Check credentials carefully before undergoing cosmetic procedure

Say you're in the market for a face-lift, a tummy tuck or even just a few injections to fill out those "smile lines."

Which doc would you choose?

A. A board-certified plastic surgeon who practices at your local hospital.

B. A high-profile cosmetic surgeon who has written books on plastic surgery and has appeared as an expert on "Oprah."

C. The obstetrician whom you trusted to deliver your three children and has now opened a medical spa.

If you're not sure, it's not entirely your fault.

Thanks to reality television shows, the public knows more about their cosmetic options than ever. But choosing the right doctor hasn't gotten any easier.

The cash-paying clientele of cosmetic surgery is an attractive market for physicians, luring more MDs -- with varying qualifications -- into the field. A fancy medical school, a few acronyms, a couple TV spots can make any doctor sound expert.

And the media aren't helping break through the confusion.

Dr. Jan Adams, the doctor who operated on Kanye West's mom, hosted a series on plastic surgery on the Discovery Health channel and also appeared as a guest commentator on "Oprah."

Sounds like an authority, right? But after Donda West's death, journalists checking Adams' credentials found he wasn't board-certified in plastic surgery, he had a history of malpractice settlements and he was under scrutiny for several drunken driving incidents.

If research staffs at respected television shows can't uncover such flaws, what's the average consumer to do?

"Honestly, anyone can say they do cosmetic surgery," said Dr. Anthony Terrasse, a board-certified plastic surgeon and spokesman for the American Society of Plastic Surgeons. "That's what's scary. You just need a medical license."

Doctors who trained in gynecology, emergency medicine or internal medicine are beginning to offer cosmetic procedures to their patients.

They might have attended a seminar to get training in the specific procedures they're offering. But Terrasse says they won't be able to present a full range of treatment options or handle complications as well as a doctor who spent his residency in a cosmetic specialty like plastic surgery.

Asking whether a doctor is board-certified is a good first step. But listen carefully to the answer. Doctors can easily mislead patients about their credentials, said Dr. Amy Derick, a board-certified dermatologist who practices in Barrington.

"I think doctors have a creative way of answering that question," she said. "They might say, 'I'm a board-certified doctor practicing in dermatology.' They don't say they're board-certified in dermatology."

Ask what specialty the doctor is board-certified in, or ask what specialty the doctor did his residency in, Derick says.

"People are willing to say what they are when it's legitimate," she said.

It's also a good idea to ask your doctor if he or she has privileges to perform this procedure at a hospital, and if not, why. Hospitals won't allow doctors to perform operations that are beyond the scope of their specialty, Terrasse said, though they can legally perform those procedures in an office.

Here's a guide to common terms and what they mean.

Board-certified: After doctors complete medical school, internship and residency, they might sit for a board exam to demonstrate their expertise in a particular specialty. Doctors have a limited number of chances to pass this rigorous test. If they fail, they can still practice medicine.

Doctors are proud of their board certifications and often list them first on a resume. If they don't mention board certification, you should investigate why. Also look into what board issued that certification; you want it to be among the 24 boards recognized by the American Board of Medical Specialties. Check up on your doctor at www.abms.org.

Plastic surgeon: After medical school, a plastic surgeon will have five years of internship and residency training in general surgery and at least two years training in a full scope of plastic surgery operations. To be board-certified in plastic surgery, he or she must perform a certain number of cases that are reviewed by a panel of experts.

Facial plastic surgeon: Facial plastic surgeons often start out on a different track than plastic surgeons; they're usually doctors who trained in residency as otolaryngologists (head and neck surgeons) and who received an additional year of training in facial plastic surgery. They might be board-certified in otolaryngology or plastic surgery. They might also be certified by the American Board of Facial Plastic and Reconstructive Surgery, though this board is not recognized by the American Board of Medical Specialists.

Cosmetic surgeon: This is more of a marketing term, not an indication of training. Any surgeon can call himself a cosmetic surgeon. Some cosmetic surgeons originally trained in other specialties and have taken continuing education courses in specific cosmetic procedures.

Dermatologist: After medical school, a dermatologist will have a year of training in general surgery, pediatrics or internal medicine followed by three years' training in skin disease and skin surgery, including cosmetic procedures such as laser treatments. He or she might be board-certified in dermatology.

Medical aesthetician: After completing a one-year course in skin care, a medical aesthetician will sit for a licensing exam. He or she might or might not have a college degree. An aesthetician who works in a "medical spa" might be supervised by a doctor, but the level of this supervision varies and the doctor might be off-site. Check the credentials of that doctor -- you want someone trained in a cosmetic specialty like plastic surgery, facial plastic surgery or dermatology.

-- Susan Stevens