Plastics vs Cosmetics?

[toofache32]

Neither is hundreds of other boards....

....such as the American Board of Oral & Maxillofacial Surgery. I guess I've been wasting my time these 6 years....

I've had similar thoughts as Fah-Q before. I've never understood how 3 years of gallbladders, pus, and trauma laps suddenly makes you more qualified to work on the face than those who spend their entire specialty training on the face. I've seen the PRS case logs at my institution (supposedly a "top-5 program"), and it's less than impressive in the facial area. However, they are obviously the guys to go to for reconstruction of the rest of the body. I just don't see how they think they can compete with people who spend their entire time on the face. Especially when occlusion comes into play.

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[GSresident]

Neither is hundreds of other boards. That doesn't make them marketing schemes. There are 24 boards recognized and the American Board of Otolaryngology is one of them. It certifies us to do general otolaryngology, not facial cosmetic surgery, even though it is part of our general training. The ABPS will certify you to do general plastic surgery, not facial cosmetic surgery, even though it is part of your general training. Additional training is not "redundant," it is prudent.

Indeed there are hundreds of boards not recognized by the American Board of Medical Specialties. There are all kinds of marketing schemes out there. For instance, for a couple hundred bucks, I could send off to the American Board of Physician Specialists (sounds kind of similar to the ABMS doesn't it?) and call myself a board certified Podiatrist. They require no actual training in the field and you can make up whatever you want to put on your board certificate. I am thinking about becoming a board certified asdghouasdfgsliuasgasd asdgifuasdfgggg.

As far as what the ABPS certifies me to do, you are just plain wrong and I am not going to argue with you. There is no such thing as general plastic surgery. There is Plastic and Reconstructive surgery, of which cosmetic surgery of the face is a part. How many of the AAFPS "board certified facial plastic surgeons" did a Plastic and Reconstructive surgery residency? I bet very very very few, because a real plastic surgeons doesn't need a phony certificate.

I

'm still waiting for you to answer my question: How many "face lifts and all other head and neck cosmetic procedures" does it take for one to become "extremely comfortable?"

I think the answer to that question depends on the person and program to program. It takes some people longer than others to learn the same procedure. We've all seen that when trying to train junior residents (at least those of us who have been chief residents before). Also there is a wide variation in the autonomy allowed to the residents in each program. You learn a lot more when you're planning and doing all the operations yourself with a little bit of direction from the staff. Sadly there aren't many programs out there that allow much autonomy any more. My program still has the traditional 'university' rotation which the resident runs. To answer your question more directly, it takes as many as it takes for you to feel comfortable.

Your fellowship must be top-notch for you to have already learned facial cosmetics, especially since you just started operating on the face 18 months ago.

Top notch to me isn't top notch to everyone. I wanted a program where I would get excellent clinical training. I am very satisfied with my program because we do get top notch clinical training. I won't be able to say that I am 'Harvard Trained' when I finish but I think I'll do just fine building a reputation based on my work.

Also, how do you know anything about what I did or did not operate on prior to 18 months ago?

Would you qualify to become board certified by the ABFPRS?

I wouldn't sully the wall of my office with a fake certificate. I haven't been in practice for 2 years so no I wouldn't qualify to get the fake certificate.

Your arrogance is palpable.

You, sir, are projecting. Furthermore I am only stating facts about the ABFPS. For some reason my stating the facts really irks you. In fact it irks you enough to resort to ad hominem. Thank you for handing me the 'I win' card.

Operating on the face is a challenge that requires extensive knowledge and training. One day you might figure that out.

Believe me I know that. That is why I have spent 7 years learning how to do it. I will only do things which I have been trained to do in my practice. I'm not looking to steal your mandibulectomy for cancer. I know how to reconstruct it but I will leave the cancer whack to the expert. I'm also not looking to steal your lucrative tube and tonsil business or your mastoidectomy business. ENT has a defined scope of practice and I don't plan on intruding. It does have some overlap with general surgery with the thyroids and parotids . Although I have training in those procedures I won't do those in practice either. See? I'm respecting your turf.

Maxheadroom - I agree with your assessment of the AAFPRS. The 100 case thing was developed to "grandfather" in all the guys that had been doing facial plastics for years but obviously couldn't stop their practices and do a year fellowship just to become board certified. This backdoor will soon be shut and all new AAFPRS members will be required to do one-year fellowships. I also agree that a general ENT wanting to do facial cosmetics needs more training. But I believe that the same should be expected of a general plastic surgeon...and it seems you guys disagree with that philosophy.

