Why a plastic surgeon?

Every so often, a patient walks into my office, referred by her dermatologist for a new skin lesion after I have previously removed one to her satisfaction, and I discover the patient has, in the interim, gone to see someone else for a cosmetic surgery procedure. Curious (and, I will freely admit, somewhat disappointed), I usually ask the patient who did the work and why they went there. Too often I am told, "I did not know you did that kind of work." This always begs the question, if the patient doesn't know her plastic surgeon is skilled and trained in cosmetic surgery, who does she think is?

There has been a cottage industry of other practitioners, some of whom have no formal residency education in surgery whatsoever, who have jumped on the aesthetic bandwagon in the last few years. This is become especially rampant in the current challenging economy.

The reality, of course, is that aesthetic (cosmetic) surgery is an established sub-discipline of plastic surgery. All plastic surgeons who train in accredited plastic and reconstructive surgery residencies are comprehensively trained in cosmetic surgery. Many plastic surgeons, in fact, choose to immediately sub-specialize in cosmetic surgery right out of residency. While many other medical disciplines have practitioners who promote themselves as aesthetic specialists, it is important to emphasize that the specialty which trains surgeons in all facets of cosmetic surgery is plastic surgery alone. Sometimes a patient will tell me that they had a procedure from a non-plastic surgeon who took a course in liposuction. I tell them, I also took a course in liposuction: it was called surgical residency, and it took 7 years. Ad hoc or limited training with weekend courses or special symposia, while potentially complementing existing training in plastic surgery, is no substitute for the rigorous experience of a comprehensive residency program that includes both complex reconstructive procedures and cosmetic surgery training.

One of the things that makes plastic surgery unique is that we operate all over the body, on children and adults of both genders. A prerequisite to understanding how to perform cosmetic surgery is an exquisite knowledge of human anatomy. I can think of no other specialty that demands such rigorous knowledge of the body's entire blood supply, nerve distribution, muscle function and layout, and functional implications of procedures, the way plastic surgery does. Our specialty requires, by its very nature, extreme adaptability, creativity, and problem solving ability as we are faced with both complex reconstructive challenges and the demands of patients who can look at their results and judge them by the externally visible outcome. When your general surgeon removes your gallbladder, the only thing you see are the scars, since most of the work was internal. In the case of plastic surgery, the results are usually detectable on the exterior, and guiding a patient to a satisfactory outcome requires skills in wound management, scar minimization, and, dare I say it, psychology. These are even more paramount issues when we are talking about cosmetic procedures, for which patients have often paid considerable fees, and they rightfully want a good-looking outcome.

In part 2 of my series, I will explore why merely wearing a white coat does not mean a practitioner has the experience necessary to perform plastic surgery.