What is a ‘Real Plastic Surgeon’?
Cosmetic (also called ‘aesthetic’) plastic surgery is more popular than ever these days.
Nearly 18 million cosmetic procedures, both surgical and non-surgical, were performed in the United States last year which is a 200% increase since the year 2000! There are a variety of reasons for this increase including improved and more natural appearing results, better products and technology, and an increase in lifespan and work years. Despite the dramatic increase in demand, there remains a significant deficiency of adequately trained and appropriately credentialed physicians and licensed professional providers. Considering these trends, it is not surprising that the number of complications and unfavorable or unnatural results, most of them preventable or unnecessary, have also significantly increased. Most of these complications or unnatural appearing results are often associated with inadequately trained or inexperienced providers, as well as treatments performed in non-certified or non-credentialed medical spas, private clinics or physician offices….and sometimes unfortunately hotel rooms!
While it has become easier and more commonplace to obtain cosmetic plastic surgery and aesthetic procedures, it also has become exceedingly more challenging and confusing for the consumer to find a qualified plastic surgeon and especially a trained professional provider that they can trust. With the internet and rapid dissemination of marketing disguised as ‘education,’ finding fair, accurate and unbiased information in order to make such an important decision has become an increasing challenge even for the most educated of consumers.
To illustrate this growing concern, let’s see how your general plastic surgery IQ relates to some of the more common questions or assumptions that face the average consumer considering a plastic surgical or aesthetic procedure. Answers can be found below the test.
All answers are either true or false.
1) Only a credentialed and board-certified plastic surgeon can legally perform cosmetic surgical procedures in the U.S. such as breast implants, tummy tucks, facelifts, liposuction, etc.
2) Any medical doctor (M.D.) can advertise, promote and legally perform any cosmetic surgical or non-surgical treatment even if they have never completed a credentialed surgical training program or validated training in the specialty involving the cosmetic procedure they are promoting.
3) A doctor who is ‘Board Certified in Cosmetic Surgery’ is also considered a plastic surgeon.
4) A ‘Board Certified Facial Plastic Surgeon’ is also considered a plastic surgeon.
5) The training and experience of a plastic surgeon in cosmetic surgery and non-surgical aesthetic procedures can vary significantly even for board certified plastic surgeons.
6) Traveling outside the United States to have plastic surgery in order to reduce costs can be safe and effective if the medical clinic and treating physician have proper credentials and certification.
7) Potential complications and risks in cosmetic surgery and non-surgical cosmetic procedures are unavoidable, infrequent and usually not life threatening.
8) State Medical Boards will not allow a physician (M.D.) who has not had credentialed surgical training to advertise, market and perform plastic surgical procedures on patients in the United States.
9) Non-surgical cosmetic treatments such as Botox or filler (Restylane, Juvéderm, fat grafting) injections, fat reduction, cosmetic laser treatments, etc., can be legally performed in the United States by dentists, registered nurses, healthcare professionals or any medical doctor.
10) The cost for cosmetic surgery procedures such as breast implants or liposuction, as well as non-surgical aesthetic treatments such as Botox and filler injections, can vary significantly between different physicians, but the surgery or treatment and the results are essentially the same.
Any physician with a M.D. degree can perform plastic surgical procedures legally in the U.S. These will usually be done in the doctor’s office or a ‘medical clinic’ associated with the physician because hospitals or accredited surgical facilities will require appropriate surgical training or verified board certification in plastic surgery in their credentialing process.
A medical license (M.D.) in the U.S. allows the physician the option or legal right to perform any medical or surgical procedure in their office or clinic even if they have not completed a validated training program in surgery or accredited residency in that treatment or specialty. Most states allow any physician to advertise or promote cosmetic surgical and non-surgical treatments even if they trained in a residency or specialty that is unrelated to the services and procedures they are promoting. Recently, however, the Medical Board of California did place some restrictions on these misleading advertising practices (see answer #3 and link below).
The only official accrediting body for medical specialties is the American Board of Medical Specialties (ABMS), and ‘plastic surgery’ is one of the 24 recognized specialties. There is no board certification or specialty of ‘Cosmetic Surgery’ recognized by the ABMS. There is an American Board of Cosmetic Surgery which is an organization created more recently by non-plastic surgeon physicians, but it is not recognized by the ABMS. These physicians are not trained in a plastic surgical residency but can take one year of cosmetic surgical training to qualify for the American Board of Cosmetic Surgery and call themselves ‘board certified in cosmetic surgery.’ Recently, the Medical Board of California denied the request of the American Board of Cosmetic Surgery (ABCS) that its members be allowed to advertise themselves as ‘board certified cosmetic surgeons’ because it is so misleading to consumers and that the ABCS is not a recognized board. https://www.plasticsurgery.org/for-medical-professionals/resources-and-education/publications/psn-extra/news/medical-board-of-california-abcs-is-not-equivalent-to-abms-board Board certification in plastic surgery requires a minimum of 6 or 7 years of surgical and plastic surgical specialty training from an accredited residency program, as well as passing a rigorous written and then oral examination.
A ‘board certified facial plastic surgeon’ is typically a physician trained in otolaryngology or ENT who then goes on to take additional training in cosmetic facial surgery to qualify. A ‘board certified plastic surgeon’ has typically completed 4 or 5 years of general surgery training from an approved residency, an additional 2-3 years in an ABMS approved plastic surgery program, and then passed both the written and oral examinations administered by the American Board of Plastic Surgery.
