bill-full-crop

*In light of the [COVID-19 pandemic](https://www.cdc.gov/coronavirus/2019-ncov/index.html), AEDIT founder and CEO, [William A. Kennedy III, MD](https://aedit.com/author/william-a-kennedy-iii-md-1) (above right), explains our approach to content and how we are supporting our users and providers during this unprecedented time.*

Dear AEDIT Community, 

Responding and helping those in need has always been at the forefront of my life. As a doctor, we are trained to put the needs of others before ours and are committed to the purpose of medicine: to save lives. Being in service during the COVID-19 pandemic has brought a whole new meaning to this purpose. Together, across the globe, we are dealing with one of the most challenging occurrences we have ever faced and are still trying to find a solution. The negative impacts caused by the virus are too many to list, and the emotions we are all feeling are endless. 

Now, more than ever, it is important to be there for one another and support each other as best we can — and I want you to know **we are here for you.** 

AEDIT was founded on the same principles that drove me to become a doctor: to help others. While this time has caused us to uproot and reconfigure the ways we are used to working, we have also been granted the time to truly reflect on what we are building and why. How can we be at your service and provide the support you need? As a team, we are doing what we can to use this unfortunate circumstance as a fortunate time to create a product that truly serves and empowers you. 

While the pandemic has caused us to press pause on the launch of some of our new features, right now we are able to respond by publishing more content covering topics we hope you will enjoy during this time. **If there is anything you would like to see or hear from us, please let us know. We are listening.** 

To our AEDIT community, we will get through this. And to my fellow doctors and medical staff, your dedication cannot be matched; thank you for the risk you are taking and your commitment to the health and wellbeing of others. I am hopeful there are brighter times ahead. 

Stay well, 

![BillSignature](//images.ctfassets.net/zw35sfestf1t/6NmK5fRFEfGASVS75dHNyo/bab408091e02ba319e6aa7241911a7bf/BillSignature.png)

William A. Kennedy III, MD, Founder & CEO 

AEDITION trendsetters-min

Now Trending Collection | The AEDITION

Now Trending

In light of the coronavirus outbreak, AEDIT founder and CEO, William A. Kennedy III, MD, explains our approach to content and how we are supporting our users and providers during this time.

A Message From AEDIT's Founder Regarding COVID-19

A Message From Our Founder Regarding The COVID-19 Pandemic

shutterstock 35658316 (1)

Whether you’ve adopted the habit of singing “Happy Birthday” twice or have chosen a different song a la the memes that have overtaken social media, cold and flu season, coupled with the outbreak of coronavirus disease 2019 (COVID-19), has put handwashing and personal hygiene in the spotlight. And, when you consider the fact that a [2018 United States Department of Agriculture (USDA) study](https://www.usda.gov/media/press-releases/2018/06/28/study-shows-most-people-are-spreading-dangerous-bacteria-around) found that people fail to wash their hands “properly” 97 percent of the time, we're all in need of a refresher course.

## **How To Wash Your Hands**
So, what is the proper way to wash your hands? Good ol’ fashion soap and water is the best way to kill germs and prevent the spread of bacteria. Below are five steps required for an effective cleanse:

1. Wet your hands with clean, running water 
2. Apply soap and lather 
3. Rub your hands together vigorously for 20 seconds — remembering to scrub the fronts and backs of the hands, in between the fingers, and under the fingernails
4. Rinse thoroughly in clean, running water 
5. Dry with a clean towel or shake dry

While it is not a substitute for washing with soap and water, alcohol-based hand sanitizers can get the job done in a pinch. Be sure the formula contains at least 60 percent alcohol and apply the product to the palm of one hand (check the label for proper dosage). For best results, rub hands together — covering all the surface area you would while washing your hands — until they are dry. 

## **When to Wash Your Hands**
Now that you know how to wash, how often should you be sudsing up? At a minimum, the [Centers for Disease Control and Prevention (CDC) recommends](https://www.cdc.gov/handwashing/when-how-handwashing.html) washing your hands in the following situations: 

- Before, during, and after preparing food
- Before and after eating 
- Before and after caring for someone who is sick 
- Before and after treating a cut or wound
- After using the bathroom or changing a diaper
- After blowing your nose, coughing, or sneezing
- After touching an animal, animal feed, or animal waste
- After touching garbage

Additionally, it doesn’t hurt to wash your hands any time you enter or exit a space, use public transportation, or get home from commuting. Wash your hands frequently throughout the work day, and, upon arriving home, you should always wash up and, if possible, change into clean clothes. 

Unless you have just finished a proper hand wash, **DO NOT** touch your eyes, nose, or mouth. When in doubt, follow the golden rule of dermatology and refrain from touching any part of your face. It’ll keep you from getting sick and will likely save you a pimple, too. 

## **How to Care For Over-Washed Hands**
If your daily handwashing quota has reached the dozens, you’re likely dealing with dry, irritated skin. Dry skin on your hands is not unlike dry skin on any other part of your body — it becomes scaly, red, tight, itchy, and dehydrated when the stratum corneum (i.e. the outer layer of the skin) is damaged. Washing your hands regularly with bacteria-fighting soaps and alcohol-based hand sanitizers draws moisture out of the skin and breaks down that protective barrier. 

But, all is not lost. There are some simple steps you can take to soften up the [hands, fingernails, and cuticles](https://aedit.com/aedition/how-to-treat-damaged-dry-brittle-finger-nails-cuticles) that have dried out from over washing.

### **1. Wash With Lukewarm Water**
Much like Goldilocks, the water you use to wash your hands should not be too hot or too cold. Cool or lukewarm water will still kill germs and bacteria, while not being as harsh on the skin.

### **2. Use Gentle Soaps**
There is a reason the [CDC is advocating for increased handwashing](https://www.cdc.gov/coronavirus/2019-ncov/about/prevention.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fabout%2Fprevention-treatment.html) to help prevent illness and avoid the spread of coronavirus — it works. Washing your hands does not, however, require abrasive soaps. In September 2016, the [U.S. Food and Drug Administration (FDA) ruled](https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html) that 19 ingredients found in so-called “antibacterial” soaps were no more effective than their non-antibacterial counterparts, which means there is no reason to not reach for a milder alternative. 

Our favorites? Gentle formulas like the [EO Hand Soap](https://www.eoproducts.com/collections/liquid-hand-soap), [Follain Refillable Everything Soap](https://follain.com/products/follain-refillable-hand-body-soap-pre-filled), [Jergens Extra Moisturizing Liquid Hand Wash](https://www.walgreens.com/store/c/jergens-extra-moisturizing-hand-wash-refill-cherry-almond/ID=prod6152706-product), and [Method Gel Hand Wash](https://methodhome.com/product-category/hand/).

### **3. Pat Dry**
While you should be scrubbing your soapy hands together during the washing process, you don’t need to rub them dry. Allow your hands to air dry or lightly pat them with a clean towel to avoid further damage to the skin. Another tip: skip hand dryers, as the hot air can have a similarly irritating effect. 

### **4. Moisturize Immediately After Washing**
You’ve probably seen personal care brands selling ‘wet skin’ lotions, but it’s more than just a marketing tactic. Applying hydrating oils and creams to damp skin will help prevent additional water loss and lock in moisture, and the same is true of creaming your hands after washing. 

But for those who would rather deal with reptilian skin than greasy digits, there are hand creams that deliver all the hydrating benefits you need without rendering them useless oil slicks. Our favorites for everyday use include: 

- [Aveda Hand Relief](https://www.aveda.com/product/17759/16410/body/hand-care/hand-relief-moisturizing-creme#/shade/4.2_fl_oz%2F125_ml): The botanical-infused formula feels rich by absorbs instantly for smoother, softer skin.
- [Deborah Lippmann Rich Girl Hand Cream](https://www.sephora.com/product/rich-girl-broad-spectrum-spf-25-h-cream-P381213): In addition to enjoying the skin-smoothing benefits of shea butter, avocado, and jojoba oil, this lightweight formula boasts a broad-spectrum SPF 25.
- [Fountain of Truth Youth In Hand Cream](https://fountainoftruthbeauty.com/products/youth-in-hand-cream): The brand's triple emulsion technology allows the cream's emollient-rich blend of shea butter, honey, jojoba, and coconut and macadamia oils to repair the skin barrier without sticky or greasy residue.
- [Supergoop Handscreen SPF 40](https://supergoop.com/products/forever-young-hand-cream-with-sea-buckthorn-sunscreen): Sea buckthorn fruit extract, meadowfoam seed oil, and argan oil are just a few of the hydrating ingredients in this fast-absorbing lotion that includes a reef-safe, broad-spectrum SPF 40.

