Credentials: Selected surgeons should be certified by the American Board of Plastic Surgery (ABPS). Any doctor (even one from a nonsurgical specialty) can legally perform surgery.

On the other hand, certification by the ABPS ensures at least five years of surgical training, including two years of training specifically in plastic surgery.

Patients undergoing a cosmetic procedure should select a member of the American Society for Aesthetic Plastic Surgery (ASAPS) to help ensure that their surgeon has extensive cosmetic surgical experience and has met ASAPS requirements for continuing cosmetic surgery education.

Hospital privileges: Cosmetic plastic surgery is often performed outside the hospital in an office-based surgical facility. Wherever the surgery is to be performed, selected surgeons should have hospital privileges to perform the specific procedure in an acute care hospital.

Facilities: Published data show that accredited office-based facilities have a safety record comparable to that of hospital ambulatory surgery settings.

Ambulatory or office-based facilities should be accredited by a nationally or state-recognized accrediting agency, or be state licensed or Medicare certified.

Health: Candidates for cosmetic surgery should be in generally good physical health and must be candid with their physician about any drugs they are taking.

The medical history should include hormones (oral contraceptives and estrogen replacement) and even aspirin, vitamins, and herbal medications since these substances can interfere with blood clotting or interact with medications used during surgery and could increase surgical risk.

Patient education: Before surgery, patients should be educated about all aspects of the planned surgery, including whether to discontinue certain medications and stop smoking. Postoperative care should be thoroughly discussed with the surgeon, as surgery is not truly over until the patient is ambulatory and has returned to a relatively normal routine.

Risks: Most cosmetic surgery is extremely safe in the hands of surgeons certified by the American Board of Plastic Surgery. However, even with the highest level of care, every surgery carries risks as well as benefits, and these should be discussed thoroughly before surgery is undertaken.

For example, multiple procedures performed at the same time may increase the risks of surgery. There are risks associated with anesthesia, analgesics and antibiotics. Smokers are at greater risk of complications including delayed wound healing, skin loss, scarring, and poor surgical outcome

Other risks include deep vein thrombosis (DVT) [formulation of blood clots in the veins] and pulmonary embolism (PE) [a blood clot that goes to the lungs preventing the lungs from exchanging air].

Factors such as general anesthesia and prolonged operating time appear to increase the risk of DVT. Both DVT and PE are unpredictable and can occur outside the surgical setting, as the result of certain medical conditions or from immobilization; for example, individuals have developed DVT following long airplane trips.

Postoperative monitoring and home care: In the immediate postoperative period, any patient undergoing cosmetic surgery should be monitored by qualified medical personnel and discharged from the surgical facility only after evaluation by the surgeon.

Usually, cosmetic surgery is performed as an outpatient procedure; occasionally, the surgeon may recommend an overnight stay. Patients should arrange to have someone available for assistance for the first day or two following surgery.