Dr. Body (Beverly Hills board certified plastic surgeon Stuart Linder, M.D.) and Dr. Face (cosmetic plastic surgeon Robert Kotler, M.D.) use a private surgical facility in Beverly Hills for their rejuvenation surgeries. The facility is designed so that patients can be released after recuperating for several hours after their procedure.

In America, surgical facilities are certified by several bodies and types of inspectors. The whole concept is to provide for the safety of patients and to provide for every possible complication, situation and occurrence – even including fire and earthquakes – that could possibly happen before, during or after plastic surgery.

Drs. Body and Face tell what the alphabet soups of inspection and certification bodies mean to plastic surgery patients.

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Dr. Body (Dr. Linder:) Did you ever have the lights go out, doctor?

Dr. Face: (Dr. Kotler:) Yes, but at home. Fortunately, I have never had the electricity fail while performing a face lift or a rhinoplasty.

Dr. Body: That situation would be covered in a certified surgical center because those facilities are required to have an emergency generator that would supply lighting in emergencies.

Dr. Face: The safety systems, backups and fail safes in America’s private surgical centers never fail to amaze me. I opened the refrigerator there after a cosmetic surgery and noticed the little gizmo that records whether or not the ‘fridge has continuously been supplied with electricity.

Dr. Body: Was that before or after the fire drill?

Dr. Face: Actually, it was during! Thankfully, we are only required to hold one fire drill every six months.

Dr. Body: Correct. If any of what we call biologicals, the chilled serums or specimens taken from a patient for later lab analysis have gone without refrigeration, we need to immediately know it.

Dr. Face: There is one rare condition, malignant hyperthermia, that can arise during general anesthesia. Anesthesiologists, surgeons and patients have no way of predicting its occurrence unless there is a family history. There is no test to identify the condition. It comes on spontaneously during general anesthesia if otherwise safe and common drugs are being used.

Dr. Body: The drug used to treat the condition, Dantrolene, must be available immediately. Chances are excellent any one surgical center will never have a need for it – or ever see a case of malignant hyperthermia — but the antidote is stocked and replaced with fresh supplies as time goes on. Having Dantrolene on hand is a requirement for certification or accreditation of the facility.

Dr. Face: One of the leading surgery center inspecting bodies is known as JCAHO (Joint Commission Accrediting Health Organizations) or just The Joint Commission; it’s the same entity that certifies hospitals. There is no “getting ready” for their inspections because they show up unannounced!  Joint Commission inspectors examine 150 items in any operating room.

Dr. Body: Another important credential you may see in an American surgery center is from the US. Government’s Department of Health and Human Services. It is for centers servicing Medicare patients. And the Medicare Certification is a requirement for payment. The certification is like licensure from the state Department of Health and is a sign that center has the most stringent safety standards.

Dr. Face: Now, we really get into alphabet soup. Another sign of certification — and safety — to look for is AAAHC, or American Accreditation for Ambulatory Health Care.

Dr. Body: Yet another, AAAASF, (American Association for  Accreditation of Ambulatory Surgical Facilities) also inspects and certifies operating rooms where patients will be safer.

Dr. Face:  Some American cosmetic plastic surgeons have an operating suite within the confines of their private offices. If that O.R. carries one of the certifications we have mentioned, it provides the same safeguards as a freestanding surgical center and even hospital operating rooms.

Dr. Body: Of course, all those are for non-emergency, elective services. You would also want to ask the surgeon of your choice where his “hospital privileges” are. That indicates his patients would be quickly admitted in the rare case of a medical emergency.

So the initials indicating safer surgery and many patient safeguards to look for on plastic surgeons’ websites are:

• JCAHO
• ASC
• AAAHC
• AAAASF

Take a look at Dr. Body’s before and after plastic surgery pictures

Here are the before and after cosmetic plastic surgery pictures of Dr. Face.

Surgeons at work

Are cosmetic plastic surgery patients at risk? The short answer — say American plastic surgeons Stuart Linder,  M.D. and Robert Kotler, M.D. — seems to be: depends on what nation you’re in.

The British medical journal, Clinical Risk, recently printed an article, “Cosmetic Surgery Patients at More Risk than Ever” which highlighted high and low points in plastic surgery in various nations.

The eminent Beverly Hills board-certified cosmetic plastic surgeon Robert Kotler, M.D.  (who blogs as Dr. Face) along with Stuart Linder, M.D. (the Dr. Body blogger) read – and carefully noted — the article for salient points for plastic surgery patients who want to visit a private American clinic.

