Cosmetic vs. Plastic Surgery

[Dupree]

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What are the most common cases for a cosmetic versus plastic surgeon?

I see the term cosmetic surgeon being thrown around a lot and was wondering what is the route to becoming a cosmetic surgeon vs. a plastic surgeon.

 

[Winged Scapula]

A cosmetic surgeon is not necessarily a plastic surgeon and the term is not an officially sanctioned (ie, by CAQ or BC) one.

Plastic and Reconstructive Surgeons are those who have done an accredited residency program (either the traditional 5+2 or the more recent, Combined/Integrated program) and are BE/BC in Plastic and Reconstructive Surgery. While most who have done the traditional route are trained in general surgery before PRS, there are also ENTs and other specialties which occasionally do a PRS residency.

Anyone who does "cosmetic" procedures can call themselves a cosmetic surgeon; as I noted above there is no certification for such which is nationally recognized. Therefore, I could set up shop and do some Botox injections and call myself a Cosmetic Surgeon as I have a license to practice medicine but haven't done a PRS residency.

A PRS who desires to have a largely cosmetic practice will often do an Aesthetic Plastic Surgery fellowship (ie, a la Dr. 90210).

Any way, moving to the PRS Forum...

 

[zbarnes]

A "cosmetic surgeon" is either a PRS who does a aesthetic fellowship or just some family practice/obgyn/dentist who paid $1500 to the "American Academy of Cosmetic Surgeons", which of course doesnt exist as an actual entity of any substance. This is why it is such a buyer beware market, many, many people doing cosmetics are not plastic surgeons, hell some arent even surgeons.

 

[Ergo]

"hell some arent even surgeons."

Well said

 

[double elle]

What about the one-year cosmetic fellowships that you can enter after ENT, DERM, or GS? Are you then "licensed/certified" or something official?

 

[zbarnes]

short answer is no, those are unofficial "fellowships", but im sure they take the time to print up a diploma of some sort.

 

[slickster]

short answer is no, those are unofficial "fellowships", but im sure they take the time to print up a diploma of some sort.

Sure your licensed. 007 - license to kill. it's akin to obtaining an online degree from some bogus university for $59.99. Those claiming to have training in "cosmetic surgery" without prior accredited PRS training are bull**** plain and simple. should be outlawed all together. that way your aunt who has no idea avoids a face lift from a "cosmetic surgeon" (i.e. dentist with a scalpel) and the complications associated with it. exploitation of our field is horrible exposure.

 

[toofache32]

Just out of curiousity, why don't the plastic surgeons complain when those dentists put faces back together from trauma?

 

[double elle]

Sure your licensed. 007 - license to kill. it's akin to obtaining an online degree from some bogus university for $59.99. Those claiming to have training in "cosmetic surgery" without prior accredited PRS training are bull**** plain and simple. should be outlawed all together. that way your aunt who has no idea avoids a face lift from a "cosmetic surgeon" (i.e. dentist with a scalpel) and the complications associated with it. exploitation of our field is horrible exposure.

http://www.cosmeticsurgery.org/Surgeons/education.asp

So, the fellowships listed here are crap? Even though you have to have at least one year gen surge to apply? I guess I thought that, say, and ENT who did original residency in an ENT and Facial plastics spot could go into one of these one-year cosmetic fellowships and be fine - if they don't want to do the 3 year PRS fellowship because they only want to do cosmetic stuff. Am I way off on this? I am entering a general surgery this year and seriously thought about this route...but I have no desire to do facelifts! However, if this is thought down-upon...I'd much rather do things the "right way". I was more interested in the derm stuff, the breast procedures, and lipo.

I don't know...it seems as if a physician knows his/her limits - then this wouldn't really be an issue....but, there's a lot of docs out there who don't know their limits. Anyway, any more info (good or bad) on the fellowships discussed in the website above would be helpful. Thanks.

 

[GSresident]

"I don't know...it seems as if a physician knows his/her limits - then this wouldn't really be an issue....but, there's a lot of docs out there who don't know their limits. Anyway, any more info (good or bad) on the fellowships discussed in the website above would be helpful."