### **5. Layer Up At Night**
It’s understandable that you don’t want to deal with greasy hands during the day, but all bets are off after hours. Skin naturally regenerates overnight, and slathering your hands (and body!) with nourishing ingredients can help to repair some of the damage inflicted by overwashing during the day. Our go-tos include creams with rich textures and multi-purpose balms that yield smoother skin by morning:

- [Ahava Mineral Hand Cream](https://www.ulta.com/mineral-hand-cream?productId=xlsImpprod3230239): Aloe vera soothes, while allantoin and witch hazel smooth and heal dry, cracked skin in this creamy formula.
- [Egyptian Magic All Purpose Skin Cream](https://www.amazon.com/Egyptian-Magic-Purpose-Stretch-Ingredients/dp/B01LRMM39U?th=1): As the name implies, the natural balm (packed with olive oil, honey, beeswax, and more) is a multitasking wonder that treats chapped cuticles, dry patches, and irritated skin with gentle ease. We like to layer it on top of our hand cream for added hydration.
- [Kiehl's Ultimate Strength Hand Salve](https://www.kiehls.com/body/hand-creams-and-treatments/ultimate-strength-hand-salve/522.html): This thick, emollient formula repairs and conditions hands thanks to nourishing avocado oil, softening sesame seed oil, and moisturizing olive oil wax.
- [Skinfix Eczema Hand Repair Cream](https://skinfix.com/collections/eczema/products/hand-repair-cream): Formulated specifically for eczema-prone skin, soothing colloidal oatmeal, beeswax, and shea butter restore the damaged skin barrier and reduce redness, itching, and stinging. 
- [Weleda Skin Food Original Ultra-Rich Cream](https://www.ulta.com/skin-food-original-ultra-rich-cream?productId=pimprod2005673): A favorite for dry, rough skin on the face, elbows, hands, and feet, this cult-favorite features calendula, chamomile, beeswax, lanolin, and more for smoother, hydrated skin.

## **The Takeaway**
If you take one thing from this article, let it be this: you should be washing your hands all throughout the day, everyday with soap and water to help prevent the spread of germs. But the practice doesn’t have to wreak havoc on your skin. Washing with gentle formulas in lukewarm water and patting (not rubbing!) dry will help to protect your skin barrier, while applying nourishing hand creams can restore moisture to your dry, dull digits.

AEDITION minimalists-min

Wellness Collection | The AEDITION

Wellness

If your daily handwashing quota has reached the dozens, you’re likely dealing with dry, irritated hands. Here are five ways to soften your skin without sacrificing safety.

How To Wash Your Hands And Moisturizers For Dry, Irritated Skin

5 Ways To Care For Over-Washed Hands

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Here’s a sobering statistic: [The National Institute on Drug Abuse reports](https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis#:~:text=What%20do%20we%20know%20about,for%20chronic%20pain%20misuse%20them.&text=Between%208%20and%2012%20percent%20develop%20an%20opioid%20use%20disorder.&text=An%20estimated%204%20to%206,prescription%20opioids%20transition%20to%20heroin.) that roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them. Between 8 and 12 percent of those patients go on to develop an opioid-use disorder. From there, an estimated 4 to 6 percent of people who misuse prescription opioids transition to heroin. 

It goes without saying that pain management is part of the post-procedure recovery process in aesthetic medicine, but many plastic surgery practices have been taking precautions and adjusting their approach to recovery in recent years as the opioid epidemic grows in the United States. “It's a cunning, baffling, powerful disease and it can happen to anyone,” says New York City-based dermatologist [Cheryl Karcher, MD](https://aedit.com/provider/cheryl-karcher-md-4323), who is [open about her own battle with addiction](https://www.nytimes.com/2016/07/24/fashion/cheryl-karcher-comeback-pill-popping-dermatologist.html) several years ago. “I am much more on the lookout now.”

Because it can be difficult to identify who will become addicted and who won’t, providers — especially those in the already scrutinized fields of cosmetic and plastic surgery — have  learned to take special care. 

“Plastic surgery has never been more prevalent, more revered, and, at the same time, more scrutinized,” says board certified plastic surgeon, [Ryan Neinstein, MD](https://neinsteinplasticsurgery.com/), of Neinstein Plastic Surgery in Manhattan. There are countless media stories of poor plastic surgery outcomes, he explains, and these are typically instances of procedures being performed by unqualified physicians in substandard facilities. “However, day in day out, plastic surgeons around the country are making surgery safer, faster, and more predictable,” he says. 

Here, three experts share the precautions they’ve taken against opioid abuse in their own practices and how they’ve adjusted their approaches to the plastic surgery recovery process in recent years. 

## **The Importance of Preoperative Counseling**
Dr. Karcher says that she now asks a lot more questions about personal and family history of addiction when she meets with her patients. She routinely recommends Tylenol (acetaminophen) or Tylenol with ibuprofen (like Advil) for pain. New York City-based board certified facial plastic surgeon [Jennifer Levine, MD](https://drjenniferlevine.com/), agrees that preoperative counseling is vital and lets her patients know that they may be uncomfortable, but the surgery is not especially painful. “Pain medication is available if they need it, but most patients do not require it,” she says. “Opiates are rarely necessary in my practice.”

## **Prescribing in Smaller Quantities**
Dr. Karcher says that if the aforementioned Tylenol is not enough or if she knows a patient will really need pain medication to get to the point where they can recover properly, a few pain pills will be prescribed. That said, the tight leash on these dangerous drugs can lead to those who need pain management not getting the medication they need. “I do, unfortunately, see patients that have needed opiates for other medical or surgical issues and were not given them,” she says. “I do think opiates have a place in very short-term pain management.” 

## **Responsible Discarding**
For Dr. Levine, most of her procedures are above the neck and, as such, most of her patients do not require opioids. “I use a local anesthetic during the surgery and some longer-acting local anesthetics for longer procedures such as facelifts,” she says. The majority of her patients only take acetaminophen after the surgery. “I do give all my patients a small supply of a pain medication such as Vicodin (hydrocodone/acetaminophen),” she says, adding that she “rarely” prescribes anything stronger. “Many of my patients come in after the surgery with the bottle of unused pain medication and ask me to discard it for them.”

## **The Next Generation of Pain Management**
One of the advances Dr. Neinstein has made to his practice is the use of a medication borrowed from the trauma world called tranexamic acid. The clotting promoter is used to treat heavy menstrual periods in women, and this low-cost drug can be added to the intravenous liquid given to a patient during surgery to aid the post-op recovery process. “This medication has quickly shown to safely contribute to minimizing blood loss,” he says. “Even in plastic surgery — where there is minimal blood loss — by reducing it even more we can further minimize the downtime and physiological change to our patients’ bodies.”

AEDITION rejuvenators-min

Medical Aesthetics Collection | The AEDITION

Aesthetics

Three experts share the precautions they’ve taken against opioid abuse in their own practices and how they’ve adjusted their approaches to the plastic surgery recovery process in recent years.

The Future Of Opioid Use In Plastic Surgery

shutterstock 731853004 (1)

You’ve done your research, saved your money, and found a [board certified plastic surgeon](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) to perform the procedure you’ve been longing for. You show up to your consultation prepared to learn the details of surgery, the length of the recovery period, and the potential risks. What you probably weren’t expecting to hear? The word ‘no.’