Keep dreaming about requiring PRS boarded surgeons to do a fellowship to book facelifts. Facelifts and other facial plastic surgery cases are established as part of the scope of practice for Plastic and Reconstructive Surgeons. If 2 years of operating on the face in an ACGME accredited PRS residency isn't enough, how is 12 months of a non-approved 'fellowship' with 1 guy? How do you explain that the ABFPS will accept my PRS training as the pre-req to get their fake certificate?

All the relevant facts about the ABFPS are in this thread. The fact that it has deteriorated to ad hominem means I'm done with this thread.

 

[Dr.Millisevert]

How many of the AAFPS "board certified facial plastic surgeons" did a Plastic and Reconstructive surgery residency? I bet very very very few, because a real plastic surgeons doesn't need a phony certificate.

Well.. I don't think that it has a lot to do with the certificate. Both ENT and OMFS are allowed to perform facial cosmetics because it is equally within the scope of their specialty too.

However, as someone stated before... We need to make sure we are ALL logging enough cases to make us competent. If ENT and OMFS are obtaining fellowships in cosmetics when they log just as much if not more cosmetic facial procedures than a graduate of a PRS residency. Then as someone stated.. it would be a good idea (including PRS graduates) to obtain extra logs/training in this area in the form of a fellowship.

 

[droliver]

This is a tired silly argument to me anymore. Scope of practice fights really have no endpoint, and it just ends up in circular firing squads among providers over who is qualified to do what.

As I mentioned waaaaay upstream, I'm convinced liability issues and likely restrictions on office-based cosmetic surgery practices will sort this out state-by-state for us.

 

[Fah-Q]

How many of the AAFPS "board certified facial plastic surgeons" did a Plastic and Reconstructive surgery residency? I bet very very very few, because a real plastic surgeons doesn't need a phony certificate...I wouldn't sully the wall of my office with a fake certificate.

Unbelievable...the funny thing is that your bookcase in your office will have books and articles written by "fake" facial plastic surgeons. Why don't you send a letter thanking them for the knowledge and telling them the certification on their wall is "phony."

If 2 years of operating on the face in an ACGME accredited PRS residency isn't enough, how is 12 months of a non-approved 'fellowship' with 1 guy?

Apparantly the pastic surgery leadership doesn't think 2 years is enough. All indepedent models will be 3 years long in the next few years.

We obviously have our own biased views on this topic. Droliver is right, this will have no endpoint.

 

[Long Dong]

Droliver is right, this will have no endpoint.

But it's been very interesting to read this thread.

 

[JaggerPlate]

Hello ... I am a pre med who is verryyyy far away from this discussion (obviously), but I am now confused about some things and I was wondering if I could get some things cleared up. The reason why I am confused is because I saw a surgeon who was a DO (not sure if this matters but I mention it because it was an AOA residency) who completed an oto - Facial Plastics residency then completed a one year cosmetic fellowship through the 'American Academy of Cosmetic Surgery' and now has a successful private practice in los angeles where she does facial and body work.

My question is that did she simply complete a residency, then a one year fellowship and is now in practice? Or was there an oto residency, a facial plastic fellowship and then the cosmetic fellowship. Also, how is this viewed? I know the academy of cosmetic surgery isn't an accredited agency so does she not have hospital access for cosmetic procedures? Would this put you at huge risk for lawsuits and give you no one to really back you if something went wrong? Also, for strictly a cosmetic practice (like she has) how is this viewed? I mean, is she a legit 'facial plastic and cosmetic surgeon' or is this a way of obtaining titles to make yourself seem qualified.

Once again sorry about this ... I am just looking for clarification on something that has been confusing me. I also wanted to state that I understand the amount of hard work, skill, and dedication that come with becoming a plastic surgeon ... therefore, I hope I am not insulting anyone, or stirring the pot by brining up someone who doesn't appear to have taken the same road.

