Dr Bucko’s Bio:
Dennis Bucko, M.D. completed his plastic surgery residency at the University of Michigan Medical Center. He completed a residency in general surgery at the University of Utah Medical Center and is double-boarded in both plastic surgery and general surgery. He is certified by the American Board of Plastic Surgery and a member of the prestigious American Society for Aesthetic Plastic Surgeons, as well as a Fellow of the American College of Surgeons. He has been an active member of the Mercy Outreach Surgical Team, which provides surgical care to underprivileged children and adults from other countries to correct cleft-lips, cleft-palates, burn scars and a variety of other conditions, for the past 15 years. He is a talented sculptor and musician.
- Chief of Plastic Surgery Scripps Memorial Hospital, La Jolla
- Medical Director, Belladerma Medical Center, Inc.
- Professional Artist and Sculptor
- Certified, American Board of Plastic Surgery
- Fellow, American College of Surgeons
- Assistant Clinical Professor, UCSD
- Past President, San Diego Plastic Surgery Society
- Past Chief of Staff, Pomerado Hospital
- Member, American Society of Plastic Surgeons
- Member, American Society for Aesthetic Plastic Surgery
- Chief Resident in Plastic Surgery, University of Michigan
- Cosmetic Surgery Specialist for over 20 years
OUTSIDE THE OFFICE
The Art and Practice of Cosmetic Surgery
An Interview with Dr. C. Dennis Bucko
If you’ve considered cosmetic surgery, you’re not alone. Acceptance continues to increase. New methods, advertising, and simply the desire to look better all contribute to the trend. More and more physicians seem to offer the latest techniques.
To better understand the latest in cosmetic surgery, San Diego’s North County Magazine talked with Dr. C. Dennis Bucko. During 25 years of practice, he’s seen many changes. “Attitudes have changed immensely over the last 15 to 20 years. People are much more comfortable having cosmetic surgery and sharing with other people they know. It’s not a stigma any more to have a facelift. No one has to sneak around or hide. Women who have breast surgery tell me they show their improved breasts to colleagues in the Ladies’ Room. It’s very open. Maybe this is only in Southern California, but l think it’s happening nationally and the numbers are way up.” Typical patients range from 35 to 80. On one end of the spectrum are those in their late thirties who are asking ‘do I need a facelift?’ On the other end of the scale are lively 80 year olds desirous of looking like they’re feeling.”
Dr. Bucko trained at the University of Michigan-in Plastic Surgery-and taught as an Assistant Professor there. The ocean brought him to San Diego in 1981. Although still affiliated with academe, his practice is 95% cosmetic surgery. He does some reconstructive work for cancer patients.
While still in medical school, he discovered sculpting. After moving here, he began studies with renowned sculptor A. Wasil at the Athenaeum School of Arts. “I really like the three dimensional aspect of sculpture.” says Dr. Bucko. His work is impressive. A bronze torso is on display at La Joule’s Contemporary Fine Arts Gallery. Another was auctioned to benefit Scripps Memorial Hospital. The connections between his art and cosmetic surgery are many. Both require manual dexterity, an eye for spatial relationships, and artistic judgement. Plastic surgery adds science and medicine.
Putting the artistic aspect aside, Dr. Bucko matter-of-factly equates cosmetic surgery to other consumer services.
“Patients pay cash for it-whatever the market will bear. There are a lot of people out there that want to have cosmetic surgery. Baby boomers are reaching the age when it is more likely to be an option.” He points out that there is generally no medical insurance company involved. This may explain why so many different medical specialties have gotten into the act.
In the past, doctors would only perform cosmetic surgery after training in a residency program or by apprenticing with another doctor doing cosmetic surgery. Plastic surgery is a medical specialty with a vast body of specific knowledge. Part of the plastic surgery residency is performing cosmetic surgery. Plastic surgeons have been doing this since the turn of the century. Historically, surgeons started doing cosmetic surgery around the turn of the century in Europe and then the United States. By the late 30s and early 40s, the American Medical Association recognized a specialty board-the American Board of Plastic Surgery. It encompassed the disciplines of cosmetic surgery and reconstructive surgery.
Dr. Bucko defines reconstructive surgery as taking a patient with a deformity and trying to make them normal. “An example is the woman who had a mastectomy, and we try to reconstruct the breast and make it appear normal. In contrast, cosmetic surgery takes patients that look normal and tries to make them look better than normal. An example is the woman with a 32B breast who wants to become a 32C.”
The American Board of Plastic Surgery examines residents who have gone through an accredited 2- year training program. This is beyond basic general surgery training. There is both an oral and a written exam. About 80 percent of the candidates receive their board certification.
