Get the Facts: What you should know about Cosmetic Surgery

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Today, cosmetic surgery and non-surgical cosmetic procedures are more in demand than ever before. Whether you are considering surgery or any other type of cosmetic procedure, you should make sure that you have all the information you need to make a properly informed decision before proceeding.

To help you make an informed decision, the College of Physicians and Surgeons of Ontario has put together this information, which includes an explanation of the different kinds of doctors who provide services, the important issues you should be aware of when considering cosmetic surgery, and a list of questions to ask before making a decision about having cosmetic surgery. In keeping with the College’s mandate to ensure quality medical practice, the regulation of cosmetic surgery providers makes certain that the doctor you choose has the skills and knowledge to provide safe medical care.

Most of this fact sheet focuses on cosmetic surgery because of the higher risks involved in surgical procedures rather than non-surgical cosmetic procedures. You will also find some helpful questions to ask if you are considering a cosmetic procedure that does not involve surgery.

If you or someone you know is considering any cosmetic procedure be sure to make an informed decision by finding out everything you can about that procedure, the qualifications of the person doing the procedure and the facility where it is being done.

  • When a physician is mentioned in any advertising or promotional materials, the physician's credentials must follow their degree(s) and must be listed as either a) the term, title, or designation of the specialty or subspecialty in which he or she has been certified by the RCPSC or the CFPC or formally recognized in writing by the CPSO or b) the title General Practitioner, if the physician is not certified by either national educational body or formally recognized in writing by the CPSO as a specialist.

    Examples of Proper Usage

    Joan Clark, MD, CCFP, Family Medicine

    Tom Smith, MD, General Practitioner

    P. Singh, MD, FRCSC, Orthopedic Surgery

    Physicians who have completed additional training in specific practice areas but are not certified specialists in those disciplines can use the phrase "practising in" which must precede any descriptive terms that are used. This is intended to ensure consistency in advertising and promotional materials, and that descriptive terms are not mistaken for formal specialization or sub-specialization.

    Examples of Proper Usage

    Charles Mann, MD, CCFP, Family Medicine, practising in palliative medicine

    JB Rodriques, MD, General Practitioner, practising in pediatrics

    E. Goldman, MD, CCFP, Family Medicine, practising in dermatology

    Francine Roth, MD General Practitioner, practising in palliative medicine and geriatrics

    Physicians are prohibited from using the title "surgery" or the term "surgeon" or a variation or abbreviation to describe their practice unless the doctor is certified by the Royal College of Physicians and Surgeons of Canada (RCPSC) in a surgical specialty or subspecialty or formally recognized in writing by the CPSO as a surgical specialist or subspecialist. Family physicians, for example, who provide cosmetic procedures, can no longer describe themselves as cosmetic surgeons.

    Restrictions are also imposed on three terms which contain the word "plastic". "Facial plastic(s)" can only be used as a descriptive term by physicians who are RCPSC certified as an Otolaryngologist-Head and Neck Surgeon or by physicians who have been recognized as an Otolaryngologist-Head and Neck Surgeon under the College's Recognition policy. "Oculoplastic(s)" and "Ophthalmic Plastic(s)" can only be used as descriptive terms by physicians who are RCPSC certified in Ophthalmology, or who have been recognized as an Ophthalmologist under the College's Recognition policy.

    See also Physician Advertising Q and A.

    It is critical that you check your doctor's qualifications and are confident that he or she has the appropriate skills and training to do the surgery you are considering. Whether or not you are seeing a specialist, your doctor should be prepared to answer any questions you have about his or her qualifications. You can also check to confirm that your doctor is licensed and what his or her qualifications are under Find a Doctor.

  • These questions will help you ask your doctor what you need to know before proceeding with Cosmetic Surgery. Print out this Cosmetic Surgery checklist and take it with you to your appointment.

    Questions about the doctor

    • What are your qualifications? (Where did you train? what certification do you have?)
    • How long have you been doing this procedure and how frequently?
    • What are your complication rates of this procedure?
    • Do you have hospital-admitting privileges if complications arise?
    • Do you have privileges in a hospital to do the procedure that you are doing in this clinic?
    • Do you have professional indemnity insurance?

