Making an Informed Decision

Reviewed by Ronald E. Iverson, MD, FACS

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The latest and most popular topic in plastic surgery is the combination treatment plan. There is a broad range of procedures and treatments available, including major surgeries, less invasive surgeries, nonsurgical procedures, and many non-invasive treatments. Results range from three months to 15 years or more. Today there is an endless selection of anti-aging solutions, and a wide variety of specialists with varying areas of expertise. So it makes sense to create a comprehensive treatment plan that involves multiple procedures. But with so many options, how do you get started?

Your first responsibility to yourself is to make an informed decision about the doctor and the procedure. A comprehensive treatment plan means that you have a clear understanding of the spectrum of procedures that are available to you. An informed decision also means that you have decided on a doctor based on reputation, credentials, the technique you desire, bedside manner, support, cost, office staff members, location, and accommodations within the office. Learn more about choosing a board-certified plastic surgeon.

There are four primary components to a comprehensive treatment plan in cosmetic plastic surgery.

1. Priority Feature List and Terminology

Develop a priority list of your physical features that you most want to have treated. In consultation with a board-certified plastic surgeon, you will need to evaluate treatment options for each specific area of concern on your body. For example, if you are an older patient and the most bothersome area of your face is your nasiofold area, then non-invasive facial fillers may be the right choice. On the other hand, your list may include the cheeks and chin as well, making a facelift and facial fillers appropriate, and possibly chin surgery. Facial Fillers may serve well for crow's feet and forehead wrinkles. However, blepharoplasty may be more appropriate for excess skin in the eye area. In fact, Botox may serve well for slight forehead and crow's feet wrinkling, while Restylane works well for the nasiofold area.

In order to clearly describe your concerns to the doctor, you may want to bring a picture of yourself from years ago. You can bring this picture to the initial consultation to show the doctor a comparison of bothersome features.

To get ahead of the game, learn the terminology before you consult a surgeon. For example, fullness in a certain area of the face may be referred to as excess fat. Sagginess is referred to as redundant skin. Sunken areas or hollowness is called just that, sunken areas. Hyperpigmentation is the term used to describe discoloration areas on the skin. That's just a start. Read the specific articles, found on this website, about your desired treatments to learn more terminology and important facts.

The treatment for each condition varies, depending upon severity, age, and other personal anatomy factors. More than one type of treatment or procedure may be necessary to produce satisfactory results. For facial aging conditions, you may need any combination of facial surgeries, facial rejuvenation treatments, and injectables and fillers, perhaps even with a bit of nose reshaping.

2. Long-Term Planning

Carefully research the short-term and long-term impact of any cosmetic procedure, on your own and in consultation with a surgeon, in order to develop an appropriate comprehensive treatment plan. Minimally invasive procedures require repetition to maintain the benefit. The appearance of implants of any type may change over time.

Many patients have needed repeat procedures, or follow-up mini or micro procedures, in order to maintain optimal results. For example, the FDA found that there was a 30 percent re-operation rate for certain breast augmentation patients. While the reasons for this re-operation rate are numerous, many cases were due to the changed breast appearance over time or the desire to further increase size. For this reason, be sure you write down and keep the information about the type of implant or other devices used in any implant procedure. Store the implant information in a safe place in case you need a second operation. No one can predict how a cosmetic treatment will look years later, and you should be prepared for the possibility of follow-ups.

3. Before and After Surgery

Before surgery, be sure you have a preoperative and postoperative instruction list from your doctor. Following instructions before and after surgery can reduce the risk of complications. Ask about the surgeon's recovery support: Some practices offer 24/7 phone communication. Other practices offer email and phone communication. You will need to visit the doctor throughout recovery. Sometimes these visits continue for up to one year after surgery. Recovery support in plastic surgery is an important part of a comprehensive treatment plan. A checklist is a good idea for a before-and-after treatment plan.

4. The Financial Picture

Most cosmetic surgery procedures comprise three costs: anesthesia fees, facility fees, and surgeon's fees. When you have multiple procedures performed at the same time, you only have to pay one anesthesia fee and one facility fee. Minimally invasive procedures or non-invasive treatments may have one associated fee. But these treatments and procedures need to be repeated in order to maintain the benefit. Plastic surgery procedures may also need to be repeated in years to come. Remember to consider the financial impact of repeat procedures when calculating your total costs. Some medical practices offer maintenance packages that include reduced fees for continued treatment.

A big part of planning your treatment is understanding your insurance coverage. In some cases, the procedure may be considered medically necessary. Medically necessary procedures may be partially or completely covered by your insurance carrier. It's a good idea to find out the extent of your insurance coverage for complications that may require additional surgery.

If the cost of a procedure is difficult for you, ask your surgeon about payment plans and medical finance options. Most cosmetic plastic surgery offices provide consumer-friendly payment plans that allow you to make monthly payments.

About the Reviewer of This Article

Ronald E. Iverson, MD, FACS, is a board-certified plastic surgeon, a member and former president of the American Society of Plastic Surgeons, a member of the American Society for Aesthetic Plastic Surgery, and an American Medical Association delegate. Dr. Iverson received his medical degree from the University of California, Los Angeles, and performed his residency at Stanford University Medical Center, General Surgery and Plastic and Reconstructive Surgery.