It is not uncommon for aesthetic surgeons to refuse to perform a procedure on a patient or suggest an alternative course of treatment. We spoke to board certified plastic surgeon [Richard J. Brown, MD](https://aedit.com/provider/richard-brown-md-4646), and board certified facial plastic surgeon [Jason D. Bloom, MD](https://aedit.com/provider/jason-bloom-md-2248), about the main reasons why a provider may choose not perform a patient’s preferred cosmetic procedure.

### **1. You Want What You Can’t Have**
The top reason a surgeon may turn down a potential patient: [unrealistic expectations](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection). There is nothing wrong with coming to a cosmetic surgery consultation with photos of a celebrity, influencer, or even a friend, so long as you are prepared to learn why the exact look you covet may not be possible for you.

“I have to constantly remind people that this is surgery,” Dr. Bloom says. “I’m going to work towards a goal, but it’s not robotic. It’s an art.” As he explains it, surgeons must take into account the relationship between what he or she can actually do, what the patient’s anatomy is, and how the patient is going to heal before moving forward with a procedure.

“I tell patients, ‘Here’s where you are. Here’s where I think you can be,’” Dr. Brown, author of *[The Real Beauty Bible](https://www.amazon.com/Real-Beauty-Bible-Navigating-Journey/dp/1599329980)*, adds. “If you can’t either meet me somewhere in between or come down to what I think is realistic for you, then you’re not a good fit for me for this operation.’”

### **2. You Have a Health Condition** 
There are a number of health and lifestyle factors that might make a surgeon refuse to perform plastic surgery — or at least to delay an operation. If a surgeon suspects that a surgical procedure may be unsafe, patients may need to undergo certain pre-operative tests, make lifestyle changes, or sign additional paperwork before scheduling a procedure date. According to our experts, some of the most common factors include: 

- **Smoking**: Nicotine constricts blood vessels, which can lead to complications (like black, necrotic skin) during the recovery and healing process. For Dr. Brown, a positive nicotine test on surgery day is a dealbreaker because he feels it’s just not worth the risk. 
- **BMI**: Someone with a high body mass index (BMI) is at risk for both healing issues and anesthesia complications. Overweight patients are prone to blood sugar issues, which can hinder recovery, Dr. Brown says.
- **Medical Conditions**: Certain chronic health issues, such as diabetes and thyroid conditions, can lead to post-op problems. While they’re not necessarily deal breakers, Dr. Bloom says that these issues do influence whether or not he takes on a particular patient.
- **Medications**: Immunosuppressants and blood thinners are two categories of pharmaceuticals that increase the risk of infection and bleeding/hematoma — even when the patient stops taking the drug prior to surgery. Plastic surgeons evaluate these patients on a case by case basis.

### **3. You’re Doing It for the Wrong Reasons**
Cosmetic surgery can do wonders for a patient’s outlook and self-esteem, but only when it’s what you truly want for yourself. “Surgery is serious and not without complications, so why would you ever put your life at risk to try and please someone else with your body,” Dr. Brown asks. “Mindset is everything.”

He steers clear of patients who are obviously wanting to change their appearance to please a spouse, family member, or friend. “When you have surgery for someone else, you are not in the mindset to be your best and surgery won’t fix that,” he says. “Surgery does not fix relationships or make them better. If you are not doing something for yourself, it's not worth doing.”

### **4. You’re Not Ready Yet** 
Both of our experts agree that patients should be within 10 pounds of their ideal weight prior to having any procedure — even [facelifts](https://aedit.com/aedition/what-you-need-to-know-about-the-latest-smas-facelift-techniques). Dr. Brown, who performs a significant amount of breast and body work, is passionate about helping patients [achieve their body goals](https://aedit.com/aedition/why-you-should-lose-weight-before-plastic-surgery) prior to going under the knife or needle. “This has nothing to do with body shaming or me wanting them to look a certain way,” he explains. “If a [tummy tuck](https://aedit.com/procedure/abdominoplasty) patient has too much visceral (internal) fat because they still have weight to lose, then I can’t possibly plicate the rectus muscles and tighten them up and make them flat. They’re still going to have bulging.” Instead, he spends a lot of time educating patients: “I tell them, ‘Look: you’re going to spend all this money to have a great operation, but you’re going to have a suboptimal result.’”

Rather than turn patients away, Dr. Brown seeks to foster a long-term partnership. “With our wellness center, we’re able to set them up with a nutrition coach to help them with their diet and a mental coach to help them with their body image,” he shares. Eventually, he plans to offer a prepared meal service as well as trainers to help craft exercise regimens. If a patient isn’t willing to undertake the wellness journey, he or she won’t be a good fit. “They can just go find another surgeon,” he says.

### **5. You Don’t Hit It Off** 
Relationships are a two-way street. Patients may be surprised to learn that their prospective plastic surgeon is also interviewing them [during a consultation](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation). After all, the relationship between patient and surgeon can potentially last a lifetime, if you factor in pre-op, recovery, maintenance, and any future procedures. “Sometimes they’re not a good fit for me personality-wise,” Dr. Brown explains. “I may turn them down because I don’t think that we’re going to mesh and they’re not going to be happy.” And, remember, this works both ways. If the two of you aren’t vibing during the initial consultation, feel free to say, “thank you, next.”

### **6. You Need a Different Kind of Care** 
During a consultation, plastic surgeons are not only evaluating your anatomy, your aesthetic goals, and your physical fitness for surgery. They are also considering your psychological health. “I certainly feel like I’m a counselor at certain times while talking to patients,” Dr. Bloom admits. While a certain level of insecurity is commonplace, a fixation or obsession is a red flag for any plastic surgeon. Patients who are overly preoccupied with a perceived flaw may never be satisfied with any surgical outcome and will most likely be refused any plastic surgery procedures. If a surgeon suspects that a patient might have a mental health condition, like body dysmorphic disorder (BDD), they may refer them to a therapist. 

### **7. You’ve Got It Wrong** 
Despite all of the time and effort you’ve put into researching procedures, you did not earn an honorary MD on Google and Instagram. You may think you need a certain procedure, product, or device to meet your goals, but only a board certified plastic surgeon can make the call. “My job is to give patients the right products for the right reasons,” says Dr. Bloom, who sees patients ask for products by name because of pervasive marketing. “I tell them: ‘How about I do something that’s going to give you better results, maybe even cost you a little less, and you’re going to be happier? How does that sound?’”

Both Dr. Brown and Dr. Bloom find that most patients who come into a consultation with preconceived notions end up being very receptive to their expert opinion. “I’ve never had a patient insist on a particular procedure once I’ve spent time educating them,” Dr. Brown says.

Dr. Bloom agrees, telling armchair MDs: “You might know a little bit, but you certainly don’t know as much as I do when it comes to this topic. So let me do what’s in your best interest to get you the results that you want.”

## **The Takeaway**
At the end of the day, it is in everyone’s best interest to achieve a stellar outcome, which means finding the best surgeon to perform the right procedure on a fit candidate. “In elective surgery, why would you take on any less than a perfect client with the most optimal opportunity to have a good result,” Dr. Brown says.

AEDITION for men-min

Expert Opinion Collection | The AEDITION

Expert Opinion

It’s not uncommon for a provider to refuse to perform a procedure on a patient or suggest an alternative course of treatment. Here, two board certified plastic surgeons explain why. 

Why A Plastic Surgeon May Refuse To Operate On A Patient

7 Reasons A Plastic Surgeon May Not Operate On You

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Whether it's monthly facials or quarterly Botox® appointments, minimally invasive and non-invasive cosmetic treatments have become a routine part of many people's beauty regimens thanks to their expediency and lack of downtime. Treating signs of aging, skin tone, sun damage, sagging skin, acne scars, and even a double chin (to name a few!) is all possible without going under the knife, but the results don't last forever.

So, how often do these non-invasive treatments need to be performed in order to maintain your desired results? Here, we break down the ideal frequency for some of the most popular non-surgical procedures.

