How To Find a Good Dermatologist
Putting your face into the hands of someone else is an act of faith and trust. Here are some tips on how to find a really good dermatologist and laser center. I also give you a link to my own list of great dermatologists all over the country.
The difference between a great doctor (and laser center) and a just-okay one is that a great doctor will get consistently good results a higher percentage of the time. And, if you have a problem or complication, a great doctor will:
Seven Questions to Ask About the Doctor and Laser Center You’re Considering
1. Is there a doctor on site? This is regulated state-by-state and, believe it or not, some states do not require the Medical Director (that is, the Doctor) of a laser center to be on the premises any more than an hour or two a month. The doctor is the doctor in name only at these clinics. There is almost no physician training, supervision, or quality control for "technicians" to ensure that the lasers are set properly for the patients, that the lasers are maintained properly, that the treatments are done correctly, and that problems are handled promptly and well.
Ask: "Is the doctor on site while the lasers are in operation, and will the doctor see me either at my consultation or at my first visit for actual laser treatment?"
2. Is the doctor Board-certified in dermatology? It’s shocking, but there is no law preventing doctors from calling themselves whatever they want. Many centers all over the country are being set up by doctors who have absolutely no medical training in skin but who have decided that they want to cash in on skin services.
Do you really want an anesthesiologist or gynecologist working on your face just because they’ve decided their lifestyle and income might be a better if they inject Botox and buy some lasers? Yes, a pediatrician or a family-practice doctor can hang out their shingle and imply or directly state that they are a dermatologist. And there’s no one to stop them from doing that!
The best way to find out if a doctor is Board-certified in their area is to go to the website www.AAD.org for Dermatology. This is the website for the American Academy of Dermatology, and it lists all the Board-certified dermatologists.
Plastic surgeons are trained primarily to operate and have generally very little training in skin care other then wound management. In Seattle, many plastic surgeons have added laser and injectable services but do not do those procedures themselves. Their main focus is surgery, so they hire nurses to do Botox/Restylane and lasers for them. My question is, "how can they supervise someone doing a procedure when they don’t know how to do it themselves?" It seems to me the doctor needs to know how to do the procedures in order to "supervise."
Ask, "Do you have a Board Certified Dermatologist on site?"
3. Have they been in business more than 5 years? This is also a key question, because many "skin clinics" and mini-spas fail within the first 3 to 5 years. They may start well initially, with heavy advertising to bring in customers. But they often cannot sustain a high level of results and safety over a broad spectrum of their customer base. So they go out of business, leaving in their wake a trail of lawsuits, unhappy and sometimes scarred patients, and patients who have paid money for services that they never received.
If the doctor and laser center have been in business more than 5 years and are well known in the community, chances are they are operating to a higher standard of medicine and are treating their patients fairly. Prices are often surprisingly comparable, so the question is, "Who do you trust with your face?"
Ask "How long have you been in business in this location?"
4. Do they advertise? Doctors who are good and have been in business for awhile are busy. It’s expensive to advertise. The only reason for a doctor to advertise is if they don’t have enough patients. If the doctor doesn’t have enough patients, the question is "Why not?" Frequently the answer is not something you really want to know.
Good doctors usually don’t advertise because they have all the patients they need. Their referrals come from their patients and other doctors. Or they may have been seen on TV or radio as an expert (a paid advertisement doesn’t count). If you hear or see a lot of print advertisement, radio or TV advertising, be concerned.
Ask "Do you advertise on TV, radio, or print?"
5. Who does the lasering? I think it is very reasonable for a Board-certified dermatologist who is laser trained and experienced themselves to delegate lasers or injectables to registered RNs, ARNPs, or PA-C (all mid level providers) who are directly trained and supervised by that doctor. Mid-level providers have the medical training, experience, and judgment to operate lasers and handle complications in conjunction with a physician, with the goal of giving their patients excellent quality laser treatments in a safe environment.
All too often in shady clinics the lasering is being done by a "tech" who is an individual with absolutely no medical education whatsoever and who is operating with little or no training in an unsupervised environment.
