Whats the difference between a plastic residency and a cosmetic surgery fellowship?

[LSU-Tech]

Is there a difference? According to this this website- http://www.americanboardcosmeticsurgery.org/fellowship_route.php
-if a physican completes residency in general surgery, he or she only has to complete a one year fellowship in cosmetic surgery. Are these fellowship hard to obtain. I'm sorry if my posts is stupid. I am completly ignorant on this topic.

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[toofache32]

There is a difference.

Cosmetic surgery refers to cash-paying cosmetic procedures. Plastic & Reconstructive surgery refers to a broad scope surgery including flaps, burn surgery, hand surgery, microvascular surgery, craniofacial surgery, and other stuff. Cosmetic surgery is included in plastics training to varying degrees, but these days there are ways to get more focused training in cosmetics, believe it or not. Historically, a plastic & reconstructive surgery residency was the only way to learn these cosmetic procedures. Multidisciplinary cosmetic fellowships are now out there which allow you to spend an entire year or two doing only cosmetic procedures. You have to remember that these fellowships are at least a full year of only cosmetic procedures, whereas the traditional plastics training (2 years) is split up over the very broad scope they practice often with only a small amount of cosmetics.

The plastics guys are gonna come on here and tell you that the American Board of Cosmetic Surgery is not a board recognized by the American Board of Medical Specialties. This is true, but it was true of virtually all specialties at some point.

 

[LSU-Tech]

There is a difference.

Cosmetic surgery refers to cash-paying cosmetic procedures. Plastic & Reconstructive surgery refers to a broad scope surgery including flaps, burn surgery, hand surgery, microvascular surgery, craniofacial surgery, and other stuff. Cosmetic surgery is included in plastics training to varying degrees, but these days there are ways to get more focused training in cosmetics, believe it or not. Historically, a plastic & reconstructive surgery residency was the only way to learn these cosmetic procedures. Multidisciplinary cosmetic fellowships are now out there which allow you to spend an entire year or two doing only cosmetic procedures. You have to remember that these fellowships are at least a full year of only cosmetic procedures, whereas the traditional plastics training (2 years) is split up over the very broad scope they practice often with only a small amount of cosmetics.

The plastics guys are gonna come on here and tell you that the American Board of Cosmetic Surgery is not a board recognized by the American Board of Medical Specialties. This is true, but it was true of virtually all specialties at some point.

Thanks for your reply toofache32

I've heard that a plastics residency is CRAZY HARD to land. Is a fellowship in cosmetic a lot easier to obtain? I'm looking at going to a D.O. school so a plastics residency is almost out of the question. I think it will be much easier to just do gen. surg (that will be difficult to match too, but not as hard as plastics). Then I plan on taking fellowship rought because all I really want to do is cosmetic procedures away. It seems more fit and more resonable for what I want to do. So, how much easier is it to land than Plastics?

Thanks

 

[toofache32]

I have no idea how comptitive they are because I have no interest in that and haven't looked into it. My gut reaction is that they're not as competitive, but then again, there are not many of these fellowships out there and you're competing with people of many different specialties.

 

[novacek88]

Anyone can do a cosmetic fellowship. They are not competitive at all. They operate more like 1-2 year long seminars as opposed to formal fellowships so these fellowships make quite a profit. The training is quite adequate as they concentrate only on cosmetic procedures, which are not all that difficult to perform from I gathered from plastic surgeons in general.

The challenge is getting into a general surgery residency. I think this is a big reason general surgery got competitive again in the last 3 years. It's because aspiring plastic surgeons no longer needed to get into a formal PRS fellowship. They just get into one of the mom and pop cosmetic fellowships that accept anyone and then focus solely on cosmetic procedures.In the future, the supply of cosmetic surgeons will increase as these fellowships begin to increase. I think you will also the demand for general surgery skyrocket as well. Now, a general surgery resident knows he or she is at least assured a cosmetic fellowship at the end of his residency.