### **Chemical Peel**
Whether you're looking for a quick radiance boost or a deep resurfacing, chemical peels can treat everything from visible signs of aging (think: fine lines and sun damage) to hyperpigmentation and scarring. The type of result you see and how often you can repeat the treatment depends on the strength of the acid(s) involved. Generally speaking, they are classified as [light](https://aedit.com/procedure/superficial-chemical-peels), [medium](https://aedit.com/procedure/medium-depth-chemical-peels), or [deep](https://aedit.com/procedure/deep-chemical-peels).

- **Light Chemical Peel**: Also known as a superficial chemical peel, an alpha hydroxy acids is used to lightly exfoliate the epidermis (read: outer) layer of the skin. Minor flaking may occur in the days after treatment, and the radiance-boosting benefits often last a couple of weeks. Treatments can be repeated every three to six weeks.
- **Medium Chemical Peel**: Medium depth chemical peels, which typically involve trichloroacetic acid (TCA), reach the papillary dermis layer of the skin (the uppermost layer of the dermis) and can correct uneven skin tone and texture. Patients can expect to deal with peeling skin for up to 10 days post-treatment, and the procedure can be repeated every three to six months for prolonged results.  
- **Deep Chemical Peel**: If ever there were a case for one-and-done, it would be this. The intensely exfoliating treatment reaches the lower layer of the dermis, which allows it to completely resurface the skin. Up to three months of recovery time may be needed to heal, and the procedure is rarely performed more than once on a single patient.

### **CoolSculpting®**
This non-surgical liposuction alternative permanently destroys fat cells by freezing targeted areas. The body contouring treatment is often used to treat stubborn fat deposits on the stomach, hips, thighs, and chin area. After one session, [Coolsculpting®](https://aedit.com/procedure/cool-sculpting) patients can expect to see a 25 to 30 percent fat reduction within about four months. A series of one to three treatments spaced at least 60 days apart are often needed to fully treat each problem area.

### **Dermal Filler** 
Injectable filler has become one of the gold standards of minimally invasive aesthetics thanks to ability to reshape the face sans surgery. From temporarily mimicking the effects of surgery (hi, [liquid rhinoplasty](https://aedit.com/procedure/liquid-rhinoplasty)) to reducing the appearance of fine lines and wrinkles, [dermal filler](https://aedit.com/aedition/everything-you-need-to-know-about-dermal-fillers) comes in a variety of forms that treat different areas and last for different lengths of time.

- **Hyaluronic Acid (HA) Filler**: The most temporary option is found under brand names like Juvederm®, Belotero®, and Restylane® and lasts six to 12 months as the body absorbs the particles.
- **Calcium Hydroxylapatite (CaHA) Filler**: CaHA injectables like Radiesse® can be expected to last 12 to 18 months thanks to the thicker viscosity that is ideal for treating deeper lines and wrinkles.
- **Polylactic Acid (PLA) Filler**: More than just a filler, PLA products like Sculptra® are classified as 'collagen stimulators' thanks to their ability to help skin naturally rebuild collagen over time, in addition to smoothing lines for 18 to 24 months.
- **Polymethyl-methacrylate Microspheres (PMMA) Filler**:  Bellafill® is the only FDA-approved PMMA injectable treatment on the market. The synthetic, biocompatible substance takes the shape of a microsphere under the skin that provides structure and firmness for about five years.
- **Polyalkylimide Filler**: Semi-permanent injections like Aquamid® have a layer of collagen form around them over time that can boost the filler-like results that already last for five-plus years.

### **Kybella®**
FDA approved to treat moderate to severe submental fat, the deoxycholic acid injection can eliminate a double chin and provide jawline definition. While the results are known to be long lasting, multiple [Kybella®](https://aedit.com/procedure/kybella) treatments may be needed to achieve desired results. A single treatment consists of up to 50 injections spaced one-centimeter apart, and up to six single treatments (staggered at least one month apart) may be administered. 
 
### **Laser Hair Removal** 
The laser therapy treatment is one of the most common cosmetic procedures in the U.S. and involves heating and killing the hair follicle to prevent future hair growth. Sessions are scheduled every four to six weeks to complement the natural hair growth cycle, with six to eight typically needed for full results. While [electrolysis](https://aedit.com/procedure/electrolysis) is the procedure FDA-approved for permanent hair removal, [laser hair removal](https://aedit.com/procedure/laser-hair-removal) touch ups are usually only needed every six to 12 months (if at all).

### **Laser Skin Resurfacing**
Like chemical peels, lasers can be used to treat a variety of skin concerns ranging from superficial to deeply resurfacing depending on the strength of the product used. Generally speaking, lasers fall into two categories, non-wounding and wounding, and the results can be judged accordingly.

- **Non-Ablative Laser Treatments**: Non-wounding lasers like [pulsed light](https://aedit.com/procedure/ipl), [pulsed dye lasers](https://aedit.com/procedure/pulsed-dye-laser), and [fractional](https://aedit.com/procedure/nonablative-fractional-lasers) lasers do not remove layers of skin, which means an initial series of treatments spaced four to six weeks apart will be for best results. From there, treatment plans can be restarted or touch ups can be administered a couple times a year, as skin tone or texture concerns return.
- **Ablative Laser Treatments**: These wounding treatments include [carbon dioxide](https://aedit.com/procedure/ablative-co2-laser) (CO2) and [erbium](https://aedit.com/procedure/ablative-erbium-laser) lasers that remove the outer layers of skin. Typically used to correct concerns in one treatment (versus the many treatments needed with non-ablative devices), results last several years.

### **Microneedling**
The collagen-inducing therapy is a minimally invasive procedure that stimulates the body's natural healing mechanisms to address skin concerns like laxity, fine lines, wrinkles, scarring, stretch marks, and pigmentation. Microneedles puncture the skin's surface to create micro wounds that activate collagen production. Combining [microneedling](https://aedit.com/procedure/microneedling) with [platelet-rich plasma](https://aedit.com/procedure/microneedling-with-prp) or [radiofrequency](https://aedit.com/procedure/microneedling-with-radiofrequency) can boost the results, but a series of three to six treatments spaced four to six weeks apart is usually needed to see best results.  

### **Neurotoxin Injections** 
Botulinum toxin type A (BoNT-A) injections temporarily paralyze underlying muscles to prevent contraction and smooth the appearance of fines lines and wrinkles (think: crow's feet, horizontal forehead lines, and frown lines). While they are colloquially called 'Botox,' the Allergan-manufactured injectable is actually one of four approved by the FDA. [Botox®, Dysport®, Jeuveau®, and Xeomin®](https://aedit.com/aedition/comparing-neurotoxin-botulinum-type-a-injections-botox-dysport-jeuveau-xeomin) each come from different pharmaceutical companies and have their own unique formulations, though each can be expected to last about three to four months.

### **Theadlift** 
If a non-surgical facelift is what you're after, [thread lifts](https://aedit.com/procedure/thread-lift) provide lifting and firming effects for six months to one year (i.e. until the threads dissolve). The goal of a thread lift is to reposition underlying skin tissue by weaving a dissolvable polypropylene thread in a cross-hatch or basket weave pattern under the targeted area to provide an immediate lifting effect, in addition to long term collagen stimulation. 

### **Ultherapy®** 
Ultrasonic skin tightening, like [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy), utilizes concentrated ultrasound waves to create heat deep within the dermis that triggers the body's natural collagen and elastin production. Most patients only need one treatment to start and maintenance sessions beginning one- to two-years after the first procedure can sustain and improve the results.

## **The Takeaway**
Unlike [cosmetic surgery](https://aedit.com/aedition/how-long-do-cosmetic-surgery-plastic-surgery-results-last), which often requires weeks or months of recovery time, many non-invasive procedures allow patients to enjoy results with little to no downtime. What non-surgical procedures lack in invasiveness, however, they often make up for in maintenance. In addition to needing a series of treatments in order to see results (think: three microneedling appointments spaced four to six weeks apart), routine touch ups (like going in for more Botox® every three to four months) will likely be needed. Consulting with a [board certified dermatologist or plastic surgeon](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) will ensure you are on the best treatment plan for your needs.

From Botox® and filler to microneedling and ultrasonic skin tightening, here’s a guide to how frequently non-invasive treatments need to be performed in order to maintain your desired results.

