Cosmetic Surgery vs Plastic Surgery

An important message from Michigan’s Premier Triple Board Certified Cosmetic Surgeon:

Patients considering cosmetic surgery are almost universally unaware of the difference between “cosmetic” surgery and “plastic” surgery.

Choosing a doctor for any healthcare need is obviously an important decision.  Patients should choose a healthcare provider based on his or her training, education, experience and demonstrated practice history; the criteria most often used by hospitals in delineating clinical privileges.  The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), through its published hospital accreditation standards, promotes the appropriate delineation of clinical privileges for medical staff and qualified practitioners based on training, experience, and demonstrated competence, and the America Board of Medical Specialists (ABMS) through its publications supports the same.  Consistently, it is the American Medical Association’s (AMA) policy that the individual character, training, competence, experience, and judgement to be the criteria for granting privileges in hospitals: and that the physicians representing several specialties can and should be permitted to perform the same procedures if they meet the criteria.  Unfortunately, those who are considering cosmetic surgery are often misled and fail to consider these criteria when choosing a cosmetic surgeon.

False Messages Misinform Patients

Patients considering cosmetic surgery are almost universally unaware of the difference between “cosmetic” surgery and “plastic” surgery.  For this reason, these consumers are easily misled to believe that board certification in plastic surgery evidences a physician’s competence to perform cosmetic surgery.  It does not.  Importantly, with an expanding number of consumers anxious to undergo cosmetic surgery and a highly competitive pool of physicians seeking to secure their business, it is imperative that consumers have access to accurate information regarding cosmetic surgery and the physicians who perform it.  It is equally imperative consumers have the freed om to choose among competitors, and that the number of qualified providers is not artificially restricted as a result of consumers being misled regarding what evidences a qualified cosmetic surgeon.  Unfortunately, the public almost universally equates cosmetic and plastic surgery as one and the same.   The consumer’s misapprehension int his regard has them relying on incomplete and false information when choosing a physician to perform their cosmetic procedure.

Understand the Difference between Cosmetic Surgery and Plastic Surgery.

Cosmetic surgery is a subspecialty that uniquely restricts itself to the enhancement of appearance through surgical and medical techniques.  It is specifically concerned with maintaining normal appearance, restoring it, or enhancing it beyond the average level toward some aesthetic ideal.  Cosmetic surgery is a multi-disciplinary and comprehensive approach directed to all areas of the head, neck and body.  Cosmetic surgery is practiced by surgeons from a variety of disciplines including board certified dermatologists, general surgeons, oral and maxillofacial surgeons, ophthalmologists, otolaryngologists, plastic surgeons, and physicians from other fields.  All of these disciplines have contributed to the vital growth of cosmetic surgery.  Cosmetic surgery is primarily learned during a surgeon’s post residency through ongoing continuing education, training, and experience.

Unlike Cosmetic surgery, Plastic surgery deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structure, hand extremities, breast and trunk and external genitalia.  Importantly, while board certification by the America Board of Plastic Surgery may evidence a physician competent in “plastic surgery,” it does not evidence competency in “cosmetic surgery” nor does it demonstrate more “cosmetic surgery” education, training, or experience than that of a board certified dermatologist, general surgeon, oral and maxillofacial surgeon, otolaryngologist, or ophthalmologist.

Yet many board certified plastic surgeons seek to equate the terms “plastic” and “cosmetic” in order to represent their certification in plastic surgery as evidence of their competency to perform “cosmetic” procedures.  The spreading of this misconception reduces patient choice and jeopardizes patient safety.  The “message” often repeated in various forums and published in advertisements by various board certified plastic surgeons across the country over the past several decades falsely and deceptively informs consumers:

  • That certification by the American Board of Plastic Surgery evidences competency in cosmetic surgery;
  • That physicians who are not certified by the American Board of Plastic Surgery are not competent to perform cosmetic surgery;
  • That the American Board of Plastic Surgery is the only “recognized” board with regard to the practice of cosmetic surgery; and
  • That the term “plastic surgery” is synonymous with the term “cosmetic surgery,” or that the term “plastic surgeon” is synonymous with the term “cosmetic surgeon.”

