Plastic Surgery

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Plastic surgery suites vary considerably, depending on the focus of the practice (cosmetic or reconstructive) and whether there is an intention to provide skin care or spa services (a recent trend). Skin care/spa services may include microdermabrasion skin resurfacing, chemical peels, permanent hair removal by a diode laser, facials, body and cellulite treatments, as well as makeup tattooing of eyeliner or brows. These procedures are explained in greater detail, and room requirements discussed, in the Dermatology section of this chapter and at the end of this section.

Another factor that will influence space planning is whether the plastic surgeon uses an advertising practice model. Some practitioners allocate a significant budget for advertising, publicity, or media consultants, and many offer educational seminars. As an example, a plastic surgeon in a building that contains a sizable breast care center may wish to conduct seminars on breast reconstruction for mastectomy candidates or may wish to conduct a seminar on skin resurfacing techniques. In these practices, the waiting room may have to double as a meeting room for slide presentations. If the design of the office makes a great first impression, it will be more valuable to entice prospective patients into the office than to conduct a seminar off site at a hotel. Plastic surgery is highly competitive since most procedures are elective and not reimbursed by insurance. Plastic surgeons have great earning power as they have been relatively unaffected by the vagaries of managed care and they realize that making an investment in outstanding interior design can enhance their image.

A plastic surgeon with a cosmetically oriented practice needs to "market" his or her skills and successes. Dentists specializing in cosmetic or aesthetic dentistry are in somewhat the same situation in terms of being interviewed by prospective patients and having to "sell the case." Often, people self-refer, based on a successful outcome of a friend or relative, but the quest for an idealized self-image and the desire to restore one's youthful appearance cause many women (83 percent of plastic surgery patients are women) to interview a number of plastic surgeons.

As it is time consuming for the busy surgeon to do these initial evaluations, factors that increase the likelihood of that patient returning to have the procedure are worthwhile. This means that the appearance and function of the office are important. The prospective patient has to make a number of stops during that initial evaluation and the office should seem orderly and well organized. The patient may be greeted by the patient care coordinator who will discuss the type of procedure the patient has in mind and who may take the patient into a private office and allow her to peruse a book of "before and after" photos of patients who have had that procedure. The next stop might be the physician's consultation room where the physician will interview the patient, perhaps sketch some possibilities, and show slides of patients who started out with a similar problem that has now been resolved. After the surgeon determines which procedures are necessary to accomplish the goal, the patient would move to the financial counseling office, or patient care coordinator, to discuss fees and payment plans and to answer any "process" questions. Ideally, the financial counseling office and consultation room would be near the front of the suite so that these patients do not have to mix with those who have already been scheduled for procedures and may be there for the pre-op workup or post-op visits.

Plastic surgeons often do surgery in their offices in a properly equipped office-based surgery center, described more completely later in this section. Those who don't, will do their cases in an ambulatory surgery center, which may be available in the medical office building; or a freestanding surgery center where they have privileges; or a hospital, which is probably the least desirable alternative for plastic surgery unless it is so extensive that the patient has to stay overnight and receive an intensive level of monitoring. It should be mentioned that there are, in some cities, 72-hour-stay recovery-care centers which allow more complicated cases to be safely handled in an ambulatory surgical setting.

There are a number of reasons for performing plastic surgery on an outpatient basis in the surgeon's office. Principally, the patient is more comfortable in a physi cian's office because it is a less clinical environment than a hospital, and it affords more privacy. Patients undergoing cosmetic procedures are often very concerned about bumping into friends and neighbors. It is not uncommon for people to visit a plastic surgeon in another city in order to safeguard their "secret."

There are other advantages to surgery outside the hospital setting.The surgeon has more control over scheduling when procedures are done in the office, and the patient avoids the generally frightening experience of being admitted to a hospital. It usually lowers the cost for the patient and permits the physician to charge a fee for the use of the operating room, rather than lose that fee to the hospital.

In some plastic surgery practices, approximately 95 percent of the surgery caseload can be performed in a properly equipped operating suite within the office. Liposuction has become one of the most commonly performed procedures for removing unwanted fat from the stomach, buttocks, thighs, or other areas. Briefly, in this procedure, an incision is made in the skin, a cannula (tube) is inserted, and the fat is suctioned out. Other procedures commonly performed by plastic surgeons include facelifts, breast augmentation (or reduction), rhinoplasty (reshaping the nose), hair transplants, hand surgery, skin grafts for burn survivors and repair of cleft palate (both usually done in a hospital setting), breast reconstruction associated with cancer surgery, and other disfiguring malformations of the face and head. The top three cosmetic procedures in the United States are liposuction, breast augmentation, and eyelid lifts.

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