How Often You Should Get Non-Surgical Cosmetic Procedures Like Botox, Dermal Filler, Chemical Peels

How Often Do You Need To Touch Up Non-Surgical Cosmetic Procedures?

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You’ve done your homework and decided you’re interested in getting a surgical or non-surgical [cosmetic procedure](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons). So, what comes next? A consultation with a board certified plastic surgeon.

Just as you wouldn’t buy a car without test driving it, you should not choose a doctor for your cosmetic surgery, procedure, or treatment without exploring your options. An initial consultation allows you to do just that. In addition to learning more about the procedure you are interested in, it is also an opportunity for you to get a sense of the doctor’s personality and practice before deciding if he or she is the right provider for you.

## **Book More Than One Consultation**
As with most decisions in life, you’ll want to get more than one opinion. You should plan to consult with at least two doctors before moving ahead with your surgery or procedure. When deciding on who to book a plastic surgery consultation with, it is important to first consider the following: 

- What is the provider’s board certification(s)?
- Does he or she have hospital privileges?
- Is he or she recommended by someone you trust?

While referrals aren’t mandatory, [researching a doctor’s board certification(s)](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) and hospital privileges (yes, even if you’re interested in an outpatient procedure) are musts. Tools like the [AEDIT provider network](https://aedit.com/providers) can help you find qualified doctors in your area.

Once you narrow down your search and schedule consultations with the providers you want to meet, there are a couple of things to keep in mind about the process. While it is standard to consult with multiple doctors before settling on ‘the one,’ it is best to not reveal the names of the other doctors you are considering. Similarly, do not share the proposals you receive from one provider with another, for it may influence what they recommend for you.

## **Questions to Ask During a Cosmetic Surgery Consultation** 
*What should you discuss in the consultation room? From reviewing before-and-after photos to learning about the pre-op and post-op care, below is a guide to the most important questions to ask during a cosmetic surgery consultation to ensure you feel empowered to make the best decision.*

### **Aesthetic & Expertise** 
**1. What procedure(s) do you recommend for me?** 
You may have your heart set on a certain procedure or treatment, but you should plan to have a conversation with your doctor during your consultation about what he or she sees as the best course of action for you and your concerns. The decision is ultimately up to you, but the plastic surgeon will be able to take a more holistic look at the situation and potentially offer [a series of options](https://aedit.com/aedition/plastic-surgery-results-are-about-proportion-not-perfection) that you are a good candidate for.

**2. How often do you perform this procedure?**
While there are exceptions, it would make sense that the more frequently a provider performs a treatment or procedure, the more time they’ve had to refine their technique and specialize in it. Asking how often they perform the procedure they are recommending or the one you are interested in will help give you a better sense of their expertise.

**3. Are there before and after photos available?**
You’ll be hard pressed to find a plastic surgeon who doesn’t readily offer a look at their previous work in the form of before-and-after photos, but don’t be shy in asking for them. In addition to seeing how the results turned out for different types of patients, you’ll also get a better sense of the doctor’s aesthetic. 

**4. Would you be willing to put me in touch with previous patients?**
If the provider you’re consulting with didn’t come recommended from a friend or colleague, asking to speak with an existing patient (preferably one who underwent the same procedure you are interested in) can be a good way to learn more about the doctor, practice, and overall experience.

### **Cost & Pre-Op Care**
**5. What is the cost breakdown of this procedure?**
Because most cosmetic procedures are considered elective, they are not typically covered by insurance. They are also not cheap. Prices can vary dramatically from practice to practice, as can the way the cost is presented. To avoid hidden fees or surprises, ask for a comprehensive overview that includes pre-op and post-op care. While it is impossible to foresee complications, getting a sense of any additional expenses that may pop up (from recovery essentials to additional procedures) will allow you to budget accordingly. With that said, certain cases of rhinoplasty, eyelid procedures, and breast surgeries (to name a few) may be fully or partially subsidized by insurance, so be sure to check with your insurance provider before booking.

**6. How many pre-op appointments will be needed?**
If you’re interested in a surgical procedure, you’ve likely already considered the recovery time that may be required. But what about the time involved with pre-op prep? From bloodwork to imaging, there are tests to be run and assets to be secured prior to going under the knife or needle. Get a sense of what the timeline looks like from the day you book your procedure until your last follow-up appointment to ensure you are able to make the commitment.

**7. Is there anything I need to do prior to getting the procedure?**
Whether you need to [lose weight before scheduling a body contouring procedure](https://aedit.com/aedition/why-you-should-lose-weight-before-plastic-surgery) or press pause on your skincare routine in the days leading up to a treatment, you’ll want to have the provider give you a sense of any pre-operative instructions or guidelines. That way, you can consider how they may impact your daily life.

### **Safety** 
**8. Where will this procedure be performed?**
Whether your procedure is being performed in a [hospital or an outpatient surgery center](https://aedit.com/aedition/unexpected-things-to-know-about-the-plastic-surgery-operating-room), you’ll want to ensure the facility is accredited. Both are evaluated for safety by [The Joint Commission](https://www.qualitycheck.org/), though outpatient surgical facilities may also be accredited (voluntarily) by the [Accreditation Association for Ambulatory Health Care (AAAHC)](https://www.aaahc.org/). If you’re undergoing an outpatient procedure, be sure your doctor has hospital privileges to avoid possible risks in case of an emergency.

**9. Does this procedure require anesthesia?**
In addition to learning whether or not your procedure requires [sedation or anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia), you’ll also want to know who will be administering it. Be sure there will be a board certified anesthesiologist or certified registered nurse anesthetist on hand to administer and monitor throughout the procedure. Knowing the type of anesthesia required will also inform whether or not you will need someone to give you a ride home and care for you post-op.

**10. What is the protocol if there are serious complications during the procedure?**
Statistically, even the most qualified doctors performing the most routine procedures can run into complications. One of the reasons it is important to establish that your provider has hospital privileges is in the event there is an emergency during an outpatient procedure. Confirming what processes are in place to deal with unexpected events in the operating room can provide peace of mind.

### **Recovery & Results**
**11. What is the downtime associated with this procedure?**
While there are plenty of minimally invasive procedures that you can schedule during your lunch break, most surgical procedures will require at least a couple days of recuperation. Ask the doctor to break down the recovery period, including how long it will be before you can resume certain levels of activity (from returning to work to exercising) and the side effects (think: pain, swelling, and bruising) you can expect to experience during each phase.

**12. Will I receive written post-op instructions?**
Sure, you may be able to wing the assembly of your IKEA furniture, but recovering from a cosmetic procedure that you just invested a lot of money in is not something you want to do blindly. Most doctors will have written post-operative instructions available for patients that detail everything from pain med and icing schedules to when you can resume basic day-to-day activities (think: showering, laying down, etc.). As simple as it may seem, you want to be sure that you will have something to refer back to when it comes time to navigate the recovery process.

**13. Is there a medical professional on call to answer post-op questions?**
No matter how much research you do beforehand and how thorough the written post-op instructions may be, you can pretty much guarantee that a question (or many!) will arise during the recovery process and require immediate assistance. In addition to good ol’ fashion phone calls, many practices now offer live chats on their websites that allow patients to speak with doctors, physician assistants, and/or nurses in real time. Check with the provider to see what types of services would be available to you.

**14. How many follow-up appointments will be necessary?**
While the exact number of post-op appointments varies by procedure, at least one follow-up is usually needed within the first week. That may be the only check-in needed for, say, an injectable treatment, but surgical patients can expect to meet with their cosmetic surgeon several times in the months following their procedure. Like pre-op care, it is important to have a sense of the timeline prior to booking.

**15. How long will it be before I see results?**
Any doctor will tell you that the healing process, like the procedure itself, depends on the patient, but there are general timelines that can shed some light on when you will start seeing the effects of the procedure and when you can expect a final result. While the results of some procedures are immediate, others can take a year (or more) to fully reveal themselves, so you’ll want to be sure your expectations and patience-level are managed beforehand. 

