Medical & Trade Publications

April 2006

by Amy M. Ortega, M.D.
Medical / Plastic Surgery

Choose Your Plastic Surgeon Wisely

Many people do not associate a cosmetic and reconstructive surgeon with extensive medical training. However, some plastic surgeons also receive the essential, baseline medical and surgical education to deal with emergencies and care for critically ill people. The surgeon uses this knowledge to care for patients who are really sick—or someone who may have an unexpected life-threatening problem during surgery.

This educational approach differs greatly from that of some cosmetic training programs, which do not include the basic component of providing emergency or critical care for the surgical patient.

General surgery residency

A fully trained plastic and reconstructive surgeon is required to complete a minimum of three years of general surgery residency (or five years of an ENT ear/nose/throat residency), followed with two years of plastic and reconstructive surgery. During these years, the surgeon learns every aspect of rebuilding soft tissue defects from head to toe, and bony defects of the hands, head and face as well.

Many people do not realize that a true plastic and reconstructive surgeon has been a member of surgical teams in many specialties—however, it is part of the required training. For example, during my general surgery training, I performed surgery on the appendix, gall bladder, colon, head and neck, lungs, big toe, and everything in between. I was on the open heart surgery team for a month, took care of critically ill patients on ventilators in the surgical critical care ICU, did several months of level-one trauma team work, and even served as chief of the trauma team.

This type of background adds incredible substance to "just a face/breast/nose" surgeon!

Before seeking surgery, patients should ask questions such as how many procedures a surgeon has performed, and how frequently a surgeon performs that particular procedure.

Plastic and reconstructive

During plastic and reconstructive surgery training, I learned a wide variety of reconstructive techniques, from rebuilding faces with traumas that made them unrecognizable to performing breast reconstructions for cancer patients, to replanting amputated fingers, correcting cleft lips and palates... you name it. Most plastic and reconstructive surgeons experience this in-depth training.

Cosmetic surgery is a natural extension of reconstructive surgery. Having reconstructed so many defects of the face and body, a plastic and reconstructive surgeon naturally develops a keen instinct for the ideal look and how to achieve it.

Cosmetic surgery fellowships

Plastic surgeons who wish to perfect their skills and increase their experience in cosmetic surgery seek out fellowships, or additional specialty training.

Fellowships are full-time, one-on-one apprenticeships with specialists. It's the way to learn the latest techniques beyond those taught in residency, and to perfect a surgeon's skills. By the time a surgeon has taken surgical fellowship training, he or she is considered to be an expert in that area.

One reason that fellowship training can be beneficial is that many residency training programs for plastic surgery place a much greater emphasis on reconstructive surgery than cosmetic surgery.

Historically, plastic surgery's specialty was entirely reconstructive. But with time, cosmetic procedures were developed. While reconstructive surgery is essential and fascinating, patients who seek a cosmetic surgery procedure should consider a doctor's specific training in cosmetic procedures. Remind patients to pay attention to a surgeon's board certifications and cosmetic training, in addition to the surgeon's basic training.

Most residency training programs are located at large university hospitals, which provide much-needed care to the indigent population. Unfortunately, this can mean that few, if any, cosmetic procedures are performed.

So, how do plastic surgeons learn about cosmetic procedures? Many programs have rotations that allow residents to observe cosmetic surgery in a private doctor's office. There are also programs that offer true surgical experience, but some are better than others in this aspect.

Believe it or not, there have actually been plastic surgeons who finished their training without completing some cosmetic procedures. Residency training programs are working to improve this.

Board certification

With plastic surgery's popularity, there has been a recent increase in physicians who perform plastic surgical procedures. Interestingly, it is not illegal for a physician to perform any procedure, regardless of whether they were properly trained in the procedure, as long as that physician has a medical license.

Therefore, patients should know to look for "board-certified" surgeons, but even that can be confusing. There are a number of "boards" that are not accredited, and do not require the experience and training previously outlined.

The only accredited board for plastic surgery is the American Board of Plastic Surgery. Visit the following web sites to learn about the rigorous training and testing requirements for the ABPS, and the value of choosing a plastic surgeon who is a member of the American Society of Plastic Surgeons (ABPS certification is required for membership).

For more information, visit American Board of Medical Specialties website, www.ambs.org; American Board of Plastic Surgery, Inc. website, www.abplsurg.org; and American Society of Plastic Surgeons website, www.plasticsurgery.org.

Do research

A well-informed patient will seek out others who have had the same procedure by the same surgeon. Questions that patients should ask include how many procedures a surgeon has performed, and how frequently a surgeon performs that particular procedure. Make sure your patients understand the potential complications as well as the benefits.

Above all, remind patients to do their research to discover the right surgeon, with the correct board certification and additional training to suit his or her needs.

Amy M. Ortega, M.D., is a board-certified, double-fellowship trained cosmetic plastic surgeon with special interest in cosmetic surgery of the face, breast and body. Her office is located in Atlanta, GA. To reach her, call (404) 751-2500. For more information ABOUT DR. ORTEGA, visit her website, www.ASAbeautiful.com.