Because board certified plastic surgeons typically have hospital privileges, they may simply utilize block scheduling to decide that if you want your surgery on such a such day, it is my hospital day versus my outpatient surgery center day.
Some surgeons do not have the plastic surgery residency training and privileges to perform cosmetic surgery in a hospital setting, because the peer credentialing process verifies that they indeed are not eligible to do plastic surgery. Those are the less trained surgeons that poo poo going to the hospital.
The standards and practices of multi-disciplinary outpatient surgery centers and hospitals are very comparable. The regulatory standards have different credentialing bodies, but in my practice I utilize board certified anesthesiologists in both sites. The infection rates and complication rates are monitored and state reportable in both.
Because I belong to a multidisciplinary outpatient surgical center as well as have hospital privileges, I usually decide on who needs the hospital resource based upon your medical history and social situation. Some patients want to be taken care of in the hospital overnight, as it unburdens their family members from having the responsibility for immediate after care. It delegates to me and my RN staff the task of stewarding you from start to finish. Though there is still healing to occur, the first 1-2 days after facial rejuvenation surgery can be emotionally trying.
That being said, patients that have more complex surgery can be perfectly happy with going home. Prior to having outpatient surgery from either a hospital setting or from the outpatient surgery center, my staff and I make sure that you and your support person is educated in a full pre-surgical consultation. This includes written materials and a review of what to expect for your particular surgery in the subsequent days and weeks after the procedure.
Finding the right procedure, setting, meeting expectations, surgeon skill and temperament, staff support, Operating room setting, location, and price are all in the mix. These factors and many others are reviewed carefully to help you decide the course of action that first and foremost serves your interests.