This very important article addresses two issues:
1. Is your surgeon a Plastic Surgeon (there are many cosmetic surgeons who would like you to think they are a plastic surgeon but they really are not). You may be shocked to find out the truth!
2. Is your surgeon, be they a plastic surgeon or not, certified by a ABMS (American Board of Medical Specialties) recognized board? Again, there may be some surprises!
If your surgeon is a plastic surgeon and certified by a ABMS recognized board, this will not guarantee you a particular result, but it will assure you that your surgeon has undergone appropriate standards of plastic surgical training and demonstrated an appropriate degree of knowledge and competency when he/she underwent rigorous examinations (oral and written) for board certification and later re-certification. Those who certified after 1995 have expiration dates on their board certification certificates and need to re-certify every ten years to maintain their board certification status. In addition to my original board certification in 1996, I successfully re-certified in 2004 and 2014 (surgeon’s typically re-certify a year or two before their certificate expires).
When selecting a surgeon for a cosmetic surgical procedure, you really need to know what you are getting. Do you want a surgeon who has completed the necessary training and has taken the appropriate specialty board examinations to validate that the surgeon has achieved a desired level of competency? Or, are you satisfied with the fact that the surgeon has a license to practice medicine with no specialty board certification and thus has not had to prove to anyone that they have demonstrated competency in plastic surgery? This article is for those that want to have a properly trained surgeon who has appropriate specialty board certification. Let’s start with a few definitions just so that we are all speaking the same exact language.
Cosmetic surgery – surgery that is designed to change ones appearance for non-medical reasons. Examples include breast augmentation, rhinoplasty and facelift. Correction of congenital abnormalities such as cleft lip are considered medically necessary and are therefore NOT cosmetic in nature.
Elective surgery – surgery that is not performed as an emergency. A scheduled gallbladder operation, a hernia repair, liposuction are all examples of electively scheduled surgeries. A perforated appendix is an emergency and as such is NOT elective. Note that elective surgery includes all cosmetic surgeries as well as many other non-cosmetic, medically necessary procedures (like gallbladder and hernia surgery).
Therefore, elective surgery does not equal cosmetic surgery. Cosmetic surgery is a subset of elective surgery.
Plastic surgery – surgery performed by a plastic surgeon, an individual who has completed a plastic surgery residency. Note, the term plastic surgery doesn’t specifically outline just what procedures they are, just that they are typical procedures done in the course of a plastic surgeon’s surgical training.
Plastic surgical training – a period of time, usually two years, when a surgeon already having trained at least three or more years in general surgery as a prerequisite now undertakes additional training in the areas of: cosmetic surgery, burn surgery, reconstruction of deformities due to cancer, trauma and congenital malformations and hand surgery. Basically, the areas of the body treated or operated upon are global and includes almost everything from the skin and whatever it covers, from head to toe.
Otorhinolaryngology (Ear, Nose and Throat or ENT) training – surgical training in the areas of head and neck surgery. This includes removing cancerous tumors, treating disorders of the ears and hearing, disorders of the nose and breathing, and disorders of the neck.
Facial plastic surgery – This term is kind of an oxymoron. Plastic surgery as defined above involves cosmetic and non-cosmetic surgery of the entire body. Otorhinolaryngologists (Ear, Nose and Throat or ENT surgeons) are concerned with cosmetic and reconstructive surgical issues limited to the face. Some otorhinolaryngologists who specialize in cosmetic surgery of the face use the term “Facial Plastic Surgeons”. As cosmetic and reconstructive surgery of the face is only a small subset of the training and experience obtained as a plastic surgeon, I do not (my opinion here) believe that it is correct to use the term “Facial plastic surgeon”. I think it would be better to term this specialty as “facial cosmetic surgery” or “facial cosmetic and reconstructive surgery”, rather than “facial plastic surgery”. This way, there would be less confusion to the lay public because they do not work below the neck. This way, the public would not make the common misconception that they are plastic surgeons of which they are not. If you accept the term “facial plastic surgeon”, then I guess that I should refer to myself as a “whole body plastic surgeon”! It’s pretty ludicrous. I even remember one instance of a facial plastic surgeon who somehow made it onto the plastic surgery on-call schedule of an area hospital. Apparently, he was taking on cases of burns to the lower extremities, something he was not at all trained to do! I am not at all implying that “facial plastic surgeons” are not as skilled as plastic surgeons to perform facial cosmetic or reconstructive surgery nor am I espousing that they should not be performing cosmetic surgery of the face – quite the contrary. There are very skilled surgeons of both specialties who perform these types of surgical procedures. My point is simply that it creates confusion for the public when they use the term “plastic surgery” when they are in fact, not plastic surgeons.