I think if you do all five years of general surgery at a decent place you should be just fine handling the cosmetic operations provided you get some additional training in it. I am inteviewing for plastic surgery 'fellowships' right now. Its going to be very competative this year. Something like 1/4 to 1/3 of all senior residents applied for plastic surgery this year. If I don't match (a strong possibility) I will arrange a hand fellowship and apply again. If I don't match again I am going to do my hand fellowship and apply for a cosmetic fellowship. I will also apply for plastic surgery yet again. If rejected the third time I am going to hang up a shingle doing hand/cosmetic which is what most plastic surgeons end up doing anyway. It would be a real shame if that were to happen because I would prefer to be an all around plastic surgeon doing cases that serve the good of humanity. It seems like a waste to go through all of this training and end up doing hand puss, boobs and butts.
I can do a whipple but because of how competative it is to get a plastic surgery fellowship, I may end up not being able to practice the full spectrum. Oh well. I guess I need all of the luck I can get about 26 days from now.

 

[River13]

Sure your licensed. 007 - license to kill. it's akin to obtaining an online degree from some bogus university for $59.99. Those claiming to have training in "cosmetic surgery" without prior accredited PRS training are bull**** plain and simple. should be outlawed all together. that way your aunt who has no idea avoids a face lift from a "cosmetic surgeon" (i.e. dentist with a scalpel) and the complications associated with it. exploitation of our field is horrible exposure.

Interestingly many of these "cosmetic surgeons" have received MORE training during their residencies in actual cosmetic procedures than your average PRS resident...so which is more qualified? The one with the "PRS" title and virtually no experience or the one with the "cosmetic surgeon" title who's received vast experience? And as asked previously, why don't people-like the above poster-talk about face trauma and how it's done by "dentists"? Could it be because trauma is poorly reimbursed? That's what I thought...

 

[toofache32]

And as asked previously, why don't people-like the above poster-whine about face trauma and how it's done by "dentists"? Could it be because trauma is poorly reimbursed? That's what I thought...

Of course it is (it was a semi-rhetorical question). This is all about money.

 

[River13]

agreed

 

[zbarnes]

Facial trauma is done by OMFS which are dentists and surgeons (dds, md), are very qualified and many also trained in some sort of plastic program, so there is a huge difference.
A gynecologist can get a certification to say cosmetic surgeon and then b/c many people over step their abilities end up doing abdominoplasties and face lifts, places obgyns should not be, thats the point.
Its when things go wrong when this matters, you want someone with the most SURGICAL training, thats whats important. A seasoned surgeon is going to be far better at cosmetic procedures in one year than some prelim who finished a year of internship and did a cosmetic fellowship and has been practicing for years.

You have to ask yourself who would you rather have your family or self see? As said before it wouldnt matter if people stayed within their area of expertise but it just doesnt happen enough to be safe.

 

[jdubya]

Interestingly many of these "cosmetic surgeons" have received MORE training during their residencies in actual cosmetic procedures than your average PRS resident...so which is more qualified? The one with the "PRS" title and virtually no experience or the one with the "cosmetic surgeon" title who's received vast experience? And as asked previously, why don't people-like the above poster-talk about face trauma and how it's done by "dentists"? Could it be because trauma is poorly reimbursed? That's what I thought...

Maybe it's not just about the money. Maybe it's about how hard it is to get into medical school and how less so it is to get into dental school. Maybe its about some of us have worked our butts off through high school, undergrad, four years of medical school and 6 or 8 years of residency for the privelege of these procedures and others have taken the shorter and easier route. I've got nothing against dentists, but I've got nothing against scrub techs either, and I don't think dentists or scrub techs should be privy to physician procedures without being a physician no matter how many they have seen or assisted on. And, by the way, I can feel your response welling up saying that you have worked as hard as any medical student and your talents are certainly as numerous, but without an MD behind your name, I don't buy it. I know you have to be near the top of your dental school class to get an OMFS fellowship, I also know you have to be at the top of your medical school class to get into plastics and of the fish that fill these two ponds, the bigger fish go to medical school.

 

[mcindoe]

Agree with above. To River13, with your logic, why not just let PAs or nurse practitioners do cosmetic procedures too? Do you think experience is simply a matter of who's seen any particular procedure more times than the other?

