Medicine and Money: Patients should research doctor, procedure before plastic surgery

As a result of managed care companies' requiring medical practices to cut costs, some medical practitioners who specialize in areas other than cosmetic surgery are literally "trimming the fat" performing plastic surgery procedures such as liposuction, as well as rhinoplasty and breast augmentation to generate additional revenue, said Carl I. Price, MD, FACS, an American Board of Plastic Surgery-certified general plastic surgeon at Cox's Ferrell-Duncan Clinic.

"The economics of medicine have changed, now that managed care has come in. Practitioners, not necessarily plastic surgeons, have begun to do different things to enhance their practices' income. One of those things is cosmetic surgery," Price said. "In this town there are dentists who are doing cosmetic surgery, there are OB/GYNs doing cosmetic surgery, there are (ear, nose and throat) doctors doing plastic surgery."

Price said the demand for and availability of plastic surgery has created a competitive market in which costs for certain procedures have stayed the same for several years. The demand has also created a surge in the market of devices for plastic surgery procedures, some of which are proven and some of which are not.

"There are a lot of new techniques out there; some of those are unproven. I think it's buyer beware. People really need to do their homework," he said.

According to Price, homework before undergoing plastic surgery involves first finding out if the surgeon is American Board of Plastic Surgery-certified.

Plastic surgeons who are members of the ABPS are graduates of accredited medical schools and have completed at least five years of additional residency, which is usually comprised of three years of general surgery and two years of plastic surgery. To be certified by the ABPS, a doctor must practice plastic surgery for two years and pass comprehensive oral and written exams.

Price said the American Society for Plastic Surgeons is also a respected organization that screens its members and has certain qualifications surgeons must meet before being permitted to join the organization. The ASPS is a branch of the ABPS and designates surgeons who are certified in the specialty of plastic surgery.

"There's a great Web site at www. plasticsurgery.org, that you can get on and find all the board-certified plastic surgeons in your area. I also think the patient should interview the doctor ... ask questions and get a feel for what the relationship will be like," Price said. "If you shop around for a car, you should shop around for a plastic surgeon, too."

The next step is asking if the surgeon has hospital privileges, Price said.

"Hospitals are now much more rigorous in terms of allowing privileges to be given, so that's another thing people should check, whether the surgeon has the ability to perform a procedure in a hospital if needed," Price said.

Some procedures should be performed in a hospital, he said, such as liposuction to remove large amounts of fat. Price said he performs eyelid surgery, small liposuctions and some laser surgery in his office in the Ferrell-Duncan Clinic.

"There are certain procedures that should not be done in the office. There are certain procedures that shouldn't be done on an outpatient basis; the patient should stay overnight in a hospital. It comes down to surgical judgment, really," Price said.

Once a coastal phenomenon, plastic surgery is now as available in the Midwest as in Beverly Hills, and the technology for new procedures and improvements to such standard procedures as facelifts and rhinoplasty is as sophisticated here as anywhere, Price said.

"Overall, the quality of plastic surgery in this town is better than most other places in the country ... we do all the cutting-edge things here that should be done," Price said.

Facial plastic surgeon Keith A. LaFerriere, MD, FACS, said the better availability and, in turn, better social acceptance of plastic surgery in the last decade has led to increased numbers of plastic surgery procedures in the Ozarks.

"People who are showing signs of aging and are in an occupation where they are competing directly with younger people need to look and feel as young and vital as their competition ... or at least younger and not aged. That is a very powerful motivator for a number of people that we didn't see 10 years ago," LaFerriere said.

LaFerriere's clinic in St. John's Fremont Avenue Medical Building provides reconstructive and cosmetic facial plastic surgery such as facelifts, eyelid surgery, rhinoplasty, facial liposuction and hair-replacement surgery. LaFerriere also offers laser hair removal and microdermabrasion, two relatively new cosmetic procedures to Springfield.

LaFerriere conducts free seminars on cosmetic surgery procedures to educate those considering undergoing plastic surgery. He said because no insurance companies cover surgery for cosmetic purposes only, his practice has not been profoundly affected by managed care.

"A third of my practice is potentially affected by (managed care). Of that third, probably 20 percent is managed care in this area, so if you take a look at the penetration, it's really not that great. On the other hand, we've had sort of a de facto managed care by Medicare for years," he said.