How to Find a Doctor You Can Trust with Your Face
Photo courtesy of Ege Işlekel
In the world of aesthetic medicine, appearances can be unusually persuasive. A surgeon may have a six-month waiting list, a roster of celebrity clients, and an Instagram feed filled with dramatic before-and-afters. None of that, Julius Few, MD, told me, is a substitute for training, judgment, and experience.
Few, a Chicago-based plastic surgeon who specializes in face and neck procedures, has spent nearly three decades building the kind of reputation that still carries the most weight in medicine: referrals from other doctors and patients who send their friends because they like what they see in the mirror. His work is known for its restraint. The goal, he said, is not to make someone look “done,” but simply like a more rested version of themselves.
As cosmetic surgery has moved further into the mainstream, the process of choosing a surgeon has become paradoxically more complicated. Social media has democratized access to information, but it has also made it easier for doctors to market themselves in ways that can obscure the distinction between popularity and expertise. One of the more startling facts Few shared is that any licensed physician in the United States can legally perform cosmetic surgery, regardless of whether they completed formal plastic surgery training.
Our conversation was intended as a practical guide for anyone considering a procedure, whether it’s an upper blepharoplasty or a full facelift. We discussed how to verify a surgeon’s credentials, the red flags that should send you out the door, what questions to ask during a consultation, and why both bargain-basement pricing and eye-popping fees deserve scrutiny. Few’s most important advice was also his simplest: do your homework and then trust your instincts. If you have an ick factor, pay attention to it.
A Q&A WITH JULIUS FEW, MD
Amy Synnott: When someone first starts thinking about plastic surgery, what should be the very first thing they look for in a surgeon?
Julius Few, MD: The first thing they should do is verify that the surgeon is board-certified by the American Board of Plastic Surgeons, which is part of the American Board of Medical Specialties, the gold standard medical board since 1933. If the surgeon isn’t board-certified, I don’t care how many followers they have on Instagram—they should seriously question whether that is the right person.
A.S.: Most people assume that if someone is calling themselves a cosmetic surgeon, they must have formal plastic surgery training.
J.F.: That is absolutely not the case. If you are a licensed physician in the United States, you can legally perform any surgery you choose. It is not illegal for a foot-and-ankle surgeon to do a facelift.
A.S.: That’s astonishing.
J.F.: It surprises a lot of people. You could have a gynecologist doing tummy tucks. That’s why patients need to do their homework.
“If the surgeon isn’t board certified, I don’t care how many followers they have on Instagram—they should seriously question whether that is the right person.”
A.S.: So, what exactly is the difference between a board-certified plastic surgeon and someone marketing themselves as a cosmetic surgeon?
J.F.: “Cosmetic surgeon” is not the same thing. There is an American Board of Cosmetic Surgery, but it is not recognized as the gold standard like the American Board of Plastic Surgeons. Those are very different credentials.
A.S.: How important is it to choose someone who performs the procedure you’re looking to get regularly?
J.F.: Very important. If you’re considering rhinoplasty, you want someone who does rhinoplasty all the time. If you’re considering a facelift, you want someone who does facelifts routinely. Ask how many they perform each year.
A.S.: And ask to see before-and-after photos?
J.F.: Absolutely. But look carefully. The lighting should be the same. The angle should be the same. There should be no makeup in the “after” photo if there isn’t any in the “before.” If the photos are manipulated to exaggerate the result, that is a red flag.
A.S.: What are some other red flags?
J.F.: The biggest one is pressure to book surgery immediately. If someone says, “I’ll give you 10 percent off if you schedule today,” that should make you very uncomfortable.
Another red flag is a surgeon who doesn’t take a detailed medical history before agreeing to operate. Safety has to come first.
“There should be no makeup in the “after” photo if there isn’t any in the “before.” If the photos are manipulated to exaggerate the result, that is a red flag.”
A.S.: What kinds of health issues can affect whether someone is a good candidate?
J.F.: Blood thinners, heart disease, autoimmune conditions, immunosuppressive medications—there are many factors that can increase the risk of complications. Your surgeon should conduct what I call a “flight check,” looking for anything that could disrupt a safe outcome.
A.S.: How often do you tell someone they’re not a good candidate?
J.F.: About 25 percent of the time.
A.S.: That’s higher than I would have guessed.
J.F.: Sometimes it’s because of medical concerns. Other times it’s because the patient has unrealistic expectations or body dysmorphia. If someone says, “I need this to be perfect,” that’s someone I won’t operate on.
A.S.: What questions should every patient ask during a consultation?
J.F.: Ask about the risks. Ask what the worst complication the surgeon has seen with that procedure is. Ask what happens if there is a complication—who handles it, who pays for it, and whether the surgeon will be available to help you.
A.S.: That last part seems critical.
J.F.: It is. Complications are rare, but they happen. What matters is whether your surgeon is there to help you navigate them.
A.S.: How can patients tell if a surgeon is recommending what they genuinely need versus upselling additional procedures?
J.F.: Ask for two or three options, including nonsurgical alternatives. There is almost always more than one way to address a concern.
“Ask about the risks. Ask what the worst complication the surgeon has seen with that procedure is. Ask what happens if there is a complication—who handles it, who pays for it, and whether the surgeon will be available to help you.”
A.S.: What role should social media play in the decision-making process?
J.F.: Buyer beware. Some of the surgeons I respect most have little or no social media presence. There are excellent surgeons on Instagram, but follower counts are not credentials.
A.S.: Reviews can be useful, though.
J.F.: They can, as long as you read them in context. One unhappy patient over a long career is very different from repeated complaints about abandonment or poor follow-up care.
A.S.: What about sites like Castle Connolly?
J.F.: Castle Connolly is not pay to play. Physicians are selected through peer review. That’s different from many online platforms that are essentially advertising vehicles.
“Some of the surgeons I respect most have little or no social media presence. There are excellent surgeons on Instagram, but follower counts are not credentials.”
A.S.: Let’s talk about price. Does paying more guarantee a better result?
J.F.: No. There is a range of pricing, and there are excellent surgeons at many price points. What matters is training, experience, and judgment.
A.S.: Is there a price point that should raise suspicion?
J.F.: If someone offers to do eyelid surgery for $1,000, that is a red flag. It is far below any reasonable national average.
A.S.: What do you think about medical tourism?
J.F.: There are talented surgeons all over the world. But if you have a complication after surgery abroad, you may have very limited recourse. What seems inexpensive at first can become costly if you need follow-up care or revision surgery.
A.S.: So, the savings can disappear quickly.
J.F.: Exactly. And accountability is very different outside the United States.
“If you have a complication after surgery abroad, you may have very limited recourse. What seems inexpensive at first can become costly if you need follow-up care or revision surgery.”
A.S.: What is the single most important piece of advice you would give someone choosing a plastic surgeon?
J.F.: Follow your gut. Do the research, verify the credentials, and then listen to your instincts. If something feels off, it probably is.
A.S.: In other words, if you have the ick factor, pay attention.
J.F.: Precisely. I’ve had many patients come to me after seeing another surgeon, and almost all of them say the same thing: “I had a feeling this wasn’t right.”