ENT / cosmetics / plastics

[anon-y-mouse]

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Are cosmetic procedures (on the face, I guess) within the scope of practice of an otolaryngologist?

 

[Jocomama]

Most OTOs do a facial plastics fellowship, which has it's own SF Match.
There are those that do full Plastics after ENT (Tom Mustoe - CHief Plastics NWestern, Chicago) and those that do some of the best Rhinoplasty work (Tardy, Toriumi) without any plastics training. In fact they write the books on this.
Thus all types, all training, etc.

However, I can't say I know many ENTs that do Face lifts, blepharoplasties, etc, without having done facial plastics, etc.
But, I think one of the suture or "lunchtime" facelift developers (quite a few on the market) is an ENT from Bloomfield Hills, MI.

Probably lots of variation in training. But then, you got Family Practice injecting Restylan, Sculptra and Botox - so I guess you can do whatever you want, if your living trust is set-up correctly, and the state allows it.

Are cosmetic procedures (on the face, I guess) within the scope of practice of an otolaryngologist?

 

[Pegasus82]

I know one ENT-guy who does rhinoplastics on his "spare-time", without any other speciality then ENT. 😎

 

[Fah-Q]

Are cosmetic procedures (on the face, I guess) within the scope of practice of an otolaryngologist?

In the area of the country I'm in, ENT does the majority (~75%) of facial cosmetics/reconstruction. A general plastics fellowship doesn't provide much training on the face. They generally focus on burns, hand, breast recon, extremity free flaps, etc. ENT's just work with the face more...but obviously don't do general, full-body plastics.

 

[maxheadroom]

And where I am, ENT does Head and Neck Oncology, but we do the reconstruction. They occasionally rasp down a dorsal hump (when they're doing a septo), but we do the vast majority of rhinos. Plastics at my place does almost all of the post-MOHS recon and virtually all of the aesthetics.

 

[bobby6]

If you watch the show Dr. 90210, half of the plastics guys are ENTs who do facial plastics.. ie. Dr. Jason Diamond, DR. PAUL NASSIF, DR. ROBERT KOTLER, DR. RAJ KANODIA.

Facial Plastics is 30% of the Otolaryngology Board exam which includes Facial trauma, Cosmetics, Head and Neck Reconstruction, and etc. On top of that, the American Board of Otolaryngology share the same subspecialty certificate of Plastic Surgery within the Head and Neck with the American Board of Plastic Surgery.

 

[JabsterL]

In the area of the country I'm in, ENT does the majority (~75%) of facial cosmetics/reconstruction. A general plastics fellowship doesn't provide much training on the face. They generally focus on burns, hand, breast recon, extremity free flaps, etc. ENT's just work with the face more...but obviously don't do general, full-body plastics.

what area of the country are you in where ENTs do most of the facial cosmetics...is it like this in the south and midwest too?

 

[GSresident]

A general plastics fellowship doesn't provide much training on the face. They generally focus on burns, hand, breast recon, extremity free flaps, etc.

I think that depends on where you train in general plastics. I'm <6 weeks into my fellowship and I have filled my numbers on rhino's and facelifts. In practice I have never seen a general surgery/general plastics trained plastic surgeon who didn't do facial work.

 

[toofache32]

I think that depends on where you train in general plastics. I'm <6 weeks into my fellowship and I have filled my numbers on rhino's and facelifts. In practice I have never seen a general surgery/general plastics trained plastic surgeon who didn't do facial work.

I thought there were no required minimal numbers for Plastics. What are the numbers you're referring to?

 

[GSresident]

I thought there were no required minimal numbers for Plastics. What are the numbers you're referring to?

We have to enter our cases into the ACGME caselog system just like everyone else. We are required to have a certain number of cases for each category, including cosmetics. For independant plastic surgery residents:

facelift 7
blepharoplasty 8
rhinoplasty 6
abdominoplasty 5
liposuction 10
other (cosmetic) 9

 

[TheThroat]

Things most otos should be able to do without fellowship:
rhinoplasty, blephs, laser skin resurfacing, otoplasty

Things most otos should do an FPRS fellowship for:
facelift, browlift


That said, you have to "market" yourself to do cosmetic surgery, which often times means devoting your practice to it. Doing a one year fellowship makes the most sense if you really want to do alot of FPRS.