## **Additional Factors to Consider Before Choosing a Provider**  
*While qualifications and expertise are certainly key components of the decision-making process, there are intangibles related to a provider’s personality, bedside manner, and practice that cannot be underestimated. Even if the provider checks all the boxes above, be sure to also consider the following before choosing who to book your procedure with.*

### **Do you feel comfortable with the doctor?**
The doctor doesn’t need to be your best friend, but he or she should put you at ease. In addition to (hopefully) answering all of your questions, consider how you feel when speaking with the provider. Undergoing any procedure (even an elective one) is a big decision, and you should feel respected and empowered throughout the process.  

### **Are you comfortable with the practice and facilities?**
Did you wait long in the office before seeing the doctor for your consultation? Did the appointment feel rushed? How was the vibe in the waiting area and patient rooms? Taking notice of how you feel about these kinds of details should play a role in how you go about choosing a provider.

### **Is the provider's staff professional and courteous?**
Truth be told, you’ll probably be interacting more with the practice staff than you will with the doctor. From the receptionist to the nurses, pay attention to your interactions with the entire team and notice how they communicate with the provider. All of this will give you insight into what kind of care you can expect before, during, and after your procedure.

## **The Takeaway**
Choosing to undergo a cosmetic surgery procedure is an important decision in and of itself, but finding the right surgeon or doctor for your needs is key to achieving the outcome you desire. Scheduling initial consultations with at least two providers and arriving armed with a list of questions that covers everything from aesthetics and safety to cost and recovery can help you compare and contrast as you narrow down your search.

From reviewing before-and-after photos to learning about the pre-op and post-op care, here is a guide to the most important questions to ask during a cosmetic surgery consultation.

Questions To Ask Your Doctor During A Plastic Surgery Consultation 

15 Questions To Ask Your Doctor During A Plastic Surgery Consultation 

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If you're a regular reader of The AEDITION, you know we always emphasize finding a 'board certified' provider to perform your preferred cosmetic procedure. But what does it mean to be a board certified plastic surgeon or dermatologist? How do doctors go about becoming certified? We're here to shed some light on the board certification process and why it matters.

## **Medical Licensure vs. Board Certification**
First things first, a licensed doctor is not the same as a board certified one. A medical license is required for all doctors who wish to legally practice medicine in the United States, and medical licensure is handled at the state level by state medical boards. Doctors must receive individual licenses in each state they wish to practice in, and they must be renewed periodically.

While the protocol varies from state to state, you can be sure that all licensed physicians (at the minimum) graduated medical school, underwent some level of postgraduate residency training, and passed a comprehensive national licensing exam (either the United States Medical Licensure Examinations [USMLE] for medical doctors or the Comprehensive Osteopathic Medical Licensing Examination for doctors of osteopathic medicine).

Board certification, meanwhile, signifies that the physician has successfully completed a residency in their chosen specialty. In order to become board certified, a doctor must have completed his or her undergraduate education, medical school, one-year internship, a residency in their chosen specialty, and passed the residency board exam.   
  
Unlike a medical license, board certification is not required to practice medicine in the U.S., but it is an important tool in distinguishing whether or not a provider has specialized in a particular area. Additionally, board certification does not last forever. Many medical specialty boards now require recertification every 10 years or so, ensuring doctors keep on top of their skills.

## **Why Board Certification Matters**
Board certification is important for all fields of medicine, but it is particularly necessary in the aesthetic space. While it cannot guarantee the quality of results, it can certainly point you in the direction of qualified doctors for the procedure you are interested in or care you need.

Titles like cosmetic surgeon, plastic surgeon, and cosmetic dermatologist have [seemingly become interchangeable](https://aedit.com/aedition/difference-between-plastic-surgeons-and-cosmetic-surgeons), but the qualifications of such doctors can vary greatly. Because there is very little regulation governing how doctors refer to themselves, understanding your provider's board certification(s) can ensure you are consulting with a doctor or surgeon who is actually trained in plastic and reconstructive surgery, otolaryngology, ophthalmology, or dermatology (i.e. the specialties that most relate to aesthetic medicine).

## **How Doctors Become Board Certified**
The [American Board of Medical Specialties](https://www.abms.org/member-boards/) (ABMS) is comprised of 24 certifying boards that are known as the Member Boards of ABMS. Specialties range from internal medicine to radiology, and while it's pretty straightforward that a pediatrician would be certified by the American Board of Pediatrics or a gynecologist would be certified by the American Board of Obstetrics and Gynecology, gaining certification in aesthetic medicine is less clear.

Sure, there is an American Board of Plastic Surgery (ABPS) and American Board of Dermatology (ABD) that offer subspecialties in hand surgery, dermatopathology, and pediatric dermatology, but there are no member boards for specialities like oculoplastic surgery or cosmetic dentistry. Further complicating matters is the fact that there are board certifying organizations that exist outside of ABMS. While some have standards that are as rigorous as the written and oral examinations Member Boards administer, not all do.

When choosing a provider to perform a cosmetic procedure or cosmetic surgery, look for a specialist in the following categories:

### **Plastic and Reconstructive Surgery**
General plastic and reconstructive surgeons complete three to five years of general surgery training followed by a two to three year cosmetic and reconstructive plastic surgery residency. Plastic and reconstructive surgeons can pursue board certification via the [American Board of Plastic Surgery](https://www.abplasticsurgery.org/), and they may be dual-certified by the [American Board of Surgery](http://www.absurgery.org/) (ABS). While they are board certified to perform cosmetic and reconstructive surgeries on the face and body, their work often focuses on the breasts and body.

### **Facial Plastic and Reconstructive Surgery**
After completing a five-year residency in otolaryngology (a.k.a. ears, nose, and throat), facial plastic and reconstructive surgeons pursue year-long fellowships in cosmetic and reconstructive procedures specifically related to the face and neck (think: rhinoplasties, facelifts, chin and jaw surgeries, etc.). While there is no ABMS Member Board specifically for facial plastic and reconstructive surgery, they should be board certified by the [American Board of Otolaryngology – Head and Neck Surgery](https://www.aboto.org/) (ABOTO). The [American Board of Facial Plastic and Reconstructive Surgery](https://www.abfprs.org/) (ABFPRS) is also an accreditation that many facial plastic surgeons seek.

### **Dermatology**
Medical dermatologists diagnose, treat, and prevent conditions affecting the skin, hair, and nails. While there are subspecialties within the field, all dermatologists board certified by the [American Board of Dermatology](https://www.abderm.org/) undergo non-surgical, cosmetic dermatology training during their residency program. Dermatologic surgeons (i.e. those qualified to perform liposuction, fat transfer, and Mohs surgery, in addition to non-invasive treatments) are often fellows of the [American Society for Dermatologic Surgery](https://www.asds.net/) (ASDS). Asking to see before-and-after photos and inquiring as to how often they perform certain cosmetic treatments and procedures will shed further light on their aesthetic expertise.

### **Oculoplastic Surgery**
While a facial plastic surgeon is able to perform eyelid surgeries (like [blepharoplasty](https://aedit.com/procedure/upper-eyelid-blepharoplasty)), oculoplastic or oculofacial surgeons are experts in procedures that reconstruct the eyelids, tear ducts, and orbital area. They should be board certified by the [American Board of Ophthalmology](https://abop.org/) (ABOP) and have additional fellowship training with the [American Society of Ophthalmic Plastic and Reconstructive Surgery](https://www.asoprs.org/) (ASOPRS).

## **Fellowships & Societies**
Doctors who wish to further specialize in a particular area of medicine may choose to continue their training and education via a fellowship. Fellowship programs are often highly competitive and last one to three years each. Due to the lack of ABMS Member Boards in certain subspecialties, fellowships may be used to denote expertise. An ophthalmologist who wishes to subspecialize in oculoplastic surgery, for instance, would complete a two-year fellowship through the aforementioned ASOPRS.