Again, Ask "Does the person doing the lasering on me have any medical education? What is their degree or certificate?"
6. Don’t buy or commit to anything at the consult. Cosmetic procedures are luxuries. No one is dying, and no immediate surgery is needed. Good laser centers that operate ethically will never try to "hard sell" you or get you to commit your money before you walk out the door.
An excellent center wants you to think over what’s involved, read all the materials they’ve given you, and have some time to decide if that’s really what you want to do. Don’t be fooled by slick sales people or bargains that are offered if you book today rather than later. Don’t commit to services or buy more than $100 worth of products at your first visit to an office.
Ask "Do I feel pressured to buy products or to book treatments at my first visit?"
7. Don’t be persuaded by before and after photographs. Deeply ingrained in us is the idea that seeing is believing. In this day of modern photography, we need to be suspicious of photos. There are two problems with before and after photographs.
The first problem is that companies and doctors will always put their absolutely best before and after photographs on a website or use them in their office. When you look at that photo, you don’t know whether 1 out of 100 people who had the procedure got that kind of result or whether 95 out of 100 people who had that procedure got that result. It’s very easy to hit a home run with the occasional patient. What matters, though, is getting consistently great results over a wide spectrum of patients. You just don’t know if that photograph is representative or not.
The second problem is that with current ability to alter digital images, you really don’t know whether that photograph is accurate or represents something that has been altered.
Ask, "Am I likely to get a result that is like the one I’m seeing in the photograph?" That answer is only as good as the honesty and ethics of the office.
Three Things to Ask Your Friends
Friends can also be a good source of information. Remember to consider the source. Some of your friends may be accurate sources of information. Others may be positive about almost everything or critical of almost everything (never happy).
Ask specifically what your friend liked about the skin doctor and their office. More specific information is more helpful than the more general. Ask "was the doctor’s staff helpful and friendly?" "Was it easy to get all the information about whatever they were having done?" "Did they have enough time with the doctor and their staff?" "Did the doctor run pretty much on time?" If your friend had questions later on, "were they answered promptly and courteously by phone?" This just gives you an idea. There may be other things that are important to you.
How many years have they been seeing that doctor and approximately how many visits have they made? If your friend has been seeing that doctor over a period of many years and has many visits, you should weigh that information more heavily than someone who’s only been to an office one or two times.
Be aware that many people who get cosmetic services are sensitive about that issue and regard it as private information. Some of my patients tell pretty much everyone everything that they are doing. I have other patients on the opposite end of the spectrum, who don’t even tell their closest family and friends about what they are doing. Just remember that your friend may not feel comfortable discussing cosmetic procedures and that may not have anything to do with the quality of the results from that doctor.
Look at your friend’s face. One of the best recommendations for a cosmetic dermatologist is how their patients look. Is your friend’s skin gradually getting better and better? Does their skin quality and appearance seem to be improving slowly while yours is not? Does their skin have a healthy glow? Are injectables like Botox and Restylane used with a light and gentle hand (rather than giving the frozen or over-stuffed look we so often see).
The answer to your question "Is the doctor good?" may be right in front of your eyes!
Dr. Irwin’s Directory of Great Dermatologists
Here is the link to my own list of great dermatologists (some people call them skin doctors). I either know these doctors or know that their reputation is excellent. I don’t collect any fees of any kind for including the doctors on this list.
Next, see Dr. Irwin’s Regional Guide to Great Cosmetic Dermatologists to find a dermatologist in your area.
See Dr. Irwin's expert answers to other reader's questions on how to find a good dermatologist.
How long do fillers really last? My dermatologist says one thing and you say another. What should I think? Sometimes you just have the flu! Arrrgggggh - confusion about Retin A/retinol and vitamin A creams! Can lasers like Fraxel Restore or Fraxel Repair cause MORE wrinkles?? Can the aging décolletage, chest and hands really be improved? Does the prescription hair reduction cream Vaniqua really work?
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