Surgeons are physicians specializing in evaluation and management of problems treated and/or cured by surgery. Cognitive (thinking) and technical (operating) skills are required. To become a surgeon, I graduated at the top of my four year college class, near the top of my four year medical school class, then apprenticed as a surgical resident days, nights, weekends, and holidays in hospitals around the United States for ten years after medical school. Many subjects are mastered, including a foundation of basic sciences such as anatomy (gross and microscopic), biochemistry, physiology (healthy function of the body), pathology (diseases), microbiology (bacteria, fungi, and viruses), pharmacology (drugs), genetics, neurosciences, psychiatry, etc. During my decade of residency, benchmarks were achieved each year to advance to subsequent higher levels of responsibility and independence. We learned about the surgical specialties, saw thousands of patients, and worked with doctors in every area of medicine. Oral and written examinations administered by the American Board of Surgery and the American Board of Plastic Surgery were passed. Training and exams were rigorous and uncompromising, designed to assess cognition (knowledge, reasoning, and judgment), technical skills, and professional ethics. All are critically important for surgery. In practice for over twenty years, I still qualify annually by reporting continuing medical education and occasionally taking maintenance of certification examinations.
Why does this matter? Because quality outcomes can only be delivered in the context of high ethical, scientific, and technical standards. Treatments we recommend should have the highest possible benefit to risk relationship: The most upside and the least downside. Because everyone is different and unique, a treatment that is beneficial for one person may be a disaster for another. To differentiate among patients what is best for one individual, we surgeons must ask questions, i.e. learn about each patient in consultation. We must examine our patients physically to know their anatomy, to understand which treatments may work best and which may not be indicated. Sometimes, we must check additional blood tests, X-rays, or other studies for more information. All that data is analyzed, options for treatment are considered, discussed with patients, and a mutually agreeable treatment plan developed. Every patient should be approached with this stepwise sequence of gathering and verifying information, analyzing the information, prioritizing possible solutions based on the presentation, finalizing a plan, and only then, implementing treatment.
As an aesthetic plastic surgeon, our office fields constant calls for this peel or that product, the latest lunchtime lift, mini-tuck, or new device, diet, or implant. Usually, callers read about it in a magazine, saw a TV show (“The Doctors”), or saw advertising. Media is a business, and media exposure is bought by business. The end game of business is sales. Sales are not necessarily about what’s best for YOU. Sales are about revenue for the manufacturer, producer, and/or marketer of techniques, devices, products, and services. We implement new information and technology in our treatments, but only as appropriate in the upside to downside calculation for each patient.
Nobody comes to us for surgery, people come for results. We specialize in results, not in procedures. Procedures are only means to an end. Often, there are several possible operations that will achieve slightly different results. Results are the solution to a problem. The problem must be properly analyzed first, and treatment solutions follow. Inquiring about solutions, whether a new product or a new procedure, before understanding and analyzing the problem is backwards.
By all means, ask about new treatments and technologies, we’ll answer your questions. As a layperson, you’re not expected to know science, biotechnology, and the human body. But you DO know, more than anyone else can ever know, what bothers you when you look in the mirror or at a photograph of yourself. You know your problem, and in our office, that’s all you need to know. We’ll discuss the rest, and decide with you which solution is the best.
You want the best result, and the best surgeon. How can you tell? Truthfully, the surgeon with the highest standards for his or her own performance reliably holds the highest standards across the board. The best surgeon will have the highest level of training and certification, and will offer you the best care, and likely the best result.
So how can you know? Plastic surgeon or cosmetic surgeon? The differences may surprise you. Because of common misconceptions surrounding cosmetic plastic surgery, you should understand what’s behind the scrubs and the white coat.
Operations that improve the human body are called Plastic Surgery after the Latin plasticus: that may be molded. The two types of plastic surgery are reconstructive surgery, after injuries, and aesthetic (cosmetic) surgery, to improve appearance. Cosmetic surgery is only a part of plastic surgery, but to perform it well, the physician must be fully trained in the entire specialty.
