Choosing a plastic surgeon: red flags
Choosing a plastic surgeon is one of the most consequential decisions a patient can make. In Bend, Oregon, where several practitioners offer cosmetic procedures, the differences between surgeons -- in training, certification, philosophy, and facility standards -- are real and worth understanding before you schedule a consultation. This guide explains what to look for, what to ask, and what red flags to watch for, so you can make an informed choice.
The single most important credential to verify is board certification by the American Board of Plastic Surgery (ABPS). Beyond that, look for a surgeon who operates at accredited facilities, communicates openly about risks and realistic outcomes, and demonstrates a track record through before-and-after photographs and peer-reviewed work.
What Board Certification Really Means
Not all board certifications are equal, and the distinction matters more than most patients realize.
The American Board of Plastic Surgery (ABPS) is the only board recognized by the American Board of Medical Specialties (ABMS) for the certification of plastic surgeons. To earn ABPS certification, a physician must complete medical school, a general surgery residency, and then a dedicated plastic surgery residency at an ACGME-accredited program -- typically six or more years of surgical training after medical school. After completing residency, the surgeon must practice independently for at least one year before sitting for both a written qualifying examination and an oral examination in which a panel of senior surgeons reviews cases from the candidate's own practice. Maintaining certification requires ongoing continuing education and periodic re-examination.
A 2024 comparative evaluation published in the Aesthetic Surgery Journal examined four boards operating in the aesthetic marketplace: ABPS, the American Board of Cosmetic Surgery (ABCS), the American Board of Facial Plastic and Reconstructive Surgery (ABFPRS), and the American Board of Facial Cosmetic Surgery (ABFCS). The study found that ABPS stands apart as the only board with rigorous precertification training requirements, competency demonstration through examinations and case logs, and maintenance of certification standards.
The American Board of Cosmetic Surgery (ABCS) is a separate organization that is not recognized by ABMS. A study published in Plastic and Reconstructive Surgery found that ABCS-certified physicians include practitioners from non-surgical primary specialties -- including internal medicine and dermatology -- who market themselves as board-certified cosmetic surgeons while performing complex aesthetic procedures outside the scope of their original residency training.
Why does this matter practically? Under Oregon Medical Board advertising standards, any physician claiming to be "board certified" must name the certifying board in their advertising. This rule exists precisely because the phrase "board certified" alone can be misleading when different boards have vastly different training requirements. When you see a surgeon's credentials, look for the specific words: certified by the American Board of Plastic Surgery.
An analysis of 1.9 million Medicare surgical procedures found that board-certified surgeons were significantly less likely to be high-complication outliers (odds ratio 0.79, 95% CI 0.66-0.94). While this study covered surgical specialties broadly rather than plastic surgery specifically, it reinforces the principle that rigorous credentialing correlates with safer outcomes.
Red Flags When Evaluating a Plastic Surgeon
Knowing what to avoid is as important as knowing what to look for. These warning signs should give any patient pause:
No ABPS board certification. A physician performing plastic surgery who is not certified by the American Board of Plastic Surgery may lack the comprehensive surgical training that ABPS certification requires. Ask directly: "Are you certified by the American Board of Plastic Surgery?" -- not simply "Are you board certified?"
High-pressure sales tactics. If a consultation feels like a sales pitch rather than a medical evaluation -- with urgency to book, discounts that expire soon, or pressure to add procedures you did not ask about -- that is a red flag. A qualified surgeon should set realistic expectations and tell you the truth, even when it is not what you want to hear.
No hospital privileges. Even if your procedure will be performed at an outpatient surgery center, a surgeon's hospital privileges indicate that they have undergone peer review and credentialing by other physicians. A surgeon without hospital privileges has not been independently vetted by a hospital medical staff. Ask whether the surgeon holds active privileges at a local hospital.
Unwillingness to show before-and-after photographs. A surgeon who has been performing a procedure regularly should have a portfolio of results. Photographs allow you to evaluate aesthetic judgment and consistency of outcomes. If a surgeon cannot or will not show relevant before-and-after images, consider why.
Unclear or evasive pricing. You should receive a clear, written estimate that includes the surgeon's fee, anesthesia costs, facility fees, and any expected post-operative costs before you commit to a procedure. A practice that avoids putting costs in writing or adds significant charges after the initial quote raises concerns about transparency.
