John Q. Cook M.D. - 10 Questions You Should Know Ask Your Doctor About Liposuction.

I have put these questions together particularly for patients who are in the process of evaluating potential surgeons for liposuction surgery. Liposuction is an extremely popular form of plastic surgery, for good reason. If your surgery is carried out by a skilled surgeon who knows how to properly select patients who will truly benefit from the procedure long term, it can offer very pleasing long-term result and a relatively easy recovery from surgery. What has disturbed me, particularly in the past few years, is that there seems to be an increasing number of bad results from this surgery. Part of this may be related to the profusion of weekend courses in liposuction. Most of aesthetic plastic surgery is essentially a very fine craft. Like any fine craft, the skills necessary to do consistent, high quality work cannot be assimilated quickly or easily. It is my hope that these questions will help you to find a surgeon who is skilled, selective, and truly committed to patient well being.

1. What are your credentials?

In Illinois, as in most states, there are no legal restrictions to the procedures a physician may perform once he or she obtains a medical license. Fortunately, it would be difficult for me as a plastic surgeon to perform open heart surgery, even though it would be legal for me to do so. First of all, ethical considerations stop me. I would not be serving my patients’ best interests if I performed such a high complexity procedure without training in an approved residency program. Even if I had no scruples, however, there would be practical limits, since no hospital in their right mind would let me carry out such surgery in one of their operating rooms. The issue of credentialing becomes considerably more interesting as we move to those procedures which can be performed outside of the hospital environment, either in surgery centers or doctors’ offices. Some surgery centers are highly selective as to whom they will allow on their staff, whereas others are not. Of course, if the doctor chooses to operate in his own office, he is probably not going to reject his own credentials.

I would suggest that if the physician who is going to treat you is serious in his or her commitment to excellent results, he would have obtained advanced training. I would suggest that you use the training required by the American Board of Plastic Surgery as a benchmark. Individuals who have chosen this path obtain five to eight years of advanced surgical training after medical school. To achieve board certification in plastic surgery, they will have passed a series of rigorous examinations and also will have been subjected to a review of their practice, including ethics. Although this doesn’t guarantee a magnificent result, it certainly is a very important first step. You should be aware that there are organizations which offer weekend courses in cosmetic surgery, such as liposuction, to any physician who is willing to pay the registration fee. A bit of common sense might suggest that different levels of training and commitment on the part of different physicians will probably produce different outcomes in the operating room.

Remember to ask about the hospital affiliation of the doctor you are evaluating. This might at first seem a strange consideration, since the majority of liposuction surgery is not performed in a hospital environment. Hospital affiliation, however, remains an important gauge of the quality of the physician. If you don’t have a good idea of which are the best hospitals in your geographic area, I would suggest that you put this on your “to do” list. We never know when we are going to need serious medical care and, if so, you would be well advised to seek it at one of the leading hospitals in your area. To put it simply, the better hospitals in a given metropolitan area are highly selective in terms of their medical staff. The credentialing process that they have gone though is yet another indication of physician quality.

2. What is your experience with this procedure?

In a given field, different doctors have different areas of interest and expertise. Although there can be exceptions, I would suggest that you seek out an individual who has performed at least 100 such procedures to make certain that he or she has at least the necessary basic experience. This question, of course, will not help you to determine the absolute skill level of the physician, but at least it guarantees a reasonable amount of experience. In one sense, liposuction is quite easy to perform in that the motions involved in the surgery are relatively easy to acquire. The problem comes when these motions are used in a coordinated and sophisticated manner to produce a sculptural result. This requires a great deal of experience.

3. When you evaluate me, are you looking at the whole picture?

The answer to this question will be revealed by the manner in which you are treated by the doctor and his staff. As I have suggested in other parts of this website, liposuction is a procedure that can offer significant value to patients and a result that will be appreciated for many years. Perhaps you are a good candidate for liposuction, but this really isn't the right time because of personal or family commitments. Perhaps you would be best served by embarking first on a diet and exercise program and then using liposuction as a finesse procedure. My point is that the physician cannot give you this type of advice unless he or she has taken the time to obtain this information. At the very least, the physician should ask about the history of your weight and its fluctuations, as well as your nutrition pattern. He or she should also have asked you about your exercise history and how consistent you are. The doctor also should have obtained a sense of what your life is like. Do you, for example, travel quite a bit for business, or do you have small children that might affect the recovery period? If these questions are asked, it indicates that the individual is interested in your total well being. If, on the other hand, you sense that you are part of a production line, I would suggest that you seek services elsewhere.