What people fail to realize is that six years of training isn't just about mastering a technique or procedure. It's about learning how to take care of your patients, before they ever get to the OR and long after they've left. I'm sure there are some cosmetic procedures that a medical student could do alone...but what happens when there's a complication? That's when our beepers go off. A lot of these "cosmetic" surgeons don't know jack about managing their patients when complications arise. I've heard more than enough stories about patients dying during office lipo cases because the dermatologist performing the procedure wasn't surgically trained....they perf the abdomen, they get septic, the cosmetic surgeon doesn't have the experience to be able to recognize what's going on...the patient dies.

I'm not making this stuff up. All I have to say is...caveat emptor.

 

[toofache32]

Maybe it's not just about the money. Maybe it's about how hard it is to get into medical school and how less so it is to get into dental school. Maybe its about some of us have worked our butts off through high school, undergrad, four years of medical school and 6 or 8 years of residency for the privelege of these procedures and others have taken the shorter and easier route. I've got nothing against dentists, but I've got nothing against scrub techs either, and I don't think dentists or scrub techs should be privy to physician procedures without being a physician no matter how many they have seen or assisted on. And, by the way, I can feel your response welling up saying that you have worked as hard as any medical student and your talents are certainly as numerous, but without an MD behind your name, I don't buy it. I know you have to be near the top of your dental school class to get an OMFS fellowship, I also know you have to be at the top of your medical school class to get into plastics and of the fish that fill these two ponds, the bigger fish go to medical school.

Spoken like a true plastic surgeon. Also on par with the malignancy of your other posts. I hate saying that because I get along pretty well with most of the PRS residents at my institution. But it seems like the arguement always results in the PRS people beating their chests and yelling, "but WE"RE the plastic surgeons!" while they show everyone the silver stripe down their back.

Let's not let this post decompose into an immature "Which is harder? Med or dental school?" You can find that in the pre-allo or pre-dent forums. Before you start feeling too good about yourself and your med school accomplishments...I had to work way harder in dental school than in medical school to get the same grades. The majority of OMFSs agree.

 

[River13]

Maybe it's not just about the money. Maybe it's about how hard it is to get into medical school and how less so it is to get into dental school. Maybe its about some of us have worked our butts off through high school, undergrad, four years of medical school and 6 or 8 years of residency for the privelege of these procedures and others have taken the shorter and easier route. I've got nothing against dentists, but I've got nothing against scrub techs either, and I don't think dentists or scrub techs should be privy to physician procedures without being a physician no matter how many they have seen or assisted on. And, by the way, I can feel your response welling up saying that you have worked as hard as any medical student and your talents are certainly as numerous, but without an MD behind your name, I don't buy it. I know you have to be near the top of your dental school class to get an OMFS fellowship, I also know you have to be at the top of your medical school class to get into plastics and of the fish that fill these two ponds, the bigger fish go to medical school.

Did you realize nearly 1/2 of graduating OMFS's have completed both medical and dental school (aka have an MD)?

 

[River13]

Agree with above. To River13, with your logic, why not just let PAs or nurse practitioners do cosmetic procedures too? Do you think experience is simply a matter of who's seen any particular procedure more times than the other?

What people fail to realize is that six years of training isn't just about mastering a technique or procedure. It's about learning how to take care of your patients, before they ever get to the OR and long after they've left. I'm sure there are some cosmetic procedures that a medical student could do alone...but what happens when there's a complication? That's when our beepers go off. A lot of these "cosmetic" surgeons don't know jack about managing their patients when complications arise. I've heard more than enough stories about patients dying during office lipo cases because the dermatologist performing the procedure wasn't surgically trained....they perf the abdomen, they get septic, the cosmetic surgeon doesn't have the experience to be able to recognize what's going on...the patient dies.

I'm not making this stuff up. All I have to say is...caveat emptor.

What you fail to realize is we also do 6-7 year long residencies, with available cosmetic fellowships to follow those, and manage as many complications as any other service, including the screw-ups made by other services.