The public in general doesn't care nor are they really aware of the differences between a PRS surgeon and cosmetic fellowship trained surgeon so I wouldn't fear a backlash by the public. It's this trend that has drawn the ire of PRS residents and plastic surgeons in general. The reality is a lot more people are going to be practicing cosmetic surgery than they would prefer.

 

[novacek88]

There is a difference.

Cosmetic surgery refers to cash-paying cosmetic procedures. Plastic & Reconstructive surgery refers to a broad scope surgery including flaps, burn surgery, hand surgery, microvascular surgery, craniofacial surgery, and other stuff. Cosmetic surgery is included in plastics training to varying degrees, but these days there are ways to get more focused training in cosmetics, believe it or not. Historically, a plastic & reconstructive surgery residency was the only way to learn these cosmetic procedures. Multidisciplinary cosmetic fellowships are now out there which allow you to spend an entire year or two doing only cosmetic procedures. You have to remember that these fellowships are at least a full year of only cosmetic procedures, whereas the traditional plastics training (2 years) is split up over the very broad scope they practice often with only a small amount of cosmetics.

The plastics guys are gonna come on here and tell you that the American Board of Cosmetic Surgery is not a board recognized by the American Board of Medical Specialties. This is true, but it was true of virtually all specialties at some point.

My compliments...very nice response.

 

[jdubya]

With a $50 check I can register the "American Board of facial plastic and cosmetic surgeons with a focus on rhinoplasty" and call myself the founding member. That doesn't mean I'm not some hack dentist trying to do things I ought not be doing because I think a residency full of wisdom tooth removal and facial plating is the same thing as a broad training in the appropriate handling of tissue. The point is this: you can do a chunk of time with a cosmetic surgeon and you can call yourself whatever you want, but unless you are a plastic and reconstructive surgeon, then you are lying to yourself and your patients by claiming to be a "cosmetic surgeon." You're the medical equivelant of jimmie baker calling himself a man of God when it is overwhelming greed and a desire to be something you are not that has guided your decisions. As the field matures and settles down, I think you will find the discerning customer will begin to do his or her homework and the non-discerning customer will continue to not. This will lead the nutcases to the "cosmetic surgeon" and the serious patients to the plastic surgeon. You are welcome to the nutcases.

 

[toofache32]

Again, I have no interest in these procedures (or more accurately...patients) but I still do them in my OMFS program because it's something to operate. I'm not sure where the "broad training in the appropriate handling of tissue" comment fits into this. So you're saying I shouldn't be using staples on the face? Just kidding...we all read the same textbooks, use the same instruments and sutures, and practice the same techniques. I'm not sure how 3 years of man-handling pus and gallbladders makes a surgeon more qualified to work on the face than those who spend their entire residencies moving that same tissue.

 

[jdubya]

being a plastic surgeon is more than being a person who does plastic surgery procedures. There is a different level of thought and appreciation that goes into a training structure where you are a plastic surgeon every day, not just on the afternoons when one of your attendings has a plastics case. That training, and for 6 years, teaches you from the start how to correctly handle tissue to minimize damage, how to approach surgical incisions in light of previous or future operative techniques and so on. This is something you cannot be expected to understand but it is a factor.

 

[LSU-Tech]

being a plastic surgeon is more than being a person who does plastic surgery procedures. There is a different level of thought and appreciation that goes into a training structure where you are a plastic surgeon every day, not just on the afternoons when one of your attendings has a plastics case. That training, and for 6 years, teaches you from the start how to correctly handle tissue to minimize damage, how to approach surgical incisions in light of previous or future operative techniques and so on. This is something you cannot be expected to understand but it is a factor.

