Over 17 million cosmetic surgery and minimally invasive procedures were performed in the U.S. in 2016. With the increasing popularity of cosmetic procedures, it seems nearly everyone is out to get a bite of the apple.

Cosmetic surgery chains are growing in size and popularity in an attempt to cash in on this market. Examples include: LifeStyle Lift in the U.S., which declared bankruptcy in 2015 and Transform in the U.K. With this growing popularity, consumers should ask themselves whether having surgery at a cosmetic surgery chain is a good idea. Today, I’m going to explain what to look for during your cosmetic surgery consultation and what you should stay far away from.

I’m in a unique position to discuss the safety of cosmetic surgery chains. First, I’m a board-certified plastic surgeon in Cleveland, and cosmetic surgery makes up over half of my private practice. I currently operate in both a traditional hospital and an outpatient surgery center. But for the past two years, I was employed part-time by one of these cosmetic surgery chains. I even had liposuction surgery performed at that center, so I’ve got a unique insider view of what really happens at those chains, and how it’s different from seeing a physician in private practice. I’m going to tell you the truth about these centers and what to look out for.

The first red flag to watch out for is high-pressure sales tactics. If you check websites such as ConsumerAffairs.com and the Better Business Bureau, you’ll find this is a common complaint about cosmetic surgery chains. High-pressure sales tactics may include:

• Requiring you to put money down before you ever meet a physician
• Pressuring you to make a decision that day
• Insisting on applying for a loan at your initial consultation
• Offering a special “limited time” discount

High-pressure sales can occur at both a private practice and at a cosmetic surgery chain. Regardless of where you encounter them, they are a huge red flag. As a consumer, you want a doctor who is focused on providing the best care possible, not on meeting a revenue goal. Focusing on money over patient care can lead to some scary medical decisions, like operating on people who really aren’t healthy enough to have surgery.

The second red flag to watch out for is misleading statements about pain during and after surgery. LifeStyle Lift had many complaints that their advertising gave the impression the procedure was quick and the recovery painless. In reality, the procedure lasted three hours or longer, and the downtime afterward was about two weeks. When you see a surgeon for a consultation, she or he should tell you what the average experience is like, as well as best and worst-case scenarios for recovery time. If this part is glossed over in your consultation, alarm bells should be going off in your head.

The third red flag you should watch out for is a surgery center or physician that only offers a very limited number of procedures. The center I worked at did liposuction, but no tummy tucks or skin removal. So if you were looking for a flatter stomach, they would only be able to offer you liposuction, even if you would get a better result with a tummy tuck. This is where the high-pressure sales comes into play again as well; if you have a sales person who needs to meet sales goals, that person is highly motivated to sell you his or her product, regardless of whether it’s actually the best option for you.

The fourth and final red flag to watch out for is the safety of the facility. Hospitals have the strictest oversight for patient safety, followed by surgery centers. But if surgery is performed with only oral medication, it can legally be done in an office that has no type of accreditation. This doesn’t mean having surgery isn’t necessarily safe, but you do want to ask what happens if there is an emergency, and how the staff are trained to deal with that. You also want to ask your surgeon if he or she has privileges to do your surgery in a hospital; non-plastic surgeons usually cannot get privileges to perform cosmetic surgery procedures such as liposuction in a hospital because they don’t have the training. If your surgeon only operates in an office or surgery center, this is a red flag that he or she is not board-certified in plastic surgery.

In my experience working for a cosmetic surgery chain, I was able to give patients some fantastic results. And I myself had a safe procedure by a surgeon I trust. But I think there is a huge difference in the mindset between a physician in private practice and a corporation. Physicians go into medicine because we want to help people, first and foremost.

Corporations exist to make money. Although there are certainly exceptions in both groups, I hope you can use the information I’ve given you to ensure you have a safe surgery experience wherever you go.

Jennifer Greer is a plastic surgeon and can be reached at Greer Plastic Surgery and on Twitter @greerplastics.

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