NEWSLETTER

Summer 2008

Who is a Cosmetic Surgeon?

Let me explain by giving a short history of American cosmetic surgery. Over 50 years ago, a few adventurous dermatologists and plastic surgeons started experimenting with new and more effective ways to improve people's appearances. The dermatologists approached the problem from the perspective of the skin above and the plastic surgeons from the structure and form under the skin. Each group of cosmetic surgery pioneers, and they were a hardy risk taking group, developed on their own various new techniques such as dermabrasion, chemical peeling and hair transplantation from the dermatologists and face lifting, nose reconstruction and breast reconstruction from the plastic surgeons. Of course there were many other types of surgeons also involved in this endeavor, some newer procedures were introduced by both groups independently and often their advances overlapped each other. By the 1980's there were a few new surgical societies which included dermatologists, plastic surgeons, ear nose and throat specialists and a larger organization which encompassed all such cosmetic surgeons, the American Academy of Cosmetic Surgery (AACS). Their own specialty organizations had originally discounted this new field of cosmetic procedures but the sudden public interest in purchasing such services led to a race among all the surgical fields to learn each new procedure and make it their own.

For 20 years or so the plastic surgery society attempted to eliminate their competition in cosmetic surgical procedures by a concerted national advertising and public relation campaign denigrating any surgeon claiming to be a cosmetic surgeon who was not a "certified plastic surgeon". In addition, their society lobbied state legislatures to get laws passed which would make it difficult for their competition. At the same time, the plastic surgeons were learning from dermatologists and other surgeons around the world, who had invented and perfected many cosmetic surgical procedures, and then they tried to claim that they had invented them and sometimes even tried to change the name of the procedures to bolster their claims. It would have been only comical except that all the other surgical societies had to spend a lot of time and money fighting these well financed attacks on their work. In the final analysis it would appear that not all Americans were convinced by the plastic surgery warnings and claims, as time and time again, their claims were proven to be untrue. It was a very confusing time for prospective cosmetic surgical patients who were looking for a qualified surgeon.

At the same time all this was going on, other non-surgical physicians were having a hard time with insurance reimbursements and were looking for ways to supplement their income. Some decided to join the AACS, go back and get surgical training and then spend an extended time in a cosmetic surgery fellowship. This takes a lot of time, effort and money and most non surgeons did not want to go this route. Instead, through their own society's training courses and those sponsored by laser companies, cosmetic products companies and well meaning dermatology professors they learned how to supervise nursing staff in the performance of minor cosmetic procedures such as chemical peeling, laser skin procedures, microdermabrasion, endodermology, Botox and other injections, mesotherapy, and sclerotherapy. Some physicians learned how to perform the procedures themselves but many were not interested. They were just looking for extra income. Learning the complexities of how the skin interacts with all these procedures takes years of training. It did not look too difficult to do and they were physicians after all. Who could accuse them of anything improper? In fact, in California any physician can advertise and call themselves a dermatologist or cosmetic surgeon as long as they do not say "board certified".

Now that we are in the 21 st century and much of the dust has settled on this issue of who is a cosmetic surgeon, everyone agrees that this type of surgery, as with all surgical services, requires a physician to take his/her craft seriously. With proper training and experience, which can be acquired during a traditional residency or through fellowships, a cosmetic surgeon should perform his/her work in an accredited surgical facility which utilizes appropriately trained staff. This training and teamwork will help assure a patient of a safe and good outcome. The American Academy of Cosmetic Surgery and the national AAAHC accreditation organization have more than 25 years experience helping the American public feel confident about their surgeons.

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