Robert E. Tuchler, MD

Denver Plastic Surgeon

Natural Beauty... For All Seasons Of Your Life

Plastic Surgery Clinic | 1578 Humboldt Street | Denver, Colorado 80218
Voice: (303) 830-7200 | Fax: (303)830-7523 | Toll-free (888) 830-7201

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Frequently Asked Questions About Plastic Surgery


Why is it called plastic surgery?

Plastic surgery is named from the Greek word "plastikos" which means "to shape" or "to mold", based on the surgeon re-shaping the form of the patient's form through surgery. It has nothing to do with the types of materials used in the surgery itself. In surgery, many different materials may be utilized, depending on the desired results and the type of surgery. Frequently, the surgeon will make use of the patient's own tissues, including tissues from another location of the body, or by reshaping the existing tissues to achieve a better appearance.

How do I know my surgeon is well qualified? What is Board-Certification?

When you are choosing a plastic surgeon, you are looking for certification by the American Board of Plastic Surgery. In order to be board certified by the American Board of Plastic Surgery, one must graduate from an accredited medical school, do internship and residency training in either general surgery or otolaryngology, complete an approved residency in plastic and reconstructive surgery, practice a minimum of two years after graduation, and pass extensive written and oral exams which include a review of all cases done by that surgeon in the past year. This is a long and demanding process taking a minimum of 7 1/2 years after graduation from medical school.

The reason for this extensive training is that the plastic surgeon is one of the few medical specialists who is regularly called upon to help with every part of the body. We tell patients that "we specialize in the skin and its contents". From brain surgery, to cleft lip in infants, ear, throat, breast, malformed genitals, injured hands, legs and feet, there is really no body part that plastic surgeons aren't called upon to fix when other surgeons run up against difficult situations.

The American Board of Medical Specialties is one of the established organizations that oversees the process of board certification of physicians. Exploring that site is a good place to start. You may find that your doctor is "board certified" but by a different board (cosmetic surgery, general surgery).

Another good place to explore is the American Society of Plastic Surgeons. To be a Member, a surgeon must have completed the above process. This society comprises 97 percent of all plastic surgeons certified by the American Board of Plastic Surgery.

Many surgeons are also members of the American Society of Aesthetic Plastic Surgery. Its members are aesthetic plastic surgeons certified by the American Board of Plastic Surgery who have met additional educational and professional requirements set forth by ASAPS to maintain the highest standard of practice

Another prestigious organization is the American College of Surgeons. In order to be a Fellow of The American College of Surgeons (FACS), a surgeon must be board certified in his or her specialty, have practiced a minimum of one year after board certification, and passed a review of clinical work, academic work and ethics in running their practice. This is yet another extensive review of a surgeon's experience and ethics, aimed at assuring a potential patient that the surgeon they have chosen has been well-trained and deemed competent by his or her peers. If the surgeon displays the initials FACS. after his or her name, that denotes that they have been designated a Fellow of The American College of Surgeons, and completed the above process.

What is the difference between "Cosmetic" and "Reconstructive" surgery?

Generally speaking, if a surgery is done primarily to improve the health of a person, or the function of a body part, it is considered medically necessary. Surgeries such as corrective rhinoplasty to improve air flow through the nose, or eyelid surgery to improve the field of vision by lifting sagging, droopy eyelids might fall into this category. These surgeries may or may not also improve the patient's appearance, but this is a secondary purpose.

If a surgery is done with the primary goal of improving the appearance of the patient, this is considered a cosmetic procedure. Usually these procedures must be paid for out of pocket. It is worth noting that these lines are often blurry, especially in terms of coverage by medical insurance.

Will insurance pay for any part of my surgery?

If the procedure is determined to be reconstructive and medically necessary it may be covered by your insurance. Sometimes, only a portion of the procedure is cosmetic. The insurance company may "apportion" their coverage and only pay for the part of the operation that they deem medically necessary. (Example: 75% necessary, 25% cosmetic- you pay 25% out-of-pocket) This can be somewhat arbitrary and certainly needs to be approved well in advance. You need to check with your own insurance company. Many times this is determined on a case by case basis with the aid of submitted photographs and review of your medical records.

I cannot afford to pay for my cosmetic surgery in advance. Is there financing available?

Yes. We offer financing which helps make surgery available to more people. For more information or pre-approval, please visit CapitalOne Financing by clicking here.

Am I a good candidate for cosmetic surgery?

The best candidates for cosmetic surgery have realistic goals and expectations. If you expect perfection or a complete transformation you are sure to be disappointed. They have researched their options and know the risks and potential complications of the surgery they seek.
Additionally they are healthy, secure and emotionally stable. Surgery is not recommended for the severely depressed, obese or people who smoke or drink heavily.

Are there any risks involved?