    Questions about the anaesthesia

    • If anaesthesia is required, what form of anaesthesia will be used?
    • Who will be administering the anaesthesia and what are his or her qualifications?
    • Questions about the surgery
    • How long will I be in surgery?
    • What are the risks of this surgery in particular, and surgery in general?
    • What protocols do you have in place in the case of an emergency?

    Questions about after the surgery

    • What care and pain relief is needed afterward?
    • How should I expect to feel in the days following the surgery?
    • What warning signs of problems should I be aware of once I go home?
    • Will I have swelling and bruising?
    • How do I contact you after hours if I have any problems?
    • When can I judge the results?
    • What if I'm unhappy with the results?
    • How long will I be away from work and normal activities?

    Don't forget to ask any other questions that you might have.

  • If the results of your cosmetic surgery are not what you expected, or you have other concerns, contact your treating cosmetic doctor. Together, you may be able to work out a solution.

    If you do not feel that your concerns have been addressed adequately, and you have a concern about your doctor, please contact the College of Physicians and Surgeons of Ontario:

    Telephone: 416-967-2600 or 1-800-268-7096, ext. 603

    College of Physicians and Surgeons of Ontario
    80 College Street
    Toronto, Ontario M5G 2E2

  • The popularity of non-surgical cosmetic procedures is also growing. Although actual surgery isn't involved, these procedures also have risks associated with them and you should make sure you understand what to expect and the training anyone has who will be performing these procedures. For example, Botox is available only when prescribed by a doctor but under appropriate supervision, the doctor may delegate the actual procedure to a qualified person, such as a nurse.

    These questions will help you ask your doctor what you need to know before proceeding with Non-Surgical Cosmetic procedures. Print this Non-Surgical Cosmetic Procedures checklist and take it with you to your appointment.

    Questions about the service provider

    • Who will carry out the procedure?
    • What training do they have to provide this procedure?
    • How frequently do they carry it out?
    • Do they have professional indemnity insurance?

    Questions about the procedure

    • Is the procedure right for me?
    • How long does the procedure take?
    • Is the procedure painful and, if so, what form of anaesthesia is used?
    • Is all equipment used sterile and used only for me?
    • What are the risks involved?
    • Are there any other options available for me to achieve the results I want?
    • Do you have any "before and after" photographs that I can see?

    Questions about after the procedure

    • What care and pain relief will I need after the procedure?
    • Will I have swelling or bruising?
    • At what stage will I be able to judge the results of the procedure?
    • How long do the results last?
    • Will I need a more than one procedure?
    • What if I am unhappy with the results?
    • How do I contact you after hours if I have any problems?

    Don't forget to ask any other questions that you might have.

  • The decision to have any operation is significant. Think about it carefully, gather all the information you can and ensure that your expectations are realistic. Here are some things you can do before you make a decision:

    Talk to your family doctor. This is a good place to start before making any decisions about cosmetic surgery. With your family physician you can discuss your reasons for wanting cosmetic surgery; your specific health issues which may be important when considering surgery; and general information about cosmetic procedures. For example, pregnancy, some medical conditions, and certain medications make cosmetic surgery unadvisable. Any medical conditions should also be discussed with your cosmetic surgery provider. Your family physician may also be familiar with the experience and training of surgeons who provide cosmetic procedures in your area.

    Ask yourself why you want this procedure. Will it change your appearance the way you hoped? Are you doing it for yourself or to please someone else? Also consider if there are alternatives to surgery that will give you some of the benefits, including non-surgical cosmetic procedures with fewer risks. It's important for you to consider these questions, in addition to talking to your doctor about whether your expectations are realistic.

    Do your research. Hospitals and clinics offering the procedure you are considering can provide information that may help in your decision-making. Although many physicians have websites that provide details about their treatments, often with "before and after" photographs, websites are in themselves a form of advertising and photographs of patients before and after procedures may be best-case scenarios. Look for other objective information from multiple sources - friends, family, the internet, etc. When you see the physician, ask to see pictures of other patients that have had the procedures you are considering. If available, consider talking to past patients who have had the same procedure.