Even among board certified plastic surgeons, training and experience in the many different cosmetic surgical procedures and non-surgical aesthetic treatments may vary significantly from program to program. Some plastic surgeons will elect to take an optional additional year or more of specialty training in cosmetic surgery and or reconstructive surgery with an accredited program and a recognized expert plastic surgeon. This additional training is called a post graduate fellowship. Dr. Barone completed post graduate fellowships in aesthetic and reconstructive breast surgery, cosmetic surgery, and facial reconstruction. Dr. Koltz completed a post graduate fellowship in microvascular breast surgery and reconstruction. The American Society of Aesthetic Plastic Surgeons is a prestigious organization that admits only board-certified plastic surgeons that have documented and proven experience and expertise in cosmetic surgery and aesthetic procedures.
Many patients are lured to travel outside the U.S. by significantly lowered pricing and other incentives to have cosmetic procedures. Although there are many well trained and board-certified plastic surgeons in other countries, it is very difficult for a ‘medical tourist’ to verify the training and credentials of physicians offering these ‘deals’ in other countries. The facilities or ‘specialty clinics’ where they are performed also have little to no ongoing regulation and validation for training, sterile technique and anesthesia safety, and the results can be disastrous. In addition, air travel after surgical procedures can be especially risky because of the potential for the development of blood clots and pulmonary embolism after surgery. Repairing complications or unfavorable results can be far more expensive and less effective than doing the procedure properly in the right facility and with a qualified plastic surgeon.
While any procedure, surgical or non-surgical, may have the risk of a complication, seeking out an experienced board-certified plastic surgeon who performs elective surgery in an accredited, outpatient operating room facility will reduce the chance of complications. In addition, utilizing an experienced anesthesiologist, as well as appropriately trained nurses and professional staff, will minimize any risks and increase the likelihood of a safe and natural-appearing outcome. It’s important to remember that the decision to have a cosmetic procedure is highly personal and impactful and can have lifelong consequences. https://www.nbclosangeles.com/news/local/Warning-Plastic-Surgeries-in-Tijuana-504213161.html
Most states do not prevent physicians from advertising or marketing plastic surgery or cosmetic procedures even if they have not had accredited training in that specialty. Because this is so misleading to even the most educated consumers, the Medical Board of California recently changed their state law and ruled that in order to advertise for a plastic surgery procedure, the physician must be trained and credentialed by the American Board of Medical Specialties which is the only recognized body for medical/surgical specialties. https://www.plasticsurgery.org/for-medical-professionals/resources-and-education/publications/psn-extra/news/medical-board-of-california-abcs-is-not-equivalent-to-abms-board There is no recognized ‘board of cosmetic surgery’ and no valid ‘board certified cosmetic surgeon’ specialty.
The legal right to perform non-surgical procedures such as Botox and filler injections, cosmetic laser treatment, and fat reduction are often regulated by state medical boards and can vary significantly in each state. Appropriately trained and certified physician assistants, nurse practitioners, registered nurses and other licensed professionals can be accredited for performing these aesthetic treatments and some have excellent training and experience, but this can vary significantly. It is critical that prospective patients do their homework on the provider and the facility before considering any aesthetic procedure.
Costs for cosmetic surgery or non-surgical aesthetic treatments may vary significantly but so can the results, safety and risks! While more cost or expense does not guarantee a better outcome, many factors involved in the total treatment can have a considerable impact on quality, risk and results. Even though the name of procedures such as breast augmentation, liposuction, facelift, and Botox injection may sound the same, quality and results can be impacted by many significant factors. Physician training and experience, technique of the surgery, quality of implants, concentration of Botox, qualifications of the treatment facility, anesthesia methods and anesthesiologist experience, pain control, nursing staff experience, training, and other factors can all have an impact on total procedure cost. The old adage ‘You get what you pay for’ may not always be true, but it is a famous and time-tested quote for a reason!
How to Find a Real Plastic Surgeon
When performed by a qualified plastic surgeon or credentialed and supervised aesthetic provider, cosmetic surgery and aesthetic procedures are not only life changing for patients, but also consistently safe and natural appearing. Natural and balanced cosmetic treatments can significantly improve self-confidence and quality of life for the appropriate patient.
But how does an interested consumer go about finding the right physician or practice from the often-dizzying array and Google lists of surgeon candidates? One helpful consideration is to organize a solid set of minimal criteria to help you with your search. The following suggestions and checklist are based on real data and outcomes and can be a helpful starting point in vetting potential surgeon and aesthetic provider candidates:
– Appropriate Board Certification
Look for an experienced surgeon who is trained in the specialty that you are considering and is certified by the American Board of Plastic Surgery, https://www.abplasticsurgery.org/public/verify-certification/ModDefault.aspx?section=SurgeonSearch which is the only plastic surgery board recognized by the American Board of Medical Specialties.
– Proven experience and natural appearing results with before and after photos only of their own patients.
– Verified and credible reviews by real patients
– Strict adherence to safety standards for the practice and all staff
– Access to a fully accredited and/or state licensed surgical facility
– Proven dedication to ongoing continuing education and training by doctor and staff
– Thorough and comprehensive patient consultations
– A personal rapport, communication and trust with the physician and staff
The decision to have a cosmetic procedure is a critically important and personal one and can have lifelong consequences. The challenge of finding the right plastic surgeon can be made easier with the assistance of the criteria listed above, professional standards and personal preferences. Patients can feel much more confident about achieving the optimal result with safety and natural and balanced outcomes when they can find a plastic surgeon that has the experience, qualifications and compassion that they can trust.
Frank Barone MD FACS