Similiarly to your story, I've heard more than enough stories of PRS's bagging facial nerves when they attempt facelifts because even though they've seen few and done less, they have the PRS title. I would rather send my mother to a surgeon who has done (not seen) and managed plenty of the procedures in the correct way during his/her residency.

No one in my residency just "sees" procedures done...we do them, correctly and skillfully, and manage all perioperative issues, on all types of patients, young and old, healthy and unhealthy...actually most seem unhealthy when they come to us.

Your comments reflect your lack of knowledge about our training.

 

[jdubya]

What do you call a doctor who couldn't get into medical school?


A dentist

 

[Ergo]

Wow, where to start.

Stories that you hear are nice anecdotally but statistics are more relevant. Of course there are bad Dr.s in every field. Fortunately, for an elective procedure patients can pick their surgeon instead of being forced to choose from the insurer's list.

PRS surgeons, who have trained at accredited programs an have been board certified have undergone years of peer scrutiny. With the skewed public perception of plastics and the litiginos nature of our society there is a great deal of self monitoring in the field of PRS. Thats why some less scrupulous plastic surgeons choose to NOT become board certified - and even less scrupulous surgeons skip the residency entirely and just take a weekend course.

U.S. PRS programs have PLENTY of hands on time. Our academic program is light on cosmetics - but after 3 years assisting with general surgeries grads spend 1 year assisting on plastics cases and 2 full years running cases alone. (note: assist is not a euphemism for observe.)
Faculty do the observing.

Good luck.

And, as a side note, thanks to my own OMFS who didnt sever my facial nerve when taking out my wisdom teeth. I knew with all that training he would do the best job, and I got the outcome I expected.
He was worth the $3000+, and deserves the Porsche and afternoon golf.

What you fail to realize is we also do 6-7 year long residencies, with available cosmetic fellowships to follow those, and manage as many complications as any other service, including the screw-ups made by other services.

Similiarly to your story, I've heard more than enough stories of PRS's bagging facial nerves when they attempt facelifts because even though they've seen few and done less, they have the PRS title. I would rather send my mother to a surgeon who has done (not seen) and managed plenty of the procedures in the correct way during his/her residency.

No one in my residency just "sees" procedures done...we do them, correctly and skillfully, and manage all perioperative issues, on all types of patients, young and old, healthy and unhealthy...actually most seem unhealthy when they come to us.

Your comments reflect your lack of knowledge about our training.

 

[toofache32]

What do you call a doctor who couldn't get into medical school?

A dentist

I rest my case. Refer to the first 2 sentences of my previous post.

You make it difficult to stay civil, until I remember that you lose whatever credibility you had when you start acting like a 3rd grader. But you've already demonstrated this well.

 

[HiddenTruth]

I had to work way harder in dental school than in medical school to get the same grades. The majority of OMFSs agree.

sorry, this is off topic, and i am not trying to be arrogant; however, wondering if going to dental school and having mastered the material already could have anything to do with it?

 

[tx oms]

Maybe it's not just about the money. Maybe it's about how hard it is to get into medical school and how less so it is to get into dental school. Maybe its about some of us have worked our butts off through high school, undergrad, four years of medical school and 6 or 8 years of residency for the privelege of these procedures and others have taken the shorter and easier route. I've got nothing against dentists, but I've got nothing against scrub techs either...blah, blah, blah

Oh, I'm sorry I didn't realize how hard it is to be a plastic surgeon. Gosh, when you put it like that I can really see how hard you've had to work. Man, I thought I worked hard to be 25, have a DDS, be an oral surgery resident, and be done with the third year of medical school. Surely I must bow to your superiority. BTW, why did you "work your butt off" in high school? It was so easy for me I left in two years. Just me though.

You're really saying the same thing most oral surgeons say about periodontists: get out of my territory. Unfortunately, it doesn't work that way. There is overlap in all areas of medicine, like it or not. Doing cosmetic facial procedures doesn't make someone a plastic surgeon; taking third molars out doesn't make you an oral surgeon. Besides, I thought most of plastic surgery was about reconstruction and wound healing. As I understand it, you can do a fellowship in facial/cosmetic surgery. Seems to me that the powers that be in plastic surgery don't really think you master it in your residency, either.

