A practical guide by Prof. Alfredo Borriello to making the most important decision before plastic surgery — whether aesthetic or reconstructive
Choosing the plastic surgeon you entrust yourself to is the most important decision a patient can make before any procedure — whether aesthetic or reconstructive. More important than the surgical technique, more important than the price. Yet many people base their choice on superficial criteria: word of mouth, the lowest price, or how good someone's Instagram profile looks. In over 35 years of surgical practice, in both aesthetic and reconstructive surgery, I have seen too many patients arrive at my office to correct procedures performed elsewhere without proper safeguards. Here are the 7 questions every patient should ask — and the answers they should expect — before choosing a surgeon.
In Italy only doctors holding the five-year specialisation in Plastic, Reconstructive and Aesthetic Surgery are legally qualified to perform plastic surgery safely. This is a postgraduate specialty school recognised by the Italian Ministry of University, requiring 5 full-time years of training after the 6-year medical degree, with thousands of hours of supervised operating room experience in both aesthetic and reconstructive surgery. This is the first and most important question a patient should ask a surgeon — before price, before technique, before anything else: it is the legal and scientific foundation of everything that follows.
Verification is straightforward: ask for the registration number with the Medical Board and check the FNOMCeO portal (National Federation of Medical Boards). Be wary of anyone presenting themselves as an "aesthetic doctor" or "cosmetic surgeon" without specifying their specialisation: in Italy the recognised specialisation is in Plastic, Reconstructive and Aesthetic Surgery — not in "aesthetic medicine" or "cosmetic surgery" as standalone disciplines.
A specialised plastic surgeon has training spanning reconstructive and aesthetic surgery, enabling them to manage any complication with competence. This is not a detail — it is your safety.
A plastic surgeon can be considered truly experienced in a specific procedure when they have been performing it for at least 10 years with hundreds of documented cases. General experience is not enough: a surgeon skilled in rhinoplasty may not be equally experienced in abdominoplasty, and vice versa, because each anatomical district requires its own learning curve. That is why patients should always ask a surgeon how many procedures of that specific type they have performed and for how many years. As Director of the Plastic and Reconstructive Surgery Unit at Ospedale del Mare in Naples, I regularly refer patients to more suitable colleagues when a procedure falls outside my daily practice: a good surgeon is not afraid to say "this is not my area of excellence".
In my case, training at the Pitanguy Institute in Rio de Janeiro — the most prestigious plastic surgery school in the world — followed by further specialisation at NYU Medical Center in New York and in Lausanne gave me a comprehensive vision of the discipline. But even with 35 years of experience, I always refer patients to more suitable colleagues when a procedure falls outside my daily practice.
Transparency about experience is a sign of professional honesty. A good surgeon is not afraid to say "this is not my area of excellence".
Yes: an experienced and transparent plastic surgeon must be able to show patients a documented photographic portfolio of their results. Before/after photos are the most objective tool for evaluating a surgeon's quality of work, together with verified reviews and patient testimonials. Photos should be taken under standardised conditions — same lighting, same distance, same background — and should represent final results 6-12 months post-surgery, not just a few weeks after (when post-operative swelling is still present). If a surgeon cannot show real photos or heavily uses filters and digital retouching, it is a clear sign of poor transparency and the patient should look elsewhere.
However, be mindful: photos should be taken under standardised conditions (same lighting, same distance, same background) and should represent final results, not those from just a few weeks post-surgery. Ask to see results at 6-12 months after the procedure.
Be wary of those who show only their best results or heavily use filters and photo retouching. Honest clinical documentation is a sign of professionalism.
Every plastic surgery procedure carries specific risks that must be explained by the surgeon clearly, completely and in writing during the first consultation. General risks common to all procedures include infection, haematoma, seroma, hypertrophic or keloid scarring, anaesthetic reactions and deep vein thrombosis; added to these are procedure-specific risks — for example dorsal irregularities in rhinoplasty, capsular contracture in breast augmentation, residual skin laxity in abdominoplasty. If a surgeon tells you there are "no risks" or minimises potential complications, it is the clearest sign of unreliability and the patient should immediately look for another professional.
Risks vary from procedure to procedure: rhinoplasty has different risks from breast augmentation or abdominoplasty. The surgeon must explain both general risks (infection, haematoma, anaesthesia reaction) and those specific to the procedure you are considering.
Discover the details of each procedure:
Informed consent is not a bureaucratic formality: it is the moment when the patient truly understands what they are about to face. I always dedicate the time needed to answer every question and every concern.