Society memberships, meanwhile, offer another way (separate from licensing, board certification, and fellowships) for providers to continue their education, in addition to offering mentoring and networking opportunities. Below are some of the academies and societies related to aesthetic medicine, cosmetic surgery, and dermatology:

- [American Academy of Aesthetic Medicine](https://www.aaamed.org/) (AAAM)
- [American Academy of Cosmetic Dentistry](https://aacd.com/) (AACD)
- [American Academy of Cosmetic Surgery](https://www.cosmeticsurgery.org/) (AACS)
- [American Academy of Dermatology](https://www.aad.org/) (AAD)
- [American Academy of Facial Plastic & Reconstructive Surgery](https://www.aafprs.org/) (AAFPRS)
- [American Society of Aesthetic Plastic Surgery](https://www.smartbeautyguide.com/) (ASAPS)
- [American Society of Cosmetic Laser Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASCLS)
- [American Society for Dental Aesthetics](http://www.asdatoday.com/) (ASDA)
- [American Society of Dermatologic Surgery](https://www.asds.net/) (ASDS)
- [American Society of Hair Restoration Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASHRS)
- [American Society of Liposuction Surgery](https://www.cosmeticsurgery.org/page/SubspecialtyOrganiz) (ASLS)
- [American Society of Ophthalmic Plastic & Reconstructive Surgery](https://www.asoprs.org/) (ASOPRS)
- [American Society of Plastic Surgeons](https://www.plasticsurgery.org/) (ASPS)

While these affiliations are voluntary, a doctor may display their memberships as an indicator of interest and engagement in their specialty. 

## **The Takeaway**
There is perhaps no more important task in your aesthetic journey than finding the right physician to perform your cosmetic surgery procedure, and understanding the board certification process is a key part of that. While all the certifications, licenses, and credentials in the world cannot guarantee results, knowing that your doctor specializes in the procedure you are interested in is the first step toward ensuring you get the best care for your needs.

If you’re interested in a cosmetic procedure, you’ve likely been told to find a board certified provider. But what does it mean to be a board certified plastic surgeon or dermatologist? The AEDITION breaks it down.

How Plastic Surgeons And Cosmetic Dermatologists Become Board Certified 

What Does Board Certification Really Mean?

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The medical tourism industry is booming, and plastic surgery and cosmetic procedures are not immune from the trend. Patients are more willing than ever to cross borders in search of healthcare services and medical care. These so-called medical tourists seek treatment abroad for a variety of reasons — ranging from affordability and healthcare costs to the availability of medical procedures and quality of care that may or may not be available in their home country. As it relates to plastic surgery and cosmetic procedures, medical travelers may find that they prefer the style or aesthetic of the results of healthcare providers in other countries.

But there are undeniable risks associated with having surgery abroad. In the long run, these complications can result in expensive and, in some cases, dangerous consequences. Here, The AEDITION explores what to consider before seeking treatment overseas.

## __Why Do Patients Travel For Procedures?__
First things first, it's important to understand why and how medical tourism destinations have come to exist. According to the International Society of Aesthetic Plastic Surgeons, the [United States performs more surgical and non-surgical cosmetic procedures](https://www.isaps.org/wp-content/uploads/2019/03/ISAPS_2017_International_Study_Cosmetic_Procedures_NEW.pdf) than any other country in the world. In 2017, the organization reports that there were nearly 4.5 million procedures performed, representing about 18 percent of the global total. Brazil came in second with about 2.5 million, and Japan, Mexico, and Italy rounded out the top five.

While it should come as no surprise then that the United States welcomes a large contingent of foreign patients annually, plenty of Americans choose to leave the U.S. for aesthetic treatments and surgical procedures in different countries.

[Patients Beyond Borders reports](https://www.patientsbeyondborders.com/media) that the global medical tourism market is growing at a rate of 15 to 25 percent, and cosmetic surgery tops the list of specialities medical travelers are most interested in. The organization, which specializes in medical tourism, estimates nearly two million Americans traveled abroad for healthcare in 2019.

## __What to Consider Before Traveling Abroad for Cosmetic Surgery?__
Sure, cost savings and the allure of new technologies can be appealing, but patients should be cautious when seeking medical treatment in a foreign country. The potential risks of traveling abroad for cosmetic surgery are multiple and varied, says Beverly Hills-based board certified plastic surgeon [Johnson Lee, MD](https://aedit.com/provider/johnson-lee-md-710). And while it is possible to receive quality care around the world, patients should take the necessary precautions before opting for medical travel.
 
1. __Safety First__: Needless to say, safety should always be your top priority when seeking treatment both domestically or abroad. Researching how cosmetic procedures are regulated in other countries, what the education and certification process is for doctors and surgeons, and how medical centers and international hospitals function can help to ensure the proper safety protocols are in place.

2. __Do Your Homework__: If a procedure is not FDA-approved in the U.S., you may want to consult with a board certified plastic surgeon or dermatologist prior to traveling to understand the potential safety risks of the treatment or technique. Viewing before and after photos and asking to speak to local patients who have undergone the procedure can provide additional insight into what to expect. 

3. __Money Matters__: Make sure you have explicit documentation about the price of the procedure (including pre-op lab work and post-op recovery fees) from the onset. While healthcare costs can be significantly less outside of the U.S., it is important to remember that a low-cost treatment that sounds too good to be true probably is. 

4. __Insurance Intricacies__: Insurance companies rarely cover elective cosmetic procedures, but you may be able to take out an insurance policy before traveling abroad for a procedure. While some health insurance plans can be designed specifically for medical tourism, you'll want to be clear on exactly what is covered by the policy. For example, coverage may be provided if you have to delay your return home for medical reasons.

5. __Communication Is Key__: Consider potential language barriers when choosing a provider. Be sure to ask whether the entire medical team (nurses, doctors, etc.) are fluent in your native language. During both the pre-op and post-op care process, you will need to understand everything that is being said, so communication is a vital part of choosing a provider.

## __Risks Associated With International Medical Care__
Whether you're being treated at home or abroad, there are always risks associated with undergoing a procedure — especially an elective one. With that said, there are certain things to pay special attention to when considering healthcare services in a foreign country. Below are five of the most common risks pertaining to medical tourism for cosmetic procedures:

### __1. Anesthesia__
The increased risks associated with anesthesia when having surgery abroad are often in relation to the resources available in the clinic where the procedure is taking place. To mitigate this risk, it is worth asking what safety protocols are in place and how the surgeon’s team is prepared to react in the event something goes wrong. Dr. Lee advises patients to ask the following:

- *What safety measures are in place before, during, and after surgery to make sure there are no unnecessary risks?*
- *If there is a complication, are the providers or medical facility knowledgeable and equipped to handle it?*

### __2. Unsatisfactory Surgical Results__
Another common concern when traveling abroad for cosmetic procedures? The potential for unsatisfactory results and the lack of recourse in such cases. Dr. Lee has seen patients in his practice who are looking for revision procedures in the aftermath of a surgery done abroad. “Most of these procedures are larger surgeries that have larger incisions or tend to require a longer recovery period, such as [tummy tucks](https://aedit.com/procedure/abdominoplasty) or [mommy makeovers](https://aedit.com/aedition/the-mommy-makeover-how-to-bounce-back-after-a-baby)," he explains. "The problem is that most patients return home shortly after their procedure and are no longer properly managed.”

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  "The problem is that most patients return home shortly after their procedure and are no longer properly managed."
</PullQuote>

There is also the risk that a provider will rely on patients not being local to cut corners, which can lead to long-term financial, physical, and emotional concerns. Dr. Lee recommends patients who choose treatment abroad find a doctor in their home country (prior to leaving!) who would be willing to treat them if something were to go wrong upon return.

### __3. Implant and Device Safety__
Ever since the [silicone implant scandal](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676226/) involving French manufacturer Poly Implant Prothèse (PIP) in the early 2000s and the more [recent recall of Allergan's textured breast implants](https://aedit.com/aedition/heres-what-you-need-to-know-about-the-allergan-breast-implant-recall), patients are increasingly aware of the need to discuss implant safety prior to surgery. This is especially true abroad, as clinical testing, medical standards, and regulation varies by country. 

