How Can I Avoid Bad Plastic Surgery?

Episode summary

How can you reduce the chance of a poor plastic surgery experience? Start by evaluating the clinician, facility, anesthesia plan and communication before committing to a procedure. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains practical questions to ask while stressing that even excellent care cannot guarantee a perfect result.

Originally published October 4, 2020. The recording describes Dr. Smith's selection principles and practice setup at that time; verify current credentials and arrangements directly.

Key takeaways

🎓 Training and certification

Understand the clinician's training and the exact board certification being claimed. A marketing title alone does not tell you that history.

🏥 Facility and anesthesia team

Ask about the surgical facility's accreditation and monitoring, who will be present and how anesthesia will be provided.

🔎 Proposal review

Evaluate a full proposal rather than being led only by a discount, impressive advertisement or before-and-after photograph.

💬 Patient feedback

Look for patterns in patient feedback, while recognizing that reviews alone cannot establish surgical quality.

🧳 Travel and follow-up

Travel requires planning for support, costs and follow-up. Feeling comfortable asking detailed questions remains important wherever care takes place.

Questions this episode answers

Can a surgeon promise a perfect result?

No. Dr. Smith explains that surgery involves living tissue, blood supply and healing, which introduce uncertainty. Understanding those limits is part of making an informed decision.

How can I check a plastic surgeon's board certification?

The episode specifically discusses certification by the American Board of Plastic Surgery. Its current public certification search provides a way to verify that claim rather than relying only on advertising.

What should I ask about anesthesia?

Ask who will administer it, their qualifications, who will monitor you and how the team is organized. The recording distinguishes selected procedures performed with local anesthesia from those involving sedation or general anesthesia; the appropriate arrangement depends on the procedure and setting.

🔗 Related information

Read Dr. Darren Smith's training and background and the preoperative preparation guide, or schedule a consultation to discuss your procedure and care plan.

Educational information, not individualized medical advice. Careful preparation can support informed decisions but cannot eliminate surgical risks. Show notes updated September 30, 2026.

Original show notes

Welcome to our 50th episode! Board certified NYC plastic surgeon Dr. Darren Smith offers some advice to make sure you have a safe plastic surgery experience and get the best results possible.

[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. How can I avoid bad plastic surgery? I hate that I have to even record this episode because it would be nice to think that everyone that is providing plastic surgery and aesthetic medicine procedures is properly licensed and trained to do so and is always delivering results and experiences that meet the highest standards of quality and safety. But unfortunately, in today's world, that just isn't the case. So the purpose of this episode is to help offer some guidance so you can avoid the bad apples in the bunch. I'd like to start with a disclaimer and that is to say that even the best plastic surgeons don't always achieve perfect results.

[01:20] Taking this one step further, anyone that promises you a 100% chance of a perfect result is misleading you. And that's because unlike a sculptor who's working with marble or clay in plastic surgery, there are many variables where we're using complicated techniques to manipulate biological tissues. and essentially coax them into doing what we want. So for example, while a sculptor can expertly carve the likeness of a breast into a block of Marable. When a plastic surgeon is performing a breast lift or mastopexy, for example, we have to take things like blood supply of the nipple and areola into account and make sure that when we're shaping the breast tissue to achieve an ideal result, we're preserving the blood supply to the nipple and areola complex and moving it in such a way that is compatible with its survival. So not only are we accounting for shape when we're performing aesthetic surgery, but we have to do this in such a way that we're also maintaining the life and viability of the tissue that we're working with. And this brings with it a whole host of complexities and uncertainties. And that is really what the mastery of plastic surgery entails. It's the ability to know the anatomy and know what tissue can and can't do.

[02:52] in order to achieve the desired result. So with that disclaimer out of the way, let's jump right in to offering some advice in avoiding bad plastic surgery. So first, I would invite you to go back and listen to the episodes on the flip side of this topic, namely how to find a good plastic surgeon. and that'll provide context for the discussion that we're going to have now. So first and foremost, when you're choosing who's going to do your plastic surgery procedure, make sure you are going to a board certified plastic surgeon. This is someone who is certified by the American Board of Plastic Surgery. The only way to get certified by the American Board of Plastic Surgery is to complete an accredited residency that has met rigorous standards to ensure that it is turning out well-trained surgeons. And after completing that residency, the surgeon needs to pass a rigorous written and oral examination to ensure that they have met the highest standards of safety and proficiency in plastic surgery. So it is not good enough to go someone who calls themselves a cosmetic surgeon because there are a lot of different ways to achieve the title cosmetic surgeon that do not involve the same degree of rigorous training that is required to become a board certified plastic surgeon. And finally, there are some surgeons and doctors that don't even call themselves cosmetic surgeons that are performing aesthetic or cosmetic procedures. So always make sure you know exactly who your surgeon is, what kind of training they have, and what kind of board certification they have. So it is critical, again, that you're going to someone who is board certified by the American Board of Plastic Surgery and not any alternative medical board. Next on the list, avoid crazy offers and discounts.

[05:03] Plastic surgery is expensive. This is not the kind of thing that you want to cut corners with. Your health and well-being and livelihood are on the line. So it's very reasonable to do some price shopping and make sure you're going to someone who's offering reasonable pricing. But it gets very dangerous to go to someone who is offering pricing that is consistently below market. Similarly, Even the most reputable practices will sometimes be running specials or discounts, but to go to someone who is offering these kinds of discounts that are significantly below what others are charging, you have to wonder how they're getting there, what corners are being cut, and we'll talk about that a little bit later on in the episode.

