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Patients are always surprised to learn that there are very few laws governing the practice of medicine. In fact, a physician certified by his state medical board--whatever the specialty--can legally prescribe just about any drug and perform any procedure.

Legally, a pediatrician could operate on a senior citizen's knee. An orthopedic surgeon could prescribe chemotherapy for lung cancer. And an adult cancer expert could vaccinate a baby against chicken pox.

Obviously, these three examples are ludicrous. But, then, why do women get their Botox at their gynecologist's office?

Don't assume that your doctor has the right credentials or the right equipment to perform high quality plastic surgery and to keep you safe. Ask him the following 10 questions:

1.'Are you certified by the American Board of Plastic Surgery?'

Make certain that the doctor is certified by the American Board of Plastic Surgery.

The American Association of Medical Specialties recognizes only one organization to certify doctors in the specialty of plastic surgery. That organization is the American Board of Plastic Surgery.

Certainly, there are other surgeons who are well-trained and who do excellent work. However, unless that physician has been certified by the American Board of Plastic Surgery, you can't be sure.

2.'What training did you have after medical school? Was it actually plastic surgery?'

By some estimates, there may be as many as 60,000 doctors in the United States who perform some type of cosmetic surgery. However, there are only 6,000 Board Certified Plastic Surgeons!

Therefore, 90% of cosmetic physicians do not have formal training in plastic surgery.

To become a plastic surgeon requires 6-8 years of a rigorous surgical residency, after 4 years of medical school, which is after 4 years of college. A weekend course is no substitute.

3.'How many surgeries of this type do you perform each year?'

Even amongst Board Certified Plastic Surgeons, some tend to focus on one area more than another. Ask the doctor to speak with a few of his recent patients.

4.'What hospital do you work in? Where do you admit your patients?'

For 2 reasons, this may be the most important question on the whole list!

a)Traditionally, physicians have policed themselves locally. The community's doctors offered staff membership at the area's hospitals only to the physicians and surgeons whom they wanted as colleagues. A doctor had to have the training, dedication, and ethics to impress his peers enough to gain membership on the local hospital staff.

If a surgeon doesn't have privileges at the local hospital or in the local medical group, you have to wonder why. Do his fellow physicians not trust him?

b)You also want to know about hospital privileges in case of an emergency. While major complications are rare after plastic surgery, they are not unheard of. If you are unlucky, you want to be sure that your doctor has the credentials to take care of you--fast and without issues.

5.'If you prefer to operate in your office or ambulatory health care facility, is it accredited?'

Just the way your surgeon should be appropriately credentialed (by the American Board of Plastic Surgery), so should his facility. Make sure that the surgery center has been accredited either by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) or by the Accreditation Association for Ambulatory Health Care (AAAHC). Those certifications indicate a higher standard of care, including emergency equipment and safety protocols.

6.'Who administers the anesthesia? Is this person a Board Certified Anesthesiologist?'

Make certain--across the board--that all professionals involved in your care have the appropriate training to keep you safe. The anesthesia is actually the most dangerous part of most plastic surgery operations; be certain that you're in good hands.

7.'What are the risks of the procedure? How often do they happen? What do you do if they happen?'

Know what you are getting yourself into! Many plastic surgery procedures have relatively high complication rates. For example, most honest American/European/Asian research studies of breast reductions report 30-40% rates of complications. For tummy tucks, 25-35%. Yes, most of those complications are minor, but you need to make certain that you and your surgeon have a strong relationship. You may be visiting his office more often than expected!

8.'What is the expected recovery for the procedure?'

You need to be able to plan'for time off work, for help around the house, for child care, etc. Consider some typical back-to-work recovery times:

a)Botox: No recovery time necessary. Just take it easy for 4-5 hours.
b)Fillers (such as Juv'derm, Restylane, Radiesse, or Sculptra): Also, virtually no downtime, but expect more swelling relative to Botox. Bruising is not uncommon, but can usually be covered with make-up.
c)Browlifts: Back to work in 7-10 days.
d)Blepharoplasties (eyelid surgeries): Back to work in a week.
e)Face/Neck Lift: Plan on 1-2 weeks off.
f)Rhinoplasty: Back to work in 7-10 days.
g)Breast enhancement: Expect 1 week to recover.
h)Abdominoplasty or Circumferential Lower Body Lift: The toughest recovery; plan on 2-4 weeks away from the job.
i)Liposuction of a single region: Back to work in 1-2 weeks.

Returning to the gym will likely take twice as long as the above guidelines. And feeling totally normal may require another 2-3 months. Full healing--for you to see the final result--usually requires patience: 6-9 months.

Do realize that your surgeon may be able to vary techniques based upon your active lifestyle. Let him know your plans so that you two can customize the experience.

9.'Are you academically affiliated?'

Another way to vet your surgeon is to ask whether he teaches at a local university or whether he has a faculty appointment. While not all of the good surgeons are on staff at educational centers, an academic affiliation does indicate that a plastic surgeon is held in high regard by his fellow plastic surgeons.

10.'Is the state medical board investigating you for any complaints or malpractice suits?'

It's true that even great physicians do occasionally get sued. In fact, among plastic surgeons, one or two lawsuits every few years are actually the norm. However, you can contact the state medical board to learn whether your surgeon has demonstrated a pattern of poor care or inappropriate behavior.

Questions that you are commonly told to ask but which are not relevant:

1.'Are you board certified?'

Nearly all physicians are certified by one board or another. Just being 'board certified' isn't good enough. The right question to ask is, 'Are you certified by the American Board of Plastic Surgery?'

2.'In what state are you licensed to practice surgery?'

Remember that any physician with a valid medical license can legally perform surgery. There are no regulations that limit doctors to practice within their specialty; not one of the 50 states forbids the practice of plastic surgery by non-plastic surgeons. The correct question to ask is, 'Did you complete a formal residency in plastic surgery?'

3.'Are you certified by the American Academy of Cosmetic Surgery? Or the American Academy of Lipo-Suction Surgery? Or the American Society for Laser Medicine and Surgery? Or'?'

Not only can just about any doctor get a 'board certification' in something, and not only can any licensed physician perform any kind of surgery, but also beware that any physician with $500 can join any number of impressive sounding organizations. Heck, I know physicians who literally create 'societies' and 'academies' so that they can call themselves 'president' and use the title as a marketing gimmick!

The only organization that really matters is the American Board of Plastic Surgery. Assuming that your doctor is also a member in good standing at the local hospitals, then you've found the right guy.