All surgery carries some uncertainty, risk and potential for complications. You should research your doctor and operation thoroughly before scheduling. I spend a lot of time with my patients on this process. This is a very important part of informed consent.

Will there be fees to fix complications?

The surgery fee covers all follow-up visits. This includes examining you every year or two if you are would like, to insure that there are no developing problems. If you have a complication or need revision within the first year after surgery, I do not charge a fee to reoperate. You would however be responsible for any expenses associated with the hospital, implants or materials or the services of an anesthesiologist.

Where will my surgery be performed?

Generally, I perform surgery in an accredited ambulatory/day surgery center or hospital. Some procedures can be done in the office. This is something I decide with my patients after consultation. It depends on the complexity and time of the procedure and the patient anxiety level and health. Cost is also a consideration.

Can I look like a particular movie star?

Plastic surgery can achieve impressive results for a patient with realistic expectations and goals. To many, the results may even seem like a miracle. Unfortunately, to think you can be made over so completely as to look just like another person is still only possible in Hollywood movies and fiction novels. Cosmetic plastic surgery's primary focus is refining a person's appearance,
rather than changing it entirely. We want to enhance what you have, make you look "your best".

Do you offer Computer Surgery Simulations or Morphing?

This is a controversial point. Although I am very computer savvy and use a lot of digital technology, I do not offer my patients computer simulations of what their surgery result"may look like." Miraculous transformations can be achieved on a computer screen using a mouse and touch-up software. This does not mean that this can be done with your real skin, bones, breasts. Tissue handles very differently than a flat computer screen and healing is a very complex, dynamic process. I feel that these pictures set up unrealistic expectations and are an implied warranty of a certain result that I cannot guarantee.

Will there be scars?

A surgical incision is a wound just like an accidental cut, burn or scrape. Any time a cut or incision is made in the skin, there will be a scar left behind as part of the normal healing process.

Plastic surgeons have received special training and have extensive experience with techniques to give you the best chance of healing with a favorable scar. Some factors include minimizing the size of these scars, careful handling of the wound edges and meticulous, multiple layer skin closure using many very fine stitches. We also locate the scars in the least conspicuous area and direction possible.

All wounds/scars take at least twelve months to mature (they fade, soften, blend better) Often the scars will become undetectable to all but the most careful examination over the course of time.

Is there anything I should use on my scars?

I believe that there are products that are good, some that are potentially harmful, and many that are probably worthless and a waste of money. I will discuss these with you thoroughly and also provide written recommendations.
Adobe Acrobat File Scar care

Will it hurt?

Any procedure is associated with some discomfort. During your surgery a board-certified anesthesiologist will ensure you are comfortable and free of anxiety. Afterwards, my nurses and I will make sure that you have the necessary prescriptions and support system to recovery comfortably from your surgery.

Will there be much swelling and bruising?

Most operations result in some degree of swelling and bruising. The amount varies dramatically with the type of procedure and the individual patient. Avoiding certain pre and post-operative medications and careful operative techniques are used to keep this to a minimum. I have found that the use of Arnica Montana and Bromelain for a week or two before and after surgery is very effective in minimizing bruising and swelling. We will also teach you proper use of ice and elevation. The majority of swelling that does occur usually subsides within a few days, and temporary bruising may be covered up with makeup.

Should I avoid certain medications, herbs or supplements before my surgery?

Yes. Many different medications can cause a variety of problems with your surgery. Bring in a list of all of the medications (even non-prescription herbs/supplements) you take to your doctor before your surgery so that he can advise you when and if you need to stop taking them before and after surgery.
Adobe Acrobat File Here is a partial list of problematic drugs and supplements.

What about birth control pills or hormones around my surgery time?

Birth Control Pills and Hormone Replacement (pills, shots or patches) can increase the risk of deep-vein thrombosis (blood clots in legs) or pulmonary embolism (blood clots in lungs). We recommend stopping them for two weeks before and after surgery to minimize this risk. Obviously, you should use an alternative form of birth control while off birth control pills and for one extra cycle after restarting them.

What supplements can I take to improve my healing or recovery?

It's best to undertake a program of a nutritious diet with vitamin and mineral supplements 2 to 4 weeks before surgery. Some of the most important pre-surgery supplements are antioxidants, vitamins A and C, zinc and selenium. We recommend the daily use of a good multivitamin with minerals. Use only the recommended dosage. There is no evidence that "mega-doses" offer any benefit and may in fact be harmful in the surgical period. (particularly vitamin E) Again, vitamins and herbs detrimental to healing should be discontinued 2 weeks prior to surgery.

When undergoing elective surgery you want every possible advantage for optimal healing and recovery. The combination of two homeopathic remedies (Arnica Montana and Bromelain) appears to decrease bruising and help it disappear more quickly. These supplements can usually be found easily. Some places in Denver that stock them include; Pencol Pharmacy (388-3613), GNC Stores, Vitamin Cottage, Alfalfa's, Wild Oats and Whole Foods. They work best when started several days before surgery and continued for a about one to two weeks afterwards.