 

[toofache32]

Hello ... I am a pre med who is verryyyy far away from this discussion (obviously), but I am now confused about some things and I was wondering if I could get some things cleared up. The reason why I am confused is because I saw a surgeon who was a DO (not sure if this matters but I mention it because it was an AOA residency) who completed an oto - Facial Plastics residency then completed a one year cosmetic fellowship through the 'American Academy of Cosmetic Surgery' and now has a successful private practice in los angeles where she does facial and body work.

My question is that did she simply complete a residency, then a one year fellowship and is now in practice? Or was there an oto residency, a facial plastic fellowship and then the cosmetic fellowship. Also, how is this viewed? I know the academy of cosmetic surgery isn't an accredited agency so does she not have hospital access for cosmetic procedures? Would this put you at huge risk for lawsuits and give you no one to really back you if something went wrong? Also, for strictly a cosmetic practice (like she has) how is this viewed? I mean, is she a legit 'facial plastic and cosmetic surgeon' or is this a way of obtaining titles to make yourself seem qualified.

Once again sorry about this ... I am just looking for clarification on something that has been confusing me. I also wanted to state that I understand the amount of hard work, skill, and dedication that come with becoming a plastic surgeon ... therefore, I hope I am not insulting anyone, or stirring the pot by brining up someone who doesn't appear to have taken the same road.

The real question here is "What type of results is she getting?" which nobody here can answer.

 

[Moravian]

I was really hoping this thread would finally go to bed, which sort of begs the question of why I'm jumping in again, but here goes....

People can pretty much call themselves anything, within reason. Where I did my plastics fellowship, there was a DDS oral surgeon who did the 3 and 4 years of medical school to get his MD. He then did a short "cosmetic" fellowship to qualify for the American Board of Cosmetic Surgery, which as you point out, is not recognized by the ABMS. In their defense, they do have some requirements as can be found on their website:

http://www.americanboardcosmeticsurgery.org/cert.php

It should be noted that these are not ACGME approved fellowships, and that the only real fellowship training requirement is that you've worked under a certified member of their board.

For the person I'm talking about, he dropped the DDS from his shingle and tried to bill himself as a plastic surgeon. He got into trouble with the local plastic surgeons who called the ABMS, ABPS and the ASPS. He then changed his sign to "cosmetic and reconstructive surgery" and on his website, he went on to say that he was more qualified than a general plastic surgeon to perform cosmetic surgery because he had "special" training. You see where this is going. Anyway, he doesn't have privileges at the university hospital for anything other than oral surgery but does have his own office where he does procedures. We did take care of one of his complications when they showed up in the ER. For the most part, I think his patients were happy...they certainly were charged a lot less for the same procedures than the plastics guys charged (caveat emptor).

So why am I blathering on about this? It's really just to illustrate that you really need to ask/research what your physicians qualifications are. Then realize that, for the most part, you get what you pay for. If the physician in question finished an ACGME approved ENT/ORL residency and did a reasonable facial fellowship, she's most likely qualified (one would hope) to perform her procedures. In a really competitive market, the addition of another certificate on the wall can't hurt, even if it may not mean much except to the uninitiated.

Anyone who is interested should visit the Board of Plastic Surgery website or the ASPS website to see what's involved with becoming a boarded plastic surgeon. I just passed my written exam, and I can tell you that it was a hell of lot harder than my general surgery board exam. There's a reason why not everybody passes. I hear the orals can be just as bad (I can hardly wait).

https://www.abplsurg.org/ModDefault.aspx
http://www.plasticsurgery.org/

To finish this up, the whole scope of practice thing will continue to play out as droliver noted. It's not always going to be fair and not everybody is going to be happy. My hope is that the primary interest in patient welfare will be foremost.

 

[toofache32]

Each specialty claims ownership of areas that the other specialties practice, but plastic surgeons have been the most aggressive at claiming ownership of cosmetic surgery to the point that they push propaganda that they are the only ones trained in it. As an oral surgeon, I don't go around telling people that plastic surgeons shouldn't do orthognathics and bone grafts....but maybe I should if I follow the logic of some of the PRS posts here.

 

[Moravian]

As an oral surgeon, I don't go around telling people that plastic surgeons shouldn't do orthognathics and bone grafts....but maybe I should if I follow the logic of some of the PRS posts here.