Let’s talk about “board certification”. What is a “board”? There are 24 specialty boards recognized by the American Board of Medical Specialties (ABMS). They are as follows:
The American Board of….
- Allergy and Immunology
- Colon and Rectal Surgery
- Emergency Medicine
- Family Medicine
- Internal Medicine
- Medical Genetics
- Neurological Surgery
- Nuclear Medicine
- Obstetrics and Gynecology
- Orthopaedic Surgery
- Physical Medicine and Rehabilitation
- Plastic Surgery
- Preventive Medicine
- Psychiatry and Neurology
- Thoracic Surgery
Note that the only ABMS recognized board that includes cosmetic surgery is the American Board of Plastic Surgery. For example, The American Board of Cosmetic Surgery and The American Board of Facial Plastic and Reconstructive Surgery are not recognized by the ABMS.
After a trainee completes their surgical residency training, they are then “board eligible” to sit for the board examination WITHIN THEIR SURGICAL SPECIALTY. For example, a resident in general surgery may sit for the American Board of Surgery examination. If they pass the test, then they are “certified by the American Board of Surgery”. A resident in plastic surgery will take the examination within their specialty and upon successful completion of that examination will be “certified by the American Board of Plastic Surgery”. Lastly, a resident in otorhinolaryngology (ENT) will sit for the exam in that specialty and after passing it will be “certified by the American Board of Otolaryngology”. A trainee can not sit for an examination for a specialty that they did not train in. For example, an ENT resident cannot sit for a plastic surgery board examination and vice-versa.
So what is with these other boards not in the above list of recognized specialty boards? There are numerous boards not in the list of recognized boards. Examples include the American Board of Facial Plastic and Reconstructive Surgery, American Board of Laser Surgery and the American Board of Cosmetic surgery.
With regard to the recognized boards, such as the American Board of Plastic Surgery, the trainees, or residents, must complete an accredited training program in plastic surgery with a curriculum approved by the residency review committee. Upon successful completion of the residency, the program director must sign off that the resident is competent and ready to take the board examination. In surgical specialties such as general surgery and plastic surgery, the board examination consists of a written part and then an oral part, usually taken about one year after successful completion of the written part. These are extremely rigorous tests and the failure rate can be substantial. For example, having completed residencies in general surgery and then plastic surgery, I have successfully completed the required written and oral examinations to obtain specialty board certification in both general surgery and plastic surgery, although I practice only plastic surgery. As the board certificates have a limited time of validity (ten years each in my case) until expiration, I have re-certified in both plastic and general surgery twice each. That is in addition to having taken and successfully passing each board exam for the first time to initially become board certified.
The non-recognized boards do not have the same rigid requirements for training and rigorous examinations for demonstration of competency in those specialties. Some such boards merely require the payment of a monetary fee to attain “board certification”. In my humble opinion, some of these boards merely exist for the purpose of misleading the public that their so-certified member has demonstrated the same degree of competence as that of an ABMS recognized board. Notice, I am not stating that the member surgeon is less skilled or competent, I am merely stating that surgeon has not had the opportunity to prove their skill, knowledge and competence as a so-certified surgeon of an ABMS recognized board has done.
Who else can perform cosmetic surgery? Well, believe it or not, dentists and oral surgeons (dentists who complete a residency on surgical treatment of the jaws and sometimes facial fractures) have been performing cosmetic surgery as well. Some have been performing facial cosmetic surgery including facelifts, and even non-facial surgery such as liposuction, breast augmentation and tummy tucks! This has been a particularly controversial area and has even resulted in legislation (i.e. California) called “scope of practice laws”.