“The FDA in the United States is particularly stringent. Most larger companies with FDA-approved implants and medications in the United States will have the exact same or similar products abroad,” says Dr. Lee, who encourages patients to ask their surgeons in other countries what types of products they use. If you are uncomfortable with what is offered, consult with another provider. The same due diligence is necessary for medical devices (think: lasers and body sculpting treatments), too.

### __4. Post-Op Travel Concerns__ 
Long-distance travel soon after surgery is one of the biggest differences in the recovery from a procedure carried out locally versus abroad. Surgeons who regularly operate on patients traveling from another country often have tried and tested protocols in place that will dictate when and how you will be allowed to travel home to prevent injury and complications.

“With air travel, you may be expected to stand or sit for prolonged periods of time or carry heavy luggage. This can be harmful to your surgical sites, in addition to being uncomfortable," Dr. Lee explains. "One of the most serious risks of flying is developing a deep vein thrombosis (DVT). This is usually a blood clot that forms in the calf area of the legs and happens because of prolonged sitting and poor circulation. Blood clots can travel through your vessels and cause damage to the lungs and even death.”

Ideally, patients would travel with a companion who can help navigate the post-op process and return trip home. Coordinating with your airline can also help to get you through the airport with less walking and standing. Regardless, Dr. Lee says surgeons should be able to provide "exercises and tips" that will help minimize the risks, "if you are traveling shortly after surgery."

### __5. Recovery and Aftercare__ 
With many procedures, patient care during the recovery process is as crucial to a good outcome as success in the OR. One of the biggest risks of having surgery in another country is the potential lack of follow-up care. Dr. Lee advises that patients try to find a doctor close to home who is willing to help them through the recovery process, if they do choose to have surgery abroad.

Scar revision, for example, is a common request of patients returning to the U.S. after having a cosmetic procedure abroad. The scarring can be due to the stress put on the surgical site while traveling home, poor post-op care, or doctor error. Larger revision or corrective surgeries (which are both financially and physically costly) may also be needed if patients are unhappy with their results.

To avoid such disappointments, make sure you ask your surgeon to outline their standard recovery practices (including when normal activity can resume and what symptoms to be on the lookout for) and how they can be carried out when you return home.

## __For Patients Traveling to the U.S. for Cosmetic Surgery__ 
Just as Americans looking to travel abroad for cosmetic surgery should take all of the potential concerns and risks outlined above into consideration, patients planning to come to the U.S. for treatment should exercise similar care. 

As in any country, finding a reputable reliable surgeon, who specializes in your desired procedure is paramount. It is important to consider his or her board certifications, aesthetic, and patient satisfaction. You will want to discuss how long you will need to remain in the country after the procedure for follow-up appointments and when it will be safe to travel long distances again. Additionally, be equipped with a list of medications and supplements you currently take and any relevant medical records to ensure things operate as smoothly as possible.

## __The Takeaway__
Regardless of where you choose to have it done, deciding to undergo a cosmetic procedure is a big decision. There are, of course, added risk factors to take into account before choosing to have a procedure abroad. Doing proper research to understand healthcare system in the country you are traveling to can help mitigate the risks and ensure high-quality care. 

Prior to leaving for your trip, you’ll want to line up a doctor close to home who is willing to treat you if side effects or complications arise post-op. Traveling with a friend or loved one is also recommended, as is securing appropriate insurance. And, if you take nothing else from this piece let it be this: The true price of a cosmetic procedure is about a lot more than dollars and cents.

“The cost of the procedure is just the tip of the iceberg,” Dr. Lee says. “When deciding to travel abroad, you should do your research and speak with your surgeon or other patients about their experiences. This is your body, not a car or a piece of jewelry. Don't shortchange yourself!”

Sure, cost savings and the allure of new technologies can be appealing, but patients should be cautious when traveling overseas for medical care. Here, The AEDITION explores what to consider before seeking treatment in another country.

Dangers of Getting Plastic Surgery And Cosmetic Procedures In Foreign Countries 

What You Need To Know About Traveling Abroad For Cosmetic Surgery

shutterstock 1174992457-min

At this point, you've likely heard that Allergan (the Dublin-based drugmaker behind [Botox®](https://aedit.com/procedure/botox-facial), [Juvéderm®](https://aedit.com/procedure/temporary-lip-fillers), [CoolSculpting®](https://aedit.com/procedure/cool-sculpting), [Latisse®](https://aedit.com/procedure/latisse), and more) issued a [worldwide recall](https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/allergan-voluntarily-recalls-biocellr-textured-breast-implants-and-tissue-expanders) of its BIOCELL® saline- and silicone-filled textured [breast implants](https://aedit.com/aedition/what-its-really-like-to-get-breast-implants) and tissue expanders. The decision followed a request from the United States Food and Drug Administration (FDA) to remove the products from the market due to a link between them and a rare type of cancer known as breast implant-associated anaplastic large cell lymphoma (a.k.a. BIA-ALCL).

## **The Skinny**
The debate about textured implants is nothing new. Amidst a growing concern about potential health risks (they were pulled from European markets in December 2018, with Canada and Australia following suit in May and July, respectively), [the FDA determined](https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-jeff-shuren-md-director-center-devices-and-3) in March 2019 that there was not enough evidence to support banning the products at the time. New data, however, has the agency changing its tune. 

The FDA now reports there have been 573 cases of BIA-ALCL since 2011, and 481 of the patients had BIOCELL® implants at the time of their diagnosis. Of the 33 deaths from the rare cancer of the immune system, authorities have been able to identify the manufacturer of the implants in 13 cases — 12 of them involved Allergan. The agency believes the risk of disease from BIOCELL® textured products is six times greater than that of other brands. 

“Once the evidence indicated that a specific manufacturer’s product appeared to be directly linked to significant patient harm, including death, the FDA took action to alert the firm to new evidence indicating a recall is warranted to protect women’s health,” FDA principal deputy commissioner Amy Abernethy said in a statement.

## **The Specifics** 
Unlike smooth implants, textured breast implants are known for their sandpaper-like exterior that helps to hold them in place. While they are common in Europe, they make up less than 10 percent of the units sold in the U.S. market. 

Even so, the FDA [recommends](https://www.fda.gov/medical-devices/breast-implants/questions-and-answers-about-breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl) (as of July 24, 2019) health care providers immediately stop implanting BIOCELL® products and return unused inventory. Patients, meanwhile, are advised to monitor for BIA-ALCL symptoms, which include persistent swelling or pain in the vicinity of the implant. While patients diagnosed with the cancer should have their implants removed, the FDA does not currently suggest the removal of textured implants or tissue expanders for those who are symptom-free.  

The recall adds yet another layer to the recent negative press that breast implants, in general, have received. In the lead up to that March FDA meeting, some providers renewed calls for so-called "breast implant illness” or BII to be classified as a medical condition due to the autoimmune disorders (think: muscle pain, fatigue, digestive issues, inflammation, weakness, hair loss, and cognitive impairment to name a few) patients and surgeons believe could be tied to silicone implants.

“While the FDA doesn’t have definitive evidence suggesting breast implants are associated with these conditions, we’re looking to gain a fuller understanding of this issue to communicate risk, minimize harm and help in the treatment of affected patients,” the agency said in the report, while imploring medical device manufacturers to invest in long-term testing for BII.

## **The Takeaway** 
So, what does all of this new information mean for the estimated five million-plus Americans who currently have breast implants?

If you have a textured breast implant, the risk of developing BIA-ALCL over your lifetime is somewhere between one in 4,000 and one in 30,000. To put that in perspective, the lifetime risk of being hit by lightning is one in 3,000. Thus, the chance of developing breast implant-associated cancer is less than the chance of getting struck by lightning, and treatment of local BIA cancer is nearly 100 percent curable with excision. 

The low odds explain why the FDA does not recommend removal of Allergan BIOCELL® breast implants in patients with no symptoms — though it has rightly banned BIOCELL® products from further use due to the unnecessarily and significantly elevated risk of BIA cancer. 

Patients experiencing symptoms that could be related to BIA or BII should contact their plastic surgeon.

In the wake of Allergan issuing a global recall of its BIOCELL® textured breast implants and tissue expanders, The AEDITION breaks down what it means for patient safety.

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