Procedural/Mohs/Surgery in Dermatology

[Transformers]

I'm starting to enjoy the surgical aspects of medicine (esp. my current surgery rotation) and I was wondering how much of a surgeon can a derm get (in addition to Mohs) in terms of facial plastics (skin flaps, lifts, plastys that head/neck or true facial plastic surgeons do)? Additionally, do you need to pursue a procedural fellowship to do some of the surgical aspects of derm or is that part of residency training? I understand Mohs is an entity in itself but I see more and more places incorporating Mohs training as part of a one-year "procedural" fellowship and hence honing many procedural skillsets with one stone (fellowship).

Thanks.

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[asmallchild]

I'm starting to enjoy the surgical aspects of medicine (esp. my current surgery rotation) and I was wondering how much of a surgeon can a derm get (in addition to Mohs) in terms of facial plastics (skin flaps, lifts, plastys that head/neck or true facial plastic surgeons do)? Additionally, do you need to pursue a procedural fellowship to do some of the surgical aspects of derm or is that part of residency training? I understand Mohs is an entity in itself but I see more and more places incorporating Mohs training as part of a one-year "procedural" fellowship and hence honing many procedural skillsets with one stone (fellowship).

Thanks.

There's no limit, procedural derm fellows do just as many if not more skin flaps than most plastics/ENT residents. Regarding more invasive procedures such as facelifts, that would likely depend on your training but here I'm certain plastics/ENT would have the advantage in exposure and numbers

A fellowship is not absolutely necessary and many residency programs offer very strong surgical exposure. Whether or not you feel that is enough exposure to go out and practice is up to you (with some obvious exceptions. Certain insurance plans will not reimburse those who are not fellowship-trained. Certain jobs may not be available to those without fellowship training as well). As with most things in medicine, the more exposure the better and I couldn't imagine a fellowship being a detriment to your practice skillset if it fits within your plans

Finally, my limited understanding (and someone please correct me if I'm wrong) is that all the surgical fellowships you are referring to are procedural dermatology fellowships which means they must incorporate some mixture of cosmetics and Mohs. I don't believe there are any "pure Mohs" fellowships that are accredited by the ACGME. There are some "pure cosmetic" fellowships being offered by the ASDS

 

[Transformers]

There's no limit, procedural derm fellows do just as many if not more skin flaps than most plastics/ENT residents. Regarding more invasive procedures such as facelifts, that would likely depend on your training but here I'm certain plastics/ENT would have the advantage in exposure and numbers

A fellowship is not absolutely necessary and many residency programs offer very strong surgical exposure. Whether or not you feel that is enough exposure to go out and practice is up to you (with some obvious exceptions. Certain insurance plans will not reimburse those who are not fellowship-trained. Certain jobs may not be available to those without fellowship training as well). As with most things in medicine, the more exposure the better and I couldn't imagine a fellowship being a detriment to your practice skillset if it fits within your plans

Finally, my limited understanding (and someone please correct me if I'm wrong) is that all the surgical fellowships you are referring to are procedural dermatology fellowships which means they must incorporate some mixture of cosmetics and Mohs. I don't believe there are any "pure Mohs" fellowships that are accredited by the ACGME. There are some "pure cosmetic" fellowships being offered by the ASDS

Thanks for that lengthy response asmallchild! Basically, I'm just starting to love the more surgical aspects of medicine and the procedural stuff im interested is less about lasers, etc... (which are cool) but I think I would really be open to the idea of doing flaps as well as more invasive procedures maybe not on a day to day basis but I suppose the one thing I do worry about about "clinic medicine" in a field such as derm in general (and heck any other medicine service) is the monotony of work....basically seeking out the variety of surgical avenues in derm maybe half the week is a pretty neat way to make the day-to-day long-term outlook more interesting. And while the quick answer for me sounds like dude, just try to do ent or plastics, my laziness aside, i really don't want to pursue an entire residency training just to for the sake of those few more invasive proecdures that I mentioned above that I was curious (and hoping) a dermatologist could pursue within his skillset and incorporate into day-to-day practice