Frequently Asked Plastic Surgery Questions - General Overview

What is Plastic Surgery?

Plastic surgery is a surgical sub-specialty that deals with the healing and restoration of patients with injury, disfigurement or scarring resulting from trauma, disease or congenital defects. It includes aesthetic or cosmetic surgery to correct or rejuvenate facial and bodily features not pleasing to the patient. Plastic surgery is named from the Greek word "plastikos" which means "to shape or mold", based on the surgeon re-shaping the form of the patient's form through surgery. It has nothing to do with the types of materials used in the surgery itself. In surgery, many different materials may be utilized, depending on the desired results and the type of surgery. Frequently, the surgeon will make use of the patient's own tissues, including tissues from another location of the body, or by reshaping the existing tissues to achieve a better appearance. Modern plastic surgeons frequently use silicone rubber, titanium, Gortex, and several different absorbable plastics. If you will receive an implant Dr. Zemmel will discuss the type of material with you at length.

What can I do you ensure a good, safe outcome?

When considering plastic surgery, it’s natural to focus more on the expected result than on the surgical process. However, to be fully informed, it’s important to learn about the safety of the procedure as well as the expected outcome. Although thousands of people have Plastic Surgery every year without complications, no surgical procedure is risk-free.

To maximize safety, ensure that:

• Your surgeon is adequately trained and is board certified by the American Board of Plastic Surgery;
• The facility where your surgery will be performed conforms to strict safety standards;
• Your surgeon is informed of any drugs you are taking and your full medical history, especially if you have had any circulation disorders, heart or lung ailments or problems with blood clots;
• The surgical facility will use a qualified anesthesia provider to administer and monitor your anesthesia and your recovery immediately following the procedure

What questions should I ask before choosing a plastic surgeon to make sure he/she is qualified to operate on me?

Bringing a checklist of questions can help ensure the safety and quality of your procedure. Questions to ask are:

• Are you certified by the American Board of Plastic Surgery?
  • When the doctor claims to be board-certified, ask by which board. Only the ABPS is recognized by the American Board of Medical Specialties to certify doctors in the area of plastic surgery.
• Do you have hospital privileges to perform this surgery?
  • Some surgical procedures can be performed in the doctor’s office or other outpatient facility but it is important to find out if the doctor has operating privileges in an accredited hospital for the same procedure you are having. Before granting operating privileges, hospital review committees evaluate a surgeon’s training and competency for specific procedures.
• Where will you perform my surgery?
  • If it’s in an office-based facility, ask if it’s accredited. Most states don’t require ambulatory or office-based facilities to be accredited, but voluntary application can be made to an accrediting body such as the American Association for Accreditation of Ambulatory Surgery Facilities. Such accreditation means the facility has met strict requirements and denotes a high standard of care.
• How many procedures of this type have you performed?
  • Also ask what training has been completed, especially in new techniques. Ask to see certificates of training.
• What are the risks involved with the procedure?
  • There are risks with any surgical procedure. Find out what they are, how often they occur, and how they will be handled if they do occur.
• What is the expected recovery time?
  • Be sure to discuss postoperative restrictions on activity and typical time periods for resuming work.
• What is your policy on surgical revisions?
  • Some cases may require revisions to achieve the desired results. Find out about any costs for which you may be responsible.
• How much will the surgery cost?
  • Cosmetic surgery is not covered by insurance, and payment usually is required in advance. Costs include the surgeon's fee and fees for the surgical facility and anesthesia. Other possible costs are the preoperative physical and blood work, medications, surgical garments and private-duty nursing.

How can I be sure that my surgeon has adequate training?

Good credentials can’t guarantee a successful outcome; however, they can significantly increase the likelihood of it. Patients are advised to find a doctor who is certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Board of Medical Specialties to certify a surgeon in plastic surgery of the face and of the entire body. Certification by the ABPS is "the gold standard" for plastic surgeons because it signifies that the surgeon has had formal training in an accredited plastic surgery residency program. If your surgeon is ABPS-certified, you can be assured that your doctor:

• Has completed at least five years of surgical residency training after medical school, including at least two years in plastic surgery
• Has passed comprehensive cosmetic and reconstructive surgery exams
• Is qualified to perform cosmetic and reconstructive procedures – everything from liposuction and facelifts to intricate wound repair.

To verify a surgeon’s certification status, contact the American Board of Plastic Surgery at 215-587-9322 or visit the board’s web site at www.abplsurg.org or the American Board of Medical Specialties at www.abms.org or by phoning 1-800-776-2378.

How can I determine if my plastic surgeon’s surgical facility meets acceptable safety standards?