This misinformation has consumers believing that when searching for a cosmetic surgeon to perform cosmetic surgery, they must look only to the universe of Board Certified Plastic Surgeons, and that they cannot find a competent cosmetic surgeon among board certified dermatologists, general surgeons, ophthalmologists, otolaryngologists, or other surgeons.

This “message,” which directs consumers to consider only board certified plastic surgeons when searching for a qualified cosmetic surgeon, is false and harms consumers in two ways:  (1) reducing their choice from among several qualified cosmetic surgeons; and (2) potentially directing them to surgeons with little or no experience.

  1. Reducing Patient Choice Among Qualified Cosmetic Surgeons.  There are certainly many extremely qualified cosmetic surgeons who are not board certified in plastic surgery.  In fact, many cosmetic procedures were developed by physicians from specialties other than plastic surgery.  As stated above, cosmetic surgery is primarily learned during a surgeon’s post residency through ongoing continuing education, training, and experience.  Residency programs, whether in dermatology, general surgery oral and maxillofacial surgery, otolaryngology, or plastic surgery, do not encompass significant training in the vast array of cosmetic procedures, and certainly do not provide adequate training to render a graduate prepared to practice cosmetic surgery.  Surgeons develop their cosmetic surgical skills through their post residency training and experience.  Accordingly, to identify the most qualified surgeon for any given cosmetic procedure, one must look to and compare surgeons’ post residency training, experience and practice history.  Therefore, a patient may find that the most qualified surgeon available to perform a breast augmentation in the community is a board certified general surgeon; the most qualified surgeon available to perform a chemical peel may be a board certified otolaryngologist; or the most qualified surgeon available to perform cervicofacial liposuction may be a board certified plastic surgeon.  The point is that a cosmetic surgeon’s skill and ability will depend on the surgeon’s cosmetic surgery training and experience, and not on his or her core board certification.  Consumers lead to consider only board certified plastic surgeons rely on irrelevant criteria and, accordingly, have their choice among qualified cosmetic surgeons greatly reduced.
  2. Directing Patients to Potentially Inexperienced Physicians for Their Cosmetic Surgery.  A physician may complete a plastic surgery residency, qualify for the American Board of Plastic Surgery board exam, and become board certified in plastic surgery without ever performing or receiving training with respect to many common cosmetic procedures.  And, while competence in cosmetic surgery is determined by a physician’s training, competence, experience, and judgment, the message has consumers duped into believing that board certification in plastic surgery is the golden seal to look for when seeking a cosmetic surgeon.  Bestowing expertise and competency upon physicians who may be unqualified (i.e. board certified plastic surgeons with inadequate or not training with respect to a given cosmetic procedure), place consumers at obvious risk.

To give a practical application of how the message impacts consumers, consider an individual seeking to undergo a blepharoplasty (cosmetic eyelid surgery) in a community where ten cosmetic surgeons are available; two dermatologists, two general surgeons, two ophthalmologists, two otolaryngologists, and two plastic surgeons.  The “message” proffered by many board certified plastic surgeons would have the consumer choose from two plastic surgeons and ignore the other eight cosmetic surgeons, regardless of whether the other cosmetic surgeons may have significantly more training, education, and experience performing blepharoplasty procedures, and regardless of whether the plastic surgeons may have never performed a single blepharoplasty procedure.

Information Cosmetic Surgery Patients Should Consider.

Instead, the blepharoplasty patient should consider the training, education, experience, and demonstrated practice history of all ten cosmetic surgeons in the area.  More importantly, the true message all cosmetic surgery consumers should understand is that there are qualified cosmetic surgeons from various disciplines with various board certifications, and there are board certified physicians from those disciplines who are not qualified to perform cosmetic surgery.

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Dr. Roche