 

[resxn]

I completely disagree with The Throat. The spectrum of facial plastics that an otolaryngologist performs is entirely based on the scope of training in his or her residency. For example I did a significant number of brow lifts, but I never did any laser resurfacing except for rhinophyma. Therefore, I would say that I'm very capable of doing brow lifts including endoscopic and open techniques much more than I would say that I am at doing laser skin resurfacing. In fact, during my oral boards, one of my questions during the plastics session was on the various techniques to improve the appearance of the aging brow using every option available to modern medicine. I had to describe each of these in detail and draw my incisions on a picture of the old lady I was supposed to help.

I do Botox injections, collagen injections, blepharoplasties, brow lifts, rhytidectomies, submental liposuction, rhinoplasties, skin cancer reconstruction, and otoplasties among other smaller things. Every residency program and has a different amount of experience with plastics. Some have tons, some have a little. I think I had a very average experience but I am very capable of performing any of the above procedures. I would not do facial implants or skin expansion or treatment of hair loss. No one person can tell you what your scope practice should be as long as it falls within the realm facial plastic surgery. That is for you to decide. That is what our Academy says.

 

[iliacus]

I completely disagree with The Throat. .

Alright then...I'm unofficially banning you from SDN 😡 Throat has handed out more useful info than anyone on this forum. If I have an ENT question the Throat is my number one resource.

 

[resxn]

Sorry to hurt your Throat-loving feelings. I agree with you quite readily that Throat's posts are very useful and typically right on the money, I think he just jumped the gun on the one above.

I make no claim to be anything as great as a long-time respected poster. Just throwing in my useless 2 cents without being asked whenever I can now that I'm here.

 

[iliacus]

Sorry to hurt your Throat-loving feelings. I agree with you quite readily that Throat's posts are very useful and typically right on the money, I think he just jumped the gun on the one above.

I make no claim to be anything as great as a long-time respected poster. Just throwing in my useless 2 cents without being asked whenever I can now that I'm here.

Dude..that was so passive aggressive

Lighten up Francis I love you too 😍

 

[TheThroat]

iliacus: thanks for being a fan. Its nice to be loved.

resxn: I don't have a problem being disagreed with and if you are well trained to do everything you mentioned, great. I still think that, on average, most otos aren't out there doing rhytidectomies without a facial plastics fellowship. Looking at my post, you should note I wrote "most." Obviously there are a few programs out there that well prepare their graduates for FPRS. Which ones they are, other than the Walter Reed Army Medical Center Residency, I don't know.

Of what you listed that you do:
-Botox injections, collagen injections: any doc can do after a 1-2 week course.
-blepharoplasties, rhinoplasties, otoplasties, skin cancer reconstruction: most otos should be able to do.
-brow lifts, rhytidectomies, submental liposuction: A few otos can do after residency. It still takes a bit of marketing to set yourself up as a "facial plastic surgeon," which if you want that type of practice, do it, because with today's decreasing insurance reimbursement rates, any out of pocket procedure pays much better than insurance-paid procedures.

 

[resxn]

Now that's something I definitely agree with, Throat.

I don't want to do plastics, but I feel competent to do those things I mentioned. I don't like feeling like a used-car salesman as a physician. And just hanging around plastics guys who do lots of cosmetics I get a creepy salesman-like vibe sometimes. I do, however, very much enjoy reconstructive plastics (from trauma or cancer excision, etc) because it is very rewarding and you're not trying to perfect a beautiful woman's already very attractive face. I will do some rhinoplasties, blephs, brows, and other stuff if requested, but I will not as a general ENT try to market those procedures. Certainly, I'm not the guy to do rhytidectomies, even though it's really not much more than the approach for a parotid, because I don't want clients/customers. There are other personalities that would do far better there.

I also think it would be tough for an ENT to market himself as purely plastics without a fellowship because the plastics guys and the fellowship trained guys would make it pretty difficult. In the world of cosmetics, everything is word of mouth.

But you are right about this. . .there is no better way to get reimbursed than out-of-pocket preprocedure cash.