Becoming a plastic surgeon

Even the most gifted plastic surgeon does not always produce a perfect, "home run" result, but it is a hallmark of a good plastic surgeon that he/she will always aim to do so, and will ethically manage complications and disappointments to the best of his/her skill set.

This is a skill set that is honed in plastic surgery residency, where plastic surgeons in training are exposed to the decision-making process of experienced mentors, and are then given gradually increasing levels of responsibility to make those decisions on their own, including learning how to do the cutting and sewing, but also how to deal with the patient who has an unsatisfactory outcome or a complication. Residency in plastic surgery requires prerequisite internship training in general surgery, encompassing many other surgical disciplines as well as rotations on anesthesia and intensive care experience. It also requires specific minimum caseloads of cosmetic surgery for any resident to complete training.

My plastic surgery residency, for example, included a dedicated cosmetic surgery clinic experience in which I was precepted and supervised by practicing cosmetic surgery specialists, but I made the aesthetic surgery decisions, and performed the operations with my hands, being guided the whole time by someone in the operating room with years of experience. Accordingly, I came out of residency very comfortable with cosmetic surgery, although I endeavor to learn - and innovate - new and even better techniques through continuing education. This lengthy course of supervised study requires a minimum of five full years of training after the completion of medical school, with considerable commitment of hours every week and significant personal sacrifice. At the end of that training process is a rigorous series of examinations, both written and oral, that are challenging but rewarding to pass. They are so challenging that many excellent surgeons require more than one try to successfully achieve a passing score. This is a mark of excellence that plastic surgery demands of its practitioners. These are not certificates for membership in societies/academies you can buy, but are instead, extremely demanding, comprehensive, peer-reviewed examinations that include review of a surgeon's decision-making, results, bills, complications, and fund of knowledge.

To gain further entry into groups like the American Society of Plastic Surgeons, one must meet additional criteria of ethical behavior and contribution to the specialty, and one must actively participate in continuing medical education that encompasses patient safety as well as comprehensive knowledge of all plastic surgery disciplines. Moreover, our plastic surgery organizations place very firm ethical restrictions on how we advertise our services, and what we can and cannot say or promise. In so doing, these organizations ensure a commitment to truth in advertising. Only plastic surgeons certified by the American Board of Plastic Surgery are subject to our ethical advertising guidelines, and we are forced to also compete with those who would say or do anything to make money in the cosmetic services industry. By and large, however, I feel that we distinguish ourselves by these checks and balances, and by just plain doing this kind of work better than others...because we were trained to.

In part 3 of my series I will look at how a background in reconstructive plastic surgery affects your aesthetic result.