Perhaps, as an oral surgeon, you should tell your patients not to get orthognathic surgery from those who were not trained in it. I did some LeFort IIIs in training and a few more in my craniofacial fellowship (along with other things craniofacial). I have not, however, done any sagittal splits or two jaw surgery. In my future practice (which finally isn't that far away), I am not going to start doing two jaw surgery. I've done enough mandible work that I could probably pull it off, but it's not something I'm going to do just as a hobby. If a patient needs to be distracted, or have a LeFort III (or maybe a I) and I have orthodontic support, it's certainly something that's in my wheelhouse. If they need a split or a two jaw, I'm sending them to the oral surgeon. (Ken Salyer wouldn't be happy with this, but I never really liked him much anyway...)

I feel the same way about cleft surgery. I don't think plastic surgeons (or ENT, OMFS or anyone else) should "dabble" in cleft lip/palate repair. It's not that it's beyond the scope of plastic training, it's all the other things that go into it....the speech therapy, psychology, genetics, nutrition/feeding, audiology, ENT, speech surgery, bone grafts, etc. I strongly feel that these kids should be treated at a center where there is a full service team available. I realize that this isn't always possible, but it's then the onus is on the operating surgeon to insure that all the appropriate follow-up care is done.

To get back on subject, plastic surgery far more so than other specialties, has seen their territory infringed upon by those less qualified. This doesn't mean all infringers are less qualified, but a large majority are. And yes, I will agree that they have been very aggressive as a group at attempting to limit scope of practice as has been discussed. I will also submit that some of it certainly has to do with money, and I hope that some of has to do with keeping patients from harm. Does this mean I think that only plastic surgeons should perform cosmetic surgery? No, but I do strongly feel that no one should be doing procedures they're not trained for just to collect the paycheck.

 

[Dr.Millisevert]

For the person I'm talking about, he dropped the DDS from his shingle and tried to bill himself as a plastic surgeon. He got into trouble with the local plastic surgeons who called the ABMS, ABPS and the ASPS. He then changed his sign to "cosmetic and reconstructive surgery" and on his website, he went on to say that he was more qualified than a general plastic surgeon to perform cosmetic surgery because he had "special" training.

...If the physician in question finished an ACGME approved ENT/ORL residency and did a reasonable facial fellowship, she's most likely qualified (one would hope) to perform her procedures. In a really competitive market, the addition of another certificate on the wall can't hurt, even if it may not mean much except to the uninitiated.

First, I'm very sorry you had a poor experience with one of our colleagues. I also disagree with his/her marketing techniques. Trust me, this frustrates me just as much as it does you. I feel that OMFS should stick to H/N. Period.

Our specialty however is Oral and "Maxillofacial" surgery, (not simply oral surgery) and we are more than "just dentists", we are specialty surgeons who have completed 4-7 years of residency training. In the procedures most in our specialty have been trained to do we are just as competent as anyone else. This includes facial cosmetics and reconstructive. If I heard of an OMFS who was interested in doing anything below the neck, I would tell them to switch to general surgery and then do PRS.

In the second half of your post... you seem to at least suggest that someone who doesn't complete an ACGME accredited program (ie. OMFS (CODA) or any Osteopathic (AOA) accredited program) wouldn't be equally qualified to perform procedures they were trained in, and this I disagree with.

I feel the same way about cleft surgery. I don't think plastic surgeons (or ENT, OMFS or anyone else) should "dabble" in cleft lip/palate repair. It's not that it's beyond the scope of plastic training, it's all the other things that go into it....the speech therapy, psychology, genetics, nutrition/feeding, audiology, ENT, speech surgery, bone grafts, etc. I strongly feel that these kids should be treated at a center where there is a full service team available. I realize that this isn't always possible, but it's then the onus is on the operating surgeon to insure that all the appropriate follow-up care is done.


...Does this mean I think that only plastic surgeons should perform cosmetic surgery? No, but I do strongly feel that no one should be doing procedures they're not trained for just to collect the paycheck.

I agree with you here. I also think that if you want to treat cleft kids, you should ideally have completed a craniofacial fellowship and work in a multidisciplinary team.

 

[Moravian]

In the second half of your post... you seem to at least suggest that someone who doesn't complete an ACGME accredited program (ie. OMFS (CODA) or any Osteopathic (AOA) accredited program) wouldn't be equally qualified to perform procedures they were trained in, and this I disagree with.

Oops...my bad. In the self centric world of plastic surgery I forget that there are other accredited programs (CODA, AOA) as you pointed out. Thanks for the correction.