4. How will you protect my skin tone?

Skin tone is one of the most important variables when a patient is evaluated for liposuction. It determines just how aggressive the surgeon can be. You can check your own tone by pinching the skin over the area where you are considering liposuction. If the skin is hard to pinch because it is tight, and if it snaps back with good elasticity, this probably means that you have excellent skin tone. If, on the other hand, the skin seems loose and can be pulled away a good distance from the underlying structures, you probably have cycled up and down in weight and experienced significant skin tone reduction. This does not necessarily mean that liposuction is impossible, but certainly the technique should be applied judiciously. Under such circumstances, overly aggressive liposuction will produce an unattractive result. This is because the skin can actually hang loosely, even in folds under extreme circumstances. For most individuals, this is not an acceptable trade-off.

5. What types of body contour surgery do you perform, other than liposuction?

This may be an indicator as to the overall experience of the surgeon. Liposuction is a wonderful procedure, in that it can offer an excellent result and a relatively easy recovery from surgery. That said, there are cases where excisional body contour surgery, such as abdominoplasty, and other types of body lifts, is really the right answer. As with any type of workman, if a physician possesses a good variety of tools, then he or she will be able to apply the best tool selectively towards your particular problem.

6. What do you think creates attractive body lines?

Plastic surgery is different from the rest of medicine in that the diagnosis is based upon concepts of beauty. There are certain aspects of beauty which tend to be enduring and persist across wide spans of time and a wide variety of cultures. There are, however, very distinct differences from one individual to another in terms of the fine points of beauty. When I visit certain Internet sites, or see certain advertisements, I am sometimes surprised by the pictures that are shown. I see, for example, legs where the beautiful curves have been broken or straightened. In my opinion, curves should be adjusted towards the ideal line, but not eliminated. At any rate, that is my concept of beauty, and it certainly benefits my potential patients to hear me articulate this. The patient can then determine whether my visual concept of beauty is in line with her own. If not, there probably is a better match. If these issues are discussed in advance of the surgery, it will go a long way to help prevent disappointment.

7. What are your specific goals for me?

If the surgeon is experienced and thoughtful, he or she should be able to tell you the zones of the body where you will obtain the greatest change, as well as those where the change may be more limited. I believe that in any form of creative endeavor, when an individual clearly articulates his or her goals, he is already on the way to achieving them. For this reason, I think you would do well to select a surgeon who is able to speak clearly about the goals of the surgery.

8. What are the credentials of the facility where you will perform my surgery, and who is responsible for my anesthesia?

This is an important question if your procedure will involve either a general anesthetic or IV sedation anesthesia. There are important safety issues in terms of equipment, record keeping, and appropriate levels of staffing that can have a direct bearing on the quality of your experience. Your safety is just too important to cut corners. You would also be wise to ask specific questions about the skill, credentials and experience level of the individual who will be providing your anesthetic.

9. Where do diet and exercise fit in with your plan for me?

As I have already suggested, I feel that liposuction needs to rest upon a foundation of healthy habits, if you are to experience a successful long-term result. Of course, not everyone will be at their ideal body weight when they undergo liposuction. That said, the closer you are to having good control of your habits, the better probability of an excellent long-term result. If you find yourself in a situation where your weight has fluctuated significantly over the last several years, and you really haven’t brought it into control, you probably aren’t going to receive much benefit from liposuction. If your doctor is truly serious about providing you with the best possible result, these issues need to be built into your total treatment plan. The answer to this question should give you a fairly good sense as to the commitment of the doctor, and his or her practice, to your long-term well being.

10. Do you own this practice?

The answer to this question may provide useful information as to the type of organization that you have encountered. In any organization, the policies and standards will be determined by the owner. It therefore behooves you to know who this individual is. In the majority of cases, the owner will be the surgeon you are speaking to, in which case the evaluation process is easy, since you have already investigated the surgeon’s credentials. In the last few years, I have seen several organizations come through the Chicago area that have a somewhat different model. To give just one example, one such organization, which has now left the Chicago area, was essentially an aggressive telemarketing organization which used the surgery as a vehicle for high interest loans. Anyone who understands the basics of economics, realizes that a far greater profit can be obtained from individuals who are unable to quickly pay back high interest loans, than from a surgical procedure. With such organizations, it is unlikely that the patient’s interests will come first. In one case that I am aware of, the surgeon did not even meet the patient until the morning of surgery. Everything was handled by the telemarketing representatives. Perhaps I am old fashioned, but this does not even strike me as minimally acceptable medical care. Remember that in any organization, it is ultimately the owner who sets the standards, or the lack thereof. Therefore, you would be well advised to investigate these issues.

Please click here to receive information on any procedure Dr. Cook performs
Return to top of page