    Contact the College of Physicians and Surgeons of Ontario. To learn about your doctor and his or her qualifications, you can call us at 416-967-2600 ext. 603 or 1-800-268-7096 ext. 603 or visit Find a Doctor on our website.

    Book a consultation with the surgery provider. This is your opportunity to get the information you need to make a decision. You should not feel pressured to proceed just because you have had a consultation. This consultation should include a detailed medical history, a discussion about your aesthetic concerns, and a thorough explanation of all the options available to you to address your concerns. In addition, you should get a clear explanation of all the associated risks, benefits and complications associated with each option. It is very common for pre-operative pictures to be taken at the time of the initial consultation and the costs associated with each option are usually discussed at the time of the initial visit.

    Take a list of questions with you. Be honest about your expectations. Ask about the doctor's qualifications including how many procedures like this he or she has done, what kind of training or certification he or she has, complication rates and how complications are handled. A list of questions you can print and take with you is available at the end of this fact sheet.

    Consider getting a second opinion. Different doctors have different approaches. Find one that suits you best.

    When you are asked to sign an agreement consenting to the procedure, make sure you understand it and are confident with what you're signing. Beware of any agreement that encourages you to make a quick decision. The decision to undergo cosmetic surgery is a significant one; take time to understand all the information given to you at the time of the consultation. Carefully read all of the information contained in the informed consent document.

    Under no circumstances should you feel pressured to move ahead quickly into surgery. Take as much time as you need to make up your mind  and avoid any provider who makes you feel rushed.

  • Cosmetic surgery involves incisions or significant alteration of the skin or underlying tissues and can involve many areas of the face and body. Common facial cosmetic procedures include facelift, brow lift, eyelid surgery, ear surgery, and rhinoplasty (nose) surgery. Less invasive cosmetic facial surgeries include facial liposuction, facial implants, micro fat grafting, and some laser resurfacing procedures. Common cosmetic surgical procedures done on the body include liposuction, abdominoplasty (tummy tuck), breast lift, breast enhancement (augmentation). There are many other procedures targeted to nearly every part of the body.

    All surgery comes with possible risks of complications - from anaesthesia, infection, and scarring, for example. Such complications can be minor or major and, in rare circumstances, even death can occur. Cosmetic surgery is no exception and the decision to consent to surgery is always an important one.

    In Ontario, any medical doctor may perform surgical procedures, including cosmetic surgery, provided that they are appropriately educated and experienced. When you discuss cosmetic procedures with your doctor, make sure that he or she has the right qualifications and experience. Surgical procedures should only be done by doctors who have the appropriate training and experience.

  • In addition to finding out about the doctor performing the surgery, you need to know about the facility where the surgery will take place.

    Cosmetic surgery is usually done in one of two types of facilities, either a hospital or a private clinic. A private clinic is one that is not affiliated with a hospital.

    Another part of the College's plan to improve the oversight of cosmetic surgery was to get the authority to inspect existing non-hospital premises where procedures using certain types of anaesthesia are performed, and approve new premises before they are operational. To do so required legislative change.

    In April 2010, the Government of Ontario, in consultation with the College, enacted a new regulation which gives the College the authority to inspect premises where procedures such as cosmetic surgery, colonoscopy, endoscopy, and interventional pain management are performed.

    The College fully supports increased access to services outside hospitals and inspections of these premises will ensure appropriate standards for procedures, infection control and quality assurance are in place. The program will also make sure that physicians are managing medical and surgical conditions within the scope of their specialty training, certification and experience.

    Wherever you are having a procedure performed, appropriate safeguards should be in place to ensure your safety. If you are having surgery outside of a hospital, the clinic should have:

    • Excellent infection control protocols;
    • All necessary equipment;
    • Clear procedures and plans to handle emergencies; and
    • Well qualified staff.

    It's critical to ask questions about what happens if there are sudden, unexpected problems and how quickly help is available.