Who Does and Who Should Do Plastic Surgery?

I wish this were simple, but it is not.

One problem is that the term "Plastic Surgery" has two meanings. One is that "Plastic Surgery" is a recognized specialty of medicine, like "Cardiology", "Orthopedics", "Family Practice", etc. with residency training, board examinations, etc. The other is that "Plastic Surgery" is a body of knowledge and procedures, like "surgery of nerves", "surgery of the kidneys", etc. Let us call the first Plastic Surgery-1 and the second Plastic Surgery-2.

A second problem is that the phrase "boarded in xxx" also has two meanings. There are medical specialty boards recognized by the ACGME (Accreditation Council for Graduate Medical Education) and others not so recognized. The American Board of Plastic Surgery, American Board of Otolaryngology, American Board of Orthopedics, etc. are so recognized.

And there is a third problem which is the variability of surgeon experience and practice. Some surgeons practice where operation X is common. Others practice where operation X is uncommon. And usually the former will do better with operation X than the latter.

So how does this all add up?

Of course, surgeons boarded in Plastic Surgery-1 by the American Board of Plastic Surgery will practice Plastic Surgery-2. That is simple.

But what about the many surgeons who are not boarded in Plastic Surgery-1 but who practice Plastic Surgery-2?

Well, some aspects of Plastic Surgery-2 are included in Otolaryngology, Oral Surgery, Ophthalmology, Orthopedics, etc. And so these surgeons, who are not boarded in Plastic Surgery-1, but rather boarded in another specialty, practice Plastic Surgery-2.

Who does Plastic Surgery-2 better? Those surgeons boarded in Plastic Surgery-1 or those boarded in the other specialties? Tough to answer. Depends upon training and experience. For example, compare me (doing Burns and Trauma at Harborview) to an Otolaryngologist (doing facelifts in Los Angeles). Who will do facelifts better?

Now is it clear? Perhaps not. So what does this mean to a person considering a surgeon? You should find out three things about the surgeon.

1. Was he recommended by a physician or friend?

2. What is he/she boarded in? Is this board part of the ACGME? Plastic Surgery-1? Otolaryngology? Oral Surgery? Ophthalmology? Orthopedics? Here you want the name of the Board and is it a part of the ACGME or not?

3. What is his/her experience with this procedure? Numbers of cases per year are probably not helpful. You just want to know is this procedure a common aspect of his/her practice or not.

Perhaps now you at least understand what is confusing.