surgeons. Beware of "bogus" boards - mail order certificates to hang on the wall, as well as people who are board certified, but not in plastic surgery specifically.
2. Check to be sure that the doctor is a member in good standing in the three major plastic surgery societies, The American Society of Plastic Surgeons, the California Society of Plastic Surgeons, and the American Society of Aesthetic Plastic Surgery.
3. Be sure that the plastic surgeon operates in a fully licensed and accredited surgical facility. Believe it or not, some doctors today - in violation of state law - still attempt to do surgery in facilities that are not licensed.
4. Look into the status of the doctor's medical license. In California, visit www.docboard.org/ca/df/casearch.htm
5. Though in no way required to be a bonafide and respected plastic surgeon, you may want to check to see if the plastic surgeon is also certified by the American Board of Surgery. Prior to specializing in plastic surgery, most plastic surgeons train as general surgeons, which includes trauma surgery, thoracic surgery, vascular surgery, surgical critical care, breast cancer surgery and much more. Being certified by the American Board of Surgery indicates that the plastic surgeon has been recognized for their proficiency in these subjects. Even though the plastic surgeon may "only" be removing fat or pulling skin tighter, knowledge that they have the firmest possible foundation and experience in the science of surgery may be meaningful to some plastic surgical patients.

Once you have done that, you come to the interesting part, namely, assessing which doctor will have the right aesthetic for you. You must recognize that there is no single plastic surgeon that is the "best" for all patients. While the responsible plastic surgeon tries to create what a patient wants, the plastic surgeon's own aesthetic sense always comes into play. It affects what surgical options they may suggest to you (e.g. brow lift v. blepharoplasty), and it affects the way in which they may carry out the operation (e.g. what direction they pull on a facelift.)

All plastic surgeons claim that they strive for "natural" results, even the ones that do the obviously pulled facelifts and disproportionate breast augmentations. I have not met one yet who said "my style is the overdone, unnatural, sensationalistic, and tightly pulled" - yet we all know that they exist. What is important is that you find a plastic surgeon that shares your concept of naturalness, beauty, and proportion.

Ultimately, you will probably make your choice base upon emotional or subconscious reasons, but these are at least some of the things that you should be thinking about:

1. Websites are only websites, but there is a profound difference between them, both in style and in content. I am surprised how well these differences actually correspond to the different personalities of the hosting plastic surgeons.
2. Look at the photographs. A broken clock is right twice a day, so everyone should have some good photos. Is the lighting and camera angle consistent in all the photos? In breast augmentation, are they showing you all three views on each patient at the same interval from surgery (even a bad result has at least one good angle at one point after surgery!)
3. We will arrange for you to speak with some of our patients - this can be very helpful.
4. Shop price only if you absolutely have to. It's one thing to shop price when buying a car; you'll get the same car no matter which dealer you get it from. But your experience will be totally different with each doctor - from the preoperative visits to the actual surgery, all the way through your postoperative course. No two doctors will be the same. Figure out who your first choice is, and then see if you can make it work financially.
5. You won't be able to make a decision just from the internet - you will need to go on consults, probably more than one, or enough until you feel comfortable with a doctor. One doctor will emerge as your preference.
6. Do not dwell too much on which specific procedure the doctor is going to do, e.g. composite facelift v. deep plane facelift - the difference between your result will be more of a difference in ability or aesthetic between the doctors than it will be due to a difference in technique.
7. You might not be a doctor, but you should have the ability to realize who is making sense. Do not choose a doctor overly confident, eager, or aggressive - but nor should you choose someone overly negative. There is somewhere a balance between hearing about risks and complications and hearing about the positives of surgery, and you should find a surgeon that explains things in a way that sounds realistic.
8. I do all my surgery, and I see patients at all their post-operative visits. In some offices, you have relatively little contact with the doctor once the surgery is done. In some office, surgical residents help with the surgery; I do all of the surgery myself. Often the junior associate or residents take calls; I take all my own calls after hours, and I give patients my home and cell phone so that I am easily accessible to them.

I do not want to operate on patients for whom I may not be the right plastic surgeon, so I am willing to be candid about discussing my style. On the spectrum, I would say that I am surgically less aggressive than others. I believe that oftentimes complications are the result of going that extra bit, and while I would choose to be that way if I were a cancer surgeon, I think that is inappropriate as a plastic surgeon. A greater aesthetic improvement is usually not worth a greater surgical risk.

I also dislike plastic surgical options that leave obvious clues that there has been plastic surgery, such as visible edges of a breast implant, flattened cheeks and a distorted ear after a facelift, or overly raised brows after a browlift. These are visually more annoying to me than the problem they were meant to correct. I would rather see a little more facial laxity than see the distorted ear.

What might this mean to the prospective patient? If you are a facelift patient looking for the maximum set-back of the clock, for the greatest reduction of every last wrinkle, then there are other plastic surgeons that would be more suitable to you.. I think facelift patients look best when not pulled the tightest, because though they are smoother and more wrinkle-free, they start to take on a more artificial look, which is less attractive. With breast augmentation, extremely large implants are more likely to stretch out skin leading to problems in the years ahead, and I do not like the appearance of visible implant edges (the cantaloupe look) or of breasts that obviously are not in balance with the rest of a patient's body. While I certainly can do "novelty" breasts, my specialty is in creating breasts that are beautiful and natural, as if they were made by nature.

I am often asked what my specialty is. It is not any specific anatomic area. Rather, it is in my overall approach to patient care and aesthetics. There is a consistent style in my results, from otoplasty to facelift to breast augmentation to tummy tucks. The real difference between Cezanne and Van Gogh is not in their subject matter, but in their styles of painting, and the same is true of plastic surgeons.