I can see where you are coming from and for the most part you are right. However, I'm not talking about someone who is a dentists pursuing cosmetic surgery. I am talking about someone who has cmpleted a 5 year residensy in general surgery pursuing these cosmetic fellowships. I mean, these guys are not quacks. General Surgery teaches doctors very important disaplines regarding surgery and patient care. In the end, I believe a General Surgery residency should produce very well rounded doctors that should have no problem performing less complecated cosmetic procedures ( WITH A VERY GOOD FELLOWSHIP PROGRAM) If these fellowship surgeons were performing risky craneofacial reconstructive surgeries I could see your point. As a physician, they should know when a procedure is way over their head and completly out of their scope of training. When this happens they should do the right thing and encourage the patient to see a doctor whose had more experience performing the procedure the patient needs. However, when it comes to basic COSMETIC precudures (Not RECONSTRUCTIVE). I believe that a doctor who has went though 5 years of general surgery and around 2 years of performing the same cosmetic procedures through a good fellowship program should be able to perform basic cosmetic procedures. That being said, I believe dentist should not be able to perform these prosedures. Except for OMFS who should be able to perform most procedues regarding the face (I mean with extra training in cosmetics, of course).

 

[toofache32]

That being said, I believe dentist should not be able to perform these prosedures. Except for OMFS who should be able to perform most procedues regarding the face (I mean with extra training in cosmetics, of course).

When you say "dentist" do you mean general dentist? I would be interested to know what general dentists are doing facial cosmetics.

 

[LSU-Tech]

When you say "dentist" do you mean general dentist? I would be interested to know what general dentists are doing facial cosmetics.

Not at all! I can now see how you might have thought that I said that. That's not what I was trying to say. I just meant Oral and Maxiofacial Surgeons with a DDS/MD. I think a general denists should just stick to the mouth. General Dentists are not physicians who are trained to diagnose treat and perform surgery on all parts of the body. Correct me if I'm wrong, but isn't it illegal for a general dentist to perform such proceures? I didn't think they were licensed to do such things. I do not beleive General Dentistry would prepare a doctor to perform risky facial surgery. On the other hand, Oral and Maxiofacial Surgery (DDS/MD) would. These guys are licensed physicans and in my opinion are well prepared to perform facial cosmetic procedures of the face (nowhere else) as long as they undergo aditional training in cosmetics.

Earlier, when I was talking about General Surgeons performing cosmetic procedures, I meant only that. Cosmetic surgery is one thing. Reconstructive surgery is something completly different than what I was getting at. Such procedures should ONLY be performed by board certified physicains who have completed a residency in plastics.

 

[OzDDS]

Not at all! I can now see how you might have thought that I said that. That's not what I was trying to say. I just meant Oral and Maxiofacial Surgeons with a DDS/MD.

These guys are licensed physicans and in my opinion are well prepared to perform facial cosmetic procedures of the face (nowhere else) as long as they undergo aditional training in cosmetics.

It sounds to me that what you're referring to as "dentists" are single degree DDS OMS guys. But these, guys typically have just as much if not more surgical training then dual degree Oral and Maxillofacial surgeons when they graduate. AND Having the medical degree too does not change your scope of practice as an OMS anyhow.

"That being said, I believe dentist should not be able to perform these prosedures. Except for OMFS who should be able to perform most procedues regarding the face (I mean with extra training in cosmetics, of course)."

Extra trainig in cosmetics... ok. Nothing wrong with that. But what if OMS residents (and ENT) do the same number of head/neck facial cosmetic cases (if not even more!!) than graduates of ACGME accredited Plastic and Reconstructive surgery residents during their training? Then I don't see what the point is, because they would both be equally qualified in this area. By that rational, You should make MD PRS graduates do a fellowship year in "cosmetics" before they should practice them as well.. (for the face).

 

[LSU-Tech]

Extra trainig in cosmetics... ok. Nothing wrong with that. But what if OMS residents (and ENT) do the same number of head/neck facial cosmetic cases (if not even more!!) than graduates of ACGME accredited Plastic and Reconstructive surgery residents during their training? Then I don't see what the point is, because they would both be equally qualified in this area. By that rational, You should make MD PRS graduates do a fellowship year in "cosmetics" before they should practice them as well.

A lot of PRS surgeons do obtain additional training in cosmetics after residency. Thats the main reason I do not believe Cosmetics should only belong to PRS.

As for an oral surgeon without a dual DDS/MD performing cosmetic proceures, I do not know much about that so I'm not going to argue the topic. You might be right; I don't really know much about it.

