In response to this growing demand, many doctors now widely advertise their ability to surgically correct the less-than-perfect parts of one's anatomy. The majority of surgeons performing cosmetic surgery are qualified and perform successful operations. however, doctors with insufficient training or experience or questionable credentials are also attracted to this field because of the millions of consumer dollars spent annually on cosmetic surgery.

As with all surgical procedures, cosmetic surgery carries with it certain risks. If performed poorly, it can be disfiguring or even life-threatening. It is essential, therefore, to select a doctor who is well trained and experienced in performing the specific procedure you desire. The following information may help you if you are considering cosmetic surgery. How do you choose the right doctor? Before beginning your search, you may want to learn more about surgical options by reviewing books on cosmetic surgery that can be found in your local library and discussing your plans with your family physician. If you decide to pursue cosmetic surgery, ask your physician for the names of qualified surgeons. You also can obtain names of appropriate physicians by calling your local hospital or consulting the DIRECTORY OF MEDICAL SPECIALISTS, available in most libraries. Plan to consult with several surgeons who specialize in the type of cosmetic surgery procedure you want. While this may seem a considerable investment of time and money (most physicians will charge a consultation fee), remember that if the operation is not performed properly, you could carry the scars for life.

Be wary of physicians who: suggest that you have features "fixed" that do not bother you, use a hard sell to obtain your business, or brush aside your concerns about safety. In addition, no responsible doctor should mind your asking the following questions.

What is your area of specialty and what training do you have in the specific cosmetic surgery procedure I want?

Make sure the doctor you choose is well-trained to perform the type of surgery you want. Ask: Where did you receive your medical degree? In what specialty did you complete an accredited residency program? Ask for information on how this training relates to the specific procedure you desire, as well as information on any fellowships, workshops, and other educational programs the physician has completed that may pertain to your operation.

Finally, find out if the doctor is certified by an appropriate medical board. A board tests the level of physician's knowledge in specific specialties. Normally, before qualifying to take the exams in a particular specialty, physicians must first complete a formal residency training program in that field. Those who pass the voluntary exams are considered "certified" in that area of expertise. Confirm the physician's credentials and board affiliation with your county medical society or state medical board.

Where do you have hospital privileges?

Even if the surgery you want will be performed in the doctor's office or clinic, you should check to see if the doctor is on staff at a local hospital and has privileges there to perform the procedure you desire. Hospital privileges generally assure that the physician you select has been reviewed by his or her peers.

How many operations like mine have you performed in the past year? During your career?

Additional surgery is sometimes needed to correct problems arising from the original operation. An ethical surgeon will answer this question. He or she also will answer questions about the probability of problems and tell you whether there will be an additional charge in the event more surgery is required.

How safe is this operation?

Nobody can guarantee an absolutely successful outcome to any surgical procedure - and you should be suspicious of anyone who does. All surgery involves some risk and unpredictability. Although rare, people have been known to die or suffer from life-limiting disabilities after cosmetic surgery. The surgeon you choose should explain all the possible risks and complications associated with the procedure you want, as well as their degree of probability.

What are the potential side effects of my surgical procedure? How long will these last?

Many doctors agree that patients are often unprepared for the side effects that may occur after cosmetic surgery. These include pain, scarring, swelling, bruising, bleeding, infection - or worse. Some patients may not be able to resume their normal activities for weeks after their operation. Be certain to have the physician you choose explain the potential side effects of your procedure.

What should I expect during and after my operation?

Have your doctor and his or her nursing staff explain in detail what to expect at every stage of the procedure. If they are not willing to spend the time needed to address all of your questions and concerns, then you should probably look elsewhere.

Information materials such as brochures and videotapes should be available for you to read or view. Note also that if your physician uses "computer imaging" to show what changes you can expect from surgery, he or she should also tell you that drawing on a "TV screen" is very different from working with real flesh and bone. The computerized image you see may not be exactly what you get.

The same is true of pre- nd post-op photographs of other patients. Before-and-after photos may give you some feel for the surgeon's skill, but every patient's physical characteristics and experiences are different.

Will you perform the operation yourself? Who will administer the anesthesia? Where will my operation take place?

Make sure that you talk to the doctor who will perform your surgery and ask who will take care of you after the operation. Find out what type of anesthesia will be used and who will administer it. Be certain the individual is qualified to administer the anesthesia.

Where will your surgery take place? If your physician suggests his or her office or clinic, ask about the facilitiy's equipment for life-support and other emergencies. If you are having major surgery, you may want to seek extra protection by making sure the facility is approved by one of the three accrediting organizations listed at the end of this pamphlet.

What are your fees?

Find out in advance what the procedure and follow-up care will cost. If your surgery will be performed in a hospital or ambulatory surgical center, remember that in addition to your doctor's fee, there will be a charge for use of the facility and the services of the anesthesiologist.

Insurance usually does not cover costs for elective cosmetic surgery, and many doctors require payment in advance. Therefore, you may want to compare fees. But just because a surgeon charges higher prices does not mean he or she is better than other physicians.

How realistic are my own expectations for this operation?

Most doctors consider the best candidates for elective cosmetic surgery to be those who are well adjusted and emotionally secure. Ideal patients desire the operation to enhance their own self-esteem - not to influence the opinions of others. Although greater self-confidence may lead to other enhancements in life, consumers who hope cosmetic surgery will help to add excitement to their social lives, win back a spouse, or obtain a promotion at work are often disappointed. Discuss with your doctor what you hope to accomplish with surgery and whether your goals are realistic.

Can I contact former patients who have had the same surgical procedure I want?