 

[JaggerPlate]

Thank you for the replies, and sorry for keeping an annoying thread on life support. If anyone else has any imput/clarification on the situation I would be very pleased to hear your input (I'm still kinda unclear)!!

 

[droliver]

I know the academy of cosmetic surgery isn't an accredited agency so does she not have hospital access for cosmetic procedures? Would this put you at huge risk for lawsuits and give you no one to really back you if something went wrong? Also, for strictly a cosmetic practice (like she has) how is this viewed? I mean, is she a legit 'facial plastic and cosmetic surgeon' or is this a way of obtaining titles to make yourself seem qualified.

Put it this way. If you have a major complication, AACS "board-certification" is going to be a very small fig leaf to hide behind when you are sued.

 

[...to_the_OR!]

Also, if plastics wants the cosmetic work - they can start buy taking all the facial trauma as a sign of good faith.

At our PRS program plastics does ALL the facial aesthetics, almost all the H/N recon, and ALL the face trauma. So it obviously varies by institution.

I plan on doing all of those as part of my practice someday without any additional fellowships. It's all about volume and experience.

 

[skilledhands]

I have researched cosmetic vs plastic surgery very seriously, and I have come to the conclusion that 1 year of cosmetic fellowship is equal to two years of plastics training if of course you want to do cosmetic surgery. Furthermore the problems within this debate go a lot further than just training issues. And cosmetic surgeons don't necessarily make more than general surgeons. My thoughts are based on the following:

1. If you do a 1 year hand fellowship after general surgery, you are qualified to perform all hand cases. Is hand surgery less complex than cosmetic surgery? I don't see any plastic surgeons upset that there are non-plastic surgeons doing hand. Of course hand does not pay as well as cosmetics.

2. You can do a 1 year body reconstruction fellowship with a plastic surgeon at certain academic centers and you are encouraged to go out and do recons even on pts you take tumors out of. Then of course there is no money in a free tram.

3. Plastic surgeons try there hardest not to be on face call and happily give it away to ENT and OMFS. Once again no money in face recons.

Now when you get to cosmetics there is money in it. That is why there are family practitioners who are doing breast augmentations etc. That is why plastics guys say you need full plastics training to do it. So I don't get it the OMFS guy can put together a face that looks like a jigsaw puzzle, but he or she can't do a facelift. I have seen some of the best plastic surgeons operate and some of the worst. And then again there are great OMFS guys and there are crappy ones. I would take a good OMFS than a crappy prs for an aesthetic surgeon.

I don't think someone with a year of intense cosmetic surgery training is any less qualified than a plastic surgeon, especially if they are boarded in general surgery. Pretty soon cosmetic surgeons will outnumber plastics guys, and then this argument will become irrelevant because they will have a larger number.

If you are a board certified general surgeon you will get hospital privileges, and then if there is a complication you can admit to your hospital. As a general surgeon I have had to take care of complications of plastic surgeons because they refused to see their patients in the hospital.

Now what really turns me off to aesthetic surgery is that it is a high overhead, highly competitive field. Every one and their mother is doing this. There are nurses doing botox, internists doing liposuction etc. Botox costs 525$ per bottle. The really people making money are the implant manufacturers and the dermal filler and botox companies. Physicians are just pushing product. We advertise the botox for Allergan, we advertise breast implants.

The real problem in medicine is the absolute lack of solidarity amongst physicians to regulate the practice and reimbursement of medicine. This is now affecting even plastic surgeons who initially thought they were immune to the insurance crisis. The insurance crisis has caused a heightened interest of all physicians into cosmetic surgery and aesthetic procedures. This interest has caused a competitive pricing market and thus lower reimbursements for all cosmetic physicians. If plastic surgeons were wise they would offer correct training for individuals who are interested in aesthetics. Not force individuals to do research + 3 years of slave labor. The first thing that should be eliminated is slave labor i.e. residency. This would dramatically increase the reimbursement of all physicians. If you get paid correctly in residency you are less likely to go into a field you are not qualified to practice in. Secondly if you get paid 100 grand in residency you should get a mil a year when you get out. Lastly physicians must in the next few years adopt a reasonable answer to the medicare professional fee schedule, which is ridiculous.

