This Sunday’s Chattanooga Times Free Press featured a front-page article This Sunday’s Chattanooga Times Free Press featured a front-page article about cosmetic surgery in Chattanooga. The “Turf War” is not, as Dr. Carey Nease points out, about business or finances. It is about providing the highest quality of care for the people of our region. As the article notes, we have had “cosmetic surgeons” in Chattanooga before Dr. Nease began practice in Calhoun.

When I was interviewed by Emily Bregel for her proposed article, I wanted to be certain that Truth (that is truth with a capital “T”) in medical advertising was part of the thrust of her piece. I think that she did a fine job. As an academic plastic surgeon, I am intimately involved with the education of plastic surgeons at the UT College of Medicine Erlanger Campus.

The training of “real” plastic surgeons is as rigorous as surgical residency gets. The public should understand the oversight that is involved in the making of a real plastic surgeon. After three to five years in an accredited surgical residency program (see ACGME’s website), the qualifications of these talented young people are scrutinized before they can begin their two to three year long plastic surgery training. We typically interview about 30 surgeons for two slots.

All plastic surgery residencies are continually reviewed by the Residency Review Committee (RRC) of the ACGME to be certain that training in all disciplines of our field is standardized across the United States. Upon completion of an approved residency, a surgeon can take his boards in plastic surgery. The American Board of Plastic Surgery (see the ABPS website) is the only Board recognized by the American Board of Medical Specialties (see ABMS website). A written and then oral examination are performed by the board officers. If the candidate passes, then they are certified by the ABPS. Incidentally, ABPS certification testing must be repeated every ten years. This is to insure that real plastic surgeons stay up to date on current treatment. To quote the ABMS website, “Certification is not a hurdle; it is a commitment and an opportunity.”

All of these organizations, (the ABMS, the ABPS, the ACGME, the RRC) were established to standardize education and provide the best patient care possible for the people of the United States. The American Board of Cosmetic Surgery is not recognized by any of these regulating bodies. The fellowship training of “cosmetic surgeons” has no recognized institutional oversight. It is of a mentorship style. The type that was abandoned by plastic surgery training programs years ago for its haphazard nature. There is no university in the United States that has a Division or Department of Cosmetic Surgery. Real plastic surgeons dominate the scientific literature. The levels of training between plastic surgery and cosmetic surgery are simply not worthy of comparison. It is utter hubris to argue the opposite. To illustrate the point, I believe I recall former Defense Secretary Rumsfeld’s comment a battlefield situation’s potential danger. He said that the most concerning element was that “You don’t know what you don’t know.” I think that applies well here, too.

An aesthetic breast surgery consultation, for example, should include a thorough review of breast cancer potential, family and personal history, examination, and appropriate breast imaging. What experience does an ear, nose, and throat surgeon have in managing diseases of the breast? Are they confident that they can identify a potential problem? Aesthetic /Cosmetic surgery requires a mastery of patient care that goes beyond the technical ability to correct physical flaws.

Ear, nose, and throat residency training and subsequent board certification permits one to refer to themselves as a “facial plastic surgeon.” Marvelously orchestrated websites and advertising spin does not change reality. Does a year of cosmetic surgery fellowship equate to the training of a Plastic Surgeon? That is a decision that our community will need to make. However, they should make it with facts in hand.
Mark A. Brzezienski, MD, MS, FACS
Diplomate, ABPS – (ASPS, ASAPS, AAHS)
Asst. Professor Plastic Surgery
Asst. Professor Orthopedic Surgery (Hand)
UT College of Medicine
Erlanger Campus, Chattanooga