[05:51] more or less you should really plan on going to a plastic surgeon that is charging fees that are more or less in line with market rates and in some cases for true experts or celebrity surgeons they may be charging above market but please do not go to someone who is charging significantly below market because there's just an important piece of the puzzle missing somewhere. Next on the list don't go to someone who has consistently poor online reviews. Now, this may seem like a no-brainer, but with the state of technology that exists today. It is very easy to get swayed by fancy advertisements and before and after photos that may actually be doctored or manipulated such that people see things that are just so incredible they may be inclined to ignore online reviews.

[06:49] And we've spoken in previous episodes about the fact that we can't rely exclusively on online reviews by any means when choosing a plastic surgeon. But if you're seeing a pattern, a clear pattern of someone having really poor reviews, that is a red flag that you should not allow yourself to be distracted from. The next point that I'm going to make is a little bit controversial and that is I would strongly advise that you avoid medical tourism. It's one thing to travel within the United States to a surgeon that you've heard great things about. Maybe you've had a friend or family member that's had surgery by someone and you really trust them and you'd like to travel to use them. And that's fine as long as you have an adequate support system in place and you understand all of the steps and often added or hidden costs that are involved in traveling to have plastic surgery. As long as you're within the United States, you can be assured that certain safety protocols are being followed as long as the facility that you're going to meet certain standards. And that's something we'll cover in a few minutes as well. But when I say to avoid medical tourism, I'm urging you not to travel to countries that are again offering plastic surgery procedures at significantly lower prices than you're finding here at home because in many many cases significant corners are being cut having to do with safety in order to offer these prices and while there are certainly excellent surgeons abroad, it can be very difficult even for trained plastic surgeons to determine how safe a plastic surgery facility or system is in another country without personally visiting and knowing the surgeon. So it is very difficult if not impossible for a member of the lay public to do this.

[08:47] And again, in the United States we have the benefit of knowing that there are certain standards that have to be met in order to operate surgical facilities. And unless you have an intimate knowledge of the regulatory systems in these other countries, it's just very hard to know with certainty that you're walking into a safe situation. So I've alluded a couple times now to the kind of facility that you're having your procedure in. You should be having your plastic surgery procedure either in a hospital or in an accredited outpatient surgical facility. So if you're going to have your procedure in an outpatient facility, it's important to speak to your surgeon about what kind of accreditation and monitoring that facility.

[09:36] has in place. So for example, we perform almost all of our aesthetic surgery procedures in our own outpatient surgical facility. And this facility is certified by the AAAASF, which is one of the most stringent regulatory organizations out there in terms of monitoring the safety practices of outpatient operating room facilities. Next on the list, avoid surgeons that are doing their own anesthesia. This is something that's sometimes done to cut down on cost so that the patient is paying only for the surgeon and not another provider to administer anesthesia. While there are many instances in which surgical procedures can be performed under local anesthesia, such as small areas of liposuction. And in these instances, it's very reasonable for the plastic surgeon to administer that medication himself or herself.

[10:40] Since the patient is remaining awake and alert and protecting their own airway, in any instance in which sedation is used, either conscious sedation or twilight anesthesia or general anesthesia, you want to make sure that a board certified anesthesiologist is present and responsible for administrating those anesthetics. And that's for the simple reason that your plastic surgeon is not a trained board certified anesthesiologist, and he or she just can't be up to date with the most advanced safety protocols, and they certainly can't be paying adequate attention to operating on you and administering safe anesthesia. Ask about the conditions under which your procedure will be performed. What staff will be present? In any case involving general anesthesia or twilight anesthesia, there should be a surgical technician to assist the surgeon at the field by handing him or her instruments. And there should be a circulating nurse to make sure that all the supplies necessary are immediately available in the operating room. And of course, as we just mentioned, there should be a board certified anesthesiologist administering anesthesia.

[11:50] Don't be afraid to ask detailed questions like will sterile drapes be used? Will everybody be wearing masks and gowns and gloves for any kind of surgical procedure? Or is the surgeon trying to cut costs by limiting supplies that are used? And just keep your eyes and ears open. Get a sense of the overall quality of the practice. If you're not sure about things during your first consultation, it's never a bad idea to go back for a second look and make sure you're happy with the way things are running. And perhaps most importantly, speak to your surgeon at length and in detail. Do you feel safe? Do you feel comfortable? Do you feel like you can clearly communicate with your surgeon and that you and your surgeon are on the same team that's dedicated to you getting you great results in a safe environment? And if you're just not feeling it, trust your gut. So while plastic surgery in general is very safe when it's performed by expert surgeons in safe surroundings, There are exceptions where some providers try to cut corners and sometimes those sacrifices are passed along to the patient. So hopefully this episode can help you identify some of those red flags so you can have a safe experience and get outstanding results. Thanks for listening and don't forget to subscribe, share the show, and head over to darrensmithmd.com for more real-world plastic surgery talk.

Original Captivate episode. Original release date: 2020-10-04. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.

• Dr. Darren Smith's training and background
• preoperative preparation guide
• schedule a consultation
• Related episode: Can I Smoke if I'm Having Plastic Surgery?
• Related episode: When is Plastic Surgery a Bad Idea?