In New York State, I am not aware of any laws that prevent a person holding a medical license (dentists hold a license in dental medicine, not the same thing) from performing a certain procedure. Although I am certain this has never been attempted (at least I hope not) if a dermatologist wanted to perform a triple bypass cardiac surgery in their office based surgical facility (which as of 2009 must be accredited), there is no law to stop them. The reality is that it would be impossible to do such a thing for logistical reasons and no sane individual would ever permit themselves to receive a cardiac bypass in such an office facility by a dermatologist. So then what would stop a dermatologist from performing a cardiac bypass? Simple. The only place they can perform such surgery, the only facility that would have all the necessary equipment and personnel to do so is a hospital. No hospital that I am aware of would grant “hospital privileges” to a dermatologist to perform such surgery. What is my point here? As a plastic surgeon, I can perform a multitude of cosmetic surgical procedures in my accredited office based surgical facility. I can also obtain (and do currently have) privileges to perform ALL THE COSMETIC SURGICAL PROCEDURES THAT I DO IN MY OFFICE IN SEVERAL AREA HOSPITALS AND AMBULATORY SURGICAL FACILITIES. What is the significance of this? First, there is another implication of competency if I have privileges to perform a procedure in a hospital as in my office because no hospital will grant privileges to someone to do a procedure if they have not demonstrated competency. Secondly, and this is very important, if there is a complication or a problem necessitating hospitalization after surgery, I have the required hospital privileges to treat that complication and operate again as needed while the patient is hospitalized. I have sincere doubts that a dentist or an oral surgeon will be able to do this. An oral surgeon may have hospital privileges top admit a patient to a particular hospital, but hospital privileges in the operating room are in addition to admitting privileges and are always defined as a detailed list of specific procedures that the surgeon is approved to perform. Cosmetic surgical procedures are generally not on that list for a dentist or oral surgeon.
That brings me back to the original question: so how do you know if your surgeon is a plastic surgeon?
Here’s how you know for certain: The plastic surgeon is certified by the American Board of Plastic Surgery. He/she may also be certified by the American Board of Surgery, although this is not a requirement. He/she has completed an approved plastic surgical residency (a prerequisite for board certification anyway). The surgeon is mostly likely also a member of the American Society of Plastic Surgeons (ASPS). This is the main specialty society, which is an organization whose purpose is to foster the growth of the specialty, support its members, provide continuing education for its members and other such services. It is not a specialty board. Only surgeons certified by the American Board of Plastic Surgery may be considered for membership in the above organizations.
If the surgeon is engaged primarily in the practice of cosmetic surgery, he/she is likely to be also a member of the American Society for Aesthetic Plastic Surgery (ASAPS). This is a sister society to ASPS and whose purpose is to serve members dedicated largely to cosmetic surgery. It is also not a specialty board.
I am a member of both the above specialty organizations. If your surgeon does not have the same board certifications, then you are not getting a surgeon who has demonstrated the same degree of knowledge and skill.
So, in summary, if you are inquiring about scheduling an appointment with a particular surgeon, ask the surgeon or his office staff the following five questions: (you may be surprised by the answers)
1. Did he/she complete an accredited plastic surgical residency?
2. Is he/she specifically certified by the American Board of Plastic Surgery
3. Is he/she a member of the American Society of Plastic Surgeons (ASPS)?
4. he/she a member of the American Society for Aesthetic Plastic Surgery (ASAPS)?
5. Which local area hospitals does he/she have admitting privileges AND does he/she have privileges to perform the particular procedure you are interested in at that hospital?
Sections – Important Things to Consider
- Why is Smoking Dangerous When Having Surgery?
- When is a cheap augmentation not so cheap?
- How to Tell if your Surgeon is Really a Board-Certified Plastic Surgeon
- Breast Augmentation and Pregnancy
- Breast Implants and Dental Work
- Implant warranties
Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Five key decisions you need to make
- One-Day Recovery Breast Augmentation
- Anesthesia – General, Sedation or Local?
- Will I need a breast lift (Mastopexy)?
- What else should I know about breast augmentation?
- Important Things to Consider When You Decide to Move Forward With Breast Augmentation
- Revision of breast augmentation
- ALCL and Breast Implant Illness
- Motiva Breast Implant Clinical Trial