Cosmetic plastic surgeons see many people every day who are interested in looking better…but may know next to nothing about plastic surgery. So every cosmetic plastic surgeon uses what Latin teachers call the “Socratic Method,” a technique we know today as “Q&A.”

But there are questions, and then there are questions surgeons wish people would ask.

Dr. Body, the eminent Beverly Hills board-certified plastic surgeon Stuart Linder, M.D. tells his choice of best questions while the equally imminent Beverly Hills board-certified facial plastic surgeon Robert Kotler, M.D. joins in.

_____________________________________________

Dr. Face:  (Dr. Kotler) What questions do patients most often ask you, doctor?

Dr. Body: (Dr. Linder) Potential patients want to know — in no particular order — if they are a good candidate for, say, breast augmentation or tummy tuck; what the major risks to each procedure are; how long does recovery from each operation take and what they are going to look like after the procedure.

Dr. Face:  O.K., those are all good questions, but is there one question in particular you wish they would ask?

Dr. Body: Yes, I wish more inquiring patients would ask “Do you perform only plastic surgery procedures of the body?” That would tell me they have been doing their homework and know that a  specialist concentrates on just a handful of procedures and performs each exceeding well, thanks to constant repetition.

Dr. Face: I like to hear the same question; but I can think of a few more that would be welcome in my ears.

Dr. Body: Such as?

Dr. Face:  “How long have you been performing this handful of procedures?” That tells me the patient wants to put his or her procedure in the hands of a cosmetic plastic surgeon who has seen every possible wrinkle, complication and outcome and immediately knows what to do in every instance.

Dr. Body: Now that you mention it, I can think of another question I wish more patients would ask during the initial consultation when we first meet.

Dr. Face: Don’t keep me in suspense!

Dr. Body: I would like to hear: “Where are your ‘hospital privileges?’”

Dr. Face:  Good choice. Hospitals are expert in knowing which doctors enhance their reputations and which doctors cause problems. If a particular surgeon falls into the “problem” category, he or she is very likely indeed to have hospital privileges withdrawn.

Dr. Body: We should tell people that  “hospital privileges” means that a surgeon can have a patient admitted with just a phone call. It’s just another level of patient safety in the unlikely event that something goes wrong.

Dr. Face:  I can think of one more question I wish more patients would ask.

Dr. Body: And that would be?

Dr. Face: ‘May I speak to a patient of yours who has had this same procedure?”

Dr. Body: When I hear that, I know I’m going to have a new patient.

Dr. Face:  If the previous patient is in the office, I just introduce the two people, excuse myself and say: “I’ll leave you two to chat over the surgery you’ve had and the surgery you want. Call me when you need me.”

_____________________________________

View some of Dr. Kotler’s revision rhinoplasty before and after pictures.

Look at some of Dr. Linder’s breast augmentation revision before and after pictures.

Surgeons preparing for an operation

Two plastic surgeries at once? By two surgeons? Yes.

It’s extremely efficient for one patient to have two plastic surgery procedures by two rejuvenation surgeons — Drs. Linder and Kotler–during a single session.

It’s a common service offered by the eminent Beverly Hills board-certified cosmetic plastic surgeon Robert Kotler, M.D.  (who blogs as Dr. Face) and Beverly Hills board certified plastic surgeon Stuart Linder, M.D (the Dr. Body blogger) tell why it’s to a patient’s advantage to have several cosmetic plastic surgeries in one session when he or she wants procedures of the face and body.

_____________________________________________________________________________________________________________

Dr. Face (Dr. Kotler):  We’ve already talked a great deal about how a patient is well served by seeing a superspecialist cosmetic plastic surgeon, one who specializes in just a handful of procedures and performs them at least weekly, if not daily.

Dr. Body (Dr. Linder): Because that surgeon performs the procedure so often, he or she is swift and efficient. That leads to less bruising, bleeding and soreness so healing is usually quicker.

Another benefit is that surgeon has seen all the wrinkles in a particular surgery. For instance, one rare complication of breast surgery is when a patient’s breast implants roll together under the skin. Known as symastia, many refer to it as a “uniboob” deformity.  It is extremely difficult to repair but many cases are referred to me because I specialize in surgery of the breast.

(See a picture of a breast augmentation that resulted in symastia.)

Dr. Face:  The two surgeon approach translates to a savings of time, money and convenience.  Two cosmetic plastic surgeons teaming up to do their respective cosmetic surgery work during one operation equals one session under anesthesia, one charge for the M.D.-anesthesiologist and one recovery and healing period. Not to mention one stay in Beverly Hills if you have traveled here from abroad as many of our patients do.

Dr. Body: Recently, a patient wanted to have liposuction of the body and cosmetic nasal surgery as well as some surgery inside the nose to correct and improve her breathing. Of course, we can’t work simultaneously. So I go first because liposuction requires vigorous movement, using long, thin tools through fatty areas of the body and that creates a little jostling. Dr. Face’s nasal surgery, however, is extremely delicate and the patient cannot be jostled.