No discussion of risks or complications. Every surgical procedure carries risk. A surgeon who minimizes risks, avoids discussing potential complications, or promises guaranteed results is not providing the informed consent process that ethical medicine requires.
Operating at non-accredited facilities. Procedures should be performed at facilities accredited by recognized organizations (such as AAAHC or state-licensed ambulatory surgery centers) or at accredited hospitals. Accreditation ensures that the facility meets standards for equipment, staffing, emergency protocols, and infection control.
Questions to Ask During Your Consultation
A consultation is your opportunity to evaluate the surgeon's qualifications, communication, and approach. Come prepared with specific questions:
About credentials and experience:
Are you certified by the American Board of Plastic Surgery?
Where did you complete your plastic surgery residency, and was it ACGME-accredited?
Do you hold active hospital privileges? At which hospitals?
How many times have you performed this specific procedure?
About the procedure:
What technique do you recommend for my goals, and why?
What are the most common risks and complications for this procedure?
Can I see before-and-after photographs of patients with a similar body type and goals?
What is your revision rate for this procedure?
About the surgical facility:
Where will the surgery be performed?
Is the facility accredited, and by which organization?
What emergency protocols are in place?
Who provides anesthesia, and what are their credentials?
About recovery:
What is the realistic recovery timeline for returning to work, exercise, and normal activities?
How many follow-up appointments are included?
What happens if I have a complication or concern after hours?
What is your policy on revisions if results do not meet expectations?
About costs:
Can I receive a written estimate that includes all fees (surgeon, facility, anesthesia, post-operative care)?
Are financing options available?
What is and is not included in the quoted price?
Pay attention not just to the answers but to how they are delivered. A surgeon who listens carefully, answers without rushing, addresses concerns directly, and does not oversell is demonstrating the kind of communication that matters through every stage of your care.
Why Some Patients Prefer a Female Plastic Surgeon
Patient preferences regarding surgeon gender are personal and valid, and the research offers some insight into why these preferences exist.
A large population-based study published in JAMA Surgery analyzed outcomes for approximately one million patients undergoing common surgeries and found that patients treated by female surgeons experienced lower rates of adverse postoperative events. At 90 days, 12.5% of patients treated by female surgeons experienced adverse events compared with 13.9% for male surgeons. At one year, the gap widened further (20.7% vs 25.0%). A follow-up 2025 study examining over 2.2 million Medicare surgical patients confirmed lower 90-day mortality among patients treated by female surgeons (2.6% vs 3.0%) and found that patient-surgeon gender concordance was associated with lower complication rates for female patients specifically.
These outcome differences may relate to communication and practice style. Research on physician communication patterns has consistently found that female physicians engage in more patient-centered communication, including more partnership building, more psychosocial questioning, and longer visits. A study of surgical residents found that female residents outperformed male counterparts on measures of treatment plan communication, patient education, and patient satisfaction.
It is important to note that these are population-level trends, not absolutes. Many male surgeons are excellent communicators, and surgeon gender is one factor among many that patients weigh. For some patients -- particularly those seeking procedures in sensitive areas like the breast or body -- comfort and trust with the surgeon are paramount, and gender can play a role in that dynamic.
The most important factor remains the individual surgeon's qualifications, experience, and the quality of the relationship you build during consultation.
What to Look for in a Bend, Oregon Plastic Surgeon
Choosing a surgeon in a smaller market like Bend has both advantages and considerations worth understanding.
Hospital and surgery center affiliations. Bend's primary surgical facilities are St. Charles Health System and Bend Surgery Center. A surgeon with active privileges at these institutions has been credentialed through peer review. Ask whether your surgeon operates at one or both facilities and verify that the surgical setting is appropriate for your procedure.
Accredited facility standards. Whether your procedure is performed at a hospital, an ambulatory surgery center, or an office-based surgical suite, the facility should meet recognized accreditation standards. Accredited facilities maintain protocols for anesthesia safety, emergency preparedness, infection prevention, and staffing ratios that non-accredited settings may lack.
Continuity of care. In a smaller practice, you are more likely to see your surgeon at every stage -- from initial consultation through surgery and all follow-up visits. In larger practices or medical tourism settings, different providers may handle different stages of care. Understanding who will be with you through the process matters.