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Dr. Face (Dr. Kotler): The state of plastic surgery sounds like the wild West in England, with increased marketing, lack of regulations and “overwhelming” media hype.

Dr. Body (Dr. Linder): All this came about when the editor of Clinical Risk asked leading experts in the United Kingdom to write about the state of plastic surgery in England and a few other nations.

Dr. Face:  The writers sure got off on the right foot because they look at everything from an aspect of patient safety.

Dr. Body:  One French plastic surgeon joined in the discussion and noted that any surgical procedure in his nation can only be done by a surgeon who is “a registered specialist” and deemed competent. And I wish this fact was more widely known by American cosmetic plastic surgery patients, and I quote: “Possession of a general medical degree, and the fact the practitioner is ‘experienced’ are not deemed sufficient qualifications” for performing plastic surgery.

Dr. Face: Well, that’s a good idea. In America, we have plenty of cosmetic plastic surgeons who are deemed competent by our demanding medical boards. Of course, a long formal training period is required first. At the end, surgeon must take a written and oral exam that “certifies” us as being recognized by the medical profession as a fully-qualified specialists. Rather than use the word “recognized” the phrase patents should look for in the U.S.  is “ board-certified”. That means the doctor has passed the tests and a board of examiners has declared him or her fit to treat patients. There are 23 recognized medical specialties that test and certify applicant-M.D.s.

Dr. Face: That’s right, we are members of our certifying boards and then licensed by the state or states in which we practice. The boards can also police our business practices. Of those 26 boards, two are for face and body cosmetic plastic surgeons.

Dr. Body: Also worthy of note are the remarks of the president of the International Society of Aesthetic Plastic Surgeons (ISAPS). He writes how important the “safety diamond” is.

Dr. Face: True enough, doctor! And we American plastic surgeons also concentrate on those four things: patient, facility, procedure and surgeon.

Dr. Body: We have to make sure the patient is having surgery for the right reasons, that he or she is healthy enough for surgery and that the surgical facility is also certified, having met the highest standards for patient safety.

Dr. Face: The procedure has to be appropriate, too. And that’s about doctor judgment, which can never be regulated or certified. If a prospective patient requests cosmetic plastic surgery that is either medically unsafe or unwise  – or because the risks of disappointment or even complications are too high — the patient should be respectfully declined. There are no forces that can make a surgeon operate if he does not believe it is in the patient’s best interests.

Dr. Body: As for checking on the surgeon’s particular training, background and experience, we’ve already discussed how to find the appropriate training and certification of American cosmetic plastic surgeons in their websites. It’s wise to choose somebody who does the procedure you want at least once weekly. It is no longer possible for any one plastic surgeon to be a master of all the complex and newer procedures.

Dr. Face:  European surgeons writing in the Clinical Risk article also discuss some “improvements” that would not go over in America at all.

Dr. Body: Both the British and the French authors recommend banning all forms of  direct and indirect plastic surgery advertising and publicity in whatever form, including the Internet.

Dr. Face: Whoa, there! I don’t think that’s wise. In America, honest advertising is really a source of information that allows patients to get up to speed and learn about medicine…. even if it is considered marketing or advertising. Both Dr. Linder and I have authored books that focus on the consumer issues a prospective plastic surgery patient should know about. The books contain insider information from two highly-focused, superspecialist MDs who know their stuff.  The books? The Beverly Hills Shape by Dr. Linder and Secrets of A Beverly Hills Cosmetic Surgeon by yours truly, Robert Kotler, M.D.

Dr. Body: Plus, using a surgeon’s website can be a great help. Just the vast collections of before and after plastic surgery pictures can help narrow down the search. The more research and homework you do, the more chances you will have finding the precise doctor who matches your needs.

Dr. Face: So the $64,000 question is: Are plastic surgery patients also at risk in America?

Dr. Body: The short answer is, informed patients who know what’s involved in plastic surgery and know how to check for themselves the patient “safety diamond” (patient, facility, procedure and surgeon) are very, very likely to be pleased.

Dr. Face: On the other hand, if you select a surgeon used by a friend, or a friend of a friend, make sure you at least see the before and after photos and speak with the surgeon after checking on his or her credentials. Then, you will really learn what the doctor’s practice is like.

Remember, just having an M.D. degree and some experience is not enough for performing plastic surgery.

(Read the plastic surgery report about cosmetic surgery patients at risk.