1. All plastic surgeons are cosmetic surgeons but not all cosmetic surgeons are plastic surgeons.
Board Certified Plastic Surgeons have more training and ARE qualified to perform both reconstructive and aesthetic/cosmetic surgery.
A Cosmetic Surgeon is NOT certified to perform plastic/reconstructive surgery.
2. The American Board of Plastic Surgery (ABPS) is the ONLY board approved by the American Board of Medical Specialties (ABMS), which accredits surgical training programs.
Plastic Surgeons ARE certified by the American Board of Plastic Surgery (ABPS).
The American board of Plastic Surgery does NOT acknowledge Cosmetic Surgeons.
3. Don’t all certifying boards have high standards? My surgeon said he’s board certified.
Confirm not only that that your doctor is “Board Certified,” but that he/she is certified by the American Board of Plastic Surgery (ABPS).
Cosmetic Surgeons who claim to be board-certified may have received their certificate from the American Board of Cosmetic Surgery; the American Board of Medical Specialties (ABMS) does NOT recognize this board.
4. Is my surgeon trained to perform my surgery?
After graduating medical school, a Board Certified Plastic Surgeon must be selected among many applicants for residency training in Plastic Surgery. If chosen, the physician learns how to be a surgeon for three to five years, then trains for at least three more years in plastic surgery. Training involves closely supervised continuous evaluation and management of many complex clinical situations, and matures the surgeon personally and professionally. Successful completion of the post-graduate residency years qualifies the surgeon for written and oral examinations administered by the American Board of Plastic Surgery. Surgeons must submit an entire year of his or her surgical accomplishments for the exam. Surgeons are not eligible for the exam until they have been practicing plastic surgery independently for two years or longer.
There are no such requirements for Cosmetic Surgeons. Cosmetic surgeons are doctors who merely decide to perform cosmetic surgery in their practice. They may be certified in any medical specialty such as a gynecology, dermatology, family physician, ear,-nose-throat, etc. Their training may consist of several short weekend courses to a one-year cosmetic surgery fellowship.
5. Why do hospitals and surgery centers only allow doctors certified by the American Board of Plastic Surgery(ABPS) to perform cosmetic procedures?
Because they know the difference! Board Certified Plastic Surgeons CAN perform both reconstructive and aesthetic/cosmetic surgery in hospital or outpatient surgery centers.
Cosmetic Surgeons are NOT privileged for cosmetic surgery at these facilities and are not allowed to perform reconstructive plastic surgery. For this reason, cosmetic surgeons usually perform surgery in office based operating rooms which are subject to more relaxed accreditation standards.
6. The American Society of Plastic Surgeons (ASPS) embraces excellence in plastic surgery. Education, research, intellectual exchange and promoting unity are core values.
Only doctors certified by the American Board of Plastic Surgery(ABPS) can become a member of the American Society of Plastic Surgeons (ASPS)
7. The American Society for Aesthetic Plastic Surgery (ASAPS) is an exclusive privilege and requires proven excellence in aesthetic/cosmetic plastic surgery.
- Members MUST be certified by the American Board of Plastic Surgery(ABPS).
- Participate in accredited Continuing Medical Education (CME) programs.
- Document the performance of a significant number and variety of cosmetic surgical cases to demonstrate a wide range of experience
- Be sponsored by two ASAPS-members to ensure that the applicant’s professional reputation meets the high standards required by The Aesthetic Society.
- Abide by ethical standards for professional conduct outlined by the Society’s Bylaws, Code of Ethics, and Conflict of Interest Policy observed by all ASAPS members.
ASAPS does not offer membership to doctors who are trained in specialties other than plastic surgery; therefore Cosmetic Surgeons do NOT meet these requirements.
For cosmetic surgery, your safest choice is a surgeon certified by the American Board of Plastic Surgery who is also a member of the American Society of Plastic Surgeons and/or the American Society of Aesthetic Plastic Surgeons. Quality is the difference.
Does the tiny cute Disney® Princess nose exist in real life? Yes, it does, but it is indeed rare. Your nose is made for breathing, and must be large enough inside for healthy air flow with reserve capacity. Still, as the centerpiece of your face, the aesthetically pleasing nose is a reproductive advantage, and therefore natural selection favors the beautiful nose.