Dr. Bucko says that in 1979 another organization appeared, The American Board of Cosmetic Surgery. Although the names are almost the same, the American Board of Plastic Surgery is recognized by the American Medical Association and the American Board of Medical Specialists. The newcomer is not.
Initially, the American Board of Plastic Surgery complained about the newcomer. The American Beard of Cosmetic Surgery then went to the Federal Trade Commission, claiming restraint of trade. There has been ongoing disagreement and debate about who should do what ever since. “Doctors are allowed to claim they are cosmetic surgeons just because they say so,” says Bucko. No law restricts a doctor to practice only within the area they are trained.
Cosmetic surgery advertising can be confusing. Although permitted now, the AMA banned such advertising for years. Dr. Bucko points out some problems found in San Diego advertising. A doctor without qualifications in plastic surgery can legally advertise cosmetic surgery. “Board certified” without stating the specific beard certification, is often used to imply board certification in plastic surgery or cosmetic surgery.
“I’ve seen advertisements that are painfully misleading. For example, there is an ad for liposuction showing the patient before and after. The caption says “no facelift,” but the “after” photo shows the patient with a chin implant. It leads those who see the ad to believe the patient has had only liposuction. it doesn’t mention the chin implant,” says Dr.Bucko. “Advertising is being used very aggressively for doctors who want patients. Patients need to be careful of advertising that seems too good to be true or makes claims about being the best.”
Three years ago, Dr. Bucko was president of the San Diego Plastic Surgery Society and says there were approximately 5 members. He believes there are at least double that many area doctors performing some kind of cosmetic surgery. “Some have merely purchased a laser and taken a weekend course. They think they have become qualified cosmetic surgeons because they know how to use a tool. To me that’s like teaching someone how to use a hammer and having them think they’re a skilled carpenter.”
The good news is that lasers and other equipment are relatively safe, according to Dr. Bucko. The natural tendency for an inexperienced doctor is conservatism with the laser. This translates into extra treatments and cost. A doctor can purchase liposuction equipment and, with literally no training, use it the next day. Fortunately, serious harm from liposuction is rare. Although results can be less than pleasing, people do not die if too much (or not enough) fat is removed.
“Cosmetic surgery is more than a technician using an instrument. It requires knowing how to take care of patients.” Determining which patients would or would not benefit from surgery is critical. But so is helping the patient reach the same conclusion. Dr. Bucko believes cosmetic surgery training should encompass patient conferences, as well as making good decisions about surgery. “The most important thing for a young doctor coming up is to learn how to make good decisions.” He admits this is one of the hardest things to learn.
He believes the care for cosmetic surgery patients is different than other medical specialties. “They expect a certain level of care. And they are paying for it out of their own pockets. With this group, you can’t have 20 people in the waiting room or an hour wait for an appointment. Cosmetic surgeons also have to be much more attentive post operatively.”
His advice to consumers is to first look for someone board-certified by the American Board of Plastic Surgery (not to be confused with the American Board of Cosmetic Surgery). The important society is the American Society for Plastic and Reconstructive Surgeons, with its distinctive circular logo. All members must be board certified by the American Board of Plastic Surgery.
“Experience is a factor that counts a heck of a lot,” says Dr. Bucko. “There is always a certain amount of risk associated with less experience.” He explains, “Plastic surgery is a two year program covering many areas in both cosmetic and reconstructive surgery arenas. No one becomes an expert in any particular area of cosmetic surgery procedures in two years. In some residency programs there is a lot of cosmetic surgery. More typically, the focus is on reconstructive surgery-which is a good background for cosmetic surgery.” He recommends that consumers inquire how many of the specific procedure under consideration the doctor has actually done. The doctor who has done hundreds over the years is likely the better choice over someone whose only experience is five cases performed during residency.
While board certification and experience are the two most important considerations, it is important to go to the doctor’s office and meet the doctor and staff. Find out if they do mostly cosmetic surgery or mostly reconstructive surgery. Do you like the doctor? Do you trust him? Does he sound reasonable? in your judgement, is he conservative or aggressive?” Dr. Bucko points out that some patients want a doctor who tells them what to do. Others want a doctor who gives them information and lets them make the decision.
He cautions against doctors who never seem to have time to talk. “If a doctor doesn’t have time to talk now, how much time will he have with you before or after surgery? This could be a problem, especially in the event of a complication. This also brings into question whether the doctor is interested in you as a person?”
Cosmetic surgery is a major undertaking. It deserves reflection and research before proceeding. Dr. Bucko is working on a handbook designed to help patients with the initial consultation. It includes what to look for, what to ask, and a point by point checklist.