In a seeming celebration of things American, two of Beverly Hills many eminent cosmetic plastic surgeons are being featured in this month’s American Way, the inflight magazine of American Airlines.

Your humble bloggers, the 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. (our Dr. Body blogger) tell more about  why Beverly Hills is widely regarded as the world Mecca of plastic surgery and why many patients come here from lands far outside the United States. Apparently, some fly the friendly skies of American Airlines.

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Dr. Face (Dr. Kotler): I’ve read a lot of amazing things about you, Dr. Linder, but according to this month’s American Way magazine, you are – and I quote  –  “one of the highest regarded breast revision surgeons….. in the world!” And, I would agree.

Dr. Body: (Dr. Linder): I’m humbled; there are many, many highly competent plastic surgeons in Beverly Hills, so it’s a real honor to receive that type of praise.

Dr. Face:  As the magazine so aptly points out, there are 39 cosmetic plastic surgeons on our street alone – and this is a very short block! Our other neighbors include 11 cosmetic dentists and 5 dermatologists, some of whom perform minor plastic surgery services like dermabrasion. You could almost call the talent in Beverly Hills an embarrassment of riches. No wonder the magazine wants its travelers to know more about the area.

Dr. Body: I’ve noticed on the television program, Dr. 90210, some surgeons tell patients, there are more plastic surgeons in one Beverly Hills office building alone than in the entire state of Montana.

Dr. Face: While we do sit cheek-by-jowl with Hollywood and its movie and T.V. industries, Beverly Hills cosmetic plastic surgery long ago stopped servicing only  the rich and famous. Sure, wealthy people still shop and use other exclusive services but the reality is that the explosive growth of Beverly Hills cosmetic plastic surgeons in the last several decades happened because the procedures became affordable for most American and International patients. The costs of face lift, rhinoplasty, breast augmentation, tummy tuck and other popular procedures came down due to:

• Better technology
• Better medications
• Shorter operating times
• Going from expensive hospitals to private outpatient surgery clinics.

Dr. Body: And so our and our colleagues’ work sits up there on the silver screen, allowing 60-year-old actors to look perhaps 40 or 45. Southern California is a huge area, so many ordinary people who also want surgical rejuvenation come to Beverly Hills. And apparently, thanks to the Internet, the word has spread to other U.S. states and foreign nations. For instance, how many patients from abroad have you served in your practice?

Dr. Face: At last count, it was patients from 33 foreign nations, and all 50 U.S. states. It’s easy for patients because they are picked up at the airport, taken to their choice of many, many local hotels and then, for the night after surgery, stay at one of several plastic surgery recovery centers which have been aptly been named “face lift hotels” by local wags.

Dr. Body: On my website, I have an interactive map of the world, showing where international patients have traveled from, including China, the Middle East and Australia. (Look at the map of Dr. Linder’s plastic surgery patients’ home nations.) I think the statistics are like yours with patients traveling in for surgery from 23 nations and 40 U.S. states.

Dr. Face: With loads of theaters, various ethnic restaurants, night-life clubs – some of which are frequented by celebs pictures in People, OK and other celebrity observers – there is much here to take in before returning home. There’s just no place like Beverly Hills and greater Los Angeles. For instance, this month’s Saveur Magazine, a guide to fine dining worldwide, devoted an entire issue to Los Angeles.

Dr. Body: A great deal of all this is possible, thanks to the Internet and the “virtual consultation.”  People in foreign nations can take some pictures of the body or facial areas they want treated and tell the surgeon a few other details so we can “virtually” consult through email, on the phone or via Skype.

Dr. Face:  But don’t get the idea it’s email-to-the-operating room. Once the patient arrives in one of our offices, we go through everything again with the concept that we have never seen this patient before.

Dr. Body:  And don’t forget economics! Currently, the U.S. dollar is relatively weak and creates some attractive bargains for people in Asia, Europe and the Middle East. Sure, exchange rates fluctuate, but right now, America looks “cheap” to much of the world.

Dr. Face: For instance, a man in Italy told me it would be more cost-effective for him to come to Beverly Hills, have nose surgery, stay for seven to ten days and fly home than to have plastic surgery in Switzerland, which was about two hours from his home.

Dr. Body: Well, here we are, doctor, talking all about the American Way article when, thanks to the Internet, we can send people there to read about for themselves.

Dr. Face: Capital suggestion! Read the plastic-surgery-in-Beverly-Hills article in American Way. Enjoy!