Secrets of a Beverly Hills Cosmetic Surgeon

Recently a very prominent plastic surgeon and urologist, Dr. Gary Alter, who practices in Beverly Hills and New York City, discussed with me some of the innovative procedures that he is performing for patients with unsatisfactory female external genitalia.

Board certified in both urology and plastic surgery, Dr. Alter has hard-earned and unique qualifications.  This is what establishes him as a super-specialist in this arena of reconstructive plastic surgery.

Dr. Alter is considered the world’s authority on labiaplasty. He has developed a technique that corrects unsightly and cumbersome anatomy whereby the lips at the vaginal opening are large and floppy.

His “Alter Labiaplasty” (labioplasty) technique removes a wedge or ‘V’ from the most protuberant portion of the labium, which leaves the normal labial edge and anatomy.  Most other techniques trim the labia and leave a scar or unnatural labial edge. More plastic surgeons are starting to use his technique.

Dr. Alter and I also discussed a concerning trend. Some surgeons, not formally trained in plastic surgery, are venturing into this region of the body to perform labiaplasty or other reconstructive surgery on the external genitalia.

Sometimes, the results are quite poor. The specialty closest to the subject is gynecology.

Now of course, gynecologists are intimate with the female anatomy and certainly understand the issues.  However, their training typically does not include mastering plastic and reconstruction of the external genitalia.

Because of poorly performed labia and clitoral hood surgeries by such specialists without that classical plastic surgery training, today, more patients are coming to Dr. Alter for repair/reconstruction in order to regain a normal external genital appearance. And, re-doing surgery that has not been successful is always a tough order.

As some gynecologists have decided to extend the spectrum of their practice to include this type of surgery, the subject is brewing into some controversy within their own specialty. The March 2010 issue of Ob.Gyn. News, a newsletter for obstetricians-gynecologists featured a headline story entitled “Controversy Rages Over Female Genital Cosmetic Surgery.” It discussed the dilemma visiting some gynecologists who are seeking to expand their practices into cosmetic procedures. If gynecologists begin performing these procedures, mimicking the work of the better trained and more established practitioners, how will the outcomes be? Will surgeons not formally trained in the techniques of plastic and reconstructive surgery be as successful as their plastic surgery brethren who have long been operating upon these tissues?

Today, with all the problems and frustrations dealing with health insurance companies, some surgeons – from various specialties – are migrating into cosmetic surgery. They see a cosmetic practice as a refuge from the misery of an insurance-based practice. For gynecologists, offering cosmetic procedures fulfills a desire to serve the patients who are already in the doctor’s practice. For example, gynecologists have some patients within their practice who desire surgery on the external genitalia.  However, it is one thing to have the patients in your database, and it is another to claim competence in an operation some of those patients want. How is the patient best served? By her existing gynecologist or by referral to a super-specialist who is a master of the particular procedure needed?  Hence, the “controversy” as described in the OB-Gyn newsletter mentioned above.

The take-away conclusion? As a medical consumer, you want to do your homework because there is much to learn. Today,the  selection of a doctor specialist is not easy. There are many issues in play, including that “specialty overlap,” whereby doctors in different specialties may claim the right to perform certain identical procedures. Which specialty houses the right specialist for your needs?

I always advise several consultations if there is any question about what is the right procedure and by whom it is to be performed. Further, prepare yourself for you consultation by some serious study.

In my book, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON, Chapter 3, “Selecting the Right Surgeon”, specifically discusses specialty rivalry and overlap. Each specialty even hires publicists to promote its case to the public.

Remember: It’s “Buyer Beware!”

- Robert Kotler, MD, FACS

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