In conclusion do what you are passionate about and understand that medicine is a business. If you love cosmetics then do it. It is better to be a happy cosmetic surgeon than an unhappy general surgeon. It is now very competitive to get into a plastics fellowship given the difficulty with insurance reimbursements. Everyone is a aware of the problems and is running to do plastics. Plastics fellowships also want people who have spent time in a lab.

 

[skilledhands]

1. Plastic surgeons are not allowed to advertise until they are boarded in plastic surgery, meaning even after you are done with your fellowship you have 3 years of case building before you can start putting ads out there. This is assuming you pass your oral boards. Source: American Board of Plastic Surgery

2. A cosmetics practice carries the highest overhead of any type of medical office. Approximately 50-80% of gross goes to overhead. Source: Medical Economics.

3. The average plastic surgeon makes 300-400 grand Source: Medical Economics.

4. Cosmetic surgery is highly affected by economic downturns. There is currently a 30% reduction in cosmetics procedures as a result of our current recession. (Wall Street Journal)

5. Cosmetic surgery is up 300% since the 1990s. ASPS

Does anyone have any comments on the business side of cosmetic surgery?

 

[dilated]

I don't think someone with a year of intense cosmetic surgery training is any less qualified than a plastic surgeon, especially if they are boarded in general surgery. Pretty soon cosmetic surgeons will outnumber plastics guys, and then this argument will become irrelevant because they will have a larger number.

Your conclusion does not follow from your premise. My grandparents live in a rural area that has at least 3 family practitioners who like to do as much dermatology (read: $$$) as possible and only one board certified dermatologist. This does not, as his infinitely long waiting list will attest, make him irrelevant.

 

[jdm51]

1. Plastic surgeons are not allowed to advertise until they are boarded in plastic surgery, meaning even after you are done with your fellowship you have 3 years of case building before you can start putting ads out there. This is assuming you pass your oral boards. Source: American Board of Plastic Surgery

you only need to compile cases for 7 months once in practice

 

[maxheadroom]

True. As I understand it, the collection period runs from Sept 1 until March 31. The part that sucks is that you don't find out if you passed until after the next period has started, so you have to keep up the pace of med records/photos and the like until you get the final word!

 

[skilledhands]

Your conclusion does not follow from your premise. My grandparents live in a rural area that has at least 3 family practitioners who like to do as much dermatology (read: $$$) as possible and only one board certified dermatologist. This does not, as his infinitely long waiting list will attest, make him irrelevant.

I personally have the highest degree of respect for all plastic surgeons and I do not believe that someone with 1 year of cosmetic surgery training can perform plastic and reconstructive surgery. But they can certainly perform all aspects of cosmetic surgery. The field of plastic surgery is far broader than just aesthetics, and I realize that. I did not mean to say that plastic surgeons are irrelevant, but this argument will be. With all the money that is being pumped into cosmetic surgery by the implant manufacturers and all the other large corporations which stand to gain money by greater practitioners in this area, there will eventually be more non-traditional cosmetic surgeons than plastic surgeons. These non-traditional practitioners will form a less regulated body, which is more consumer and corporate driven and will have more power. They are not restricted to advertising laws or anything else. Plus most academic plastic surgeons frown on private practice cosmetic surgery. Everyone knows that you should never mention cosmetic surgery in a plastics interview. As the academic body of plastic surgery continues to turn its back on the reality of cosmetic surgery, it will continue to grow unregulated. Instead of being leaders in this area, plastic surgeons have only criticized and mocked anyone outside their own small group. This is certainly a mistake. Plastic surgeons are also very competitive with one another, whereas cosmetic surgeons are far more helpful to one another because they have a common cause. Some of the atrocities that have happened to cosmetics patients have been at the hands of highly trained plastic surgeons. Jan Adams is trained in plastics and has done a 1 year aesthetics fellowship on top of that. Robert Rey has also done a plastics fellowship along with a secondary breast fellowship. So doing advanced training in plastic surgery does not necessarily make the greatest of surgeons. Plastic surgeons really should take the initiative and embrace non-traditional cosmetic surgeons, and form a serious regulatory body which makes sense for everyone. At the going pace it will probably be the cosmetic surgeons who start setting the standards.

