The Essential Cosmetic Surgery Companion

Robert Kotler, MD, FACS; 2005; Ernest Mitchell Publishers; softbound; ISBN: 0-9712262-2-9.

Robert Kotler, MD, author of The Essential Cosmetic Surgery Companion is also the author of The Consumer's Guidebook to Cosmetic Facial Surgery and Secrets of a Beverly Hills Cosmetic Surgeon. He is the featured cosmetic surgeon on E!! Entertainment's show Dr. 90210. The thing that I admire most about this book is that author is very upfront about his opinions. He recognizes that media outlets often report on a procedure when it is very new and this immediate exposure gives the procedure credibility and popularizes it too soon. He recognizes that patients need "more information than they can glean from the snippets shown on television." His mission is to help patients get that information. However, since accurate information is the goal, I was surprised that in the Recommended Resources section of the book, he included 18 magazines including CosmoGIRL, Cosmopolitan, Elle, Glamour, In Style, Teen Vogue, and others. There are better sources of information that I would send my patients to first.

He refers to this book as a workbook. It is organized into 10 chapters. Each chapter helps the patient walk through a decision. For example, in Chapter 1, the question is "Are you really a candidate?" The 15 questions and answers will tell you. The book contains many checklists that the patient is encouraged to photocopy, write on, and take to the doctor's appointments. The 14 most common procedures are covered with checklists of questions that the patients should ask their surgeons. A component of these checklists is a diagram of the body part that is to be operated on. The patient is to ask the surgeon to draw on the diagram where the incisions will be, or to sketch in the desired result on the diagram of the nose. The back cover of the book sums it up nicely:

"This step-by-step workbook features:

* A 5-minute telephone screening-script to use when speaking with a surgeon's office manager before committing to a time-consuming and costly consultation.

* Checklists for the 14 most popular procedures

* The 29 Most Important Questions to Ask at the Consultation as well as a Consultation Summary Form for each practice.

* A 37-Question Quiz to rate and compare each cosmetic surgery practice (including anesthesia and surgical facilities)

* A Cost Tabulation Worksheet

* A Glossary of Medical Terms, a Directory of Companies that Finance Cosmetic Surgery, and Anatomical Sketches for the doctor to illustrate his game plan."

By offering the numerous checklists and encouraging the patient to interview several surgeons, the patient is more likely to compare "apples to apples" since he or she would be evaluating the same variables at each practice. This is an organized approach that would help the patient sort out the vast amounts of information being gathered. How many times have we suggested to our patients to "write a list of questions?" The author has written the lists for the patient and naturally included many questions the patient would never have thought to ask. This approach also empowers patients to indeed "interview" the surgeon. Most patients I have met don't seem to grasp the concept that the surgeons are working for them.

The lists related to the business issues (price, payment, etc.) would be very helpful to the patient who is reluctant to ask such questions. He or she could have the list in-hand and say to the office manager, "Let's go over this list."

If a patient buys this book because she is interested in one procedure, I would still recommend that she read the checklists for other procedures. I found some good questions under the augmentation section that weren't included in the mastopexy section (i.e., related to symmetry, weight gain, resuming sex, and more).

This would be a good book for the surgeon, the office manager, and nurses to read because they should know the criteria on which their practices are rated. There is an excellent checklist in the section called "what to expect from a great office practice."

There are also excellent questions raised regarding where the surgery should occur: hospital versus surgicenter versus the surgeon's office. While I always contend that a patient should have surgery in the plastic surgery suite that is within the hospital (in case of complications), the author contends that surgeries in the cosmetic surgeon's office is optimal if the office is in a medical building or location where there are other doctors around.

The author and I have differing philosophies on the appropriate credentials for a plastic surgeon. The author encourages potential patients to seek out the "superspecialist" to perform the surgery. In his words, "there are great benefits to patients when a surgeon narrows his scope and chooses not to perform most other operations within his specialty[horizontal ellipsis]This fine honing of specialization in modern medical practice is known as superspecialization: a narrow, focused, 'boutique' practice." According to Dr. Kotler, a cosmetic surgery superspecialist will typical limit his practice to 15 or fewer procedures.

He states that a qualified cosmetic surgeon would be board-certified in one of these four specialties: dermatology, ophthalmology, head and neck surgery, or plastic surgery. The surgeon practices cosmetic surgery only, has completed a cosmetic surgery fellowship, and has performed only cosmetic surgery for 10 or more years. He cautions the patient if the surgeon's resume states that he/she does reconstructive surgery, burns, hand surgery, and cancer surgery, the surgeon is not focused enough on cosmetic surgery to be a superspecialist and therefore not the best choice of surgeon.

The American Society of Plastic Surgery Nurses has steadfastly recognized that the Board Certified Plastic Surgeon, that is the surgeon certified by the Board of Plastic Surgery, is the best choice for the patient since it is the preferred credential.

The author of this book is board certified by the American Board of Otolaryngology/Head and Neck Surgery and is not credentialed by the American Board of Plastic Surgery.

Despite philosophical differences I have with the author, I still think this is a worthwhile book for the nurse to read and to share portions with her patients. I have no doubt that the author has the patient's best interests at heart. It is commendable that the proceeds of the book are donated to fund leukemia research in honor of the author's daughter, a cancer survivor.

Kathleen Walsh Spencer, MSN, MA, RN, CS, CPSN

Editor of PSN, William Beaumont Hospital, Royal Oak, Michigan