Recovery environment. Central Oregon offers a genuinely supportive setting for surgical recovery. A foundational study published in Science demonstrated that patients recovering with views of natural settings had shorter hospital stays, fewer negative evaluations, and required less pain medication. Bend's access to clean mountain air, gentle walking trails, and a calm environment provides the kind of restorative setting that supports healing -- a meaningful practical advantage for patients who live here or are willing to travel for their procedure.
Local accountability. A surgeon who lives and practices in a community has a long-term stake in their reputation and their patients' outcomes. The relationship does not end when the last suture is removed.
Dr. Borsting's Approach
Dr. Emily Borsting is a plastic surgeon in Bend, Oregon, certified by the American Board of Plastic Surgery (ABPS) -- the only plastic surgery board recognized by the American Board of Medical Specialties.
Training. Dr. Borsting graduated from Trinity College with Honors in Biology, Summa Cum Laude. She earned her medical degree from the University of Miami Miller School of Medicine and completed six years of integrated plastic and reconstructive surgery training at the University of California, Irvine -- a well-established academic plastic surgery program.
Research. With more than 50 peer-reviewed publications, book chapters, and scientific presentations, Dr. Borsting brings an academic foundation to her clinical work. She received the K. Hardesty Award, a distinction recognizing outstanding resident scientific presentation in her program. This research background means her clinical decisions are informed by evidence, not trends.
Surgical philosophy. Dr. Borsting's approach is grounded in the principle of "refresh, not remake" -- results that look natural and complement each patient's anatomy rather than conforming to a single aesthetic ideal. Whether the procedure involves the face, breast, body, or injectables, the goal is the same: outcomes that patients feel confident about for years to come.
Facility standards. Surgical procedures are performed at St. Charles Health System and Bend Surgery Center, both of which maintain rigorous standards for patient safety, anesthesia care, and emergency preparedness.
Consultation approach. A consultation with Dr. Borsting is an opportunity to discuss your goals openly, ask questions, understand the options and risks, and receive an honest assessment of what surgery can and cannot achieve. There is no pressure and no obligation.
Frequently Asked Questions
How do I verify that a plastic surgeon is board certified?
You can verify ABPS board certification directly through the American Board of Plastic Surgery website or the ABMS Certification Matters directory. Enter the surgeon's name to confirm active certification. Under Oregon Medical Board rules, any surgeon advertising board certification must name the specific certifying board -- look for "American Board of Plastic Surgery" specifically.
What is the difference between a plastic surgeon and a cosmetic surgeon?
A plastic surgeon certified by ABPS has completed an ACGME-accredited residency in plastic and reconstructive surgery, covering the full scope of the specialty including reconstructive, hand, burn, craniofacial, and aesthetic surgery. A "cosmetic surgeon" may hold certification from a different board (such as ABCS) that does not require the same breadth of training. The distinction is in the depth and rigor of surgical education, not just the types of procedures performed.
Should I choose a surgeon based on price alone?
No. The lowest price may reflect lower facility standards, less experienced anesthesia providers, or a surgeon with less training. A comprehensive quote should include the surgeon's fee, facility fee, anesthesia fee, and post-operative care. Compare what is included, not just the bottom-line number. Revision surgery to correct a poor outcome is always more expensive -- in cost, recovery time, and emotional toll -- than choosing a qualified surgeon from the start.
How many consultations should I attend before deciding?
There is no required number, but consulting with at least two surgeons gives you a basis for comparison. Evaluate not just the surgical plan but how each surgeon communicates, how thoroughly they discuss risks, and how comfortable you feel asking questions. The surgeon-patient relationship is a partnership that lasts through recovery and beyond.
Does Dr. Borsting offer virtual consultations?
Dr. Borsting's practice offers consultations for patients who want to begin the process before traveling to Bend. Contact the practice to discuss scheduling options.
Ready to Learn More?
Choosing a plastic surgeon is a decision that deserves careful research, honest information, and a consultation where your questions are fully answered. If you would like to discuss your goals with Dr. Borsting, the next step is a consultation -- an opportunity to evaluate whether her approach, credentials, and philosophy are the right fit for you.
Schedule a consultation or call (541) 316-0627 to speak with the practice team.
