Ob/Gyn's performing cosmetic procedures- please shed some light on this

[clc8503]

I started this same thread in the ob/gyn forum. However, I believe their are two sides to this issue. Since I am greatly interested in this topic I would also like to hear what you guys think about this.

My aunt recently told me that her ob/gyn performed a tummy tuck operation while he was in the process of performing her Hysterectomy. Forgive if I'm wrong but I did not know ob/gyn's were qualified to this. Could someone please shine some light on this for me, as I am very interested in this topic. Can ob/gyn's really perform breast augmentations and tummy tucks? Forgive me if this questions has been brought up before in this forum. Could someone please give me the name of a website where I can find some info on this topic?

There is another ob/gyn, that is partners with the ob/gyn that performed my aunts tummy tuck, that performs breast augmentations. He never did a residency in plastics. However, he has done advanced studies in benign and milignant diseases of the breast as well as infertility, mangaement of menopause, and laparoscopic surgery. DOES ADAVANCE STUDY IN BENIGNED AND MILIGNANT DISEASES OF THE BREAST ALLOW HIM TO BE QUALIFIED TO PERFORM BREAST AUGMENTATIONS?

I'm not trying to bash this physician. I just find it very interesting that he can perform these cosmetic procedures within his pratice. I'm wondering were he obtained the knowledge to perform these procedures. I am just a pre-med, so my question may be somewhat irretating to some of you guys. I am sorry if that is the case but I would really appreciate any feedback regarding this issue.

Thanks

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[lattimer13]

maybe what you're talking about is a panniculectomy (similar but not the same as abdominoplasty) with your aunt's TAH. on my ob/gyn rotation i scrubbed in on one of these. so yes, other gyn surgeons do this procedure although the surgeon told me he was one of a handful that performed it.

 

[GSresident]

Who knows if he is qualified. That is a very hard judgement to make. The more interesting question is why are those 2 OB-GYN's, who seem to want to be plastic surgeons, focusing on just those two plastics procedures? Why aren't they interested in swinging flaps for decubs or in burn surgery? Why aren't they interested in sewing up the drunk guy's eyebrow at 3 in the morning?

 

[toofache32]

Who knows if he is qualified. That is a very hard judgement to make. The more interesting question is why are those 2 OB-GYN's, who seem to want to be plastic surgeons, focusing on just those two plastics procedures? Why aren't they interested in swinging flaps for decubs or in burn surgery? Why aren't they interested in sewing up the drunk guy's eyebrow at 3 in the morning?

I know what you're saying, but it's probably because this procedure is at least related to the pregnancy or the area where they have already operated for the c-section. Obviously, it's a cash procedure also. I'm guessing that eyebrows are not an anatomical location frequently operated by OB/GYNs and therefore have no interest, regardless of qualifications. I don't really have an opinion on this because I'm not too familiar with the operative scope of OB/GYNs. But the same is probably true for many private practice plastic surgeons...they try to focus on the cash procedures while avoiding trauma and other less paying procedures.

 

[Plastikos]

There in it for the money, period. The scope of OB/GYN surgery is the pelvis and its contents. Most plastic surgeons arent interested in flaps or burns, its too much work for too little reimbursement. Are they qualified, who knows, there not extremely complex surgeries but you dont want to have a OB/GYN background on the stand after a complication for sure.

Honestly once your out in private practice you can do whatever you feel comfortable with, and unfortunately people feel comfortable doing things they have almost nil experience with if it pays well. Dentists (not OMFS) even do breast aug's, you have to be careful out there.

 

[toofache32]

Dentists (not OMFS) even do breast aug's, you have to be careful out there.

You mean general dentists? Who and where?

 

[OzDDS]

Dentists (not OMFS) even do breast aug's, you have to be careful out there.

hahah.. show your sources! Please.

 

[grandeelmd]

food for thought- more than one plastic surgeon has told me that over half of their work is "fixing" bad plastic surgery...so it seems that there are quite a few people out there doing procedures that they should not be doing

 

[toofache32]

food for thought- more than one plastic surgeon has told me that over half of their work is "fixing" bad plastic surgery...so it seems that there are quite a few people out there doing procedures that they should not be doing

While I'm sure this is sometimes the case, there are unfounded assumptions in these kinds of statements. How do we know if the original surgeon was a PRS or cosmetic surgeon? This implies the latter, but all surgeons have their share of less-than-satisfactory results. And second, why was the "bad" surgery deemed bad? Were there some sort of complications or scarring? Or was the esthetic result simply not what the patient hoped for? These are 2 very different things. These are just bits of info that are really needed to paint an accurate picture when surgeons make claims like this. Don't get me wrong, I'm sure this happens....but there are also non-PRS surgeons doing revisions as well (at least on the face).

Again, I'm an OMFS and really have no interest in cosmetics. But we don't go around talking about all the facial fractures done by plastics/ENT that we end up "fixing".

 

[Apollyon]

In my (worthless) Ob month 2 years ago, one of the (female) attendings was talking about something similar. A patient that was 6wks s/p NSVD came in with her husband, and HE was bitching about the appearance of her external genitalia. The attending was saying that she could improve the look, but the Gyn/Oncs and Urogyns (especially) could put the "Penthouse *****" back. I extrapolate that to be Ob's may do vulvoplasties, but I wouldn't extend that much above the ASIS, much less to the umbilicus.