Dr. Face: As you may know, I specialize in cosmetic procedures of the head and – on a daily basis — perform rhinoplasty and other nose surgery, face lift, eyelid lift, ear pinning, or otoplasty plus nonsurgical wrinkle removal. I was trained in all aspects of  face and neck plastic surgery but limit my practice to just the cosmetic procedures, including revision rhinoplasty.

Dr. Body: I, on the other hand, only perform procedures of the body and specialize in breast surgery, including breast surgery revision and reduction – for both men and women – plus liposuction and tummy tuck. Revision breast surgery is also one of my specialties.

Dr. Face: When the patient goes under anesthesia, one or the other of us will do our procedure and then step aside for the other surgeon. The anesthesia time considered safe in cosmetic plastic surgery is up to ten hours.

Dr. Body: But because we are both highly focused specialists, the total time for our joint procedures is usually somewhere around two and one-half hours.

Dr. Face: There are over 125 different plastic surgery procedures. It’s impossible for any one surgeon to master them all. Plastic surgeons are becoming ever more specialized. For  instance, some do only plastic surgery of the hand while still others only do reconstructive surgery.

Dr. Body:  In fact, all of American medicine is becoming extremely superspecialized.  While some surgeons specialize in chest surgery, others specialize in heart surgery only. Some eye surgery specialists only perform surgery on the retina while others limit their practice to cataract surgery.

Dr. Face: Today,  some heart surgeons super specialize in one area like the coronary arteries while another will specialize in operating on heart values.

Dr. Face: I know superspecialization is great for the patient because I was a surgical patient not long ago.

Dr. Body: What did you have?

Dr. Face:  I needed a hernia repair and choose a surgeon who does nothing but hernia repair. A neighbor of mine had the same procedure but went to a general surgeon who does many other operations.

Result? I was hiking  the next day! But my neighbor took weeks to recover.

Look at Dr. Body’s before and after breast augmentation pictures.

See Dr. Face’s before and after rhinoplasty (nose job) pictures.

Many American plastic surgeons, like

Both are also voracious readers of those publications and do their best to help patients – and even other doctors – understand the importance of new findings.

They often summarize their readings and findings in News & Views, reviews of the latest articles from the professional press.

While many more professional news reviews will follow from time to time, here is just one.

________________________________________________________________________________________________________

Dr. Face:  (Dr. Linder)Everybody is interested in identical twins. But did you know that many, many twins have been studied before and after plastic surgery? One famous study compared twins who lived a healthy lifestyle with twins who smoked, drank, spent too much time in the sun and partied unto the wee hours. Guess which twin most needed facial plastic surgery?

Dr. Body: (Dr. Kotler) Probably the “bad” twin. But do I sense something new in the works about twins and plastic surgery?

Dr. Face: Indeed you do, doctor. As you may know, surgeons have always debated which particular surgical procedure yields the best and most long-lasting results. To find out, four plastic surgeons operated on four sets of twins back in 1995. Each surgeon used his own favorite surgical method which included neither unorthodox nor experimental approaches.

Dr. Body: Good idea for a study. What did they find?

Dr. Face: Plastic surgeons followed the twin patients at professional meetings in 1996, 2001 and 2005. At the last comparison, all of the twins looked good although nobody could answer the question, “Was it the surgeon or the technique?” The twins still look like each other, even after plastic surgery.

Dr. Body: What conclusions did you draw?

Dr. Face: That experienced plastic surgeons who perform a lot of procedures, say. at least two times a week of one particular procedure, get great results, even if they are using a different procedure.

Dr. Body: Very interesting! In what publication was the study printed?

Dr. Face: Plastic and Reconstructive Surgery, Volume 123, # 3, March, 2009.

Dr. Body: The article on twins I read was in the same magazine a month later. 186 sets of identical twins filled out a lifestyle questionnaire and provided photos. A panel of experienced cosmetic plastic surgeons then analyzed everything and presented their conclusions.

Dr. Face:  What was found?

Dr. Body: Of the leading most important lifestyle factors – things like marriage, body mass, sun exposure and even hobbies – cigarette smoking was fingered as one of the most significant. Because you could compare a subject to another person who is a genetic match, it was shown that every ten years of smoking equaled a two and one-half year older appearance.

Dr. Face: Another good reason not to smoke! If one twin smoked for, say, 30 years, he or she would look seven and one-half years older than the non-smoking twin. That is significant for somebody in the late 40s or 50s.

Dr. Face: Another important finding was that sunscreen did offer some protection from sun damage. Also, the study showed that women who had hormone replacement therapy after menopause looked younger than twins who skipped that therapy.

Dr. Body: For people who want to look that study up, how can they find it?

Dr. Face:  Just ask the medical librarian for Journal of Plastic and Reconstructive Surgery, volume 123, #4, April, 2009.

Note: Dr. Body is a leading breast surgery revision specialist while Dr. Face specializes in revision rhinoplasty surgery.