The message that one should only go to a board certified plastic surgeon is the public relations message of general plastic surgeons. While there are many excellent skills that general plastic surgeons offer, it is essential to understand that very few of these surgeons were trained to perform cosmetic surgery in their plastic surgery residency. Additionally numerous surgical subspecialties offer high quality cosmetic surgery and were very extensively trained in these procedures in residency and fellowship programs. In many cases, the subspecialist cosmetic surgeon offers a level of service that is better than what can be obtained from the majority of general plastic surgeons. It is my opinion that general plastic surgeons betrayed their public trust by not doing more to bring up the standard of care in cosmetic surgery and for so long failing to properly train their resident surgeons to properly perform cosmetic surgery. For this reason, the public is often much safer getting their cosmetic surgical care from the subspeciality cosmetic surgeon and not a general plastic surgeon. The Wall Street Journal just published an article that completely ignored this issue. Here is the letter I sent to the Wall Street Journal.
I read Robert Johnson’s article “A Nip and a Tuck” about cosmetic surgery for the 65-plus crowd that appeared in the October 31, 2011 WSJ. The article only mentions a single specialty that offers cosmetic surgery: general plastic surgeons certified by the American Board of Plastic Surgery. Either general plastic surgeons are very good at public relations (they are), or the author was unmotivated to provide readers with a balanced perspective. General plastic surgeons are not the only board certified surgeons who offer safe, high quality cosmetic surgery.
For years general plastic surgeons failed to train their residents for cosmetic surgery. General plastic surgery residency instead focused on broad training in reconstructive general plastic surgery. Despite claims to the contrary, treating a burn is not the same as performing liposuction, a facelift, or an eyelid surgery. This lack of leadership has resulted in a less than ideal standard of care for these elective cosmetic surgeries.
Over the past 40 years, otolaryngologists, ophthalmologists and dermatologists have built excellent fellowship training programs in facial plastic surgery, oculofacial plastic surgery, and dermatologic surgery that provide in-depth training in cosmetic surgery to allow these surgeons to offer cosmetic surgery to the American public that is arguably safer and of better quality than that offered by general plastic surgeons. The American Board of Cosmetic Surgery, a non-ACGME board, accredits high quality cosmetic surgery fellowships that are open to a number of surgical specialties including general surgeons, gynecologists, oral maxillofacial surgeons, as well as general plastic surgeons. These highly trained specialists provide a quality alternative to board certified general plastic surgeons who lack formal training in cosmetic surgery. It is now well accepted that fellowship trained dermatologists practicing liposuction are much less likely to be sued for liposuction malpractice than general plastic surgeons to cite just one example.
It is not controversial to state that general plastic surgery residencies do not provide adequate training in cosmetic surgery. Fortunately the field of general plastic surgery has recognized this and now offers a growing number of fellowships in aesthetic surgery for board eligible general plastic surgeons. However, compared to fellowship trained specialists in facial plastic surgery, oculoplastic surgery, dermatologic surgery, and cosmetic surgery; general plastic surgeons still have a ways to go before the public trust in this specialty is truly deserved. Unfortunately readers of Mr. Johnson’s article were left unenlightened about these issues.
Associate Clinical Professor
Division of Orbital and Ophthalmic Plastic Surgery
Jules Stein Eye Institute
David Geffen School of Medicine at UCLA