Eight secrets plastic surgeons only tell their friends

Plastic surgery is all the rage, from the celebrity glamour to the alluring before and after photos, but with all the rage it can be rife with risk.

Four board-certified plastic surgeons from Austin-Weston, The Center for Cosmetic Surgery revealed what you need to know if you're considering going under the knife.

Forewarned is forearmed... continue reading to find out the secrets behind the scalpel, straight from the plastic surgeons themselves.

The key to good plastic surgery is in the head, not the hands

People assume that the art of plastic surgery relies on a surgeon's ability and skill with their hands; essentially, technical ability.

In reality, it has little to do with your hands. For most procedures, the outcome is more affected by planning and decision-making than what the hands can do – I'd say about 80% head, 20% hands. Some surgeons link to think of themselves as artists, and that's fine, but I can assure you that being talented with a brush or pen does not translate into excellent surgical outcomes. On the other hand, an eye for beauty or fashion is useful, but again, it's in the head.

Knowledge, creativity and wisdom are key components in the value of using your head. Knowledge is crucial because it's just as important to know what we can't do, as knowing what we can do. Creativity is required when the problems we face are unique or when the old solutions won't work. And it is just as important, if not more so, having the wisdom of knowing what operation not to perform.

One of my favorite mantras is, "just because you can, doesn't mean you should." Beautiful execution of a poor choice does not yield a satisfied patient. We must start with our heads on straight.

– Byron Poindexter, MD

Unhappy patients keep plastic surgeons up at night

With so many wonderful patients singing our praises, we should be walking on cloud nine. But the reality is, the small few that are not happy (and may never be) weighs on us far more than all the positive outcomes combined.

During a consultation, we sometimes come across patients who we feel cannot be satisfied and we do our best to identify this group, choosing not to take them as a patient in the first place (and saving ourselves a headache).

But it's not a reliable system and people slip through the cracks. Despite all our efforts before surgery to make sure a patient's expectations are realistic and doing what we can to achieve their desired results, we can't make everyone happy all the time.

Some surgeons aren't affected by it and seem just to brush it off; others are outright mean and divert the blame on the patient. That's not how things are handled in my or my partners' practices. We take it to heart, probably too much, and it can be crushing.

– Byron Poindexter, MD

The best way to look young is to prevent yourself from looking old

Ask anyone in their 40s, 50s or 60s who looks younger than their actual age about aging gracefully, and they'll have the same advice: take care of your skin and protect it from the sun. This means applying 30+ SPF daily, using sunscreen that has a zinc mechanical blocker and free of oxybenzone chemical blocks. I repeat... daily. Even if it's overcast, UV light damages DNA in the skin (along with smoking), and once the damage is done, it's permanent.

With damaged skin comes the appearance of fine lines and age spots associated with old age. If you haven't been religious about applying sunscreen, it's not too late to start, and you can prevent future DNA damage.

To repair existing damage, you may need to wind the clock back with a chemical peel or some skin lasering. The tan 20-somethings of today will be the lined- and older-looking 40-somethings of tomorrow.

– Christopher Knotts, MD

When it comes to implants, bigger is not always better

I hear from so many patients and plenty of surgeons that bigger is always better when it comes to breast implants, but this is shortsighted advice. If a patient feels this way now, they will change their mind eventually (even if it's 20 years down the road).

Breast implants are not a three or six-month journey – many patients who have surgery will only need one operation in their lifetime. And as 20-something women get into their 30s, 40s and 50s, they will appreciate that larger breasts aren't always better.

Being a surgeon in a mature practice, I see more patients in their 50s and 60s interested in a breast reduction or breast lift, rather than wanting to go larger. Bigger is definitely not always better.

– Christopher Knotts, MD

A tummy tuck requires upkeep, not just a scalpel

A tummy tuck is a very common procedure – I did almost 100 last year alone! It's a major surgery and usually has spectacular results. We've figured out ways to get people through surgery with minimum pain and downtime, and the clear majority love their results for years after the procedure. Many people get a tummy tuck when they feel like they are too far gone and see it as a "reset button" or springboard to jump powerfully into the rest of their lives.

The surgery is a stepping stone, but it's up to the patient to take it the rest of the way by maintaining a healthy lifestyle. A tummy tuck is a great and powerful medicine and like all such things should be treated with care.

– Robert Sigal, MD

Kybella is not always the answer (or easier)

Drooping or hanging necks are caused by loose skin, fat under the muscle, or a combination of these and more. A plastic surgeon can diagnose what's going on, and if it's just fat under the skin that's causing the heaviness, then liposuction may be a better option with a faster recovery time than Kybella.

Kybella is not Botox or Juvederm. Unlike these two products, Kybella is more invasive, has a longer recovery time and works marginally well in comparison.If the area under your chin is bothering you and you're considering Kybella, schedule a consultation. Kybella may be the answer, but it's not for every patient. A doctor will know and can help make the right decision based on what's best for you.

– Robert Sigal, MD

When it comes to cosmetic surgery, you get what you pay for

With most buying decisions there's cost, service and quality to take into consideration – but with cosmetic surgery, there's also safety to factor into the equation. You will not get the best quality, service, safety and the cheapest cost. If told otherwise, it's a flat out lie. The worst part is that often a patient doesn't recognize the mistake of going with the "cheap" option until it's too late.

It's difficult, and sometimes impossible, to fix a surgery that's gone wrong. It's critical to take steps to avoid this beforehand. For starters, choose a doctor that's certified by the American Board of Plastic Surgery. It seems like common sense, but many doctors performing cosmetic procedures are not "real" plastic surgeons. Beware of doctors who say that they are board certified in "cosmetic surgery" – this is not a legitimate board nor recognized by the American Board of Medical Specialties.

Finally, be wary of "cosmetic medicine specialists" such as dermatologists or family practitioners. Believe it or not, I've seen patients who've had liposuction performed by OB/GYNs, radiologists, family practitioners, dermatologists and neurologists. Not only do they have minimal training compared to plastic surgeons, it's easy for a doctor to claim they perform plastic surgery. It is very hard, however, to train to be a real plastic surgeon certified by the American Board of Plastic Surgery.

– George Weston, MD

Experience and real results are critical when selecting a plastic surgeon

All plastic surgeons and practices are not created equal. We have different abilities and different levels of experience. Compare results by looking at before and after photos on their website and critique them carefully. Use resources like online reviews to read testimonials and seek referrals from former patients. Schedule a consultation and trust your intuition!

Choose a plastic surgeon who frequently performs the procedure you want to have done (this goes for any surgery). Again, use your common sense but be sure to do your homework too. Most people don't realize that not all plastic surgeons specialize exclusively in cosmetic surgery. In fact, 90% do not.

Most plastic surgeons perform fewer than 15 facelifts per year. Wouldn't you prefer to go to a plastic surgeon who performs 100 per year? In my professional opinion, with experience comes better results and more satisfied patients.

– George Weston, MD