 

[toofache32]

The attending was saying that she could improve the look, but the Gyn/Oncs and Urogyns (especially) could put the "Penthouse *****" back.

Hmmmm....I may need a picture to understand this.

 

[Apollyon]

Hmmmm....I may need a picture to understand this.

The "Penthouse *****" is a direct quote from a woman Ob/Gyn.

 

[nipdoc]

The "Penthouse *****" is a direct quote from a woman Ob/Gyn.

I never thought of them as "Penthouse *****". Does that mean "retouched"?

Anyway, during one of my rotations, the OB/Gyn did a Csect and did an awesome, painstaking job suturing. ("No staples! Only butchers use those!!")Very much unlike the other doc that just hacked away and was more concerned about "speed" , rather than aesthetics.

When I complimented him, he said he was very into cosmetic surgery. But, also did gender reassignment surgeries overseas - where training and licensure concerns are not as strict. He said he does this once a year (in former Eastern bloc countries). He gets to do what he loves doing , and manages a vacation along the way.

This OB dude will put some PRS to shame.

 

[primadonna22274]

IMHO this is just irresponsible coming from the OB-GYN. Anyone who's seen enough vulvas postpartum knows they eventually tighten up and look pretty again--6 wk ppt is NOT enough time to see toning. Give the woman a break...she just had a baby! That husband should have been firmly put in his place and told to get over it and love his wife for bringing his child into the world.

Lisa PA-C
(plenty of GYN in my background)

The "Penthouse *****" is a direct quote from a woman Ob/Gyn.

 

[Fah-Q]

Plastics is more a technique than a specialty. There is nothing in plastic surgery that is unique to plastics (i.e., something that ONLY a plastics trained surgeon would do).

 

[navysurgeon]

Fah-Q

What about a free flap?

free-Tram, free-lat flaps...

Not many dentists or OB-GYN doing them, are there?

I don't think an abdominoplasty is a particularly challenging (or rewarding) case to do...let the OBs do them. Gen surgeons do them too...who cares.

X-TNS

 

[toofache32]

Fah-Q

What about a free flap?

free-Tram, free-lat flaps...

Not many dentists or OB-GYN doing them, are there?

I know what you're saying. I think he was trying to say that just because a "plastic surgeon" performs the procedures doesn't mean it's the sole domain of plastic surgeons. Hand surgery is also done by orthopods. We oral surgeons consider much of the facial cosmetics we do as maxillofacial surgery, etc.

 

[ajmacgregor]

Not many dentists or OB-GYN doing them, are there?

You know what I find most interesting about your posts? The fact that you constantly refer to physician specialists by their specialty name, but always lump oral surgeons as "dentists"...It's almost as if you believe that periodontists, prosthodontists, pedodontists, orthodontists, general dentists, and everyone with a DDS is out doing facial cosmetics...

True, oral surgeons are dentists, but they are also surgeons who have spent at least 4-years in the hospital doing surgery. As has been reiterated here time and again, you don't learn how to operate during medical school; you do so during residency. Even patient management, which is a large part of surgery (probably larger than actual cutting), is truly mastered only in residency...

 

[Fah-Q]

Fah-Q

What about a free flap?

free-Tram, free-lat flaps...

Not many dentists or OB-GYN doing them, are there?

I don't think an abdominoplasty is a particularly challenging (or rewarding) case to do...let the OBs do them. Gen surgeons do them too...who cares.

X-TNS

Many head and neck cancer surgeons (ENT and OMFS) do their own reconstructions (free and pedicled flaps). We do about 10-20 free flaps per month at my institution and about 75% of the facial cosmetic and reconstructive cases. The plastics service does mainly pedicled flaps, burn care, and hand.

My point is that there is not some secret surgical skill set that only plastics residents/fellows learn.

 

[droliver]

Many head and neck cancer surgeons (ENT and OMFS) do their own reconstructions (free and .

No, I don't think thats true. More accuratly I would say is it's not rare at some large,tertiary teaching hospitals for ENT to have their own microsurgeon (usually seperate from the oncologic surgeon for billing purposes). It's exceedingly rare outside that scenario for that to occur. It's also pretty rare for most of the large H&N resections to be done outside those same tertiary centers.

 

[Visioncam]

who seem to want to be plastic surgeons, focusing on just those two plastics procedures? Why aren't they interested in swinging flaps for decubs or in burn surgery? Why aren't they interested in sewing up the drunk guy's eyebrow at 3 in the morning?

If functional cases and reconstruction is the gold standard to determine if a surgeon is qualified to do cosmetic cases, then plastic surgeons are not qualified to do some cosmetic cases that they do.

For example, eyelid reconstruction and ptosis repair are commonly done by oculoplastic surgeons (or ophthalmic plastics) but not plastic surgeons. By that logic, only oculoplastic surgeons should be doing cosmetic eyelid surgery.

The same logic could apply to ENT and neck surgeries.

Plastic surgery is such a large field that it is not easy to master all the techniques and have lots of experience in everything. Plastic surgeons tend to be smart but sometimes overestimate their skill, as is the case with many people.

This is not to say plastic surgeons are bad or unique in this regard. For example, general surgeons think they know everything about burns but the burn fellowship trained plastic surgeon (or burn fellowship trained general surgeon) often has a lot more experience and knowledge. ER physicians think they've seen a lot, but their breadth is not matched with the experience of plastic surgeons.