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AAD Offers Tips on Seeking Out Safe Cosmetic Procedures

The American Academy of Dermatology recently offered suggestions on what patients should look for when choosing where to have minimally invasive cosmetic performed.

Today, there are more ways than ever before to “get a little work done.” From skin fillers to fat reduction procedures, the options are endless for those looking to improve their appearance and boost their self-esteem. But with so many physicians and options from which to choose, consumers can be confused about where to start and who to trust to perform a cosmetic procedure.

At the American Academy of Dermatology’s Summer Academy Meeting 2009 in Boston, dermatologist C. William Hanke, MD, MPH, FAAD, clinical professor at Indiana University School of Medicine in Indianapolis, offered advice to help patients determine if a cosmetic procedure is right for them, including questions to ask the physician to ensure a safe and effective result or outcome.

“The best advice I can offer consumers is not to be afraid to ask physicians direct questions about their credentials, training and patient results with any cosmetic procedure,” said Dr. Hanke. “If you are not satisfied with the answers to your questions or if a physician becomes defensive, then these are red flags and you should seek another opinion.”

To help consumers in choosing a qualified physician for a safe and effective cosmetic procedure, Dr. Hanke recommends the following:

  • Look for a physician who specializes in the cosmetic procedure. Dr. Hanke cautioned that no physician is an expert at every cosmetic procedure. For example, some physicians specialize in laser procedures or liposuction, so Dr. Hanke suggested that consumers look for physicians with particular expertise in the procedure they are considering. Ideally, patients should request to see “before and after” photos of a physician’s actual patients, rather than of another physician’s work.

    “To help them learn about the expected outcomes and downtime involved with a procedure, patients should ask their physician if they can speak with a patient who has undergone the procedure,” said Dr. Hanke. “This might help them feel more comfortable about asking questions and to determine if a procedure is right for them.”

    The American Academy of Dermatology also recommends consumers ask physicians how many procedures they have performed, what results can be expected, how long the recuperation period is and what are the risks.

  • Consider the highly trained skills of a dermatologist for minimally invasive cosmetic procedures. Dr. Hanke explained that most of the minimally invasive cosmetic procedures available today were either developed or refined by dermatologists, such as tumescent liposuction (liposuction using tumescent local anesthesia on awake patients), soft tissue (skin) fillers, and cutaneous laser surgery which includes the removal of tattoos, unwanted hair, and vascular birthmarks, and the treatment of sun-damaged skin.

    “Dermatologists specialize in minimally invasive procedures that do not require general anesthesia. This greatly reduces the potential for complications since the patient is awake during the procedure and recovery times are decreased,” said Dr. Hanke. “These procedures offer patients an enhanced version of themselves, and most patients would rather have subtle results than a drastic change, which is indicative of a major procedure.”

  • Ask who will be performing the procedure. Dr. Hanke acknowledged that there is inconsistency among physicians as to which cosmetic procedures can be safely and effectively performed by non-physicians. In its official position statement on the use of non-physician clinical personnel that offers guidelines to its members on this practice, the Academy recommends that under appropriate circumstances, a physician may delegate certain procedures and services to appropriately trained non-physicians, such as physician assistants or nurse practitioners. Specifically, the physician must directly supervise the non-physician clinicians to protect the best interests and welfare of each patient.

    “Each physician must determine what procedures can safely be performed by nurses or other staff members in his or her own individual practices. This distinction should be made to patients up front to ensure they are comfortable with the expertise and training of the person who will be performing the procedure,” said Dr. Hanke. “However, it is imperative that a physician be on-site to evaluate patients prior to a procedure and to respond promptly to any questions or concerns during or after the procedure.”

  • Evaluate a physician’s credentials before considering a procedure. Although it may be difficult for consumers to ask physicians about their credentials and professional background, Dr. Hanke believes this information is crucial for a safe result or outcome. According to Dr. Hanke, one of the most telling questions that consumers can ask physicians is whether they are board certified by one of the 24 boards of the American Board of Medical Specialties (ABMS), such as the American Board of Dermatology. He explained that board certification is important, as it could indicate a physician’s knowledge and experience with certain procedures.

    In addition, consumers can research physicians on the Internet. State medical board Web sites typically offer information on physicians at no charge. “If a person isn’t comfortable broaching the subject of credentials with a physician, there are ways to research this information online,” said Dr. Hanke. “What’s important is that consumers do their homework before selecting a physician.”

    Dr. Hanke also pointed out that physicians who are members of professional associations must meet certain qualifying standards as part of their membership. Professional organizations such as the American Academy of Dermatology and the American Society for Dermatologic Surgery offer members high quality, accredited educational courses to learn about the most recent advances in the field and to refine their skills.

  • Discuss where the procedure will be performed and if office-based surgery is an option. "A fully equipped physician's office that follows accepted standards for safety is an excellent option for patients to undergo a minimally invasive cosmetic procedure,” said Dr. Hanke. “Compared to hospitals and ambulatory surgery centers, office-based surgery provides many advantages, including decreased costs, greater privacy, efficiency and less risk of infection.”

    The Academy also cautions consumers to avoid cosmetic procedures performed by non-physicians in spas, shopping malls and private parties or functions. While these venues may appear convenient or more cost-effective than a traditional medical setting, they are not necessarily equipped to handle complications or medical emergencies.

    “The success of any cosmetic procedure depends on patients doing their homework up front and selecting a qualified physician to ensure a safe and successful outcome,” said Dr. Hanke. “A good doctor/patient relationship is extremely important, and it increases the likelihood that a patient will feel comfortable asking the physician critical questions and discussing their expectations and concerns.”

For more information on cosmetic procedures, go to the “AgingSkinNet” section of, an Academy Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.

Headquartered in Schaumburg, Illinois, the American Academy of Dermatology, founded in 1938, is one of the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or

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