#64 – Zol Kryger, M.D.: Plastic surgery—common procedures, reducing risk, & picking the right doctor

KEYPOINTS

• 01

  Most US plastic surgery isn't done by plastic surgeons

  Kryger, a board-certified plastic surgeon who was Attia's medical-school classmate, estimates that 90–95% of plastic surgery in the US is not done by board-certified plastic surgeons. Legally, any licensed physician can perform any procedure. A family doctor one month out of medical school could try heart surgery; what stops them is hospitals refusing privileges, so much cosmetic work happens in office suites and small surgery centres beyond that oversight.

• 02

  What real plastic surgery training looks like

  Plastic surgery used to be a fellowship after general surgery. It is now usually its own six- to seven-year residency, with early years focused on general surgical basics and later years on reconstructive work across the whole body. Kryger contrasts that with doctors who learned liposuction or fat grafting at a weekend course.

• 03

  Hospital privileges are a key safety check

  Kryger sits on a hospital credentialing committee that checks training, expertise and malpractice history, and grants privileges only for procedures a doctor is trained to do. A gynaecologist doing tummy tucks may be able to admit a bleeding patient but not treat the problem. Asking where a surgeon has privileges for this exact procedure tests what happens if something goes wrong.

• 04

  Ask how they handle complications, not just how often they happen

  Attia recalls New York publishing heart surgeons' 30-day mortality rates, which led some to cherry-pick easy cases. Kryger splits complications into early ones, such as bleeding, infection and seromas (fluid collections), and late cosmetic ones, where the patient dislikes the result. Patients rarely sue over a bad result itself, he says, but over how they were treated; sometimes a surgeon should 'eat some money' to put things right.

• 05

  Capsular contracture is the main long-term risk of breast augmentation

  The body walls off any implant with scar tissue. When that capsule hardens and tightens, the implant can ride high and feel firm. Kryger cites rates of 2–8%, lower with saline implants (closer to 2%) and with placement under the muscle. He also says many implant studies are run by surgeons paid by implant companies.

• 06

  Textured implants carry a rare lymphoma risk

  Textured implants, including all teardrop-shaped ones, which need texture to stay in place, are linked to a lymphoma that forms in the capsule. The estimate has risen from about one in 300,000 to about one in 3,000 for certain implants. Kryger says there are no cases with smooth implants, and Europe pulled many textured implants. In his view texturing offers no clear advantage.

• 07

  Kryger's breast augmentation defaults

  He favours an incision under the breast fold over the armpit or nipple, where pain, numbness and other problems are more common. Most implants go under the muscle, which looks and feels more natural, interferes less with mammograms, lowers contracture rates and supports the implant's weight. He makes a strong case, but the patient decides.

• 08

  Tummy tucks fix skin, muscle separation and hernias

  About 95% of tummy tucks are on women after pregnancy; 5–10% are men, mostly after massive weight loss. The operation removes skin below the navel and tightens stretched rectus muscles (diastasis). It also repairs belly-button hernias, which can trap intestine. Seromas are usually drained in clinic, about 95% of the time without help. Scars are worst at the high-tension centre.

• 09

  Liposuction is a 'wild west'

  Kryger guesses that 80–90% of liposuction is done by non–plastic surgeons, often in offices using one of 20–30 marketed devices. He isn't a believer in CoolSculpting. Prices run from about $1,000 for one small area to $7,000–8,000 for several. Less-trained providers often charge a third as much, partly because they operate without an anaesthesiologist or operating room. Adding liposuction to a tummy tuck raises the complication rate.