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Who can you trust?  The Critical Importance of Making Informed Decisions in Aesthetics

EVOLV / April 26, 2023

Considering cosmetic surgery or a non-surgical aesthetic treatment?

You are not alone.

Market research reports reveal a significant increase in both surgical and non-surgical (lasers, injections, etc.) cosmetic procedures not only in the U.S but also globally and this widespread demand does not appear to be a passing trend. In 2022, consumer statistics reported nearly 2 million cosmetic surgical procedures and over 4 million non-surgical treatments provided in the U.S. alone at a total cost of nearly 16 billion dollars. The factors driving this increase in demand are multiple and include better outcomes, increased awareness, improving safety, technology, products and services and the impact of social media. 

When performed by an appropriately trained, credentialed, and experienced professional, aesthetic surgical and non-surgical treatments have an outstanding safety profile and can provide natural and balanced long-term outcomes. 

The concerning and growing problem however is that along with the steadily increasing popularity and demand, we are also experiencing an alarming increase in complications and unfavorable results in both surgical and non-surgical cosmetic patients. According to statistics provided by the American Society of Aesthetic Plastic Surgery (ASAPS), the most recognized professional organization in the specialty, the reported number of patient complications has been rising dramatically.  The reasons for this increase are several but primarily involve the fact that the demand for treatments has significantly exceeded the number of qualified professionals that are adequately trained or certified to provide them.

The consequence of this situation is that many inexperienced and non-credentialed providers in the medical field have been aggressively marketing on social media, offering ’too good to believe’ pricing, providing treatments in non-certified facilities and utilizing unproven and inferior quality products to support the lower pricing and attract unsuspecting and less informed patients.  The popularity of plastic surgery entertainment such as the television show ‘Botched’ is testimony to this concerning issue.  The problem has had recent local impact in the permanent revocation of the medical license of a Maumee radiologist, due to a 10-year history of complications, who was performing surgery, hormone therapy and other aesthetic procedures completely outside the scope of his training specialty.   Reports of serious injuries and other unfavorable outcomes in Americans traveling abroad lured by lower priced cosmetic surgical treatments is another growing concern. 

While it is true that complications and unfavorable outcomes can occur even with the most experienced and appropriately trained plastic surgeons and professional providers, they are typically rare and less severe.  Most patients are not aware that any physician and their staff, regardless of their specialty and training, can legally perform any cosmetic service, surgical or non, in their own office or clinic treatment rooms.   Surprisingly, State Medical Boards do not regulate or control physicians in their offices performing procedures outside the realm of their residency and specialty training programs.  The obvious consequence of this little-known lack of regulation issue is a higher risk of injury, complications and unfavorable results caused by inexperienced and inappropriately trained providers.   

Because of the growing community impact and increasing problem of this situation, here are some of the most common related questions and considerations for patients considering cosmetic surgical and non-surgical treatment: 

1) Why should I seek a board-certified plastic surgeon when considering a cosmetic surgical procedure or treatment?

To obtain board certification by the American Board of Plastic Surgery, a physician must complete at least 6 years or more of specialty training after medical school, pass comprehensive oral and written examinations, complete lifelong medical education and training including safety measures, and perform surgery in accredited, licensed surgical facilities.  Board eligibility requires qualified physician candidates to complete supervised and regulated training specifically in all aesthetic fundamentals, procedures, and treatments. Be aware that advertising or promotion of board certification in ‘cosmetic surgery’ or similarly sounding boards that are. not recognized or accredited by the American Board of Medical Specialties (ABMS), the only governing body for physician specialties, and are not the same nor is the training comparable.

2) Why does the cost of cosmetic surgical and non-surgical procedures vary so significantly?

The cost of the elective aesthetic treatment can be significant but is a function of the training/experience of the plastic surgeon and their professional staff, whether an accredited facility is used versus an office room, and the quality of the medical products andequipment utilized.  Patients should beware of unusually low pricing that varies significantly, marketing that aggressively promotes providers and services, and non-certified ‘board certifications’ that are not authorized or recognized by the ABMS.   

3) Who can legally perform cosmetic surgery in the U.S.?

As discussed above, most consumers are completely unaware that any physician, regardless of accredited specialty training or experience, can legally perform cosmetic surgery and treatments in their own clinics and offices as they are not regulated by their State Medical Boards.  The State Medical Boards will typically only intervene after the fact if there are reported complications and injuries. 

4) Where can cosmetic surgeries and treatments be legally performed and does the location matter?

While cosmetic surgery can legally be performed in any doctor’s office operating room or clinic, board certified plastic surgeons are required to perform major procedures only in accredited, state-licensed surgical facilities.  This is because these accredited facilities are regularly monitored to keep their accreditation and this means all functions of the facility, anesthesia services, the equipment, medications, and products must be reviewed and approved by the appropriate licensing agencies to provide the optimal and safe environment for patients.  This is one reason why pricing is aggressively marketed by non-plastic surgeons offering surgery in their clinics. 

Choosing to have plastic surgery or a non-surgical aesthetic procedure is a highly personal and potentially life changing decision; and so is selecting a qualified plastic surgeon or aesthetic provider.  It is the essential and basic concept of trust that is being eroded through the misleading and blatant marketing of aesthetic procedures to the public.  These aggressive promotional tactics, often by unqualified providers, treat plastic surgery like a commodity such as buying a car and looking for the ‘best deal’.  Nothing could be further from the truth.  We are not selling a product; we are providing a service – a highly personal service that should be customized to each patient and their goals, and one that carries risk unlike those encountered at a spa or beauty salon.   This is a high-end service that should encompass the entire patient’s experience. 

All of us at EVOLV Plastic Surgery and Medical Aesthetics in Toledo believe in uncompromising patient safety and achieving consistent and natural appearing results in cosmetic surgery and non-surgical treatments.  This is also the most important priority of board-certified plastic surgeons and their associated nurses and aesthetician providers.  This is only possible by building trust, long-term relationships, and complete transparency with our patients along with a lifelong commitment to learning and patient education.  We urge any patient considering cosmetic surgery or aesthetic treatments to take their time, do their research and thoroughly evaluate the training and qualifications of their provider. 


Frank Barone MD FACS