If nasal pulchritude is not part of your genetic inheritance, no problem: You can buy it, more reliably now than ever before. Plastic surgical techniques to feminize nasal features are better understood by doctors, including ethnic variations in anatomy. The surgical procedure to change shape and/or size of the nose is called “rhinoplasty,” (rhino = nose, plasty = to mold, to shape) and is accomplished by specialists in plastic surgery.
High speed surgical burrs soften visible angles and projections, precise instrumentation re-arranges bony support, cartilage grafts add pretty curves and inflections, and fine sutures skillfully placed bend or re-positioning cartilage. These methods are all part of the modern plastic surgeons’ armament. Rhinoplasty related deformities and irregularities that divulge surgical modification are less common because of improvements in nasal aesthetic surgery technique and because new materials are available to conceal minor imperfections. Dermal matrix, injectable fillers, and other off-the-shelf products are used as camouflage when necessary to improve the result. Most operations to beautify nasal appearance are accomplished under direct vision, the “open” approach. In the past, rhinoplasty was performed by feel and by appearance of the evolving result beneath nasal skin (closed approach).
Rhinoplasty is an operation that changes shape and size of bone and cartilage support of the nose. Your outcome results from skin re-draping over the changed underlying structures, and emerges after months of healing and slow resolution of swelling. Some maneuvers, such as narrowing the base of your nose or improving definition of finer features are accomplished by thinning or removing specific portions of nasal skin and soft tissue.
As a plastic surgeon with over twenty years of rhinoplasty experience, Dr. Steve Laverson is excited about these developments. Together, they help plastic surgeons achieve more predictable outcomes, and offer the possibility of improved lifelong beauty for many. Every woman can now have a Disney® Princess nose!
Better understanding of aging anatomy is heralding a NEW era of smaller, safer, easy recovery plastic surgical procedures with long lasting changes that essentially prevent an aged appearance for your entire adult life. Even in your sixties, seventies, and eighties, with annual, bi-annual, or semi-annual maintenance and attention to smaller procedures, men and women can manifest youthful vibrance and allure. You’ll NEVER lie about your age, your appearance will do it for you.
Gravitational settling of facial soft tissue is managed by segmental (minor) lifts rather than a full face and neck lift. Cheek lift, temporal brow-lift, eyelid-lift, ear-lobe lift are all office procedures. Even minor face and neck lift operations can be performed safely and comfortably in the office while you’re awake and relaxed. Some skin sagging is corrected by removal and re-arrangement of descending tissue. Examples of this are jowl removal ,lip-lift, and “anguloplasty” (corner of lip lift) procedures. Skin wrinkling can be treated by laser or by filling with fat or off-the-shelf products. Hollows on the aging face create shadows that send a signal of darkness, depression, and sadness. Others interpret this as hostility and avoid you. The face should reflect light, and be bright. Small implants, fat grafting, minor surgical lifts, and off the shelf fillers re-shape surface contours to reflect light in a youthful way.
Subtle improvements offer the added advantage that others notice you look good, but don’t really know that something was done. You still look like yourself, but younger. Although major rejuvenation still requires a trip to the operating room for general anesthesia, Dr. Steve Laverson, a San Diego Plastic Surgeon, performs many improvements in the office under local anesthesia. Among these minor enhancements, he includes brow-lift, upper and lower eyelid lifts, cheek-lift, minor nose re-shaping, lip shaping and lip lifting, facial fat transfer or filler, neck liposculpture, jowl removal, laser skin smoothing and wrinkle removal, laser skin tightening, and others.
Procedures to maintain youth are secondary to healthy lifestyle, especially moderate diet and regular exercise. Cosmetic and plastic surgery are most effective in the context of ideal body weight and overall fitness.
Choosing minor procedures doesn’t mean they can be performed well by a “minor” cosmetic surgeon. Certification by the American Board of Plastic Surgery means your plastic surgeon has met the highest standard for his or her own performance, which increases the chance that he or she will hold himself or herself to the highest standard for your care and your result.
