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Behind the Doors of a Park Avenue Plastic Surgeon - Part 1

Behind the Doors... Z. Paul Lorenc, MD, is a well-established New York City plastic surgeon who wrote “A Little Work: Behind the Doors of a Park Avenue Plastic Surgeon,” a book that tells what really goes on behind the scenes in the office of a cosmetic surgeon. Dr. Lorenc graciously allowed to excerpt a chapter, “The Never List” which explains 15 things a patient should never do in plastic surgery. Here, we present his first nine.

The Never List: What You Really Need to Know and Ask Your Plastic Surgeon Because If You Don’t You Might Be Sorry

MORE THAN ANYTHING, I WANT EVERYONE TO UNDERSTAND THAT PLASTIC surgery is serious business. So here's my fifteen plastic surgery com­mandments, or my never list.

1. NEVER Shop for a Bargain

Sorry, but there is no such thing as a bargain when it comes to plastic surgery. If you go to someone who promises to give you Botox for a third of the price that others are charging, there's a reason.

You'll be getting only a third of the quantity that I'd give you.

Drugs like Botox have a fixed price. Trust me, no one gives anything away.

Same with surgery. If you go to a doctor who charges less, the odds are good that he or she is less qualified or less experienced than someone who charges more.

I'll admit, however, that there are exceptions. You may find a young and extremely talented doctor who's just starting out, and you can bene­fit by getting a better price from him or her than you would from some­one with more experience. But generally speaking, surgeons with more experience are better because they've seen more and done more. They understand how wounds heal. They know how much skin softens up and goes slack. Plastic surgery is a subtle field whose intricacies can be learned only over the years. It becomes a knack. I'm not trying to be arrogant saying that-I learned it after years of experience. My work now is far superior to the work I did when I first started. Doctors charge for that, simply because they can.

It's your face, your body, and your life. If you can't afford someone good, save your dollars until you can.

Honestly, would you want someone without the deepest possible knowledge and experience slicing off your face or sucking out your fat? I recently saw a woman who'd had a chemical peel at a hair salon in Florida and ended up with a massive, disfiguring scar on her face. No one should get anything but the mildest peel from a salon. I was flabbergasted.

I may not be Einstein, but I would know enough to not go to a hair salon to have chemicals put on my face.

It's up to you to take responsibility for your health and well-being. Plastic surgery is most often elective surgery

Elect to be smart.

Searching for bargains will most likely cost you triple in the long run. The only one who gets the bargain is the doctor who has to fix the mistakes.

Like me.

It's amazing how irrational some people are in their effort to save a few dollars. A woman came for Botox. She called the next day and wanted information on how and where we ordered it as well as how large a syringe we used. When Lorraine asked her why, she said that her hus­band, who was a podiatrist, was going to inject her with Botox next time. I would have said nothing, because that's my style. But Lorraine doesn't keep her opinions to herself. She told the woman that she was foolish to have a podiatrist - husband or no husband - give her Botox injections.

Her face would end up looking like a foot.

2. NEVER Have Surgery by Anyone Other than a Qualified, Board-Certified, Experienced Plastic Surgeon

Don't pick a surgeon based on an advertisement in a newspaper-much less the subway. Generally, good plastic surgeons don't advertise. Our professional society, the American Society for Aesthetic Plastic Surgery, frowns on this practice.

Ask doctors you trust for recommendations. Choose three surgeons to consult; doctors who you believe are at the top of the field where you live. Then interview them. Write your questions down so you don't for­get any. Speak up. You're paying for the doctor's time, and any surgeon worth his or her reputation will be happy to answer anything you ask, no matter how trivial you think it is. Informed, prepared patients make our job much easier.

Behind the Doors... After the novelist Olivia Goldsmith died during surgery for a chin-lift in January 2004, there was a lot of publicity about her case. The only good thing to come out of it, as far as I'm concerned, was that patients started asking me more questions. One woman in particular asked me a question that I thought was brilliant. I was doing only a minor, laser procedure on her, but she wanted to know whether the kind of doctor who is doing the surgery actually makes a difference. She wasn't asking whether I could do a better face-lift than someone else. She was asking whether the doctor's overall experience would make a difference when it came to saving her life.

Of course, it does. Let's say, hypothetically, that I was doing a breast aug­mentation, and all of a sudden there was a major catastrophe to this patient m the operating room that necessitated my opening up her chest. Do you want a doctor who has training in that, or do you want a dermatologist who has never seen a chest tube placed in a chest cavity since his or her surgical training rotation in the emergency room twenty-five years before?

God forbid someting major happens to you during elective (or any kind of) surgery. But on the minuscule chance that it does, you want the door with the deepest surgical experience to be in the room to help you survive.

Sadly, I don't think young surgeons have that kind of training any­more. Now they go directly into training for plastic surgery. They never do trauma cases, or run a service at Bellevue the way I was trained. I'm extremely grateful that I have that knowledge stored away so I can call upon it if I ever need to. I think all surgeons should have it.

Also be sure to ask about the protocol for surgical emergencies.

This protocol extends to the facility where you will be having the sur­gery done. Always make sure that it has the proper licensing and equip­ment. Ask to see the doctor's certificate for the operating room if it is in his or her office. There are reasons for this. In a case not long ago, an eighteen-year-old woman who went to a Philadelphia area doctor for liposuction died not long after the procedure when a clot of fat entered her lungs. There's no way of knowing whether the medical facility lacked something that could have saved her. But during the postmortem inves­tigation, it turned out that the facility wasn't properly licensed.

3. NEVER Have Gore-Tex or Silicone Put in Your Lips

I've taken care of enough problems caused by these materials to know it's not a good idea. Implants made from these permanent substances are too extreme and artificial looking. Worse, removing this material is not easy. It has to be cut out, and that can leave a visible scar and a deformed lip.

4. NEVER Have a Face-Lift without Asking Where the Incision Will Be

It must be behind the front part of the ear, called a retrotragal. Otherwise the scar will be more obvious. Incision placement is so important you must pay attention to it and ask questions.

5. NEVER Say Yes to a Large Procedure When a Smaller One Can Just as Easily Give You the Result You Want

There are doctors who pull what amounts to an insurance scam by suggesting you get a large procedure-perhaps a realignment of the jaw-rather than a chin implant. They do that because the jaw surgery may be reimbursed by the insurance company as a necessary reconstructive pro­cedure, but the implant won't be. A chin implant isn't anywhere as com­plicated or painful as realignment.

6. NEVER Get Breast Implants if Your Mother or Sister Had Breast Cancer

Implants in most cases pose absolutely no problem. But if significant scarring develops, that can interfere with mammography, and cancer might be difficult to detect. There's no way of predicting who will develop scarring, so for people with a high risk of breast cancer, it's not worth the risk. (Editor’s note: For an entire article on this topic, Click Here)

7. NEVER Get Buttocks Implants

Every single one I've seen, whether presented in real life, photographs, or journals, looks ridiculous. Women appear to have bubbles in their butts.

Besides the fact that they look completely bizarre, there are medical reasons to stay away from this procedure. It's crazy to put a foreign body in a weight- and tension-bearing area. Especially an area like your rear end, which is constantly in motion. The implant will rupture from the pressure, or move, or contract.

But there are always doctors who will do surgeries that really aren't appropriate.

And patients who demand that they're done.

To be continued.......

Excerpted from A LITTLE WORK: Behind the Doors of a Park Avenue Plastic Surgeon by Z. Paul Lorenc, M.D., F.A.C.S., and Trish Hall. Copyright © by the authors. Reprinted with permission from St. Martin's Press, LLC.

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