Using Arnica Montana & Bromelain

Bromelain - An enzyme derived from pineapple. It works as a natural anti-inflammatory agent. Bromelain is an effective agent to reduce bruising. In plastic surgery this is particularly useful for eyelid surgery, facelift, and liposuction.

Arnica Montana - Is a supplement recommended for its ability to reduce inflammation and bruising.

Here are instructions to get the best results:
Start both pills three days before your surgery and continue them as directed below:

Arnica Montana 30c: Take Arnica Montana tablets starting three days before your surgery and continue two weeks after or until bruising subsides. Take 3 tablets, 3 times a day. Please see technique below.

Do not eat or drink anything or brush your teeth, 20 minutes before or after taking this remedy. If you do the substance will not work. Arnica comes in the form of small, sweet, white pellets that you place under your tongue and let dissolve. You must not touch the pellets with your hands; they will neutralize and not work properly. Instead, roll the correct number of pellets directly into the bottle cap and throw them under your tongue directly from the cap.

Bromelain - 500 mg: Start taking Bromelain capsules one week prior to surgery and continue one week after surgery. 1 tablet, 3 times a day as follows: Bromelain should be taken between meals preferably on an empty stomach. You may drink a sip of water with the capsules. Capsules should be taken throughout the day, for example: upon awakening, late morning, late afternoon, and before bedtime.

Will you operate on smokers?

I recommended cessation of smoking for three weeks before and after surgery to reduce, but not eliminate the smoking-related risks. This includes all nicotine containing products such as chew, snuff, patches and gums.I will expect the patient to sign a contract to this effect or to accept the increased risks if I believe they are acceptable. My patients are all counseled regarding the danger of smoking before and after surgery. We review that scientific study has proven smoking markedly decreases the blood flow and delivery of oxygen to the skin. People who smoke or are exposed to second-hand smoke have an increased risk of complications including bleeding, infection, skin death and poor or delayed healing. Unfortunately the use of nicotine gum and patches are not allowed around the time of surgery either. The nicotine in these products can interfere with healing in the same way as the nicotine in smoking products. Patches may be especially damaging because the constant supply of nicotine can interfere with the blood supply in procedures that create thin skin flaps, such as facelift, breast lift or reduction and tummy-tuck.

I want to look good for an important upcoming event. How long before the event should I schedule?

Recovery time varies widely from person to person and for different surgeries. Try to consult with your doctor long before your event to make sure you have time for recovery and important postoperative visits. I rarely recommend having less than four to six weeks time to heal.

Should I get a second opinion?

Even if your surgeon has the appropriate certification and training, he or she may not be "a good fit" for you. We all have different approaches, personalities and styles. If you are unsure what surgery is right for you, or if you don't "connect" with your doctor after your initial visit, I recommend that you get another opinion. This is a very important decision and you need to be comfortable with your choice, and confident in your surgeon.

What about surgery on teens?

The subject of cosmetic plastic surgery in adolescents has sparked national debate and concern.

The female breast appearance may continue to change into the late teens in some individuals. For that reason most plastic surgeons are reluctant to perform breast surgery or even liposuction until 18 or 19. Breast reduction in very symptomatic teens may represent an exception here. Rhinoplasty ("nose job") can usually be done around 15-17 in females or 17-19 in males.

There are severe congenital or developmental deformities of the female breast and hormonal disturbances, that may, under certain circumstances prompt earlier intervention. Examples include congenital absence of a breast and the underlying muscle (Poland Syndrome) or severe asymmetry.

Breast augmentation is a very popular operation, and most patients are very happy with the results. Is it advisable for a 17 year old to have it done? I determine this on a case by case basis. The factors I consider when seeing a young woman are family support, her level of maturity and motivations for surgery. I also consider the age at which she began to have periods, whether her gynecologist has evaluated her hormonal status, and the shape and size of her breasts. If, for example, she has reached a level of maturity that shows good judgement and responsibility, has been having periods for 5 years or so, is hormonally and otherwise physically normal, she may be a candidate for breast augmentation. The chances are she will not develop more, so if I think I can give her the desired result I will do the procedure. If she is below the Colorado age of consent (eighteen) she will, of course, have to have parental consent.

Are there surgeries that you do not perform?

Yes. In order to maintain optimal skill and competency, I believe that a surgeon needs to manage certain cases regularly. Because I have seen some surgical problems so rarely, I do not perform:
cleft lip or palate repair, craniofacial reconstruction-including facial birth defects, jaw fractures, tumors of mouth, tongue or parotid gland, laser tattoo removal, hair transplant or restoration, buttock or calf implants, penis enlargement, microsurgery (also known as free-flaps or free-tissue transfers), replantation or reattachment of severed fingers/limbs.