A personalised surgical plan is an operative project built around the anatomy, expectations and clinical conditions of the individual patient: there is no "standard" procedure that fits everyone. During the consultation, the plastic surgeon must evaluate the tissues, study proportions, discuss realistic goals and propose the most suitable technique — explaining the alternatives available and the rationale behind each decision. In my clinical practice I routinely use 3D morphing technology to show patients a realistic simulation of the expected result, a fundamental tool for aligning expectations. If a surgeon proposes the exact same plan to everyone without listening to specific needs, they are not the right professional.
In my practice I use 3D morphing technology to show patients a realistic simulation of the expected result. This tool is essential for aligning expectations and helping patients understand what is realistically achievable.
If the surgeon proposes the exact same plan they offer everyone, without listening to your specific needs, they are probably not the right professional for you.
The type of anaesthesia used in plastic surgery depends on the scope of the procedure and the clinical conditions of the patient and can be local, local with conscious sedation, or general. Local anaesthesia is sufficient for small outpatient procedures (nevus removal, blepharoplasty, otoplasty); conscious sedation, administered by an anaesthetist-resuscitator, is indicated for medium-scope procedures such as lipofilling or some mastopexies; general anaesthesia is mandatory for major procedures such as abdominoplasty, complex rhinoplasty or breast reconstruction. In all cases, the surgeon must explain the advantages and risks of each option during the pre-operative visit, and the facility must have a dedicated anaesthetist-resuscitator present throughout the entire procedure.
Always ask who the anaesthetist will be and whether a dedicated anaesthetist-resuscitator will be present throughout the entire procedure. Before surgery the patient must undergo an anaesthesiological assessment with ASA classification (American Society of Anesthesiologists), which quantifies the operative risk from ASA I (healthy patient) to ASA V (moribund patient): this assessment guides the choice of anaesthetic technique, drugs and level of intra-operative monitoring. A good surgeon plans the anaesthesiological consultation at least several days before surgery, leaving time to perform the necessary pre-operative tests (blood count, coagulation, ECG, possibly echocardiogram or specialist consultations) and to optimise any modifiable clinical conditions (hypertension, diabetes, anticoagulant therapy).
The facility where the procedure is performed must meet the minimum regulatory requirements established under Italian law (DPR 14 January 1997 and subsequent regional accreditation standards): a compliant operating room, continuous monitoring of ECG, blood pressure, oxygen saturation and capnography, an emergency cart with a defibrillator and life-saving drugs, and the ability to manage difficult airways. General anaesthesia, in particular, cannot be performed in "day surgery" offices lacking the structural requirements for post-operative resuscitation and emergency management. Before the operation, always ask the surgeon for the exact name of the facility and verify that it is officially authorised by the local health authority (ASL).
The post-operative recovery pathway in plastic surgery varies depending on the type of procedure, but follows a predictable general pattern that the surgeon must outline to the patient before surgery. For medium-scope procedures (rhinoplasty, blepharoplasty, mini lifts) return to work typically occurs within 7-14 days, light physical activity after 3-4 weeks and the definitive result becomes visible between 6 and 12 months. For major procedures such as abdominoplasty or breast surgery, the timeline extends: 2-3 weeks of convalescence and 6-8 weeks before resuming sport. A good surgeon always provides written post-operative instructions and a scheduled follow-up plan, because the final result depends as much on the surgery itself as on the healing phase.
Be wary of "zero downtime" promises for real surgical procedures. Every procedure requires a healing period and recovery varies from person to person. A good surgeon prepares you mentally and practically for this journey, providing detailed post-operative instructions and scheduling follow-up appointments.
Post-operative care is an integral part of the result. The relationship with your surgeon does not end in the operating room: it begins there.
Choosing a plastic surgeon is not like choosing any ordinary service — whether for an aesthetic or reconstructive procedure. Your health, your body and your peace of mind are at stake. The 7 questions I have listed are not an interrogation: they are a protective tool that every patient has the right — and the duty — to use.
A surgeon who responds with transparency, who is not in a hurry to get you into the operating room and who treats you as a person rather than a clinical case is the surgeon you deserve. In over 35 years of career, the most important lesson I have learned is that the best result always comes from a relationship of mutual trust.
This content is intended for informational and educational purposes only. It does not in any way replace professional medical advice, diagnosis, or treatment. For any medical questions or concerns, it is essential to consult your physician or a qualified specialist.
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