The American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery have issued a statement to their members that by July 1, 2002 all plastic surgery performed under anesthesia, other than minor local anesthesia and/or minimal oral tranquilization, must be performed in a surgical facility that meets at least one of the following criteria:

• Accredited by a national or state recognized accrediting agency/organization such as the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), Accreditation Association for Ambulatory Health Care (AAAHC), or Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
• Certified to participate in the Medicare program under Title XVIII
• Licensed by the state in which the facility is located

Patients should ensure that the facility is accredited or is in the process of being accredited. Dr. Zemmel performs cosmetic surgery in his office-based operating or ambulatory surgical centers which meet the above criteria. Patient safety is Dr. Zemmel’s primary consideration. Reconstructive surgery is usually performed in a hospital facility.

Why is it so important for my plastic surgeon to know detailed information about my personal and family health history, even if I am only having a simple cosmetic procedure?

There is always risk with any surgical procedure. However, as a patient, you can play an important role in reducing your risk by providing a full and complete health history to your surgeon. The more information Dr. Zemmel has about you, the more accurately he can assess your needs.

Certain elements of your personal or family health histories may increase your risk of complications. Dr. Zemmel will review your complete history prior to the surgery.

How can I be sure that the anesthesia care I receive in my plastic surgeon’s surgical facility is adequate?

Anesthesia care in an accredited or licensed facility has reached a level of sophistication that is absolutely comparable to the care received in the hospital.

All anesthesia will be administered by a qualified anesthesia provider. Dr. Zemmel performs cosmetic surgery only with CRNA (Certified Registered Nurse Anesthetists) or Board-Certified Anesthesiologists.

Before any type of anesthesia is used, the surgeon and anesthesia provider must take a full medical history. Dr. Zemmel will also perform a physical examination and appropriate lab tests will also be performed. Dr. Zemmel needs to know if you have any serious medical problems or have had previous adverse reaction to any other type of anesthesia. Also, you must let the anesthesia provider know about any medications you are taking (including herbal supplements), any known drug allergies, when you last ate and whether you smoke cigarettes or use alcohol or illegal drugs.

You should be assured that you will receive individual monitoring by skilled, licensed personnel before, during and after the procedure. Staff who are familiar with the warning signs of cardiac or respiratory distress and are trained in advanced cardiac life support (ACLS) will be on hand to monitor your procedure and recovery following your surgery.

If you are told that you will be kept overnight at the surgical facility while you recuperate, make sure that the facility is accredited by a recognized agency. In an accredited facility you will receive around-the-clock care and monitoring by two or more skilled and licensed staff members with at least one trained in ACLS. You will also be assured that the facility has the necessary equipment and medications to handle complications that may arise and an emergency plan in case you need to be transferred to the hospital.

What is important in choosing a plastic surgeon?

Most importantly you must feel comfortable with your surgeon. You should verify your physician is Board Certified by the American Board of Plastic Surgery. This means your surgeon has undergone a thorough peer review and testing on all plastic and reconstructive surgery standards. You should also carefully consider where you surgeon wishes to perform your procedure. Make sure your surgeon is qualified to do the procedure you are considering in a local hospital before allowing it to take place in an office based surgery center. Some surgeons operate in office operating rooms in order to do procedures they have not been credentialed to do in the hospital.

Is plastic surgery safe?

All surgical procedures are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons. Our expert team is dedicated to making your operation go smoothly. We careful review your medical history and current health condition before deciding if it is safe for you to proceed with surgery. It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved. We will take every precaution necessary to reduce the possibility of any complications.

How do I know if plastic surgery is right for me?

There several important factors that come into play when deciding whether plastic surgery is the right option for you. One of the most important factors is your health. Being in good health greatly reduces the risk of complications occurring during surgery and leads to a speedy recovery. Next, you need to ask yourself what your motivations are. People who have plastic surgery generally find that the surgery enhances their overall appearance and self-esteem. Thirdly, you should have realistic expectations. Plastic surgery is both a science and an art, neither of which are perfect. Set reasonable goals as to the result you wish to achieve and be prepared to thoroughly discuss these goals during your initial consultation.

Can I have several procedures performed simultaneously?

It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation. This allows the surgeon to better “sculpt” your final appearance. In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once. However, having too much done at one time can lead to complications. The decision to have multiple procedures done depends on which procedures are being done, the extent of surgery, the operating time, and your age/health. Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.

Does it matter how old I am?

Due to the variety of procedures available in plastic surgery, there can be no blanket rule on age although age will be taken into consideration when planning your operation. People of all ages have taken advantage of the image-enhancement offered by plastic surgery. There are even procedures appropriate for young children! It is important to realize the limitations of plastic surgery. Plastic surgery cannot “fix” every situation or reverse the aging process. What is a good procedure for one person may not be an appropriate procedure for another. We are committed to making your plastic surgery experience a successful one.

What happens during my initial consultation?