I personally had the opportunity to take a 3 year plastics fellowship at a program which offered very little to no aesthetics training. This would have meant taking an additional aesthetics year after I was done. So I made a serious evaluation of this area. In total by the time I would have finished, it would have equaled 10 years of post-graduate training. In addition once I finished I would have to work for someone, because I really do not see how you can build a cosmetics practice without advertising given the restrictions of the ABPS. This is in contrast to doing one year and being unrestricted. I really think it is a no-brainer. Why would anyone go through being paid nothing for years on end just to be able to say that they are a plastic surgeon at a dinner party or a chat room. I would rather get paid correctly for my time, and provide a better life for my family.

 

[Leforte]

Droliver, agree with some of what you said, but an ENT does not go to a weekend course and because AAFPS certified. I some of our generalist ENT practices here, we do complex rhinoplasty, blephs, forehead flaps, cervical facial flaps, facial trauma, etc, etc. As with General Plastics, we, too, have RRC minimum facial plastics requirements.

If you can do a coronal flap for a frontal sinus obliteration - you have the knowledge to do a brow lift. Let's face it, endoscopic lifts are not rocket science. If you're doing orbital floor trauma, the approach is the same for a bleph. Rhytidectomy approaches and skin elevation is a variant of a parotid approach. Personally, I think that the fundamentals of facial plastic surgery are not that difficult to grasp given good ENT training. I do agree, however, that to do it well it takes years of practice, regardless of the surgeon being FPS or ABPS certified.

Also, some surgeons are more gifted than others and there are a few who I wouldn't let touch me. No specialty certification means that a surgeon is gifted, just competent. My personally opinion of who should be performing any operation is that as long as you were trained and have kept your skills up, the primary surgical specialty shouldn't matter.

I never really understood why surgeons get upset with other surgical specialties that have overlapping procedures. Nor have I understood why cosmetic surgery is so cut throat.

It is interesting, however, that I often find that everyone seems to want the cash cow cosmetic stuff, but will easily pass the facial trauma to another specialty.

 

[PRS Man]

As surgeons, we have the privilege to do something we love each and every day. If you are doing cosmetics because of the money and not because of the love for the cases and the patients, then you are going to be unhappy...guaranteed. We all could have chosen a number of other professions that would have made us more money, but we chose to help people and have a great time doing it. If micro, hand or craniofacial is what turns you on, doing anything else will leave you unsatisfied. Join an academic center, don't par with insurance, play the stock market...figure something out. As a chief resident, I have had a very bountiful cosmetic experience. I enjoy the cases, the immediate results, the gratitude of the patients, and the general overall good health of my patients. For these reasons, I am going to pursue cosmetic surgery. On a complete tangent, how many General, ENT, and plastic surgeons in this forum do some sort of mission work...cleft lip/palate, ect. Does anyone feel strongly about a surgeon who is trained in cleft lip/palate surgery from residency without a craniofacial fellowship doing these mission trips once or twice a year?

 

[PRS Man]

Furthermore, that "General" Plastic surgeon concept is bogus. In my program, we are equally trained in reconstructive surgery as cosmetic surgery. Each program across the country, obviously has a greater focus in one particular area. It is the job of the program to get its residents adequate exposure to all 4 areas of plastic surgery: hand, recon, craniofacial, and cosmetics. The vast breadth and depth of plastic surgery is what makes it such a unique specialty.

 

[maxheadroom]

You shouldn't be doing cleft lip and palate work outside of the U.S. if you don't do it as part of your practice in the U.S. Operation Smile now has a minimum number of clefts that you have to do per year in order to go on trips (they've grandfathered in people who were already involved with the organization). They did this in response to increasing concern about unqualified surgeons doing less-than-stellar repairs and the high number of palatal fistulas that they were seeing in their patients.

If you want to do mission work or "give back" you can do it best by taking care of a reasonable number of Medicare/Medicaid patients. You don't have to bankrupt your practice to give something back to your own community. Give money to the missions organizations so they can send someone who is best suited to that kind of work and take care of your own neighbors in your community.

 

[Pir8DeacDoc]

You shouldn't be doing cleft lip and palate work outside of the U.S. if you don't do it as part of your practice in the U.S. Operation Smile now has a minimum number of clefts that you have to do per year in order to go on trips (they've grandfathered in people who were already involved with the organization). They did this in response to increasing concern about unqualified surgeons doing less-than-stellar repairs and the high number of palatal fistulas that they were seeing in their patients.