 

[toofache32]

It sounds to me that what you're referring to as "dentists" are single degree DDS OMS guys. But these, guys typically have just as much if not more surgical training then dual degree Oral and Maxillofacial surgeons when they graduate. AND Having the medical degree too does not change your scope of practice as an OMS anyhow.

Not to get off-topic, but this is exactly right. OMS is a dental specialty. The MD is optional and peripheral to the training. The non-MD programs actually spend more time on OMS and theoretically may have more surgical experience. You don't really learn to operate in medical or dental school....you learn it in your residency. A few weeks of finding xrays and lunch for my residents (as a surgery med student) did nothing to further my surgical education. I really only bothered with the medical degree because I'm planning on an academic career, and 2 more letters after your name helps in the academic world.

 

[droliver]

AND Having the medical degree too does not change your scope of practice as an OMS anyhow.

But what if OMS residents (and ENT) do the same number of head/neck facial cosmetic cases (if not even more!!) than graduates of ACGME accr.

1. In point of fact, single degree dentists/OMFS are vulnerable to being legislatively prohibited from performing cosmetic surgery & have been in a number of states. There is a huge state by state battleground going on about this right now. Dual-degree DDs-MD are not affected by this (presently) as MD's are given much wider lattitude for scope of practice traditionally. That idea is likely to eventually be mothballed as states increase scope of practice regulations for all physicians, nurses, CRNA's, LNP's, dentists, and other alied health providers. You can see the writing on the wall about this increased regulation down the road.

2. You're making a false comparison trying to equate advance dental training with what's traditionally been a post-graduate fellowship with much more experienced surgeons as the trainees. I think certainly an oral surgeon brings much more advanced concepts of occlusional relationships & craniomaxillary orthopedics to the table, but to parlay that into an argument about soft-tissue based aesthetic surgery is an rhetorical exercise in medical economics rather then qualifications

 

[jdubya]

I can see where you are coming from and for the most part you are right. However, I'm not talking about someone who is a dentists pursuing cosmetic surgery. I am talking about someone who has cmpleted a 5 year residensy in general surgery pursuing these cosmetic fellowships. I mean, these guys are not quacks. General Surgery teaches doctors very important disaplines regarding surgery and patient care. In the end, I believe a General Surgery residency should produce very well rounded doctors that should have no problem performing less complecated cosmetic procedures ( WITH A VERY GOOD FELLOWSHIP PROGRAM) If these fellowship surgeons were performing risky craneofacial reconstructive surgeries I could see your point. As a physician, they should know when a procedure is way over their head and completly out of their scope of training. When this happens they should do the right thing and encourage the patient to see a doctor whose had more experience performing the procedure the patient needs. However, when it comes to basic COSMETIC precudures (Not RECONSTRUCTIVE). I believe that a doctor who has went though 5 years of general surgery and around 2 years of performing the same cosmetic procedures through a good fellowship program should be able to perform basic cosmetic procedures. That being said, I believe dentist should not be able to perform these prosedures. Except for OMFS who should be able to perform most procedues regarding the face (I mean with extra training in cosmetics, of course).

I guess my take on things is again, general surgeons are trained in general surgery techniques, where staples rule the day and machines, not hands, do a lot of the anastamosis. You are not taught the things that make a good plastic surgeon a good plastic surgeon. You are taught the intricate details of the things that are important to a general surgeon but while you are learning the basic science of liver disease and UC, plastics residents are learning the basic science of wound healing in great depth, the basic science of skin grafts and flaps in great depth and so on. Both gen surg and plastics residents develop a knowledge infrastructure that guides them during their careers and fellowships and, plain and simple, without doing a formal plastics residency or fellowship, a general surgeon's knowledge and appreciation for these things is inherently inferior. Same goes for dentists. It is not the technical details of a face-lift that make it specific to plastic surgeons, it is the foundation of their training that allows them to work on these very aesthetically sensitive areas. This, of course, is in reference to the best plastic surgeons, not all of them.

