Plastic surgery fellowship?

[Giovanotto]

Hi y'all,

Wanted to ask this community a question that a family friend of mine has been asking me, and I am not quite sure of the answer. They are looking for a plastic surgeon to perform a cosmetic surgery, and as I was looking at the plastic surgeons training, I noticed:
Internal year, surgery > Residency, Head & Neck Surgical Oncology/Microvascular Reconstruction (well respected institution) >Fellowship, Facial Plastic & Reconstructive Surgery @ "a no name type of surgery center place."

This raised some red flags to me but I admit I'm not familiar with the plastic surgery world and how common this is.

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[TheLesPaul]

The world of plastics is much more apprenticeship-based than academic compared to the rest of medicine. Surgeons tend not to say they trained at "University of X", they say they trained with "Dr. X". There are many excellent fellowships that are run by private practice surgeons, very loosely affiliated with an academic center. This isn't a red flag.

 

[Pir8DeacDoc]

I would echo the above. Especially in Facial Plastics, it seems a lot of the training is with specific doctors and less so at specific institutions. General Plastics is a different deal- because of the breadth of their training it's generally at institutions.

 

[HighPriest]

Here’s what matters -

Did they train to do cosmetic surgery?
Did they train under someone who does a lot of cosmetic surgery?
Do they dabble in cosmetics, or is that their primary focus?
Do they do a lot of whatever procedure it is your friend is looking for?

So be honest, most cosmetic procedures aren’t technically that difficult in principle. (I think).
What’s hard is taking the extra time to make sure you do it well, in accordance with what the patient wants, and knowing when to tell a patient you can’t give them what they want (whether someone else can or whether it’s just not possible). And having experience enough to know that you’re going to get that outcome when you’re putting in your stitches. Like anything, I guess.

But the point is: the key to learning how to do it isn’t necessarily to be at a big academic institution. It’s just doing it a lot with someone who has a lot of experience.

But academic institutions matter for cancer treatment, for example, because you need the massive bulwark of support of the many specialties and services provided there to do the worst cancer cases. Cosmetics doesn’t need that. I’d you’re doing cosmetics on someone who needs a functional neuro icu to recover, you have a problem.

If this guy does mostly head and neck cancer and reconstruction and your friend wants a cosmetic rhinoplasty, that may be a bad fit.

If your friend wants a hump reduction - anyone who feels comfortable doing any middling complexity nasal surgery can do that and get a fairly decent outcome (in my opinion). But of course that’s only true if the patient has a big hump. If they only have the body dysmorphia version of a big bump, well, that’s when you have to know when to say no.


If your friend wants a third revision rhinoplasty with a face/brow/bleph/neck, then you should find someone who does those all of the time (and hence makes all of their money out of pocket and not subsidized by oncology). Let the market decide for you if they’re good.

In theory, someone with those credentials could do all of that, but not a lot of people do a head and neck fellowship and then go on to just do cosmetics. I’m sure it happens.