Repeatedly voted as one of Houston's Top Docs, Dr. Joseph Perlman has been a plastic surgeon for more than 25 years. The director of the Advanced Plastic Surgery Centre, Dr. Perlman completed fellowship in both hand surgery and microsurgery. As a board certified plastic surgeon, he is a distinguished member of the American Society of Aesthetic Plastic Surgery and an Associate Clinical Professor in the Department of Plastic Surgery at Baylor College of Medicine.

What criteria should I use when choosing a plastic surgeon?
When choosing a plastic surgeon, the most important decision is finding a physician who you are comfortable with. By this I mean someone who is well qualified, has experience to perform the procedures that best suit your needs, and you feel confident in.

A plastic surgeon who is certified by the American Board of Plastic Surgery is the best starting point. There are physicians who are certified by boards other than this who may not have the adequate training to perform the procedure that you need. These physicians usually call themselves cosmetic surgeons, not plastic surgeons. Other criteria include asking your personal physician who he or she might recommend, as well as talking with friends of yours who have had plastic surgery, whether or not they were happy with their surgeon and the results.

Are there any new techniques in plastic surgery that have improved results, less scarring or the length of recovery?
Plastic surgeons are always striving to obtain the best result possible. This has led to many new techniques being developed. The main emphasis over the last 10 years in plastic surgery has been to develop less invasive procedures than before, use shorter incisions that result in shorter scars, and also use adjunctive procedures to either take the place of or complement surgical techniques. The concept of "less is moreî has become one of the mainstays of this philosophy.

How safe is plastic surgery?
No surgical procedure is "risk free." Although hundreds of thousands of procedures are performed yearly, it is important to discuss with your physician any health factors that may compromise the surgery or subsequent healing. This includes not only medicines you take and health problems that are presently being treated, but also tobacco, alcohol and recreational drug use. Over-the-counter vitamins and herbal medicines may also contain substances that can interfere with your optimal healing.

Surgery should be performed in a facility where the patient's care is not being compromised. This includes having the proper anesthesia staff and other skilled licensed healthcare personnel on hand. Studies have shown that plastic surgery procedures performed in facilities that are nationally accredited have excellent safety rewards.

Is plastic surgery permanent, or will I return to my previous appearance quickly?
In most cases, plastic surgery will give long-lasting results. Depending on your age, body type, overall health and lifestyle, results will vary. A facelift for example will usually turn the "clockî back five to seven years. The results of a breast augmentation, reduction or breast lift will be affected by having children in the future, or if there's a significant weight change.

How expensive is plastic surgery? Do surgeons offer payment plans?
Plastic surgery is not just for the rich and famous. There were more than 2 million surgical cosmetic procedures and almost 10 million nonsurgical cosmetic procedures performed by plastic surgeons last year. The average surgeon's fee for a breast augmentation last year was approximately $4,500, and the average facelift was $6,000. Many physicians offer payment plans either through their office, or they arrange outside financing at a reasonable interest rate.

Will my surgeon help me to decide which procedures will be best for me, or will he/she encourage me to the most expensive procedure?
Most physicians including myself, look at the process of cosmetic surgery as a team effort, involving not only the physician and patient, but also the entire staff, including the estheticians. In my practice, I individualize treatment based on what bothers the patient about their appearance, as well as time and financial constraints. Sometimes the patient will want something as a quick fix, and I explain that this may do in the short run but they will probably require something more extensive in the future. It's important for the patient and the physician to be realistic about the goals that they are trying to achieve. Reflecting back to the first question, the patient needs to feel comfortable with the physician and the treatment program that has been established.

What if I am interested in more subtle result? Are there some noninvasive procedures that can restore a more youthful appearance?
Plastic surgeons are saying many more people in their 20's and 30's as well as some Baby Boomers are looking for procedures that have less downtime and can be performed in the office with little or no anesthesia.

These procedures are what I call our "Quick Fixes." These may involve injections to fill in and plump up the skin. The most popular one that we use is Restylane. We also inject Botox to treat many of the facial lines and wrinkles. My esthetician, Lisa Filer, offers chemical peels, microdermabrasion and IPL phototherapy to help the face attain a more youthful appearance.