Michael Jackson, at the peak of his earning power and fame, repeatedly received very poor value for his surgical dollar. (And no, boys and girls, that's not a prosthesis; it's surgical tape on the tip of his nose.) If having more than enough money and unlimited access doesn't ensure a good outcome, what does?
The common online sentiment casts the ethical cosmetic surgeon as paternalistic gatekeeper. Most of the public expects these and all physicians to at a minimum abide by primum non nocere (not actually part of the Hippocratic Oath). It's safest to stick with caveat emptor: "let the buyer beware."The most often hyped consumer advice is to choose a board certified surgeon. This is what Kanye West's dead mother did not do, having apparently evaluated her surgeon's credentials based an Oprah appearance.
For the prospective patient, board certification is the most readily accessible confirmation of a surgeon's training and experience. This is different than state licensure, ie, is the doctor behaving, which is confirmed here.
The vast majority of safe elective cosmetic surgery is performed by board certified plastic surgeons and otolaryngologist–head and neck surgeons. There is plenty of bad territorial ju-ju between the two specialties arising from intense competition for cash. It colors and distorts most of what is published about how-to-pick-a-surgeon. What makes these two kinds of cosmetic surgeons different from one another? There are two divergent training and certification
pathways.Here, along with the alphabet soup, is a set of cliff notes and links so you can be an informed consumer.
All physicians with M.D. after their name complete the basic 8 years post-high school education of undergraduate and medical school.
Cosmetic plastic surgeons go on to an additional 7+ years of training and certification in:
- General Surgery Residency - 5 years
- Plastic Surgery Residency - 2 years (some combined programs are 3 years of each)
- ABPS board written and oral examination in Plastic Surgery
- optional Fellowship - 1 year
- ABPS board subspecialty examination (Plastic Surgery Within the Head and Neck)
Cosmetic otolaryngologist–head and neck surgeons go this direction for 5+ years:
- General Surgery residency - 1 year
- Otolaryngology - Head & Neck residency - 4 years
- ABOto board written and oral examination in Otolaryngology - Head & Neck Surgery
- optional Fellowship - 1 year
- ABOto board subspecialty examination (Plastic Surgery Within the Head and Neck) or the ABFPRS subspecialty exam
The American Board of Medical Specialties (ABMS) is the major examining organization whose Member Boards (of which the ABPS and ABOto are two) certify physicians in more than 130 specialties and subspecialties. For a chart listing the current certificates offered by ABMS Member Boards, go here. (There are other, overlapping certification organizations as well.)
These board certification exams are probably the most difficult, stressful part of the not-so-young physicians training experience. The written boards are all-day specialty-specific computer-based examinations (completing the more general knowledge exams taken at the end of the first residency year). If passed, an excruciating oral examination takes place where senior physician examiners interrogate the candidate and pass judgment on the ethical and technical aspects of his/her practice.Subspecialty certification is not required in order to practice cosmetic surgery. It's important to physicians preparing to practice because it is a recognition of exceptional expertise and experience specifically in that field.
What's important for the consumer is that board certification under the ABMS umbrella brings with it an requirement for continuing education and re-testing every 10 years. That makes these surgeons a safer bet for you and me.
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