If you want to do mission work or "give back" you can do it best by taking care of a reasonable number of Medicare/Medicaid patients. You don't have to bankrupt your practice to give something back to your own community. Give money to the missions organizations so they can send someone who is best suited to that kind of work and take care of your own neighbors in your community.

Great thoughts on this topic. Thanks!

 

[maxheadroom]

Glad you appreciated it. It just pisses me off that surgeons who haven't done a cleft in years will go and assuage their conscience for their cosmetic-only practice by doing clefts in the third world (and often doing them poorly) when they won't take care of the patients in their own community. If everybody would do a small part, it wouldn't be a big deal.

 

[PRS Man]

It just pisses me off that surgeons who haven't done a cleft in years will go and assuage their conscience for their cosmetic-only practice by doing clefts in the third world (and often doing them poorly) when they won't take care of the patients in their own community. If everybody would do a small part, it wouldn't be a big deal.
Max,
There are cleft surgeons in my community doing these cases and helping these children. While I may not do these cases in my practice, I was trained to do these cases to the standards expected of us as plastic surgeons. While taking medicaid is important, there is something special about going into the mission field and helping these families who have no other hope. I do not do mission work to assuage my conscience, I do it because I enjoy it and I enjoy helping those less fortunate.

 

[Leforte]

We do mission work as part of our training. Our FPS attending goes, and usually is doing facial reanimation work. We don't do clefts at our institution, and it would be inappropriate for us to do them in another country. As ENTs, when we go as residents (R4/R5 year) we do ears, thyroids, etc - no FPS stuff. If a trained surgeon wants to do them in a foreign country, I'm not sure what my feelings are - clefts are a tough niche to build, and there are far more kids in developed countries than surgeons to perform the operation. Importantly, one can not just show up and do them - therw is a credentialing process, just like any other type of privileging.

The guy who does the most here in town is ENT/Plastics/Craniofacial trained. Does ~50 a year and, of course, has a whole program to support the kids. In our field, several FPS felowships offer good cleft training (UC Davis comes to mind), but certainly not all train a cleft surgeon - Our intergrated plastics program does a few a year.

 

[skilledhands]

I have a met a number of guys who claim to be plastic surgeons, and then when you ask where they did their training they qualify that they are "facial plastic surgeons". It probably would be best for plastic surgeons to trademark the term plastic surgeon and facial plastic surgeon, hand plastic surgeon, penile plastic surgeon etc. Then sue anyone claiming to be a plastic surgeon. Plastic surgeon of the face really means you can handle congenital defects, cancer recon all over the scalp and face, burns to the face etc. As a general surgeon when I have a consult for a burn to the face I am not going to call a facial plastic surgeon. This is just a way to mislead patients into thinking that ENTs are plastic surgeons. They should call themselves something else and stand on their own merits.

 

[Pir8DeacDoc]

As a general surgeon when I have a consult for a burn to the face I am not going to call a facial plastic surgeon. This is just a way to mislead patients into thinking that ENTs are plastic surgeons. They should call themselves something else and stand on their own merits.

blah blah blah.

Maybe you should take this up with the ancient Greeks. Let them know that your PRS colleagues have trademarked their word.

 

[Moravian]

blah blah blah.

Maybe you should take this up with the ancient Greeks. Let them know that your PRS colleagues have trademarked their word.

Hey, I'm Greek (well, half greek), but not that ancient yet. Speaking for my fellow countrymen, I completely agree. As long as you don't call yourself "board certified" when you're not, even though we've had some major discussion on what that means, let's not give the lawyers any more of our paychecks.

As an aside, I have witnessed (as I'm sure some others have had as well) board certified plastic surgeons who I wouldn't let put a stethoscope on my pet turtle. Thankfully this is a rare occurrence, but it just goes to show that a name isn't everything.

Can we please talk about something else now?

--M

 

[-Goose-]

I have sirius sat radio, and on my drive to school the other morning I heard an advertisement for a very-shading sounding "1-888-doctor-say-yes" company(http://doctorssayyes.net/pricing.php). They claim 100% financing, no one will be turned down, etc. They say their surgeons are 'board certified'. The commercial sounds like someone trying to lure you into a car lot.

My question is in what? I thought there were laws restricting PRS physicians from advertising like this. Are these docs board certified by the American Board of Cosmetic Surgery? Anyone know?