 

[toofache32]

I guess my take on things is again, general surgeons are trained in general surgery techniques, where staples rule the day and machines, not hands, do a lot of the anastamosis. You are not taught the things that make a good plastic surgeon a good plastic surgeon. You are taught the intricate details of the things that are important to a general surgeon but while you are learning the basic science of liver disease and UC, plastics residents are learning the basic science of wound healing in great depth, the basic science of skin grafts and flaps in great depth and so on. Both gen surg and plastics residents develop a knowledge infrastructure that guides them during their careers and fellowships and, plain and simple, without doing a formal plastics residency or fellowship, a general surgeon's knowledge and appreciation for these things is inherently inferior. Same goes for dentists. It is not the technical details of a face-lift that make it specific to plastic surgeons, it is the foundation of their training that allows them to work on these very aesthetically sensitive areas. This, of course, is in reference to the best plastic surgeons, not all of them.

I understand what you're saying here and I tend to agree to a certain extent. ..I agree that these fundementals you mention are important, but I disagree that PRS attendings have a monopoly on this knowledge and experience. Like I said before, it's not like Plastics uses 6-0 Prolene on the face while everyone else uses staples. Also, the face is all we OMFS guys know, so we treat it delicately from day 1 of residency, versus the way I see the general surgery guys cut into bellies and hack away at amputations...it really must seem like a shocking and novel way of thinking to transform into the Plastics years where wound eversion actually matters.

I came into OMFS believing the things you've said, merely because "they're the Plastic Surgeons by golly!" and that's just what all outsiders have been fed over the years by either the media or the Plastics guys. But after doing over half my OMFS training, and rotating on Plastics, the only difference I see when operating on the face is the egos & attitudes, mainly with the attendings. I'll not go into detail there because I have great respect for my Plastics buddies and I don't want to start anything sour here...I'm really enjoying this thread and I'm glad it's staying civil. I just think that many assumptions are made about OMFS by people who have little interaction with the specialty other than jawing around (pun intended) in the hall or locker room. I just don't thing everyone is as qualified as they think they are to make the comparisons they claim.

I'm really only talking about the face here. Looking at the Plastics case logs, our OMFS chiefs average about 3x the number of noses (for example). But on the other hand, it's not surprising because we spend a longer residency only on the face while Plastics have to spend a shorter residency where they have to worry about the whole body.

 

[OzDDS]

The fact is.. Oral and Maxilofacial surgery has more in common with Plastic and Reconstructive surgery than any other surgical specialty around. As they were both created from the same group of individuals.

http://www.plasticsurgery.wustl.edu/Teaching/History.asp

the American Association of Oral and Plastic Surgery (later renamed the American Association of Plastic Surgeons)

It was OMS and Plastics that both together pioneered facial plastic surgery in the first place during WWI!

 

[LSU-Tech]

I guess my take on things is again, general surgeons are trained in general surgery techniques, where staples rule the day and machines, not hands, do a lot of the anastamosis. You are not taught the things that make a good plastic surgeon a good plastic surgeon. You are taught the intricate details of the things that are important to a general surgeon but while you are learning the basic science of liver disease and UC, plastics residents are learning the basic science of wound healing in great depth, the basic science of skin grafts and flaps in great depth and so on. Both gen surg and plastics residents develop a knowledge infrastructure that guides them during their careers and fellowships and, plain and simple, without doing a formal plastics residency or fellowship, a general surgeon's knowledge and appreciation for these things is inherently inferior. Same goes for dentists. It is not the technical details of a face-lift that make it specific to plastic surgeons, it is the foundation of their training that allows them to work on these very aesthetically sensitive areas. This, of course, is in reference to the best plastic surgeons, not all of them.

I agree with you 100%. I never mentioned that a general surgeon should practice plastic and cosmetic surgery without the proper fellowships. Even though it does happen, it is insane for a surgeon to believe that general surgery alone would prepare a doctor for these procedures.

 

[navysurgeon]

Dr. LSU-Tech,

Will you please do my wife's facelift?

You sound like a ****ing genius.

X-TNS

 

[startswithb]

So general surgeons can perform all body and face cosmetic surgeries after just a one year fellowship? How is that enough training? Are nose jobs and body lifts that simple?