During your consultation we will discuss your desired changes and expectations, review your medical history and current health, and make an assessment on whether the procedure(s) in question are right for you. This is a good time to ask specific questions about the procedure so that you are fully prepared, mentally and emotionally, for surgery. We will discuss the results that can be achieved, with the aid of photos and/or computer imaging. When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.

How long will it take to recover from my surgery?

Generally, post-operative instructions call for rest and limited movement in order to speed up the healing process and recovery time. The length of recovery varies with each procedure and is different for each individual. Bruises usually disappear within a few days, and most swelling is gone in a matter of weeks. If you follow our post-operative instructions carefully, you will be able to enjoy your normal activities within no time. Your scars will fade over time but are permanent. We take care to conceal any scars so that they are barely visible, if at all. The image-enhancing effects of plastic surgery become more evident over time with certain procedures taking up to a year for your body to fully adjust and settle into its new look. When you come in for your consultation we can discuss your expected recovery period and any post-operative instructions in detail.

Will my insurance cover the surgery?

Insurance providers generally cover costs for reconstructive surgery but not for cosmetic surgery. For example, insurance providers will often pay for breast augmentation to reconstruct a breast following a mastectomy; breast reduction to remedy back pain caused by heavy breasts; eyelid surgery to remove sagging skin that blocks vision; nose surgery to allow for a patient to breathe better; or tummy tucks to remedy the vertical separation of abdomen muscles known as diastasis. Insurance providers are required by law to cover breast reconstruction surgery and any cosmetic operations necessary to create symmetry in either breast. If your surgery is covered by insurance, pre-certification is required. We will be happy to assist you with the process.

Do you offer patient referrals and testimonials?

Please refer to our testimonial page for written and video testimonials. Dr. Zemmel’s office staff can also arrange for your to speak with current and former patients of Richmond Aesthetic Surgery.

What is the fee for cosmetic consultations?

Consultations are complimentary.

Do you offer financing?

Yes, once you have had your consultation, the Dr. Zemmel’s patient coordinator will help you submit an application, which takes a very short time to complete. You will receive an answer regarding approval very quickly. We also accept all major credit cards. Richmond Aesthetic Surgery participates with Capital One and Reliant Financing which can be found on the internet.

Is there any visible scarring?

Any time an incision is made in the skin, there is a scar left behind as part of the normal healing process. Plastic and Reconstructive Surgeons have received special training and have extensive experience with minimizing the size of these scars, creating the least noticeable appearance of them, and locating them in the least conspicuous areas possible. Often the scars will become undetectable to all but the most careful examination over the course of time. In addition, scars may be hidden in the hair, along a wrinkle, in the mouth, etc. to minimize the visibility of the scar. Other times scars are more visible. Dr. Zemmel will discuss the approximate placement and length of the incisions with you before surgery. You can review the photos gallery with similar incisions.

How does a physician become a plastic surgeon?

Training to become a plastic surgeon is a difficult task.To become board certified by the American Board of Plastic Surgery a physician must complete a specialized post-graduate training course of five to seven years. Background training usually includes a thorough grounding in general surgery however, a background in ENT or orthopedics may be acceptable. The final two to three years of training must be in an approved plastic surgery training center. Prior to official certification by the American Board of Plastic Surgery the physician must pass a rigorous set of both written and oral examinations. While numerous physicians use the term "plastic" surgeons only those certified by the American Board of Plastic Surgery are true plastic surgeons.

What procedures do plastic surgeons perform?

Aesthetic (also called cosmetic) problems with the face, neck and trunk, including forehead, eyes, nose, ears, lips, chin, neck, breasts, abdomen, hips, buttocks, thighs, calves, arms, and skin.

Congenital deformities of the hands and face, including clefts of the lip and palate.

Benign (non-cancer) and malignant (cancerous) tumors of the head and neck, skin and soft tissues.

Traumatic injuries of the bony facial skeleton and hand as well as soft tissue injuries of any part of the body.

Surgery of the hand. Surgery of the jaw and facial skeleton.

Any type of skin cover and replacement problems.

All types of reconstruction following removal of cancer resulting in disfigurement of any part of the body including the face, breasts, trunk.

What is aesthetic (cosmetic) surgery?

Aesthetic surgery, also known as cosmetic surgery, seeks to improve an individual’s appearance. These types of operations most often involve the nose, ears, face, forehead, eyelids, breasts, abdomen, hips and thighs.

Is a plastic surgeon a skin specialist?

Dermatologists specialize in skin, but the plastic surgeon has an equally important role of the treatment of benign and malignant tumors of the skin. The skills of a plastic surgeon are especially needed when large areas of the skin must be removed and replaced especially where disfigurement may result or when these areas are in conspicuous areas such as the face. Plastic surgeons also perform skin resurfacing techniques, for cosmetic purposes, in order to achieve healthier looking skin by reducing facial wrinkling and pigmentary changes of the skin.