Talking to former patients who have had the same procedure you desire is one way to learn more about the operation and your doctor. But keep in mind that each patient has different physical characteristics and expectations. Although a physician may have had a good result with one person, that does not guarantee your surgery will turn out the same.

What are some common cosmetic surgery procedures and their potential risks?

Before having any operation, it is important to understand the possible risks and side effects. Below is a brief, simplified overview of some of the potential complications and side effects of common cosmetic surgery procedures. It cannot substitute for a consultation with a properly trained physician.

• Face Lift (Rhytidectomy): Although the results of a facelift can last five to ten years, the surgery will not stop the aging process. Following the operation, there may be significant puffiness and bruising for several weeks, and in a very few cases, blood that has collected beneath the skin must be surgically drained. Some individuals may feel a temporary numbness or tightness in the face or neck. However, nerve damage that causes permanent loss of sensation or movement in the facial muscles is rare.

  The scars resulting from a face lift are normally in the hairline and folds of the ear, and usually lighten with time until they are barely visible. The kind of scars cannot be predicted with total accuracy, because everyone heals differently.

• Nose Surgery (Rhinoplasty): Changing the shape of the nose is one of the most complex procedures, even for a skilled surgeon. If too much cartilage or bone is removed, the nose can look misshapen. Additionally, if care is not taken with the internal structure of the nose, you can end up with a nose that does not function correctly. Before the operation, make sure you and your doctor thoroughly discuss what kind of changes you would like and how the changes will "fit in" with your other facial features.

  It can take several weeks for bruising around the eyes to go away and several months for any swelling that occurs to completely disappear. You may experience some difficulty breathing for some weeks following the procedure.

• Eyelid Surgery (Blepharoplasty): Performed to remove excess skin and fat above and below the eyes, this procedure usually causes bruising that fades within a week to ten days. However, discoloration can last for several weeks, and some people experience dry eyes. Although rare, the small scars within the lash line can become thickened and may be difficult to repair. In addition, the physician must be very careful not to remove too much skin, which could cause too much "white of the eye" to show.

• Breast Enlargement or Reduction: Breast enlargement or augmentation has become one of the most popular cosmetic surgery procedures for women. In augmentation, silicone "bags" filled with salt water, silicone gel, or a combination of both are implanted to enlarge the breasts. Implants are sometimes used as well in operations to lift sagging breasts.

  Perhaps the most common side effect that can occur is called "capsular contracture," in which the capsule of scar tissue that forms around the implant contracts tightly inward - making the breast feel unnaturally firm. Some physicians have had success in preventing or alleviating this condition with such techniques as using different types of implants, placing implants under the chest muscle rather than over it, or instructing their patients to massage their breasts regularly. In the case of significant capsular contracture, further surgery may be needed, or - in rare cases - the implants may need to be removed.

  The presence of implants can make it more difficult to examine the breasts using mammography, but most physicians agree that if special techniques are used by an experienced radiologist, cancer detection should not be inhibited. Discuss this issue thoroughly with your surgeon.

  With breast reduction or lift surgery (mastopexy), there will be some degree of scarring and there may be unevenness in breast size. You will want to ask your physician about this and other possible effects, such as a temporary or permanent change in nipple sensation or a decreased ability to breast-feed.

• "Tummy Tuck" (Abdominoplasty): The common nickname for this procedure - which removes excess, sagging skin from the abdomen - belies the fact that it is major surgery normally done under general anesthesia. An incision is made from hip bone to hip one and, although it is located low along the "bikini line," a significant scar results. Full recovery, as with other major surgery, may take a couple of months or perhaps even a little longer.

• Injections: Facial wrinkles may be treated by injecting them with collagen or fat. Neither substance produces permanent results, and collagen carries a small risk of allergic reaction. The longevity of the results depends on the patient's skin and reaction to the collagen.

  Although some physicians "plump out" wrinkles by using liquid silicone, this substance has not been approved for this purpose by the Food and Drug Administration, except in experimental studies at selected teaching centers.

• Liposuction (suction-assisted lipectomy): To perform this very popular procedure, a doctor inserts a thin tube into a fatty part of the body and using a special vacuum pump suctions out unwanted fat, leaving a flattened area with little scarring. The growing popularity of the procedure has attracted many physicians with widely varying training and experience. There have been reports of blood clots, fluid loss, infection, and even death following liposuction. Make certain the doctor you choose is well-trained and experienced in performing this procedure.

  Contrary to popular belief, liposuction is:

  1. Not a substitute for good routines of diet and exercise. Ideal candidates are close to their ideal weight, but have pockets of resistant fat on their hips, thighs, abdomens, or chin.

  2. Not a cure for "cellulite," the popular term for the dimpled skin often found on the thighs.

  3. Not a solution for people with stretched-out, inelastic skin that cannot redrape around body contours.

  If you are a good candidate and proceed with the surgery, you will need to wear a girdle or other compression garment until any bruising and swelling disappear.

For more information

If the physician you choose suggests that your operation be performed in his or her office, check with one of the following organizations to see if the facility has passed an inspection: the Accreditation Association for Ambulatory Health Care, Inc. (708-676-9610); the American Association for Accreditation of Ambulatory Plastic Surgery Facilities (708-949-6058), or the Joint Commission for the Accreditation of Healthcare Organizations (312-642-6061).

After surgery, if you have a problem that cannot be resolved with the physician, contact your county medical society, state medical board, or your local consumer protection agency.

You may also report any problems to the Federal Trade Commission. Write: Service Industry Practices, FTC, 6th and Pennsylvania Avenue, N.W., Washington, DC 20580. Although the FTC does not generally intervene in individual disputes, the information you provide may indicate a pattern of possible law violations requiring action by the Commission or referral to state authorities.