 

[tx oms]

Our academic program is light on cosmetics...

What? Who is this "our"? You signature says you'll have an MD in 2006. Seems to me you are not a PRS nor have you even matched into that program. Dellusions of grandure if you ask me. Symptom of schizophrenia...

 

[Celiac Plexus]

And as asked previously, why don't people-like the above poster-talk about face trauma and how it's done by "dentists"?

?

the prs faculty at my institution cover face call (shared with omfs), and consequently handle a fair amount of facial trauma, and facial reconstruction. i'm sure you know that craniofacial surgery is a component of prs training, and a number of prs trained surgeons focus their practices on this type of surgery.

also a lot of times omfs and the prs faculty work together on a patient.

 

[toofache32]

...i'm sure you know that craniofacial surgery is a component of prs training, and a number of prs trained surgeons focus their practices on this type of surgery...

Not to quibble, but this is also true for OMFS.

 

[TheThroat]

Oto's who get a year of credible Facial Plastic and Reconstructive fellowship training are at least as or more qualified to perform facial plastic procedures than "normal" plastic surgeons. The question is: is the fellowship credible? Unless you are a facial plastic surgeon, its hard to know.

This is copied from another thread on this board:

"A general statement that the American Board of Plastic Surgery is the only board authorized by the American Board of Medical Specialties to certify physicians in plastic surgery is incorrect. Concerns have been expressed that this could imply that practitioners certified by the American Board of Otolaryngology who received training in facial plastic surgery of the head and neck and have been examined in this area are not qualified to perform facial plastic surgery. In an effort to update the diplomates of the American Board of Plastic Surgery on recent developments, Dr. David J. Smith, Jr., in the ABPS annual newsletter, stated the following6: “The American Board of Otolaryngology (ABOto), in 1998, was granted approval by the American Board of Medical Specialties (ABMS) for a subcertificate, entitled Plastic Surgery Within the Head and Neck (PSWHN). "

I am currently working with a FPS in Des Moines who is incredibly successful and well-known in the area. Of course, he knows his boundaries (nothing below the neck). That is really where people get in trouble. I have no problem with OMFS doing surgeries if they are well-trained to do them. But just like a general oto doing face lifts, they shouldn't be doing them without fellowship training.

 

[toofache32]

Oto's who get a year of credible Facial Plastic and Reconstructive fellowship training are at least as or more qualified to perform facial plastic procedures than "normal" plastic surgeons. The question is: is the fellowship credible? Unless you are a facial plastic surgeon, its hard to know.

I am currently working with a FPS in Des Moines who is incredibly successful and well-known in the area. Of course, he knows his boundaries (nothing below the neck). That is really where people get in trouble. I have no problem with OMFS doing surgeries if they are well-trained to do them. But just like a general oto doing face lifts, they shouldn't be doing them without fellowship training.

I would agree with this. But I know some ENT programs get a really good exposure to facial plastics, and I'm not sure a fellowship would be entirely necessary other than for credentials. Same for OMFS.

 

[TheThroat]

I guess its just a matter of preference. I wouldn't want a non-fellowship trained surgeon doing my face-lift, but I would let a OMFS work on my facial fracture and I would let a general Oto do a septorhinoplasty on me.

 

[jdubya]

What? Who is this "our"? You signature says you'll have an MD in 2006. Seems to me you are not a PRS nor have you even matched into that program. Dellusions of grandure if you ask me. Symptom of schizophrenia...

They must have taught the spelling of the word grandeur in the third year of high school.

 

[jdubya]

What? Who is this "our"? You signature says you'll have an MD in 2006. Seems to me you are not a PRS nor have you even matched into that program. Dellusions of grandure if you ask me. Symptom of schizophrenia...

They must have taught the spelling of the word grandeur in the third year of high school. And by the way, why didn't you go to medical school and then into ENT or plastics? If medical surgical operations is your interest, I don't understand why dental school?

 

[Mithridates]

They must have taught the spelling of the word grandeur in the third year of high school.


Had to do it... just one more time.

 

[mcindoe]

...and the correct spelling of "delusions" was taught around that time as well.