Dr. Steve Laverson is certified by the American Board of Plastic Surgery, is a member of the American Society of Aesthetic Plastic Surgeons, the American Society of Plastic Surgeons, a fellow of the American College of Surgeons, and has been in practice in North San Diego County since 1993. For consultation, call his Encinitas office at 858-295-4001 or visit feelbeautiful.com.
Innovative approaches for preventing and controlling pain after cosmetic surgery may be combined to help patients tolerate procedures as much as they will enjoy the result. New methods we incorporate include:
1. Surface (topical) anesthetics before skin injection: These can include Ethyl Chloride, a fine spray that instantaneously freezes the skin, overwhelming nerves that transmit pain impulses with sensation of cold so that subsequent painful stimulus is not recognized. Also, local anesthetics such as benzocaine, prilocaine, lidocaine, and tetracaine are now formulated into creams or gels that promote better penetration through your skin surface to create numbness in the area to be treated. These applications are spread over the area to be treated 20-30 minutes beforehand to allow absorption into the skin. Covering the skin with plastic wrap prevents evaporation, and may improve effectiveness. These skin anesthetics are popular before cosmetic laser and injectable enhancements.
2. Regional anesthetics: These include injection of local anesthetics to neutralize a specific sensory nerve that transmits pain from a specific area of the skin. Lips are among the most highly sensitive areas of your face and body, so this method is valuable before lip augmentation with filler. Dr. Laverson uses topical anesthetic on the skin, then carefully numbs the specific nerves that supply sensation to your lips. This allows completely pain free lip enhancement. Filler must be placed well within the substance of the lips, and topical (surface) anesthetic doesn’t penetrate deeply enough to sufficiently numb your lips without addition of a regional anesthetic to block pain impulses.
3. Cannulas for injection instead of needles: Blunt tipped fine sterile cannulas are now marketed to allow distribution of cosmetic injectables within the face or body without painful needles. These cannulas offer the added benefit of avoiding nerve or blood vessel injury. Sharp needles more easily cut small nerves and vessels beneath the skin, leading to bruising and other side effects. Blunt tipped cannulas, when carefully used, are more likely to push aside these structures, allowing injection to proceed with less trauma to surrounding tissues.
4. Long acting local anesthetics: Use of injectable anesthetics and/or anesthetics to moderate pain for as long as three days after surgery is available thanks to Pacira Pharmaceuticals’ introduction of Exparel®. Now FDA approved, this long acting local anesthetic (bupivacaine) is packaged biochemically as a “liposomal suspension” (within tiny lipid globules) for slow release. Exparel® can be distributed within your tissues before surgical closure. While not totally eliminating post-surgical pain, your discomfort may be reduced to a much more tolerable level. Use of Exparel® may diminish your dependence on narcotic analgesics such as morphine, oxycodone, meperidine, hydromorphone, and hydrocodone, all of which have undesirable side effects.
5. Nausea prevention: One cannot discuss advances in pain control without mentioning nausea prevention. The classically most effective analgesics are narcotic medications which promote nausea, easily their most miserable side effect. First off, if you are nauseated after rhinoplasty, breast implants, or tummy tuck, you’re unable to hold down pain medicine. You’re not only nauseated, but in pain, a difficult combination. Second, if you’re vomiting after nose, face, breast, or liposuction surgery, the entire experience of aesthetic enhancement becomes tainted with bad memories. We plastic surgeons want to prevent nausea and vomiting as much as possible, knowing that if you are miserable, you’re less likely to come back for more. The introduction of anti-nausea medications such as ondansetron (Zofran®), aprepitant (Emend®), scopolamine skin patch (Transderm SCOP®), and alvimopan (Entereg®) combined with traditional anti-nausea treatments droperidol, metoclopramide, and others offer much improved pain control by narcotics and a better surgical experience.
6. Finally, discovery and use of non-narcotic analgesics are helping. Intravenous acetaminophen (Ofirmev®) given toward the end of major surgery, ketorolac (Toradol®) in the recovery room, and tramadol extended release (Ultram® ER) at home to supplement narcotic medications offer significant relief with minimal side effects. Also, muscle relaxers such as Carisoprodol (Soma®) are useful.